From time-to-time we are reminded that Covid19 is not the only story in town and even more importantly that there are good news stories that have nothing to do with Corona virus.  A recent story from Georgious Orishaba, the psychiatric clinical officer at Kisiizi Hospital is a case in point.

Later Mary remembered that she had worked a time for a member of staff from Kisiizi Hospital and so a little information about Mary became known.  She was also diagnosed with a range of issues including depression and psychosis associated with HIV as well as a number of other conditions. 

Over time and with treatment it became clear that Mary had been abused as a child from an early age and had not only lost one child but had also had two others.  As a result of this she had been blamed by both her parents and her employer and so it was she was eventually found at the side of the road.

Although Kisiizi is a not-for-profit hospitals, patients are normally expected to contribute towards their medical costs and to provide their own food.  For Mary this was a non-starter since she had no resources to meet any of the costs.  However, Kisiizi Hospital stepped in and supported Mary from September, 2019 until her eventual discharge in July, 2020.  After 10 months of treatment members of her family were finally found.  Unfortunately both her parents had died but we are pleased to report that Mary has finally become settled with her aunt.

At Jamie’s Fund, we are always delighted to hear stories about patients who have come through challenging times and are very pleased that, through the Jamie’s Fund investment in the Ahamuza Centre, Kisiizi is able to provide a certain amount of long-term care of this kind.  We are also aware, however, that the cost to the hospital of providing both medical and nutritional care is significant.  

There are many stories like this and Jamie’s Fund is pleased to support work with patients like Mary.  If you would like to contribute towards the work with people with mental health in Uganda, please click here.

Hugh Burgess.

In most African countries there is no such thing as a welfare state. Families try hard to give their children a good education, with the hope that they will get well paid jobs and take over the support of the younger children – particularly the payment of school fees. 

Jane is the only girl in her family, the eldest of eight – seven brothers! She did well at secondary school, and with the hopes of her parents invested in her, she achieved a degree in accounting at Makerere, Uganda’s top university.

Jane got a job at a high performing accountancy firm. She was able to pay the school fees for her brothers, and to take good care of her parents. She thought she could now aim higher, and set out to gain a postgraduate diploma.

At this point when Jane’s life appeared to be going very well, she experienced some stress and her mood began to go down. She lost concentration and both her work and her studies suffered.

Then came a dramatic change in mood, which went up to way above normal, too active and overtalkative. When she became irritable and argumentative, that did it: she was immediately fired from her job.

“When someone has physical pain, they can go to the hospital and tell the doctor that I have pain here, but my challenge is that I had pain but it was not physical. I lacked the person to talk to, it was killing me silently” she says.

Bipolar disorder is a serious mental illness common all over the world. You can control the moods to some extent with medication, but talking about the illness and learning how to manage it is one of the crucial treatments. The mental health team at Mukono Hospital, supported by Jamie’s Fund, are great at offering time to talk as well as giving out the right pills.

Jane’s family didn’t seek treatment at first because they didn’t even know that what was happening with her was a mental problem that could be treated. They just looked on and when she was out of control, they locked her inside the house.

 “We saw it as an embarrassment in our family and we didn’t ever want the community to know about it” her mother says.

“It was only when a family friend told us about the initiation of mental health services that we went to Mukono Church of Uganda Hospital.”

As Jane eagerly agreed to treatment, so mum readily agreed to become an ambassador for mental health in her community, happily celebrating her daughter’s new life. 

After just two months there was a clear improvement and Jane was happy and well. She was continuing to attend the hospital for her regular treatment sessions, but as with most patients who live some distance from the hospital, it’s likely that the lockdown conditions will have prevented her getting her treatment at times. 

All of the teams supported by Jamie’s Fund face huge challenges in supporting their patients and enabling them to continue with their treatment. Not so many people in rural areas have access to phones – for on-line psychotherapy! – and they normally receive their medication from the team in the clinics at the hospital or village health centre. The results of the virus and especially the very strict lockdown, may be far reaching and far more damaging than anyone will be able to measure. 

Please remember people with mental illness and epilepsy in Uganda, and the teams who care for them with so much love and devotion. 

