Concrete plan
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And so, after three fascinating months, my
time in Pohnpei has come to an end; the training programme has
officially finished, and I have had to say my reluctant farewells.
But this is hopefully the beginning of something, not the end.
Over the last few weeks we have been trying to
focus on service development and capacity building and putting
together a concrete plan of how to disseminate the knowledge and
skills gained to other people. Three of the trainees have
shown good competency in the ability to train other people and so
we have appointed them as the official people who will take on the
task of developing a training programme for each of the four FSM
SAMH programmes. One possibility is that they will come
together periodically as a peer support group, supervising and
advising each other in difficulties arising in training others or
in the practicalities of using the Mental Health Gap Implementation
Guide provided by the WHO, which has formed the basis of our
training.
What is needed as a matter of priority is the
appointment of one or two dedicated medical professionals from each
State hospital, to participate in mental health training and take
on the role of mental health doctor for the SAMH programmes.
It has been difficult to access the doctors here in Pohnpei and we
have not had any along to the training, which I think is something
that will need to be addressed in future training
initiatives.
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Supervision I have been in email
contact with a Dr Wally, a Palauan doctor who specialises in mental
health and who has provided input to the FSM in the past, who has
given me much valuable advice regarding the FSM. Two days before I
was due to leave she arrived for a short spell in Pohnpei, so we
have been able to meet in person and with the trainees, to discuss
how best to take things forwards.
One of the trainees who has been appointed as
a trainer is a 26 year old lady who has only recently started work
at the clinic as a counsellor. Delpihn has a degree in public
health from Fiji but hasn’t been able to find a position in the
public health department here, so has been appointed to the mental
health team instead. I’m very glad – she has been a great
participant, really enthusiastic and interested. But what I
wasn’t aware of was how difficult it is going to be for her to
provide training to certain members of the SAMH programme here.
Dr Wally raised this issue in our meeting -
the traditional hierarchies which exist in the FSM, hierarchies
based on clan but also on age and sex, mean that using certain
terms and concepts, such as supervision and mentoring, don’t work;
in fact, they disrupt the existing lines of communication and
structure of the organisation. There are ways around it – Delpihn,
for example, could train in another FSM state, and group training
will not apparently pose such difficulties; it’s to do with the
implications of the term “supervision”. I was aware that
Delpihn might find it hard in a position of teacher, but not
specifically in this contentious area of supervision, so I’m still
finding out about huge cultural issues such as this, at the
eleventh hour, and I’m sure, if I was able to stay longer, these
kinds of obstacles would keep on surfacing.
Big issues Raising awareness of
the existence of SAMH and of mental illness in general is a big
issue – in the twelve weeks I have been here there have been very
few new referrals but there have been, very sadly, two completed
suicides. There are many reasons why people do not come
forward, including stigma, a lack of knowledge with regards mental
illness and the possibility of help, and practical reasons, such as
the fact people here who live a long way from the central town and
who do not have vehicles or phones. As they cannot afford to pay
for medical input or medications, they tend not to seek medical
help unless it seems very necessary. People do not like to talk
about their personal difficulties, particularly with people they do
not know well.
All of these complex factors need to be taken
into account when addressing the problems of mental illness here in
Micronesia. But hopefully, the trainees and I have managed to
take some small steps towards doing so, in the three months we have
spent together, and I really hope that I will be able to remain
involved in mental health development in the FSM, in some way or
another, in the future.
There are many things I would do differently,
if I was starting over again – I think, for example, it would have
been really useful to have been able to spend time in the other FSM
states, working with the individual trainees from Yap and Kosrae
and Chuuk. Each of the four FSM States are quite different in their
cultures and geography and language, and it will be interesting to
see how the mental health initiatives we have been discussing
will need to be adapted to fit these different islands. They
each seem to have their own unique characteristics – Chuuk is made
up of many small islands, which are difficult to access; Yap is
less Westernised, more traditional; Kosrae is very small and the
church is hugely important there.
Gear-Up
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While hanging out at the Peace Corps office
one day I bumped into an American woman who is working in the
schools in Pohnpei, setting up an initiative called Gear-Up,
focusing on encouraging students to complete high school and
improve their grades.
As part of this, she is planning a summer camp
with the theme of self esteem, and asked if the mental health team
would be able to help out. So we arranged a meeting with the
SAMH coordinator Aieleen, myself, this lady and her colleague – a
school counsellor who works with kids who have problems with
attendance and keeping up their school work. She hasn’t any
mental health training herself and said she feels underskilled in
recognising which children may have emotional difficulties, so we
have arranged for the SAMH counsellors to spend some time with her
looking at screening for emotional problems and early warning
signs, and how to refer those identified to the SAMH clinic.
I remember when Aieleen and I first met, and
were discussing the problem of suicide in young people, and the
difficulties in discussing the issues given how taboo it is in the
FSM, we had spoken about addressing contributing factors such as
self esteem and identity issues in the adolescents here, so it’s
really satisfying that this meeting has come about, and there are
plans afoot.
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Melting pot
So many exciting things just beginning; so
much still to learn; but I have to leave, and am writing this from
a hotel room in Guam, waiting for my “red eye” flight to
Seoul. Guam is a very interesting place – I have a 23 hour
stop over and have been exploring in the drizzle. It is, to my mind
at least, a mad mix of the seedy side of Vegas, suburban American
strip malls, and Bondi beach - a melting pot of stunning
cliffs and golden beaches, huge five-carriage highways and
sprawling shopping centres, run down high rise hotels, shooting
ranges and strip joints on nearly every corner. I would
happily spend another three months sussing out this place too!
I have had a great time – not easy at all, but
always interesting, and a huge learning experience for me, about
culture and mental health, about training in general, about myself
and how my own culture has shaped me and my values and ideals, how
I conceptualise mental health and illness, the assumptions I have
held without realising it. For all these reasons, I’d
recommend volunteering to everyone who is considering it. And
Micronesia in general – not much visited by UK tourists but most
certainly a hidden gem worth discovering!
Thanks for reading my blog.
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