Delivering Psychiatry Training in Somaliland
Somalilandsun – Dr Lauren Gavaghan is a Specialist Psychiatrist and Mental Health lead for the King’s Tropical Health & Education Trust-THET Somaliland Partnership (KTSP). She is spending eight weeks in Somaliland as a volunteer teaching Mental Health (MH) to medical students and delivering a Training of Trainer (TOT) course for MH focal people and Medical Faculties.
Everyday until the 8th November Dr. Gavaghan will be posting a new diary entry on the THET blog page to give readers a unique insight into delivering mental health training in Somaliland.
Here’s the the program so far
Day 1 – 18th September 2013
Arriving from Nairobi on the ECHO humanitarian flight was a familiar journey this time. I have visited Somaliland twice before as a volunteer, working alongside THET, though only for 2 weeks at a time. This time my trip is for 2 months. I am excited, yet also a little nervous given the longer time period and the fact that this time I leave the UK alone- with co-workers arriving later on during my trip to work with me.
I am pleasantly surprised by the new runway at Hargeisa airport, which makes for a softer landing than in May when we landed in the bush.
As always, I am greeted at the airport by the driver from THET, who rapidly teaches me some Somali on the way to the THET office, which I rapidly forget!
I meet the team, most of whom I have met before and at once feel at home again. Samatar, the Logistics and Security Officer runs me through a further security briefing and the logistics of my extended trip. I also meet with Thomas the Programme Manager and Wario, the Country representative. A number of emails and phone-calls later, and I have plans for the following day, to meet with members of the Core Mental Health Working group, a group made up of doctors who have an interest in mental health, many of whom have been mental health representatives in the past and continue to advocate for better mental health in Somaliland. Late in the afternoon, I am driven to my now almost second home, the Mansoor Hotel, where I shall stay for the coming weeks. It is validating to be remembered by so many staff I see and welcomed warmly.
Day 2 – 19th September 2013
An early start in the THET office to meet with the team to discuss my schedule for the next 8 weeks. The time will fly by I have no doubt, as every day is planned out. Dr Mariam, a member of the mental health group, also joins the meeting. She has been busy organizing participants for the Mental Health Training Skills course we shall run next week in Hargeisa. I work alongside Samatar to get the resources we will need ready, and we discuss how we might manage a potential of nearly 70 5th year medical students to teach at the end of my trip. I communicate via telephone and email to Dr Jibriil in Borama, who is working hard to prepare those in Borama for the upcoming courses.
Having conducted a final Skype interview yesterday for a potential applicant for the yearly position of mental health rep, we make the final decision today. Mental health reps are two newly qualified doctors, who are chosen annually via a competitive and standardized application process and who will take an active role in the teaching of psychiatry to medical students later in the year, as well as take a lead role in the advocacy of mental health in Somaliland. They are offered mentorship from seniors in the UK via the platform Medicine Africa and so gain added skills in team work, leadership, teaching and management, all of which are integral to any career they may later choose in Medicine/ Surgery. This extended trip of mine means that I will be available to work more closely with them prior to the annual medical student teaching, which this year will occur earlier than usual in October.
I finish up my day by talking with Naj, a Somalilander who currently lives in London and is a documentary film maker. She is currently working alongside THET to develop a documentary detailing their work and my journey, with others who shall follow me. We map out potential opportunities during my trip for filming and we arrange to meet on Sunday for our first interview.
Day 3 – 20th September 2013
The weekend in Somaliland is Friday and so I spend today preparing for my course on Monday, emailing friends, having Skype discussions with those in more distant places. I also receive supervision from Dr Susie Whitwell, Consultant Psychiatrist and Lead for KTSP.
Day 4 – Saturday 21st September
Further preparation for the teaching on Monday. I meet today with a previous mental health representative, Dr Adam, at the Mansoor hotel. Dr Adam was previously chosen for the position of mental health rep as he was keen to learn more about psychiatry and teaching. Mental health reps are newly qualified doctors, who are chosen competitively each year for the position. They assist KTSP in the annual teaching of medical students, which gives them the opportunity to improve their teaching skills and gain leadership and team working skills. They also participate in online supervision and act as mental health advocates in Somaliland amongst their peer group. Many previous reps are still heavily involved in psychiatry/mental health work, and some have made great progress with projects they have started and published articles about their work.
Day 5 – Sunday 22nd September
This morning begins with a meeting with the Dean and the head of clinical work at Hargeisa University, to discuss the upcoming medical student teaching. This year we are due to teach a total of 68 5th year medical students, which is a record number. We will have to adapt our plans to facilitate this number and the meeting discusses such plans. Following this meeting I head back to the THET office where I take part in a filmed interview with Naj, a Somalilander, who currently lives in London, though is undertaking a placement with THET to document the work we are doing. She would like to film my current work as a volunteer and the interview is focused on my current hopes and expectations for my extended trip.
Day 6 – Monday 23rd September
An early start to begin the Mental Health Skills Training course in Hargeisa. This is a ‘teaching the trainers’ course. I shall be teaching mainly new doctors and junior doctors teaching skills that they may utilise in their own practice. This is the first time such a course has been run in mental health and it is an exciting opportunity. 15 participants attend, and I find I know many of the participants as they were medical students when I taught in 2012 in Somaliland. It is a real privilege to be here and to be able to facilitate their development further. They have all recently graduated as new doctors.
Also on the course are more senior doctors who wish to improve their teaching skills. Many of the course participants comment that they have rarely taught using techniques other than lectures/ powerpoint, and they are keen to learn. They are also aware that their involvement in the course has changed, and rather than being passive recipients of information that is given, during this course they will all be practicing their teaching skills. Some are confident, others a little more nervous, though as the day progresses, I am impressed by their level of interaction. We spend today thinking about what makes a good teacher, what skills a teacher needs to use, what different roles a teacher may take on and how teaching is very much linked to professionalism, leadership, team work, supervision and audit. Most doctors were not familiar with audit, something which is very much needed here in Somaliland to improve the quality of services.
Day 7 – Tuesday 24th September
The Mental Health Skills Training Course continued for the second day at Hargeisa Group Hospital today. It is a joy to see the participants develop and become more confident, as they try out teaching techniques and move away from using only familiar techniques. Giving and receiving feedback and constructive criticism is something the doctors are not as comfortable with and so we spend some time practicing this. We visit the mental ward in the hospital grounds, in order that the participants can explore how they might lead a group of students if they were teaching in the clinical setting. The doctors appear calm and confident on the ward and I remember back to last year during their psychiatry course when many of them stated how scared they were to go onto a mental ward. It illustrates their opinions and attitudes have changed. I see a patient who was there in May when I last taught on this ward. She is a young female with learning disabilities who now unfortunately lives on the ward as her family cannot look after her. She is happy to see us and spends much time watching the doctors carefully as they answer questions asked about teaching.
To find out more about THET’s work in Somaliland, visit THET Somaliland Programme page.