Day 7 - Green
Early travel to Hargeisa- the national Capital. It has been
raining - I have never seen the area so green. We stop to take
photograph of a resting camel. Preparations for exams at
Day 8 - Review of exam site
Visited the psychiatric ward at
Hargeisa Group Hospital. The ward has improved so much. I speak to
the staff - Maryam and Mustapha know me as I have been
coming here since 2008. I have done some training with them as well
on a previous trip through an interpreter. They have
only one patient chained currently. Last time I was here,
many if not most male patients were chained. This is in great part
due to the input of GRT- an Italian NGO, WHO and THET. This Italian
NGO has worked on the ward to enable the patient numbers to be
reduced. This leaves the staff able to offer a therapeutic
The big struggle as always here is to mitigate
the ever present risk of khat chewing or Qat. This is a “mild”
stimulant leaf that is chewed. Its effect mirrors the effects of
cannabis in many ways including those on mental health. It is
a major problem for Somaliland and Somali people. One of the staff
told me with great honesty the effect Qat-Khat has on him. He
starts with confusion, then euphoria, then a hangover type effect
the next day.
The staff showed me their newly refurbished
areas of the hospital, their new uniforms and new toilets. It
is remarkable and lovely to see a staff so rejuvenated in morale.
Most importantly they are getting regular salaries. I will try and
do some training during the week for the staff.
There is one area that still needs urgent
refurbishment. This is an area of single rooms, or more
appropriately, cells. The place stinks and is filthy. It is not
suitable for humans. I hope we can get some practical support to
improve this as soon as possible.
Day 8 - Exam
preparationExam preparation in Psychiatry. For complex
reasons there is only a small number taking psychiatry this
time. We did Psychiatry exams for some of this cohort in December
2010. Most of the current examinees are resit students who have
passed their psychiatry previously.
Security: this has not been a problem for us.
We go to and from the hospital to hotel and back in a taxi approved
by THET. Our hotel is fortified against attack. Cars are searched
for explosives and searches on entering the hotel. The
situation in Somaliland can be volatile. The influence from the
south of Somalia can be present in terms of occasional
hostility to foreigners. My colleagues here for the longer term
report an occasional sentiment of hostility to foreigners
from a few but nothing more than that.
My own experience has been Qat-khat induced
hostility towards us foreigners in one trip to the market a few
years ago. Somalilanders have been so welcoming to us in general.
The country has had a general election in the past year and had a
peaceful and successful succession to a new government.
Day 9 - Psychiatry exams
We have a joint examining OSCE station with Dr
Peter Hughes and a Somaliland counterpart. The expectation is for
the Somalilanders to take over the examining role completely in
time. The students are strong in picking up psychosis,
violence, and depression but less skilled at anxiety. All pass
Back at the hotel before evening
curfew; the goat kebab is fantastic.