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.
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
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.