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Improving Mental Health Care in Kenya

by Indiana Institute for Global Health, Inc.
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Improving Mental Health Care in Kenya
Improving Mental Health Care in Kenya
Improving Mental Health Care in Kenya

In 2016, 2017, and 2018, a team of two attending psychologists and three child and adolescent psychiatry fellows traveled to Moi University to participate in a training exchange through AMPATH with Moi University School of Medicine. 

This was the third consecutive trip that the Albert Medical School of Brown University worked with the Tumaini Shelter for Orphaned and Street Children.  Tumaini is an 18 bed residential shelter for boys 9-18.  Each year, we have collaborated with program staff to offer staff training as well as group skills training for the boys. 

For the staff training, we have used an empirically based parent training program called the incredible years, which focused heavily on positive supports, building schedules and routines, and setting expectations.  Staff have been actively involved in thinking about how these approaches might change their interactions with the boys and also shared their pleasure in having training. 

For the boys, we ran a group a week with different skills focus each time:  self-esteem, managing anger, and some skills from dialectical behavior therapy focused on regulating emotions.  There were some challenges with language and translation, but many of the older boys also spoke English and clearly enjoyed functioning as “junior leaders” for the “muzungus”.  At the end of our last group meeting, we had pizza and juice, and the boys taught us their favorite dance.  We learned quickly that the challenges these boys face are quite similar to the children that we work with in the US; handling trauma, managing strong feelings, and getting along with each other- but also that there is universal joy in sharing food and fun. 

As a side training benefit, many of the US medical students working with AMPATH at the time expressed interest in attending our groups and so gained some incidental exposure to psychiatric intervention.  We have a trip planned for 2020 and will do an additional set of groups during this trip. 

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Stuart Mannon, M.D., community psychiatrist, acted as preceptor for 2 Indiana University “triple board” residents, Amna Aziz M.D. and Corissa Dionisio M.D., during the month of February in Eldoret. 

We collaborated with faculty, residents and medical students from Moi University School of Medicine and faculty of the MHTR hospitals including the Psychiatric inpatient facility and residential rehabilitation facility for substance use disorders.  We were able to participate in inpatient rounds and outpatient clinics at these facilities.  Spoken mostly in Kiswahili, intermittent summaries of content were provided by the interviewing physician during the course of the patient interview, creating an opportunity for us to be involved in the evaluation and treatment process. 

Activities included observing ECT, attending resident journal club and grand rounds.  We spent time at the Rafiki clinic, an AMPATH facility dedicated to adolescents and teens affected by HIV.  Lectures by Mannon, Dionisio, Aziz were given on trauma informed medical treatment, stress reduction for staff, and aspects of Cognitive behavioral therapy, respectively.  Mannon gave lectures on suicide risk assessment and cognitive behavioral therapy for psychosis to both psychiatric residents and medical students, and medical psychology students.  Mannon and Aziz gave lectures to the child life staff at the children’s hospital about recognizing mental illness, teaching staff how to help parents advocate for their children, and specific strategies for managing symptoms like pain and anxiety for hospitalized children.

One of the highlights was accompanying AMPATH’s psychiatric nurse Lilian Rono on home visits and consultations at outpatient AMPATH clinics. We learned about Kenyan culture and living.  We also saw the need to expand psychiatric care in the community setting, and witnessed early stages of establishing the mental health component for the Chronic Disease initiative taking place.  We had the privilege of being in Eldoret while Dr Joe Mamlin was there, which is unforgettable.

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In October this year, Brown  University welcomed two third year registrars from Moi Medical School to complete training within the Department of Psychiatry and Human Behavior at Alpert Medical School.  Drs. Sarah Bahati Standa and Michael Makali Wekesa came to the US for five weeks as part of a training agreement with Moi via AMPATH.  As part of this agreement, registrars receive their child, adolescent, gerontology and neurology rotations at Brown.  For the Child rotation, registrars spent a week each at the Children’s Partial Hospital Program at Bradley Hospital, working with Drs Majczak and Walters.  Bradley is one of the nation’s oldest free standing children’s psychiatric hospitals and the program provides milieu based treatment to 7-12 year old children with severe mental illness and their families.  For the adolescent rotation, registrars spent a week on the Adolescent Inpatient Program at Butler Hospital working with Dr. Van Schwalkwyk.  At this renowned free standing adult psychiatric hospital, they learned to provide diagnostic clarification and to stabilize adolescents in acute psychiatric crisis so that they were safe enough to be transferred to a lower level of care.  On the gerontology service, registrars worked with Drs. Halt and Marino, and focused on the specialty of psychiatric disorders in the elderly including various stages of dementia and Alzheimer’s; senile psychosis, depression and anxiety. On the neurology service, Drs. Weinman, Friedman and Cahill provided a wide diversity of neurology experiences, including patients with parkinsonism and other movement disorders, behavioral neurology in an inpatient psychiatric setting and consultation in a large general hospital outpatient neurology service. Over the past 5 years, 4 cohorts of Registrars from Moi have traveled to Brown for those portions of their training that are less available in Kenya, to great benefit to participants in this unique training and cultural exchange opportunity.   

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This quarter, we're sharing with you a recent article on the overall state of mental health in Kenya, and AMPATH's impact.  

The article was written by a German investigative reporter, Jakob Simmank, who spent time in Eldoret with AMPATH staff.  Here are a few exercepts and we encourage you to check out all 4 articles in his series! 

Thank you again for the support you provide to change the care received by those with mental illnesses in Kenya! 

"There is only one psychiatrist in Kenya per 500,000 people and the mentally ill are often locked up rather than treated. But there are paths out of the crisis."

"There are only an estimated 100 psychiatrists in the entire country, which means that each mental health expert is responsible for an average of a half-million people. The health-care gap in mental health is thus higher than in almost any other sector of clinical medicine."

"A trip through western Kenya, from the city of Nakuru via Eldoret and Turbo to the rural hinterlands, shows that in many places, there is a lack of knowledge, financial resources, trained experts and belief in psychological care. Despite the fact that mental illness is one of the most serious health care challenges in the world, millions of people in Kenya suffering from schizophrenia, epilepsy or depression have no access to adequate care. But the trip also demonstrates that the situation is improving."

https://www.zeit.de/wissen/gesundheit/2018-10/kenya-africa-mental-illness-psychiatrists-treatment-stigmatization-english

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A team from Brown University composed of two Child psychologists and two Child and adolescent psychiatry fellows traveled to Moi last February. The goal of the visit was to continue to expand capacity for providing Child and adolescent psychiatry services. 

We worked directly with registrars and consultants seeing patients in the newly opened child outpatient clinic (part of the general outpatient clinic), consulted on several child/adolescent cases in the inpatient Mental Health Unit, and visited the new Rafiki Center for Excellence in Adolescent Care.

Additionally, our team engaged in education and training, visiting the Eldoret Special School with one of the consultants and providing Q and A on careers in psychology for several psychology classes at Moi University. We also attended a lab session for one of the psychology classes on assessment, provided consult/liaison with the pediatrics team for several cases, provided workshops on providing visual supports for individuals with developmental disabilities, and provided a workshop on motivational interviewing. 

During the visit, we also traveled to Webuye to provide consultation and training to family medicine registrars, and provided both staff training and a weekly psychotherapy group for the Tumaini Shelter. 

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Organization Information

Indiana Institute for Global Health, Inc.

Location: Indianapolis, IN - USA
Website:
Facebook: Facebook Page
Twitter: @ampathkenya
Project Leader:
Deborah Neary
Indianapolis, IN United States
$942 raised of $12,000 goal
 
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