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

Khat effects

Day 7  -  Green scene

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 Hargeisa.

Examiners at Hargeisa Group Hospital

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 environment.

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 preparation

Exam 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.

Examiners at Hargeisa Group Hospital

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 comfortably.

Back at the hotel before evening curfew; the goat kebab is fantastic.

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About this Blog

Dr Peter Hughes - consultant psychiatrist

 

 

 

 

 

 

 

Dr Peter Hughes is a consultant psychiatrist based at Springfield University Hospital, London. He has an interest in international psychiatry and has been travelling to Africa over the last five years doing short-term assignments in mental health. He has recently flown to Somaliland to work on a mental health programme.

 

This personal blog reflects Dr. Hughes' own views and does not represent any Somaliland organisation in the UK. However Dr. Hughes is indebted to KINGS-THET partnership for providing an opportunity to take part in this exciting project. He is grateful to Dr. Susie Whitwell who leads the programme for mental health, and companions Professor John Rees, Dr. Suleiman Yusuf, Helena Tabry from UK and all colleagues in Somaliland.

 

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