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


Day 12 - Mental health ward

My colleagues Professor John Rees and Dr. Helena Tabry leave today as only two people at a time are allowed on the ECHO – EU flight to Nairobi. So I stay behind until Saturday. 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 repeatedly 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.

Ward team supervisors - Somalialand

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.

Ward team supervisors - SomalialandWe 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.

Ward team supervisors - Somalialand

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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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