Tough times

A rural road – but no-0ne on it

The Ugandan hospitals are facing hard times at the moment, as are many of the local people. The initial lockdown because of Covid was eased slightly on the 5th of May but there is still no public or private transport allowed without specific authorisation.

This makes it hard for people to get to hospitals when they are ill and there are too many disaster stories about mothers in labour not being able to reach hospital for timely interventions. Staff who live some distance from the hospitals also struggle to get there to work, or have to stay at the hospital if they can, but apart from their families.

Access to food is a problem in some places. Surveys in different African countries have shown that more than two thirds of people said they would run out of food and over half would run out of money if they have to stay at home for 14 days. The lockdown in Uganda has been longer than this already.

People in different countries are saying “It is hunger I am worried about, not the virus”
So far Uganda has done well at limiting the known number of cases of Covid and many of the rural hospitals have not seen any cases. So, you can understand the sentiment.

Because of the restrictions on transport, the hospitals we work with are not seeing anything like the numbers of patients they are set up to treat. They are also having to spend more than budgeted on hand sanitizer, PPE clothing etc. This means the hospitals are under significant financial pressure.

There is a risk that resources are being diverted from other health issues such as HIV and TB. Much progress has been made in establishing effective programmes to maintain people on their treatment, but the current restrictions make it hard for some of these programmes to operate and there is a risk that some of the progress in treatments made in the past decade will be lost.

Even a small amount of water makes roads difficult to pass

 

Parts of Uganda are facing other challenges. In the west, one of the hospitals we visited last year has been largely demolished by flood waters and many people have lost homes and crops. One lady said “You tell us to stay at home, but we now have no home. You tell us not to go to the market, but to work in the smallholding, but we now have no small-holding.”

 

 

 

In the east of Uganda and in Kenya and South Sudan there is the largest swarming of locusts there have been for many years. They devour enormous quantities of crops and vegetation, resulting in hunger.

Life in a low-income country can be tough.

Ewan Wilkinson

Looking over the Uganda border into Western Kenya

 

 

Covid 19 “Lockdown” affects many aspects of life.

A village road (prior to lock down)

“Esther”, one of the three women we are sponsoring to train as a psychiatric clinical officer sent a message telling us how things aren’t working for her in Uganda.

They were sent home from the training school in Kampala when all institutions were closed by the Government. They were told that when they came back they will have to sit exams on what they would have been taught, had they been in school. They have been given the teaching notes on their computers, so they are expected to work from those.

She lives at home with her parents, some miles from the hospital. She hoped to be able to work in the hospital once she was home, but because of the ban on public transport she can’t get there. Not even the ubiquitous boda bodas, the motorbike taxis, are allowed to move.

Consequently, Esther is working with her parents on their small farm during the day, so they have some food to eat, and she studies as best she can in the evenings.

Many people in Uganda only earn enough to live on for a day or two at a time. This lockdown is causing severe problems, especially for the poorest who have no reserves.

It is possible that the lockdown will be lifted on 5th May.

Ewan Wilkinson

A life changing story of an 8-year-old is worth sharing.

Our friend and colleague Lamet is a clinical officer in the Church of Uganda Hospital in Mukono, a township a few miles outside Kampala. He thought this story worth sharing: we think he’s right!

Here is his account.

Suleiman, just 8 years old, lived with a disabling illness for 6 years until Mukono Church of Uganda Hospital (MCOUH) with Jamie’s Fund offered him a new life. His mother lights up with much joy as she looks back and the realisation of how her son’s life has been changed for the best.

Their story

Teopista and Henry, Suleiman’s parents, are peasant farmers in a rural remote area of Uganda. They could barely afford any resources to save the life of their child.

They were blindfolded by their traditional beliefs into accepting that Suleiman’s situation was permanent, not knowing that this was an illness that could be treated.

“Suleiman has been a survivor and strong fighter. I have had nine children, five of whom have passed on, leaving me with four”, his mother says.

Teopista goes on to say in agony that her son had been born at home instead of in hospital because the closest health facility was 75km away.

