Tuesday 22 May 2012
We concentrate on some challenging areas
within Psychiatry - taking a sexual history and risk assessment.
Sexual history-taking proves a real challenge for the students and
they are simply not comfortable discussing such matters. We work
through a number of different scenarios to enable them to think
about ways in which sensitive questions and areas may be managed.
Whilst discussing risk, it is clear to me how lucky we are in the
UK, to have a functioning mental health act, secure wards, and
clear protocols to work alongside. Managing risk in a country where
no mental health act exists, and where there is a stark lack of
staff available is another challenge altogether.
Wednesday 23 May 2012
Today is the students’ OSCE examination. Two
cases have been picked and the actors are other medical students
who have kindly volunteered their time. I examine alongside Layla
and Peter is alongside Adan, with the reps carrying out the bulk of
the marking, in order that they get a true experience of examining.
The OSCE went smoothly, somewhat surprisingly, as it takes
organization and strict time-keeping, to make it work. The
reps had done a good job. The students demonstrated their
enthusiasm and I was impressed with their progress after just 2
weeks of teaching.
Peter and I met with Faduma (the head of
nursing) later that day. She requested that we interview a man, who
was suffering from a manic psychotic relapse. He had a diagnosis of
Bipolar Disorder and was on medication, though had not taken it
during a recent reported incident of violence. Peter and I met with
him in the company of Faduma, who translated for Peter. He was now
taking Olanzapine regularly and was much improved in his mental
state. He was wiling to be followed up by Faduma who was also
supporting him financially as he was not able to work. Cases were
brought to our attention, and we often interviewed people in the
lunch breaks, even if only to offer advice or sign-post to a
relevant person to follow-up the case.
Thursday 24 May 2012
We go through the post-course MCQ exam, and
were pleased to see that some attitudes towards mental illness had
changed positively from when we started the course. Small prizes
were given out to the top scoring students and certificates were
awarded to all. The students seemed pleased with their performance
and we were delighted that all of them had passed the course. This
is important as they cannot pass their final medical school
examinations without succeeding in Psychiatry. It is a testament to
how much further up the agenda Psychiatry has come since the
teaching started, only a few years ago.
Then group photos, individual photos, team
photos, university photos, class photos, friend photos, photos with
reps, photos with tutors, photos on the grass and photos under the
university sign…Somalilanders LOVE photos!! It was quite simply
wonderful, and little did I know there would be a repetition of
this later that night.
The two universities, Amoud and Hargeisa, had
organised a dinner, for all the students and teachers, including
the deans of the respective medical schools and various other
academics. I was lucky enough to be dressed up in traditional
Somalilander attire by two of the female students and attended
dinner looking quite unlike my usual self. Many speeches followed,
which made me reflect on just how important this teaching was and
how appreciative the students were. I felt privileged to have been
given the opportunity to be involved in such a trip.
Friday 25 May 2012
Our last day in Borama was spent inputting data and report
writing. This is an integral part of any teaching trip, for without
numbers, we are not able to reflect upon and ultimately improve our
teaching for future trips.
DrJibriil and the reps joined myself and Peter
to work on developing the final year medical student OSCE exams and
to develop the written examination.
Saturday 26 May 2012
I bid goodbye to Borama and we make the
journey back to Hargeisa. I get to see glimpses of Borama, a sleepy
dusty town that reminds me of little villages in Kenya. It is early
morning and as we get out onto the open road, I get a real sense of
space. I breathe the African air and feel happy to be moving,
able to see life going on around us: herders with their
black-headed sheep, women walking together, men steering their
heavily laden donkeys along the road, the mountains in the
distance, tortoises crossing the road, camels and baboons.
Somaliland blue sky sees us all the way to
Hargeisa where we briefly stop by the THET office for a final
de-brief and are on our way again, to the airport.
Soon we are on the ECHO flight, a small
humanitarian aircraft that routes through northern Kenya. Back on
the flight, I look out of the window and think about all we
have achieved in the last two weeks, I think through all I have
learned. I feel a great sense of achievement, and real joy in what
I have done. It has truly been an incredible journey and I hope to
Dr Lauren Gavaghan
CT3 Psychiatry trainee