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Spent the day in the mental health ward again. The patient who
assaulted staff members has absconded - probably desperate to get
away from medication or desperate to get Qat-Khat. I don’t know
what he can do in a virtually mute state on the streets here.
Looked around from the car but didn’t see him anywhere. I am sure
he will come back to hospital by his own means or by others. He has
a fluphenazine depot in him now anyway which might take the edge
off his distress.
The mosque patient is much calmer but still homeless. I see Zamzam
on the ward. Zamzam regularly helps us in our training in
Somaliland. She has bipolar disorder but is well now and employed
as a cleaner in the hospital. When unwell she has gone to battle
front lines and put herself at great risk. She has a child as well,
who she is sole parent for. She recognises me and even knows my
name. It is great to see her doing so well.
It is a Friday and day off but some of the staff have agreed to
come in on their day off to have a case supervision session with
me. It is effectively a CBD with a group. The nurses struggle to
speak English but can understand. We go through many cases and I
think they have learnt some things. I tell them that I am not here
to tell them what to do. However I can pass on what WHO tells them
to do with their new mhGAP IG document which is a practical manual
for treatment of mental illness in low resource environments.
I leave the hospital with sadness. I wish I could stay and be
part of an exciting time of improvement. I always am left wondering
whether I am more useful back in UK or in Somaliland where it can
be so rewarding. It takes an immense amount of energy and
commitment to change an inpatient unit in a place such as this.
With Julie, I think they have someone who can do this if anyone
I make sure to have the goat kebab as my treat before leaving.
This is one of Somaliland’s best attractions. I am about to leave.
We have achieved our goals but there is much still to be done in
this challenging environment. There is a drought but not to the
extent of Somalia in the South. It is one of the most difficult
environments for a foreigner but it is also one of the most
rewarding experiences. The needs are immense, but you can make a
What I get most from this, apart from direct experience and
sense of accomplishment, is that for these few weeks I can totally
forget my NHS work and stress! It’s all about the clinical care and
nothing more. Somaliland is my best vacation destination for that
reason - and so many more. It is a country where I have grown to
feel very much at home.
I can genuinely say I want to come back - yet again.
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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.