World Mental Health Day – 10th October 2020.

This Saturday is World Mental Health day, focusing attention on an area that is all too often ignored or low down the agenda in many situations.

As you know Jamie’s Fund is doing what it can to increase access to mental health care in Uganda.

We were asked this week to describe to those at a virtual conference the work we are doing in Uganda.  Prof Maureen Wilkinson and Joshua Ssebunnya, senior clinical psychologist at Butabika Hospital in Kampala describe our approach in this video. You may need to register to watch it and the quality isn’t great.  The echo was off-putting to the speakers and listeners.  The section on JF starts at 26 minutes 15 seconds.

Maureen and Joshua

Flash floods at Kisiizi Hospital

Following the flooding at Kisiizi in 2017  and the preventive that was undertaken, we were very sorry to hear that there have again been floods affecting Kisiizi Hospital.  Although the Power House (which is next to the Ahamuza Center which Jamie’s Fund sponsored) and the Children’s Ward were again hit, we are pleased to report that the Ahamuza Centre was unaffected.  This flash flood which overwhelmed the defences put in after the 2017 flood and some of the concrete and stone defences around the powerhouse were washed away.  Not only was the power supply affected but also the water supply, as the pipes bringing clean water to the hospital were bent and broken.

Fortunately no-one was hurt and Kisiizi were quick to get the clean up underway.  This was not a pleasant job as lots of mud was deposited as the waters receded.

In one of the pictures sent by Kisiizi, we can see the flood water stretching out towards the Ahamuza Centre in the background.  You can also see the banda (the round hut with the red roof to the right of the picture) which was paid for last year by Jamie’s Fund as a place for patients to shelter from the sun (or the rain)

 

All hospitals in Uganda are very much challenged by the lockdown for Covid19 and Kisiizi Hospital is no exception so the last thing the hospital needed was the additional costs associated with this flood.  We all wish the team well at Kisiizi as they work to bring everything back into service.

Hugh Burgess

Up and Down – Reflections on a cycle ride!

As a very “part-time” cyclist it has been an interesting experience trying to find time to do the promised miles but when the time has been found it’s also been an interesting time for reflection.

As I have cycled the leafy lanes of North Wales, I have been reminded of the challenge that many mental health patients face in Uganda.  Where I can simply jump in a car and go and see someone (or at least I could if things were “normal”), many people in Uganda simply have to walk.  This is true especially for those going to hospital or to a health centre.

For those seeking help with their mental health, this is a cost not only for them but also for anyone who accompanies them because it takes them away from any sort of economic activity.  When you add in the cost of treatment as well, it becomes an almost impossible burden for many families – and that’s where Jamie’s Fund makes a difference.  By encouraging hospitals to go TO the patient we are able to remove many of the costs for the family and have enabled the changing of many lives.

A well loaded bike

As I labour up the next interminable hill, I think of the people taking their bananas to market to earn a few shillings.  I’ve used a picture  of some of these people on my fundraising page partly because it shows bicycles in Uganda but more because it reminds me that whatever pain I’m going through they have to do this day in and day out.  Cycling is not a leisure activity but an essential means to sustain life.

 

And then, reaching the top of the hill and levelling out for a few hundred yards I fall into a reverie until a loud “PLOP” on the road in front of me wakes me abruptly and my heart pounds.  My initial reaction is that a very large bird has just passed over, but I then realise that it’s a squirrel that has fallen out of a tree – no doubt itself woken by the sound of my laboured breathing!  And then I’m further startled as the squirrel scuttles back up the tree. Again, I’m reminded of the contrast between the UK and Uganda.  Here, in our relatively rich country, we have many small animals, some beautiful birds and even large animals like deer – but it’s nothing compared to Uganda.  While Uganda has little wealth and many people live on the edge, the country itself is rich in wildlife although much is endangered: beautiful birds, amazing butterflies and of course some incredible large animals, elephant, hippo, zebra, lion and my favourite, gorillas.

 

And that only makes me reflect on encounters with some wonderful people I’ve met, ill with mental health issues and often speaking languages I can’t understand.  In contrast to them, I have everything I need (and more), live in relative comfort, have access to health services and supermarkets, have many more than one change of clothes, have cash in my pocket and a car on the drive (as well as a bicycle in the garage). But as we exchange glances and perhaps communicate through one of the nurses, it is another special moment as our common humanity comes through: Yes, we a separated by geography, language and material wealth but we are both human and that makes us very much the same and I’m pleased that everyone who has been involved with Jamie’s Fund over nearly ten years has made a difference to the lives of other people in an often forgotten corner of the world.

 

And at last, home!  Safe! With a few more miles under my belt (what a silly expression!) and after a shower and a sleep ready to do it all over again – or maybe I’ll just take a walk before bed!

Hugh Burgess

“On yer bike, Vicar!”

Professor Ewan Wilkinson, the CEO of Jamie’s Fund is a keen cyclist, getting out on two wheels on most days while the Rev’d Hugh Burgess, the Chair, is more likely to be found tramping the byways of North Wales on foot.  This has led over the years to some gentle ribbing at the other’s expense, Ewan preferring to get there quickly while Hugh likes to watch the grass grow!

Hugh in Spain

In the past, both Ewan and Hugh have raised money for Jamie’s Fund through their preferred forms of exercise.  Ewan has undertaken a number of cycling challenges not least in both Uganda and Rwanda while Hugh completed a 1500 mile walk from North Wales to Santiago de Compostela in North West Spain.

