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

Getting my hands dirty

Uganda Kiboga health centre

Day one - London

I leave London Heathrow in Emirates new Airbus A380. Those who know me will know exactly how delighted I was be to go on this for the first day. And it didn’t disappoint. This is the only way to fly – even down the back.


Day two - Kampala

Arrive in Entebbe airport and I'm carted off to Kampala which is about an hour’s journey. The hotel is huge and incredibly dark.

Kampala seems like a nice town to me. Warm weather. Gentle hills. I just can’t see many people around. Unlike other places I go to it is amazing to be able to go outside without security briefing and a security guard. It is a really safe place apart from petty crime - although there has been some East African terrorism here in the past year.

Then I meet Erin from the partner and donor organisation to the project -  World Vision. World Vision is a huge worldwide, non-governmental organisation. They are one of the few who work in mental health. I hadn’t realised how enormous they are and even in Uganda they are a huge operation. They are children focussed and Christian, but are clear about never evangelising and are open to beneficiaries of all backgrounds.Erin is in her twenties and leaves me speechless with her mastery of the NGO world, policies and ability to synthesise varied and complex concepts in a concise way that even I can understand. They are a very impressive organisation.

A pleasant supper in the almost dark dining room that evening.

Day three - Kampala

I meet with the formidable and delightful Dr. Sheila. She works in the Ministry of Health and is lead for mental health in Uganda.

I had met Sheila once before in Italy at a conference on mhGAP. Sheila is a Public Health Physician and has a background in mental health work. She has a remarkable drive and vision on mental health in Uganda. In Africa it is so important to have key people with a commitment to mental health. This whole project would have no beginning middle and end without the backing of Sheila. I know that she can make the project work.

My job was to gather background information on mental health and health systems in Uganda. It was a struggle to keep up with Sheila’s pace as she is so passionate on the subject and knows it from the ground up.

In the end, I felt that I knew more about the health service in Uganda than the health service in the UK. There is a very well structured tiered layer of health clinics running down from national and regional centres. The health centres feed into a volunteer village level - the Village Health Team. There are two national psychiatry centres close to the capital Kampala.

Sheila, I believe,  is actually the most important part of the project as she has been with mhGAP from its launch in WHO. She really drives the mental health agenda in Uganda. Uganda is lucky to have such a dynamic force.

Day four - Kiboga district in the west of Uganda

Today's task was interviewing health workers on their services. Armed with my notebook and my WHO copy of mhGAP manual, I headed to a rural area in the west of Uganda. This was a three hour drive from Kampala along mud roads past villages with no water or electricity. The poverty was overt.

We met a health worker who was clearly committed to her work but struggled to understand concepts of mental illness. When I asked about schizophrenia she talked about referring to an ear specialist for hearing problems. Yet when I left the little corrugated roof building, I soon saw a homeless man who was clearly psychotic and homeless.

The next practice was in a much better building and supported by Irish Aid. Here there were two skilled health workers. Yet here they said they didn’t see any mental illness. Just before I started to speak to them I saw a young Ugandan lady with four children. She looked depressed and sad. They told me she attended frequently with physical health problems. They had never asked her about depression. However, when I talked to them about it and showed them the manual I could see that them make the connection. I know they will ask her about this next time and maybe think a bit more about mental health. I hope in the future all these areas will have access to mental health information. In the meantime people are referred on for further advice through the layers of health services.

At this stage I felt this was real volunteer work - going to clinics, seeing front line workers and getting my hands dirty.

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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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