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The Royal College of Psychiatrists Improving the lives of people with mental illness

Knuckling down to some work

The multidisciplinary team in action
The placement is progressing quickly - It is about time to talk about some of the expected outputs from the RCPsych link. The first part that I have been working on with Professor Mullick is a research project to culturally validate life stressor rating scales for both adolescents and adults in Bangladesh. This has been identified as a local priority area – stigma surrounding mental health is huge here, but people do seem to understand the role of life stressors, and placing mental illness in this context can help individuals understand.
There is a huge respect for qualifications in Bangladesh, and perhaps more importance is placed on these than outright experience – because of my Msc in Transcultural psychiatry I have been judged the right person to write the research protocols for the adolescent and adult rating scale validations - which I have just sent to local research and ethics for approval. To summarise, the research will be of mixed methodology and comprise of focus groups and a survey phase. The current life stressor scale commonly used was designed in the states in the 1960s and has less relevance to Bangladesh today. A large number of potential life stressors need to be added that are culturally appropriate here - eve teasing, dowry stress, effect of siblings getting married, to name a few. The research will continue after I have left, but it is hoped that a validated rating scale will be produced by the end of the year which can be utilised in Bangladesh and possibly in areas of the UK with larger Bangladesh communities The curriculum for the mental health trainees in Bangladesh is a mix of that in the United Kingdom, the States, and Canada, and is being re-written at the moment. A lot of the buzz words familiar to those trained in the UK are becoming topical here – competency based learning is in the process of being introduced, with a slight shift from purely relying on knowledge. I have been working with the curriculum designers here to improve the curriculum a little (although it is already very comprehensive) and will be working on an OSCE programme for the trainees over the next few weeks. The other project just starting is working with the doctors here to establish whether an early intervention service would be feasible. There clearly isn’t any more budget, and there isn’t any community psychiatry, so the work centres around whether such a service could be re-created at outpatients to cover pharmacological and psychological interventions, and by the use of the family to provide some of the social interventions. Patients here usually have the benefit of a stronger family network than compared to the west. Watch this space.
The alternative to the cycle rickshaw
Aside from the above, I have been giving weekly talks at the journal club, up to now on transcultural psychiatry, the royal college scheme and early intervention in psychosis, and am hosting more informal teaching sessions each week for the trainees on a variety of practical-experience-based topics, including treating early onset psychosis and presenting a lecture (trying to think about what I was taught on training the trainers….)

I spend a large proportion of the week working directly with the junior doctors seeing patients on the ward, and at outpatients, which I am finding the most rewarding, including a very interesting steroid induced psychosis case on the medical ward, which we had to assess in the corridor surrounded by about twenty people holding their drip bags above their heads as the ward was being fumigated for bed bugs. I have a few interesting visits lined up for the next few weeks – I shall be going to Patna, the “tertiary” referral centre I guess, which is the largest inpatient unit in Bangladesh and is around five hours away. I don’t want to end on a negative point, but have heard a few “rumours” about conditions there, and, I guess, want to make up my own opinion. Afterwards I will be going along with the WHO to one rural Upazilla health centres to look at the work they are doing educating primary care staff in mental health.


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About this blog

Dr Adrian Phillipson

 

 

 

 

 

 

Dr Adrian Phillipson is an ST5 in general adult psychiatry, based in South Yorkshire.  He is currently part way through a year out from his training rotation, utilising the time to pursue research and travel interests.  Adrian is the first psychiatrist to take part in a new Royal College of Psychiatrists Volunteer Scheme Link with the Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh.  He hopes that this blog will provide good insight into the link, and will encourage others thinking of taking part in the volunteer scheme.

Adrian’s attraction to transcultural psychiatry stemmed from a chance encounter with a local practitioner in Malawi in 2003, where he witnessed a traditional healing ceremony for psychosis.  He has further developed his interest through completing a masters degree in Transcultural Mental Health Care at Queen Mary, University of London, as well as through further overseas exposure.   In 2010 Adrian made an initial scoping visit to Bangladesh to look at mental health services and help establish a sustainable link.  A report from this project can be found here.