Another person released

Samuel (not his real name) was first brought by his mother to one of our monthly village meeting points some distance from Bwindi hospital. He was shackled on both hands and legs. His mother reported that he had been sick for 4 years presenting with aggression and violence, talking to himself and adopting unusual positions. He also had beliefs about being persecuted or threatened in some way. His relatives had chained him as they were afraid that he would destroy property and harm the people around him.

When we assessed him, we diagnosed schizophrenia, a serious mental illness. He was given antipsychotic medication in the form of tablets.

On our next visit, a month later, he came in with his mother, but this time he was free from his shackles. His mother said that he had started participating in some everyday activities at home including going with his parents to the land where the family grow their food. When we examined him again his state of mental health and wellbeing had improved markedly, and he was functioning well. He is continuing on treatment.

“mhGAP” Training the Trainers course recently completed

The participants with Joshua Ssebunnya in the centre

We are delighted that Jamie’s Fund has been able to sponsor a course at Butabika National Hospital in Kampala from the 20thto 24thAugust 2018 to train trainers to teach the WHO “mental health GAP” programme.  This approach enables clinical staff who are not specialists in mental health to be more aware of the importance of mental illness, how to identify it and begin treatment for individual patients who come to their general clinics.

We were encouraged by the enthusiasm of psychiatric staff from across Uganda who attended.  They came from nine different hospitals. We work with Kisiizi, Bwindi and Kagando, but have only just become aware that the other six each have one or two specialist mental health staff or are hoping to develop their services.

One of the outcomes of the training was that the participants have set up a mental health staff support network, as some of them are working in relative isolation. This gives us the possibility of providing further postgraduate training for them as a professional group.

The training was expertly organised and run by Joshua Ssebunnya, a clinic psychologist working at Butabika and Makerere University who has a lot of relevant experience.

Being awarded her certificate.

Meeting James, Rahab and Gorrette.

Some people might remember that in November 2016 we first met James, chained in the darkness of his hut in the Ruwenzori Hills for 15 years. On treatment, he has made a wonderful recovery so that in May last year he and I had a lovely conversation in the sunshine. On this return visit – a long trip up into those hills again, stopping off to do a clinic at a health centre on the way – we found him happily playing cards with his brother. He was relaxed, cheerful, engaged, and totally accepting of the group of white visitors who crowded into the small room to meet him.

We also went to see Rahab again. Her  house is down a very steep slope and it was raining hard! She had been known as someone whose mental illness made her very violent and destructive and was chained for a similar length of time to James.

Ewan found me a slightly less skiddy slope and we slid down towards the valley and then clambered up to Rahab’s house. Our team has successfully formed a therapeutic alliance and she too has been on treatment. Here we found an elegant woman looking well-nourished, free of her chain, beautifully dressed and ready to talk quietly about herself and her future. And do you know, she even had nail polish on her fingers and toes. Another life transformed from darkness to light, from imprisonment to freedom.

Gorrette

We found Rahab as soon as the word was out about James. This time, another new patient awaited us, her restlessness held firmly under control by her father. Skinny, malnourished, unkempt, overtalkative and thought disordered, Gorette too has a serious mental illness and will need the team to come alongside to work with her and her family so that she can receive treatment.

A joyous day!

Today (20th Feb 2018) was a joyous day for many reasons.

Several years ago I (Maureen) met Francis, who was shackled at home because his family and the village were too frightened by his mental illness to allow him any freedom. Not long afterwards he succeeded in killing himself. Today we met his son, who had been in prison for three years with no treatment for his mental illness and was beaten most days. Julius has been at home now for 2 years and has been cared for by the mental health team from Kisiizi, with monthly injections for his mental illness.

Grandma, Nancy & the cabbage

For the first time he is free from symptoms. He no longer hears the tormenting voices, is clean and well nourished. He still wears his shackles but the family are so thrilled by his progress that they are almost ready to remove them. Today was the first time that Sister Nancy has seen Julius smiling, and his grandmother smiled the whole time we were there. As we left, Grandma plunged into the vegetable patch, seized a cabbage, and ceremonially presented it to Nancy, still smiling.

We climbed up a steep goat track in another village to meet a young man whose wrists were still shackled but not locked together. When ill, Richard is very destructive – he managed to completely destroy his mother’s house on one occasion. Now, with treatment from the team, he is well and able to work in the family fields, playing his proper part in family life for the first time.

Not far away a local teacher discovered that Bruce, a mentally ill man in his early twenties, was shackled and left bound hand and foot in a banana plantation, where he was unwashed and uncared for, half naked, with no toilet facilities, and barely fed. The teacher alerted our team, treatment was begun, and we met a transformed young man, clothed and in his right mind.

An update on James at Kagando

In November 2016 Dr Maureen Wilkinson went with staff from Kagando hospital, to meet James, a young man with a long term mental health condition that had remained untreated for a number of years.  Maureen was able to make a diagnosis for James and treatment was begun.

In October, 2017 Hugh Burgess and John Taylor (respectively the Chair and Treasurer of Jamie’s Fund) were privileged to meet James at his home.  They are delighted to report that James has continued to make good progress thanks to regular treatment given by Kagando Hospital with the on-going support of Jamie’s Fund.

