Supervision

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 resource.

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 dreadful.