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.

Hugh’s account of the Grand Opening of the new Ahumuza centre!

The completed Ahumuza Centre.

Over the last few years a lot of people have very generously donated to Jamie’s Fund and so, by the beginning of 2016, we were in a position to begin building a new mental health unit at Kisiizi Hospital. A British architect designed a very swish building but after lengthy discussions about the costs and the location of the unit, the design was simplified.

Building eventually began in the middle of 2016.  It was quickly discovered that the chosen site was very wet and so a redesign was needed and two “ground beams” constructed to keep the building rigid.  Bricks were sourced locally and the building went up quickly.  Fitting out took rather longer and so it was only in April 2017 that the building was eventually handed over to the hospital by the building contractor.


The bright airy and clean Men’s ward in the new Ahumuza Centre today …

I visited Kisiizi in November 2016 when much of the work had been completed but the building was still empty.  It was wonderful to see it but it was still only a shell until it had people in it and using it.

... and the old ward today - where so much extraordinary work has been done over the years with so little!

… and the old ward today – where so much extraordinary work has been done over the years with so little!

Following the hand-over, patients were moved from the old, dilapidated ward to the new Centre.  In May this year I visited the old building (a single ward housing men, women and children plus the relatives who were caring for them) and it was in a very poor state of repair which is hardly surprising after more than 70 years of use.


Jim and Avril get their first view of the new Centre

This year, seven of us, including Jamie’s parents, Jim and Avril, travelled to Kisiizi where we arrived on Thursday, 18th May.  After being welcomed by old friends from the hospital, we were taken to see the new Ahumuza Centre.  Ahumuza means “Comfort” or “He comforts” in Rukiga.  It was a much more emotional experience than I imagined and more than a few tears were shed.


The plaque to commemorate Jamie

Later in the afternoon Jim and his brother Mark, installed a stone plaque that had very generously been made in the UK and taken to Uganda by Jim.  A second plaque was also put up celebrating the Grand Opening by the Prime Minister the following day.  In the
event the PM wasn’t able to be there due to an emergency meeting of Parliament but he sent the Permanent Secretary at the Ministry of Health, Dr. Diana Atwi
ine, in his place.  Incidentally, Dr Diana is also the personal physician to the President of Uganda.

The 19th of May was a beautiful day and there was great excitement as final preparations were made.  The concrete path to the Generator House and the new fences that screened the “long drops” and kitchens of the maternity ward had been finished.  There were final touches and the sweeping and tidying away of unwanted materials so that by 10 o’clock, when the visitors began to gather at the primary school next to the hospital, all was ready.


VIPs waiting to greet the Guest in Chief

As is the way of these things Dr Diana didn’t appear until about 1pm but there was great excitement, particularly among the children, as she came by police helicopter from Kampala and landed on the school playing field in a great cloud of dust.  There were magnificent Rukiga dancers to meet her and the large crowds already there grew during the day.

The first order of the day was the official opening and so a great party of people, important visitors, politicians, clergy, police, doctors, nurses, patients and a host of others wandered up to the Ahumuza Centre where there prayers and a blessing were offered followed by a short hymn.  The plaques were unveiled and then Dr Diana invited Avril and Jim to join her in cutting the ribbon, as she declared the Centre open.

Cake Cutting by Dr Diana , Sr Nancy and Jim and Avril Devaney

Cake Cutting by Dr Diana Atwiine, Sr Nancy and Jim and Avril Devaney

The crowds continued to mill about and the VIPs and others were then given a guided tour by a very proud Sister Nancy.  A large cake was then presented and cut by Dr Diana and Avril and Jim, with portions being given to VIPs, patients, staff and no doubt to many of the people who’d simply turned up to see what was going on!

The tour of the Ahumuza Centre was followed by a brief tour of other areas of the hospital with a long crocodile of people involved before everyone gathered in the school hall where we were welcomed by the Chair of the Hospital (I think) who introduced many of the individuals and organisations represented.  There was some wonderful Rukiga dancing and very moving play and dance put on by the staff and patients of the Mental Health Centre.

Some of the dance performed by the Patients Group

Some of the dance performed by the Patients Group

As this group danced a very energetic Rukiga dance, they were very movingly joined by Dr Sheila Ndyanabangi, Head of Mental Health Services in the Ministry of Health in an impromptu show of support for those with mental health issues.

There were speeches by a number of people.  Dr Lionel Mills, a GP in the UK, spoke movingly of the start mental health services at Kisiizi in the 1990s.

Dr Diana Atwiine thanks Jim and Avril and all those who have given so generously through Jamie's Fund.

Dr Diana Atwiine thanks Jim and Avril and all those who have given so generously through Jamie’s Fund.

Dr Sheila spoke about the importance of mental health services and the particular place that Kisiizi had in her heart.  I spoke about Jamie: how he came into my life, that he was a very special little boy and that although he is no longer with us, his untimely death has encouraged many others and leaves an immense legacy not least in the Ahumuza Centre.  I also cautioned that there is much more to be done in Community Mental Health work as well as in the hospital itself.