Here is James (seated) with three members of the team from Kagando hospital outside his home, the wattle and daub house at the rear of the picture.  His home is very simple and has the corrugated iron roof that is very common in Uganda.  The straw on the roof helps to keep the temperature inside down at a reasonable level (and the noise down when it rains!)

For many years James had had to be restrained and so it was wonderful for John and Hugh to see him now walking free and able to take an active part in the consultation with the medical team.  Having seen this work at first hand, Hugh and John are very pleased that a few thousand pounds provided by Jamies Fund is able to make such a significant difference in the life of James and others who would otherwise have very little hope.

We are delighted to be partnering with Kagando Hospital in this work.

Developing community mental health in Kagando

In a recent trip to Uganda (October, 2017), Hugh Burgess and John Taylor visited Kagando Hospital where Jamie’s Fund is supporting an initiative that is taking mental health care into the community.  Here they outline the approach Kagando is taking.

Kagando is a busy Church of Uganda hospital, not far from the border with the Democratic Republic of Congo, and it provides a wide range of health services to the local community.

We were impressed with the work being done there and especially with the very busy maternity ward.  It was a big surprise to meet inpatients being treated for leprosy, a disease I thought had disappeared.

Kagando is fortunate to have two trained psychiatric nurses.  They have mainly been working in general medicine  but with funding from Jamie’s Fund, they are being released for part of the week to go out into the community.  Jamie’s Fund has also provided funds for a motorcycle to facilitate this.

The model they are using is to send out a message to a local community to invite those with mental health needs to meet the mental health team at a given place and day.     Patients’ conditions are then diagnosed and a course of treatment planned.  This is then delivered by the nurses travelling to patients’ homes or local villages on a regular basis.

Travelling to a clinic along “murram” roads.

The advantage of this approach is that it helps patients who are very poor or distant from the hospital to get treatment that might otherwise be unavailable to them.

We felt privileged to attend some of these clinics and to see the plan in action.  Here the clinic is being held under a mango tree on the edge of a village.  Five patients were diagnosed here.

A clinic under a mango tree.

Follow-up treatment was arranged for a few days later.

We were hugely impressed by the compassionate and professional care that was shown by the Kagando team and are delighted by the progress that is already being made in finding some of those who most need treatment and care.  This is being delivered in the community, which not only reduces that difficulty faced by patients in getting to hospital but also eliminates the costs of hospital care that can often deter patients and their families seeking care in the first place.

The community mental health team at Kagando hospital find another person imprisoned in darkness.

We are so grateful to Jamie’s Fund for the funding for the Community Mental Health programme here at Kagando.

The programme is going well; we were seeing another new patient in the community just six days ago who has steel shackles on both legs, and spends his days lying in the dark. He will be seen again tomorrow, but is already responding to the injection that we gave him last week – just one more of what we know are many others suffering from severe mental illness in the community.

He is more accessible than the patient whom we tried to meet when you were with us! (some patients are not accessible by road)

Dr Rob Morris,

Deputy medical director at Kagando hospital

A life transformed.

In May we visited Kagando hospital in Western Uganda for the second time, having been there for the first time in November last year. They are only just beginning to establish a mental health service.

I ( Dr. Maureen) spent the morning in clinic with Robert, psychiatric nurse, and George, a clinical officer. A mix of patients with epilepsy and mental illness, most of them doing well. Epilepsy tends to be regarded as the remit of psychiatry in many African countries, as it is to do with the brain and there are almost no neurologists in Uganda or the other countries.

Last November we went on safari up into the hills with Fred the social worker and Seriphas the palliative care worker, and met James, now about 42, mentally ill since his twenties, and shackled in the darkness of his hut for the last 15 years. His relatives had taken him three times to the national psychiatric hospital in Kampala, a seven-hour journey in a vehicle with a disturbed adult. Each time he had relapsed. Either he run out of medication or wouldn’t take it, we don’t know. So the relatives didn’t know what else to do, apart from chain him in a hut and look after him there, as he could be aggressive when ill.

I found he was very thought disordered, and he said only two things that made sense. One was to ask for food, the other was to ask for an injection. When we left, Rob, one of the doctors at the hospital, was to examine him medically then start him on a depot injection for schizophrenia. Rob has visited monthly with Robert, the psychiatric nurse, to give the injections.

Again we climbed up that winding, rocky road, up to James’s village. 

Here we were, five months and five injections later. James was able to walk out into the sunshine, sit down and talk to me, making good sense, and expressing his hope and dreams for the future. He would like to become a teacher.  That’s a transformed life after fifteen years in the darkness.

 

 

Many more people across rural Africa are chained up and not able to contribute to society as their relatives don’t know that western medicine can help them return to a more normal life.  The team based at Kagando hospital are finding more and more people who are permanently restrained due to their mental illness.

The local understanding of mental illness and epilepsy is complex, as the causes can be attributed to the influence of evil spirits or witchcraft or because the ancestors have been offended. We in the UK largely accept a medical or social model of disease, but this model doesn’t answer questions which are part of the local culture, such as why did this happen now?  Did anyone else do this to me? So there is a need to work with local people and services to find ways to reach out and spread the information that mental illness can be treated with effective Western medicine and counselling.