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I have the opportunity to go to the mental
health ward. First I am diverted to do a home visit - or rather a
mosque visit. We go to a mosque on the other side of town where
they are having a convention of Islamic “missionaries”. Amongst
them is a Somali man from Ethiopia who is saying he is Christian
and shouting out repreatedly about being Christian.
I first think this could be a Christian
missionary but as I arrive and speak to him I soon realise he is
not mentally well. He wants to find a wife in Hargeisa. He has
walked from Djigjiga in Ethiopia. He says he is a doctor of the
spirits. He is clearly manic and my colleague with me organises a
treatment plan but the real problem is the social one and getting
him back to his home in Ethiopia.
I get back to the hospital just as a staff
member is hit by a patient. The patient is mute and clearly
paranoid. He has a twirling movement of his right hand. He has been
hiding his medicine for the past few days. He gets a depot. The
twirling is probably a stereotypy or a catatonic symptom. There is
no real EPSE.
We have a wide range of medication from WHO and from MSF.
We lack intramuscular lorazepam and anti-cholinergic but the supply
is not bad. The hospital supplies medicines for free and there is
good security around the medicine store. I note one of the
nurses looks different from the last time. I hear that she
suffered a serious assault from a patient with head injuries. This
ward can be a dangerous place even now.
I spend a morning of supervision of the
medical and nursing staff going through cases and discussing
together means of treatment. There are some areas of improvement
and I feel good that this exercise does show up areas of immediate
improvement. I base my advice on the WHO mhGAP Implementation guide
and “where there is no psychiatrist” by Vikram Patel. I note they
have a few copies of this book in the hospital. An excellent
Evening time I meet an old friend from
Somaliland. She is due in Mogadishu for work shortly, and that is
not something she is looking forward to. Security there is
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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.