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

Mental health in Boroma

Day 1Examiner and actor OSCE station

Arrive in Boroma after a long “road” journey of several hours. We swerved past a giant tortoise leisurely crossing the road. Also there are baboons and camels loiter in the distance. Other drivers pass with people hanging from all grabable parts. It’s surprisingly green as this is the rainy season. Usually this area is a yellow barren wilderness. Arrived escorted by an SPU security vehicle in convoy with two soldiers for our protection.

Day 3 - Boroma

Boroma is a small town about one mile from Ethiopia. I have never walked around it in my many visits here so don’t know exactly what it is like, but it does look a bit like Haiti after the earthquake in terms of rubble strewn across the “roads”. There’s hardly a car in sight, but goats wander the main streets with no fear.

I orientate myself to Ray’s hotel - the place to be in Boroma - if not the only place in Boroma. We are a short walk to the Fistula Hospital, but we can never walk there without our armed guards. This is a heartbreaking place where women whose lives are ruined by obstetric misadventure have their lives returned to them by a relatively simple surgery.

We can however cross the road. It's about five metres to the venue for the final medical exams. Nine students wait anxiously for their obs and gynae exams. This morning they had surgery.

This is OSCE format. There are many amazingly and disconcerting anatomical specifications to do a removal of a placenta, deliver a baby and other tasks all in eight minutes. The exam is now over so I can reveal one of the OSCEs was a discussion with a woman (actor) whose baby had died. The actor gave a wonderful performance. Most candidates were sensitive and empathic to the plight. Maybe in some way our mental health training last December helped this group. If I wasn’t a psychiatrist I would want to be in obs and gynae after seeing what happens here to women and the dreadful problems of giving birth in this country.

I met Dr Jibriil who is doing fantastic things for mental health in Boroma. I taught him some years ago as a medical student and now he is developing psychiatry out-patients in Boroma, a maternal mental health programme and community services along with the support of the wonderful Faduma. Faduma is a Somalilander who lived in Canada then came back to her homeland. She devotes herself to developing maternity health in the region but also is a strong supporter of mental health work. I always come away enriched after speaking to Faduma who in her quiet way has improved the lives of so many people in direct clinical training contact, and by her selfless devotion to others around her.

Looking around at the medical students and nurses, I acknowledge that I have taught mental health to just about everyone. I am unsure if I feel a sense of accomplishment or just old! Abdel Ghani is another keen nurse who now works in mental health and helped me during nursing teaching last December. Everywhere, I see my old students who are now working, teaching and giving life to the principle of sustainability.

It is now raining with thunder and lightning. So much for the tropical weather and break from the UK. However this is not a place to go for a walk. We are allowed to walk around the hotel and that is it. There isn’t a feeling of poor security as we follow the rules and 8pm curfew, and never walk around outside of the hotel complex unescorted.

It has been reported that there is a risk of attacks on foreigners since the death of Osama Bin Laden. Al Shabab in Somalia have taken to using women as their preferred method of weapon. Yet Boroma has been a peaceful place relatively for some years. We are about one mile from Ethiopia.

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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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