Some of the guests enjoying the dancing and speeches

Bishop Patrick Tugume (retired Diocesan Bishop) then spoke very movingly and personally about Jamie and the gift that he was, a theme that was then picked up by Dr Diana who was very moved (and moving) about the work done by Kisiizi Hospital, and particularly for patients with mental health needs.

The day was rounded off by the National Anthem and a delicious meal prepared overnight by members of the Hospital team.

It was a wonderful day and, for me, it was particularly exciting to see the Ahamuza Centre “open for business” and to see Sister Nancy beaming from ear to ear!!

I would like to thank everyone who have contributed to the building of the new Ahumuza Centre, however much or however little because, as we have always said, every penny counts towards improving mental health care in Uganda.  Thank you!

And a photo gallery of other parts of the day


Jim and Avril with John “the Brickie”, the clerk of works. (Banner made and presented by members of Heswall URC)


Scouts and Guides from the school tell the story of mental health work at Kisiizi in song


The Chair and Chief Executive of Jamie’s Fund with the team responsible for building the new Centre


Dr Sheila (left) and Dr Maureen deep in professional conversation


Members of the Patients’ Group prepare to dance!


Jim and Avril enter the Centre for the first time


We Still Need Your Help!

Although there is great progress towards completing the building of the new Mental Health Unit at Kisiizi we still need your help to ensure that the building is completed and fitted out to the highest standard, so please don’t stop your fundraising efforts!

It has taken longer to get to this point than we had hoped but a lot of people have worked very hard to get the project to this point and we are in the most exciting phase.  Once the building is complete, mental health patients and their families can receive even more support from the great team at Kisiizi.

You can donate very easily on-line by clicking here… and please don’t forget to Gift Aid your donation if you can – it costs you nothing and significantly increases the funds Jamie’s Fund receives.

Thank you!

Four hundred miles by bike from Entebbe to Kigali

We set off from the guest house in Entebbe, Uganda in the cool of the morning and dropped down to the shores of Lake Victoria. Our bikes were loaded into a small boat and we puttered across the bay. We reassembled the bikes and panniers and set off down the dirt road on our journey to Kigali.

There were three of us, me from UK and two Ugandan friends. Bosco, a driver and Isaac, a computer science student and Scuba instructor.

Avoiding the busiest, dangerous roads and using a mixture of dirt and tar roads we wove our way south west across Uganda. Some of the dirt roads were hard going, rough with loose grit on top and with the occasionally steep hill. But we saw so much of rural life, away from tourist routes. Countless children were excited to see a “mzungu”, a white person, cycle past. We could hear the birdsong and identify a number of the calls.

Cycling4Most of the tar roads were good, many with a meter wide shoulder for cyclists and pedestrians, making us feel safer from the occasional bus roaring past.

A rest day with some bike maintenance then we headed out on the last lap. First a gradual climb up a valley leading to a stiff climb at the head to get over the ridge. On to the Rwandan border and then a steady climb of three thousand feet to reach our resting place.

We relished a glorious twenty mile descent the next morning, with views over the valleys at first and then becoming more restricted as we got lower. There were a number of men on bikes with 40 litres of milk on the carrier heading to Kigali. We kept pace with some of them for a while, they were faster on the descents than we were, with their greater weight, and we would overtake on the more level bits, where our gearing made the difference.

Cycling2And then we turned a corner and there was a group of multi-storey buildings on a hill top in the distance. Kigali, our destination. Eight miles later we were there and we celebrated with a banana split, as nothing like that had been available en route.

403 miles, no punctures, no hassles or security problems and a chance to see rural Africa in a way that allows genuine contact.

Recent Newspaper Articles

jamie-devaneyJamie’s Fund has recently been mentioned in a number of newspaper articles.  Links to two of these are given below.  We’d be very interested to get any feedback you may have.

Mental Health for Sustainable Development

APPGFollowing the recent review on global mental health held at the UK Parliament by the All-Party Parliamentary Group (APPG) on Global Health and APPG on Mental Health, a new report was launched on 26th November 2014 titled ‘Mental Health for Sustainable Development’.

The review was Chaired by Lord Nigel Crisp and James Morris MP, with an aim to assess why and how the UK should act to help improve mental health in low and middle income countries. In addition to individual written reports and interviews, the review held two oral evidence sessions for parliamentarians to hear from and question leading experts in the field of international development and global mental health. Dr Maureen Wilkinson, who you will know as an Advisor to Jamie’s Fund, attended Parliament and was involved in the evidence sessions.

Three quarters of people with mental health problems live in low and middle income countries and receive little or no evidence-based treatment. This report sets out three important arguments why mental health matters globally and why development activity will not be truly successful without tackling mental health issues and sets out four clear recommendations for ‘doing more’ and ‘doing differently. To view the report please click here.