At the tender age of two, Suleiman started experiencing a lot of painful attacks characterised by loss of consciousness and stiffness of the body. The attacks became more frequent every now and then and began to endanger Suleiman’s life.

Teopista, Suleiman’s mother giving history about the son’s illness

This illness is known as “Ensimbu” by local people, and associated with evil spirits. Suleiman’s parents first ignored it until he turned three years.

Teopista says, “The village elders advised us that the only way we could get our son healed was to please the ancestors through making sacrifices because this illness was a sign that they are unhappy about us.”

This condition was assumed to be a curse on their family and so they continued seeking ancestral guidance and healing through sacrifices for the following 4 years. But there was no improvement but rather increased severity of the attacks.

” My son was increasingly deteriorating both mentally and physically, thus I gave up”

At the age of 8, even though Suleiman’s condition had not resolved, his mother tried to enrol him into a nearby private school so that he could at least learn how to write his name and to read a few little things.

However, this became expensive, and most of Teopista’s income was coming just from her small garden. There was no help from her husband whose only work then was drinking alcohol from morning to sunset.

While at school, Suleiman’s major challenge was stigma from both the teachers and his fellow learners. They kept on laughing and calling him unpleasant names like “possession child”. They would not associate with him because they thought that his illness could spread to them.

After just a month, Suleiman had a terrible attack while at school that almost cost his life. He spent about 4 hours unconscious. “The next day, he refused to go back to school mainly because of the insults and humiliation” mother said.

The turning point

“It was a Sunday around 9:30 am. A team from MCOUH visited our church to health educate us about mental health services at the hospital.” Teopista reports.
She added “I seldom went with my son to church due to fear of embarrassment, but that day I was the happiest person to receive such information, I was so humbled and will never forget that day in my life”

Teopista says that day the light of hope dawned in her family.

At the hospital

Lamet takes up the story: “It was a Friday morning; I saw a worried, humble woman holding a very weak child in her hands. The child had a big scar on the right leg. I found out later on that he had at one time fallen into the fire in their home.”

On thorough assessment, Suleiman had long been battling with epilepsy. Unfortunately, in the middle of the interview he went into ‘status epilepticus’, and the fits kept coming continuously. He was reported to have had multiple attacks over the previous days.”

I admitted Suleiman, and as we managed the seizures, so he stabilized.”

 “Whenever I reviewed this child on the ward, the mother would say “The rest of my hope lies here” and this statement made me reflect and think more deeply of how much this family had suffered with this illness.

Three days later, Suleiman was discharged home after being initiated on treatment and a review date was set. Mother left the hospital very happy.

 

On the second visit

Teopista never gave up fighting for her son’s life and not at any time did she think of doubting the team that was working on her son.

Suleiman had had just one single attack in a month while on treatment. This was amazing to both mother and son.

“My son’s dream of continuing with education has been reborn ” she said. Suleiman could not stop telling his mother of how he wants to become a doctor.

 

The new changed life of Suleiman is worth celebrating

Suleiman is attending the mental health clinic at MCOUH every first Friday of the new month. He has shown great improvement on treatment and is cooperating very well with taking the medication.

He has been re-enrolled back to school and has started his first year in a nearby school. The family is so grateful for the services supported by Jamie’s fund at MCOUH.

Every single day, we get children like Suleiman who have long been battling silently with their own lives to fit into society, especially because of the stigma associated with the illness they bear.

Thanks to Jamie’s Fund

You will probably know those friends who are perpetually there for you any time you need them. They easily sense when you need them and immediately engulf around you and turn your worst nightmares into big smiles.

It is the reason we shall continue to be most grateful to our partners – Jamie’s Fund – for supporting the mental health of our dearest communities.

Lamet Jawotho
Clinical Officer
Mukono Church of Uganda Hospital

If you would like to contribute to the work Jamie’s Fund is doing in Uganda, please click on the Donate button above.