Ewan has now encouraged Hugh to set aside his walking poles for a few weeks and to get on his bike as part the 200×100 Cycling Challenge that Ewan is organising to raise critical funds for work with mental health patients in Uganda.  During September Ewan is asking Hugh and as many other willing volunteers as possible each to cycle 200 miles during the month and to raise a minimum of £200.

Ready to go

Hugh is delighted to take up this challenge even if it means eating his words about the risks of being on two wheels rather than two feet!  Hugh plans to do much of his parish work by bicycle.

Talking about the cycling challenge and the work in Uganda, Hugh said: “Having been to Uganda and seeing a woman literally chained up because she is mentally ill, changes the way you see the world.  I have seen that woman set free from her chains and I know how little money it takes but how big the need is. That’s why I’m delighted to take up Ewan’s challenge in September and I encourage anyone reading this who can pedal to join in too.  We will use every penny we raise to help some of the poorest people with their mental health”.

He’s off!

If you would like to sign up for the challenge please click here.

If you aren’t able to do the challenge but would like to support Hugh then please click here.

For more information on the 200×100 Challenge, please click here

STARTING – AND THEN PAUSING – PCO TRAINING

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.

 

Dr Maureen Wilkinson and the three nurses.

Maliba Outreach Clinic and the contribution of Psychiatric Clinical Officers

 

In mid-March, just before the Covid 19 internal travel restrictions were imposed in Uganda, the mental health team from Kagando Hospital went out by motorbike to hold an outreach clinic at Maliba, about 25 miles away. Joseph, the Psychiatric Clinical Officer (PCO) led the clinic, Rachel, one of the regular MH nurses was helping, and Bisiah, a newly qualified PCO, volunteered to gain experience.

 

Between them, they saw and treated over 70 local people with epilepsy and psychosis. Some 55 of these were expected returnees, and the rest, although less reliable attenders, were mostly somewhat familiar to the staff. As mental healthcare services based at hospitals such as Kagando, Bwindi and Kisiizi have established themselves and grown over time, one of the important things they do, is to maintain vulnerable people on treatment, keeping them well and productive in their communities.

Psychiatric Clinical Officers are usually the leaders of mental health services in Uganda. They work at a level between experienced nurses and junior doctors, having undergone a three-year training in the management of mental illness. Jamie’s Fund is sponsoring the training of more PCOs, to enable hospitals without staff trained in psychiatry to develop one of their own staff as a mental health service leader and so develop mental health services at their hospital. This is a real partnership, as Jamie’s Fund meets the fees and other immediate costs of the training, while the hospital continues to pay the trainee’s salary, and bonds that person to return to work there for a period of time after qualification.

We have 3 individuals training currently at the PCO School at Butabika in Kampala. Many more are needed as most hospitals don’t have a PCO. The current cost met by Jamie’s Fund is about £1,300 per person each year. Could you, your organisation, your family, or a group of friends sponsor one person for one year’s training, or see them through to qualification as a PCO over the three years? Please get in touch if you would like to discuss this further.

Linda Shuttleworth

Health Care Challenges

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.

Empty waiting rooms

 

 

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.

Fewer patients

 

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

MENTAL HEALTH AWARENESS PROGRAMME AT KISIIZI

An Important aspect of mental health work in Uganda, is to offer the local community an alternative understanding of mental ill health. Traditional beliefs about epilepsy and mental ill health can be unhelpful, and delay or prevent the person accessing healthcare. After all, if you believe that your child’s fits are because he or she is cursed, why would you go to the trouble and expense of taking the child to a hospital or health centre? Likewise, if your relative’s erratic thoughts and behaviour are apparently caused by witchcraft or sin, how could a clinician help? And these traditional beliefs can be very strongly held, even beyond the more isolated rural places, and by well-educated people.

Jamie’s Fund has been supporting Ugandan healthcare staff to inform local people as well as to treat them. Many of the hospitals we know have been spreading the word since the first mhGAP* training course we sponsored in 2018. Mukono Hospital just east of Kampala has reached thousands of people by giving mental health talks at local churches, straight after the services. St Stephens Hospital in Kampala has reached out to local youth among the urban poor in their catchment. Other hospitals such as Kisiizi, Bwindi and Kagando routinely deliver a community mental health message every time they arrive for an outreach clinic.

Primary school class

Georgious, the PCO (Psychiatric Clinical Officer) leading the service at Kisiizi, just sent us a report of the mental health awareness programme they started in December 2019. Between then and February, they visited 3 Primary Schools, 2 Secondary Schools and one of the churches. You can see images of some of their activities here. Travel restrictions to control the spread of Covid 19 have now halted their programme until further notice, but they have plans to resume as soon as they can.

Secondary school class

The Covid restrictions in Uganda have also put a temporary halt to Kisiizi staff holding their regular outreach clinics. But the good news is that, because staff from 5 Health Centres were included in Kisiizi’s mhGAP training rollouts, they have been able to continue to treat 35 to 45 patients every month in the outlying areas. The figures Georgious has given us show another important achievement; that the number of new patients is now small compared to the number of repeat attendances (9 new to 272 repeats); this means that people who need it are being maintained on treatment and followed up effectively. Great work Georgious and the Kisiizi mental health team!

Linda Shuttleworth

*mhGAP is the World Health Organisation programme to train non-specialist healthcare staff to recognise and treat the common presentations of mental ill health and epilepsy.

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.

Maureen 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