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

Meat of the trip

Uganda Kiboga Health Centre

Day five - Desk review

Desk review - this was something new! It's similar to preparing a review paper. You assemble information related to health in Uganda at all levels and then prepare a report based on this.

This was beyond tedious! I wondered whether this would be helpful or not.

From discussions, I do now realise that this is an important part of the process which fleshes out the background for the task ahead and feeds into a formal report. It helped me understand Uganda's health needs. It also helped me participate in a workshop.

This is hard, dry work but useful.

Days six and seven -  Entebbe

Desk review continues each day as it is an ever expanding task. I'm sent papers from all sides to incorporate into the desk review.  At the end I feel like I have something that is reflective of the information I have...although some of the data seemed out of date in 2012.

Wondering around Kampala: Mark from WHO Geneva is a welcome addition to our group. Over the last few years, I have been in contact with Mark about mhGAP and different projects. It was nice to spend time with him in person rather than email. I learned a lot from Mark about international work and WHO. He's a master of technical knowledge as well as very nice company.

On Sunday we travel to Entebbe. Entebbe is either a very tiny place or I missed most of it. There are a few roads and little traffic. Bizarrely the hotel seemed populated by lots of Russians as well as the expected NGOs.

I expected mosquitoes and got none -  instead I had lake flies.On arrival at the hotel I had so many lake flies in my hotel room -1000s if not millions that I slept in the bathroom. It was literally a carpet of insects by the morning. I have never seen anything like it.

We had a buffet at the hotel - this was a place we began to hate!

Days eight to twelve - Workshop

This was the meat of the trip and a new type of process for me. Designing the mhGAP project in Uganda may have been long and sometimes exquisitely tedious, but by the end I realised how this would ensure that the project would work.

This is a Ugandan project that World Vision sponsors - WHO provides technical advice and the owners are the Ugandan health services and ministry. So there was a variety of stakeholders at the meeting including psychiatrists, psychologists, ministry people, NGOs representing epilepsy and psychosocial work. My role was a bit less clear in my mind. I was there to share my modest experiences of mental health in international primary care work. 

There were new terms for me to learn and understand: log frame, detailed implementation plan, monitoring and evaluation as well as budgeting. The workshop day begins with prayers and end with prayers.

Ugandans like to talk and there's lots of participation. Chairing was a challenge and I did my share. There was lots of enthusiasm and ideas. Log frame means the logical framework. This was the core of the workshop which is about the skeleton of the design. It consists of a table  featuring goal, outcome, output, indicators, and assumptions. This took the bulk of the whole workshop and is the base for the implementation. We ended up with a goal and several outcomes. The workshop fleshed these out with input from all stakeholders.

Detailed implementation plan is a plan to role out the outputs and outcomes with a time line. The budgeting discussions were predictably  difficult. As normally happens the initial budget goes well over budget and then needs to be painfully trimmed down.The end result was a design which was scaled down, realistic, achievable but still valuable for patients with mental, neurological and substance use problems in Uganda.

What was very interesting was the input on user groups. This became an important part of the discussions and became a structural part of the design. User groups would be able to combat stigma, publicise and market clinics. They would drive the momentum for the service to continue. My own feeling was that epilepsy would be a key condition that could generate its own market. The community will see the benefit of treatment and insist on treatment continuing long into the future. Something I had seen previously in Chad.

By day five I was so shattered that I realised that doing direct clinical work or training –the “exciting” stuff - is actually less exhausting.

Day thirteen - Day off

This was a great day. Dr. Mugaga was our wonderful host who took us sightseeing. We saw waterfalls and were taken to schools with unbelievably well-behaved school children. We also went to the source of the Nile in Jinga District and had a boat trip. Dinner was with Word Vision in Kampala then back to Entebbe.

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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 Uganda to work on a mental health programme. This is a personal account of Dr. Peter Hughes' volunteer mission with Who and World Vision Australia.


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