Covid 19 Training for Ugandan colleagues

On Good Friday, Dr Nick Bass and Edmund Koboah, from the East London NHS Trust, facilitated an online presentation and Q&A session around Covid 19, for staff from some of the health facilities we work with in Uganda.

 

 

We had invited seven of the hospitals we know to participate, but some had difficulties with getting good enough access to the internet to take part. In the event, seven staff from two hospitals “zoomed” in.

Ugandan staff learning to use PPE (from A.M.R.E.F.)

 

 

They told us that they have access to some PPE, and that they have not yet had Covid training from the Ugandan Ministry of Health, so this was timely and helpful. They had questions about managing the safety of their families and communities while looking after patients with Covid.

 

 

 

We were able to forward the presentation to all seven hospitals, together with some useful documents. Nick recorded the session, and we hope to find a way to send that too. Good teamwork!

We are grateful for the generosity of East London NHS Trust who offered to share their Covid 19 training which they adapted for the Ugandan mental health staff. The training was about the safe assessment and management of mental health service patients who have or may have the coronavirus.

Linda Shuttleworth

 

FRONTLINE MENTAL HEALTH STAFF OVERCOME COVID 19 RESTRICTIONS, THANKS TO mhGAP!

PCO* Joseph Wakabi, who leads the mental health team at Kagando Hospital, often gets in touch with encouraging photos and information about the clinics they have just held in the more remote villages.

However, the Ugandan Government, like many others, last week imposed movement restrictions to try to curb the spread of the coronavirus. This means that the team is unable to continue their usual programme of outreach clinics.

But…Joseph has just told us that they have been able to send supplies of medication to the outlying Health Centres. Not only that, because a staff member from each Health Centre was trained in the course of Kagando’s mhGAP roll-out programme, the Health Centres have been able to carry on treating and caring for those with mental illness, even under lockdown.

Lake Katwe outreach

 

And the regular Tuesday mental health clinic at the hospital still runs as normal; 40 people came for treatment yesterday.

Great work, Joseph and the Kagando team!

 

 

 

 

 

 

*A PCO is a Psychiatric Clinical Officer; these staff usually lead mental health services in Uganda.
Kagando Hospital lies to the west of Uganda, almost on the border with Congo.

Linda Shuttleworth, JF Trustee.

KAGANDO HOSPITAL MEETS THE GROWING NEED FOR MENTAL HEALTH CARE

 

Joseph Wakabi, a psychiatric clinical officer, and his small team of mental health staff used to hold their monthly outreach clinics at Kitabu and Kyarumba on the same day. The numbers of people coming for treatment have increased, so that now they visit Kitabu on a Monday and Kyarumba on a Thursday.

At Kitabu, patients such as James are seen at home to continue the treatment to improve their mental health. As the community begins to hear about the service, and understand more about mental ill health, and the possibilities for treatment, more families are asking for help.

 

 

 

This second man, newly started on treatment, has been shackled at home for more than a year, because his family did not know what else to do. these shackles are made from bent steel bar so they are on his legs permanently. Can you work out how to change his trousers – it can be done but not easily! Try and imagine living with these shackles. But with treatment we expect he will return to a more normal life and have the shackles removed with the agreement of his community

 

At Kyarumba Health Centre this week, 40 people were seen and treated for conditions such as psychosis and epilepsy.
Jamie’s Fund supports the work of Joseph and his colleagues, enabling them to take mental health care out to remote parts of the community where it is most needed.

Linda Shuttleworth, 13.03.2020

COVID-19 Statement by Jamie’s Fund

At the beginning of March, Jamie’s Fund was delighted to support another mhGAP* Train the Trainers course. Healthcare workers from nine hospitals were equipped with the skills to teach their clinical colleagues to identify and treat routine forms of mental ill health.

It is unfortunate that this has happened at this time when the world is closing down as a result of the Coronavirus pandemic. Although this virus seems to have been rather slower to spread to Africa than elsewhere in the world, we are beginning to see an acceleration in some places. However, governments in countries such as Uganda have used the time to implement preventative action to try to protect their citizens. In Uganda, for example, there have been measures to control and discourage the movement of people at the borders, schools and universities have been closed, and large scale social, cultural, religious and political gatherings have been suspended.

