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

Two seconds to say yes

Uganda - Kampala

March 2012

I wasn’t originally going to write a blog on this assignment as I considered it would be an uninteresting read in terms of the nature of the mission here.

However, after some rumination and discussion with colleagues, I thought maybe it would be good to show the more mundane part of international development work. I love doing direct clinical care, training and training of the trainer, but this was work was almost entirely paper-based. Also I was stuck indoors in a giant eight day meeting.

I have always said that if you are doing international work right it is probably somewhat dull. I wouldn’t describe my experience  in Uganda as dull even though it may sound dull being stuck in workshop for eight days. It was actually a fascinating experience and I learned a huge amount of how to do this work right.  

February 2012

As Idi Amin is no longer President of Uganda, some of the Asians he drove out are coming back. Uganda has been at peace for about seven years now which is why many are incensed at Joseph Kony,Lord Liberation Army, who gave the impression that Uganda is still at war.

Tackling AIDSs has been an astounding success but the rate is increasing again. People are highly aware of HIV and prevention is though a multi-pronged campaign of education.

Uganda is known for its homophobia but is probably not much different to many other countries in the region. I know that there are those in UK who  feel that we should not support Uganda because of this. It is a tricky area. At least in mental health we' re committed to designing programmes which are non-judgemental, where there's unconditional respect for all patients and carers.

One of the big challenges facing Uganda at the moment is the increasing rates of the bizarre,chilling  and unexplained Nodding disease in the north of the country. In this condition, children between 5 to 15, developa  nodding motion when faced with food and stop eating. They eventually die. In Uganda it falls under mental health. It appears that the disease has been spread by hysteria but there are more conventional medical cases. It is also found in South Sudan and a few other countries and is currently the subject of an international health investigation. Our health ministry colleagues were very preoccupied with Nodding disease and it'll be a big challenge to a poor country.

In February 2012, WHO contact me (out of blue) to ask if I would be interested in doing some work in Uganda based on the mhGAP. After about 2 seconds I said yes. I am passionate about the mhGAP approach, especially incorporating mental health into primary care.

In case anyone still hasn’t heard me talk about this - this is the WHO approach of addressing the inequality of mental health provision in low and middle income countries. It means that mental health is brought to primary care level and health workers are trained to identify and treat basic mental health problems. They refer on any that are in any way complex. It is a double system of primary care mental health clinics with secondary referral systems for complex cases. There is a manual that is a guide to management. Coupled with this are training materials and supervision systems. It is a way of scaling up mental health in places that wouldn’t have access to any service otherwise. Conditions covered are the MNS conditions  – mental, neurological and substance abuse. So the anomaly, for a western psychiatrist, is that epilepsy is part of the mental health system.

This can work as long as there is a political, training, supervision drive and a robust secondary referral mechanism. So with all this in the background I was proud to be asked by WHO to be part of the design planning of a programme to scale up mhGAP in parts of Uganda.

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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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