Lamet Jawotho and Mo Wilkinson

Miria’s Story

Miria is one of three nurses currently being sponsored by Jamie’s Fund to train as a Psychiatric Clinical Officer (PCO). This course is only offered at the Butabika training school, part of the national psychiatric hospital, near Kampala. This is about four hours by bus from her home where her husband has to care for 3 children in her absence. Miria is part way through her first year of the three year course.

In a country with few psychiatrists and clinical psychologists, local mental health services are usually developed and led by PCOs. After training, these Jamie’s Fund PCOs will go back to their hospitals and get working to develop services in their communities!

As has been the case for many in education across the world, Miria feels frustrated that government restrictions to limit the spread of Covid 19 in Uganda have meant that all the universities and training schools have been closed since March this year. Like many other students and trainees, she has been sent home with lecture notes to study and course work to complete. Yet her tutors have been unable to offer any support and guidance. Access to reliable internet is another challenge, made worse by the increased demand on mobile data systems by all those trying to work or study from home. Add to that the familiar situation of trying to meet the needs of the whole family whilst everyone is confined to home. Not easy.

When I spoke to Miria in July, she was still praying to return to her course, but had no word on when that might be possible.

Q: What inspired you to do this training? – It was the mhGAP* course in 2018, it inspired me very much. Although I already tried to help when I saw patients with mental illness, I had no training and did not know what should be done. After mhGAP my colleague Patrick and I really understood a lot more, and we told the hospital management how the staff should pick out and handle these cases! And now we have trained other staff at the hospital in mhGAP.

Q: What have been the challenges? – It is hard to be far from my family. I miss my children. My husband has had to become mummy and daddy. But they all support me, always. My first born prays for me when I am away, ‘Let mummy pass her exams’…And the food is not good, only posho (maize meal with a dough-like consistency) and beans!…I felt lost when I first went there, but I have been getting good results in the tests, and now I am more confident.

Q: What has been good about the training? – There were no surprises, really, I was already used to these patients. I like working with people with depression, especially with risk of suicide, I have the heart for these people. I am proud to have been helping the inpatients, and learning new skills too. I have made new friends among the other students. We mostly help each other, and we relax together.

Q: Anything else? – Only that I feel bad about losing all this time. Studying at home is not the same, you do not have the same motivation, and there is nobody to ask if you do not understand.

Linda Shuttleworth. 6 August 2020.

*mhGAP is a World Health Organisation (WHO) programme to train non-specialist health staff to identify and treat the common presentations of mental ill health. Jamie’s Fund has been supporting the roll out of this training since 2018.

 

As much of the world has been engaged in coping with the Covid 19 pandemic, we have been keeping in touch with our partner hospitals in Uganda. We were keen to understand the challenges they have been facing, and how they have been responding. Towards the end of May, we contacted all our active partners, and soon had replies from nearly half of them.

 

 

All hospitals have faced reduced income, because their training schools have been closed, and fewer patients are coming for treatment. In some cases, numbers attending are 25% of what they were. The barriers for patients are lack of money and lack of transport as public transport had been banned for some time, only now beginning to be allowed again, with increased spacing.

The hospitals have the frustration of seeing drugs in their pharmacy being wasted as they go past their expiry dates.

 

 

 

Mental ill health is on the increase, not only because people are unable to access treatment. Poverty and isolation can tip vulnerable people into mental ill health, as anxiety, depression, and suspicious beliefs run unchecked. And hospitals are noticing an increase in domestic and gender-based violence, drug and alcohol misuse, and teenage pregnancies.

 

General health is suffering too, as people are less able to access child immunisation programmes and regular HIV clinics or access emergency treatment. As people delay seeking treatment in the early stages of illness, they are more often becoming severely ill and less likely to recover.  The number of deaths from Covid has thankfully been low, but many people have suffered in other ways due to the virus and wider impact of the lockdown both on health and on the economy.

 

 

 

Despite having a fraction of the resources available to us, hospitals have done their best to respond to the crisis. They have provided transport and temporary accommodation for their staff to enable them to be at work. The mental health teams have reached out to their communities with phone calls and radio broadcasts, encouraging people to come in for treatment. They have set up informal helplines. They have gone out to bring people in who were at risk of becoming mentally unwell. And they have done their best to keep everyone safe, with social distance and available PPE.

Uganda has its Healthcare Heroes too!

 

Linda Shuttleworth