These measures will inevitably have an impact on the process of cascading the mhGap training, as further workshops will need to be delayed till life returns to more normal. Despite this, the mhGap model has proved to be a strong and effective one and we expect to resume delivery of the training soon after the present measures are eased and it is considered safe to do so. In the meantime, we continue to give our support to the frontline staff in Uganda and to wish them good health.

While our thoughts are very much with the clinicians and patients in Uganda, for us as a charity the present emergency also means that our planned visits to our partners in Uganda have been postponed until the situation improves. However, we also continue to communicate with many of friends, colleagues and partners in Uganda and we can still support them in their planning as they look to grow their mental health services. Perhaps the most important thing, though, is to give them encouragement and to let them know that they are not alone. They need this message now, especially now.

We are still able to send funds and continue to support many important initiatives as well as look at new projects and you can help. We recognise that there is a great deal of uncertainty and concern about incomes and jobs in our own country but if you are able to help, please click on the DONATE button or send messages of support which we can pass on to staff in Uganda.

Linda Shuttleworth, Trustee, Jamie’s Fund.

*mhGap is a World Health Organisation programme designed to give non-mental health clinicians, particularly in low and middle income countries, a good understanding of mental illness so that they can diagnose and treat many of the more straightforward conditions.

SECOND mhGAP TRAIN THE TRAINERS COURSE A GREAT SUCCESS!

 

Jamie’s Fund has been pleased to be able to sponsor a second mhGAP ToT course at Butabika in Uganda. This was in response to the desire of the many hospitals and health centres visited in September to grow their ability to deliver mental health care.

The course was held over 5 days, 17 th to 21 st February 2020, at Butabika National Referral Hospital. This is where most of the training for mental health staff takes place. Sixteen health staff from nine PNFP (Private Not for Profit) hospitals participated. Many were part of the more recently contacted Uganda Catholic Medical Bureau (UCMB), and one from the Protestant Medical Bureau (UPMB). The course was led by senior Butabika teaching staff: a psychiatrist, 2 clinical psychologists, a principal tutor at the PCO School, supported by a community psychologist.

 

 

The knowledge of the trainees was tested before and after the course, and their informal feedback was also positive and enthusiastic. Jamie’s Fund will support them to cascade the mhGAP training to staff in their own hospitals over the coming months. We know from previous experience that this will lead to improved ability to identify and treat mental ill health in their communities.

(mhGAP is a World Health Organisation (WHO ) programme to train non-specialist staff to identify and treat the more common presentations of mental ill health)

 

 

Linda Shuttleworth 15.03.2020.

Jamie’s Fund Supports New Service at Bwindi Hospital for People with Depression

Kuule Yusuf, PCO, is the mental health lead at Bwindi Community Hospital. Dr Holly Tyson is a UK GP with an interest in mental health, who is working there for 12 months. Together they began to look for an effective and sustainable psychological treatment for the many people presenting there with depression. They found that Group Interpersonal Therapy (IPT-G) had been successfully rolled out elsewhere in Uganda and that the trainers were still active locally.

They devised and costed a Group IPT pilot scheme of initial training of local staff, to be followed by roll out of three 8 week IPT groups over the coming six months. If found to be successful, Bwindi Hospital Management committed to making it part of the hospital’s ongoing mental health workplan.

Jamie’s Fund has been supporting the mental health team at Bwindi for some years as they work to deliver mental healthcare across their remote community. So Kuule and Holly asked if Jamie’s Fund would support the training. We were pleased to be able to help with sponsoring the training.

Group IPT training sessions

Moderate to severe depression is said by the World Health Organisation to be responsible for a very significant personal, economic and social burden globally. Antidepressant medication can be effective, but for many people, the underlying causes also need to be recognised and addressed. Across the world, these are often to do with relationships and loss. Additionally, in low income countries, reliable and affordable supplies of medication may be limited.

