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


Patient at the mental health ward - Somalialand

Day 13 - Last day in Somaliland

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 can.

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 difference.

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.

THET Somaliland Programme

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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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