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Thursday, 9 April 2015

Developments in Mental Health at Connaught

I joined the King's Sierra Leone Partnership (KSLP) team as a volunteer Doctor in February 2015. Like most people, I had followed the news about Ebola, particularly the devastating effects it was having on Sierra Leone and its people. Having been born in Sierra Leone, the events were particularly personal to me. I moved to the UK when I was 6 years old, but have many links to the country with family and friends still living there and many fond memories of my childhood.

As a Psychiatry trainee at South London and Maudsley NHS Foundation Trust, I hoped to be able to provide not only physical health care but also psychosocial support to those affected. I was keen to come out to support colleagues, both local and international, who had been working tirelessly to control the outbreak. The process of being released from my training programme was straightforward and I was granted a 6-month sabbatical.   

Dr Stania Kamara and Jennifer Duncan examine patient records 
When I arrived in Freetown the number of Ebola cases had dramatically reduced. It was great to see that the months of hard work were paying off and there was a sense that things were settling down; however, our clinical leads were, understandably, being prudent and cautioned against complacency.

I went through a period of training on how to work safely within the Isolation unit at Connaught Hospital including how to wear PPE. Within days I started work in the Unit, a holding bay for patients suspected of having Ebola and awaiting their blood tests. Whilst they await their results, they are given treatments to combat other possible diseases that could have caused their symptoms.  These duties are performed by both local and international staff. The team is comprised of doctors, nurses, surveillance officers and Ebola decontamination cleaners. It's a great and inspiring team to work alongside. 

On the way to the isolation unit one day, I noticed a middle aged man stooped on the walkway clothed in torn pyjamas.  He was disheveled and confused. I was told that he was a patient with TB and HIV who had spent some weeks at the hospital displaying bizarre behaviour. He would not take his medication, had absconded from the ward on multiple occasions and had spent the last few days living in the corridors of the hospital grounds.  

It was clear that he was experiencing psychotic symptoms and this was likely affecting his ability to comply with his medical treatment. Following some discussions with senior clinicians, we were able to admit him to the hospital and initiate treatments for his medical problems as well as his mental illness. Despite this, the man passed away, succumbing to his medical condition. 

Jennifer Duncan, a Mental Health Nurse, speaks to a patient at Connaught
This patient reminded me of the importance of good mental health care and how integral this is to any healthcare service. Had his mental illness been identified and treated earlier , his compliance to medical treatment would have been better and therefore more successful. His sister explained that he had been a professional with a well respected job; however, over the last year his mental health had deteriorated. The family had been unable to access appropriate care. She seemed to have reached the point of exhaustion having been the sole person to shoulder the burden of caring for her only brother, and she was comforted by the thought that at least he would no longer suffer.

I found myself in a challenging situation: I had volunteered to be an Ebola outbreak Doctor, albeit one with specialist mental health skills that I was sure would be useful in helping patients affected by Ebola. However, faced with a reducing numbers of cases and a clear and acute need for mental health care, I felt increasingly driven to giving my time to those with mental health needs. I recalled the WHO slogan 'no health without mental health' as I contemplated a change in the focus of my work. 

I shared my sentiments with Oliver Johnson, KSLP Programme Director and was enthused by the support he expressed for me to do more direct mental health work. Mental health is a priority for KSLP, and one of the key areas in which they have been making great strides. Prior to the Ebola outbreak, Katy Lowe, a mental health nurse from South London and Maudsley NHS Foundation Trust had been volunteering with KSLP to provide training and supervision to some newly trained mental health nurses. Unfortunately this work ground to a halt with the Ebola outbreak, and Katy switched focus to providing support for staff and patients affected by the outbreak.  It was clear KSLP were keen to resurrect the training and supervision and were committed to working with local partners to develop robust and effective mental health services.

Prior to the Ebola outbreak there was poor provision of mental health services in Sierra Leone. The majority of people requiring mental health and psychosocial support were unable to access it. There is only one Consultant Psychiatrist in the country, now retired, to serve a population of over 6 million people. There is one mental health hospital in Freetown and little mental health or psychosocial support otherwise. This situation has worsened during the Ebola epidemic. A recent study by the International Medical Corps Sierra Leone found that many people affected by Ebola are reporting psychological problems and require mental health care.
Whilst I envisioned spending my time here in Sierra Leone sweating through scrubs in full PPE in fact I am now spending most of time working outside of the Ebola holding unit supporting KSLP mental health projects. It feels like exactly what I should be doing especially as the need is so great. 

At Connaught I am fortunate to work with the brilliant and enthusiastic Jennifer Duncan, one of only 20 recently trained mental health nurses posted throughout the country. Together Jennifer and I are providing psychosocial support focused on stress management and psychological first aid principles to healthcare workers at the hospital. Many of the staff have been directly affected by Ebola and lost colleagues, friends and family to the disease; together, they share experiences and promote psychological resilience.

Using the new official ledger to record patients

A new department is born
We are also supporting Connaught to set up a mental health and psychosocial department, the first of its kind in the country. It will offer an in-hospital liaison service and an outpatient clinic for the local community. It is wonderful to work with the senior management team who are fully committed to providing comprehensive, integrated and responsive mental health services at Connaught. They have shared with us their vision for this service to be the model on which other such units are created throughout the country; thereby providing a much needed service to a greater number of people. We've started seeing patients and the need is clearly visible: our work so far has been varied and has included supporting families to facilitate the treatment at home of individuals suffering from acute mental disorders, providing advice to the inpatient medical teams on the management of acute delirium, and identifying livelihood opportunities for patients affected by the Ebola outbreak. 

Within the KSLP team, I am also supported by the Mental Health Group; a UK based group of clinicians and non-clinicians, led by Dr Peter Hughes (Consultant Psychiatrist) who meet regularly to support our work here. 

It's great to be working with KSLP and Connaught Hospital and to know that by developing mental health and psychosocial services we are meeting a crucial, and so far unmet, need. It is exhilarating work, in an exciting and dynamic environment, and I'm proud to be a part of it.  


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