Role-play in action during training session

 

This is why the WHO mental health training for non-specialist staff, mhGAP, includes Group Interpersonal Therapy as a front line treatment for depression. In a collective social culture like Uganda, group interventions can be particularly acceptable and powerful. IPT focuses on understanding the links between the person’s mood and their interpersonal difficulties, and on finding new ways to deal with these difficulties.

Having brought the IPT trainers over to Bwindi in late February, the first steps towards a new service have already been taken. We will post updates as we get them.

The mental health team after training

Linda Shuttleworth, March 2020.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A very psychologically minded hospital

We first visited St Paul’s in Kasese in November 2018. St Paul’s is a Health Centre IV, essentially a small hospital, on the edge of town.

A former chapel building has been creatively divided up to form wards. It is surrounded by other buildings housing a range of facilities, and trees provide welcome shade.

When she arrived at St Paul’s in June 2018, Alihabwe Sudaat, the Psychiatric Clinical Officer (PCO), was soon given the opportunity to attend the mhGAP Train the Trainers course, sponsored by Jamie’s Fund, and delivered by some of the Ugandan tutors at Butabika Hospital.

In her Mental Health role, Sudaat was seeing about 10 patients a month. Because of the
cost, few of her patients were able to return to St Paul’s for follow-up after leaving the
hospital.Apart from a psychologist colleague in the HIV/AIDs service, at that stage Sudaat was a little isolated professionally, and perhaps needed support to gainmore confidence in her role.

She qualified in mental health 10 years previously, but as so often happens, she had worked in other departments. St Paul’s was her first full time MH post.

Jamie’s Fund supported Sudaat and some of the mental health staff from Bwindi and Kagando Hospitals to meet and share ideas and experiences about services and data collection. They all embraced this opportunity enthusiastically, soon spending a couple of days together at Bwindi.

Feeling encouraged, Sudaat and her colleagues rolled out a very successful mhGAP course for the non-specialist staff at St Pauls, teaching them to identify and successfully treat common presentations of mental ill health.

On our visit in September 2019 we found a newly trained and highly enthusiastic team eager to report on their progress and offer ideas for future developments.

Most of them not only had received mhGAP training but have also been through a new psychosocial support training programme designed to enable support to families affected by Ebola, currently rampaging in nearby Democratic Republic of Congo.

(Thankfully the one case of ebola that came into Uganda was very effectively dealt with at Kagando Hospital).

Reverend Dr Peter, the new medical director at St Paul’s, is warmly supportive of all developments, both current and potential, to improve services for people with psychological problems, mental illness and epilepsy.

He told us that so many of the individuals who present to the hospital with physical symptoms in fact have depression and anxiety. The hospital now has this newly trained team putting their skills to very good use in detecting and treating such patients.

The team has identified a particularly vulnerable group: local teenagers and young adults. Like many young people in Uganda, they are troubled and anxious, and many turn to drugs and alcohol. The rates of self-harm are worryingly high.

The hospital runs a service specially designed for them – 80-100 attend regularly – and children with disabilities also have a special place. They would love to have a centre for children with special needs in their newly planned Mental Health Centre.

Madam Sudaat with Dr Simon and Dr Maureen

St Paul’s can in truth be described as “a very psychologically minded hospital”.

They have plans to reach further into the community. Sudaat and her local colleagues, together with others from Kagando hospital, have continued to roll out mhGAP training to include health centre staff, opening up the possibility that mental health clinics could be held at the health centres, bringing the service much nearer to the people and solving the challenge of transport costs.

The cathedral in Kasese is proving a great focus for sensitisation programmes: take the message to where the people are! Sudaat is finding that even some of the African church pastors are beginning to see that modern medicine can be helpful for epilepsy and mental illness.

The St Paul’s team has planned an ambitious programme of further sensitisation and training for clergy, police, prison officers, teachers and local leaders.

Linda Shuttleworth and Maureen Wilkinson