Training Time: Adjust Your Standards

Wow. So many emotions are racing through me this week. The 9^th marked 1 month of living in South Sudan. On a personal level it has been a month where I have learned a lot and have experienced a lot. On the professional side of things, I have faced much aggravation and challenges. I suppose I was warned of this but still I do not feel prepared.

On Monday I was planning on presenting but this was mis-communicated and I did not end up doing my mental health presentation at the office. Honestly, I was late as I had tried to get a ride to the office because I wanted to eat breakfast before coming to work. Of course, things didn’t go as planned so I was late after I walked to work due to not having a ride. So not presenting was okay.

Then I had expected to leave for Nzara for the start of our training on Monday and that we would start Tuesday Morning. So, the plan was to leave Monday. Of course, silly me expected this to remain the case. The Minister of Health for Mental Health Services in South Sudan, and the other facilitator were late to arrive and would not get to Yambio until Tuesday. I decided to try and go to the clinic instead but was told I was heading to see some people in another office just as soon as the car was ready. We never went so I stayed in the office reading for the day.

Tuesday, I arrived to the office with my stuff for the trip. I expected we would leave by 10am at the very latest. I don’t know what time we left but it was not on time. No shock. The Minister of Health for Mental Services (MOH) finally arrived and then we had to go and meet with the district governor. She then had to travel with us to the training in Nzara.

We arrived a little before lunch, maybe 1pm. There was a formal ceremony by the district governor while she opened the training officially. Apparently here training like this is almost a formal ceremony at the start of this. There are so many different aspects that we had to account for before it even started. And the disorganization that exists adds an extra layer to everything.

I think it was rather fortunate that Tuesday was a short day as we didn’t seem to have enough organization to be able to really start the education. It was scattered and did not make a lot of sense to me. We spent an hour discussing what were expectations, how to behave in a meeting, and what would happen if you did not follow the rules. Apparently this is a normal part of a training like this but I didn’t particularly think it was professional.

Wednesday training started in reality. Training is so much different here than it is in the US. I think I may have said it already but I think it is a point that bears the need to be repeated. Training is something that I have had to adjust my expectations around because of all the differences. There are times that it is still disorganized and a bit unprofessional but slowly things seemed to adjust and improve.

So, Wednesday we started off later than we were supposed to. If you haven’t noticed by now, things in South Sudan rarely start on time. I struggle with this, especially when things start an hour later than they were intended to  start. But they started off with prayers and well wishes for the training ahead. There are prayers throughout the day here. It is a part of the training process, along with making sure all of the participants are provided with food and drinks throughout the day.

The first day of training was on grief, stress, and depression. We talked through what each one of them was and the different categories for diagnosing them here. Apparently the criteria of who is able to diagnose someone with a disease or disorder is very different in South Sudan. As a registered nurse even I can diagnose mental health conditions. This was very new to me.

The second day we discussed epilepsy, suicide, substance abuse, and psychosis. Again, the focus was on how to diagnose them. Full days 3 and 4 were on how to treat each of these conditions. In total it is 5 days of training, with two tests, and certifications for the participants to engage in.

I taught a few of the different topics but since the MOH was the one who brought the presentations and the first time I saw them was when I got up to teach it was a bit weird to teach on the subjects. In the US, especially in New York, I would not have found it as strange but here there are so many cultural considerations and standards that are not what I would teach on that it was challenging.

Saturday training ended with a ceremony. I, along with another the MOH, District Governor, CMMB staff, and several others got up and spoke about the work and the importance of the training. We talked about next steps forward. We celebrated the end of the training with prayers, singing, and a large meal. There were group photos, and lots of chatting.

It was a moment to realize that one of the goals I set out to achieve when I left the US is started to come through. I will continue to support the 22 people that I helped to train while I am here. I hope to be able to travel to each of the sites to see how they are doing and what needs they have. I truly hope the training works well for them and they are able to use it, as I know the need is there.

In the end it is good that we did not use the material I created as I have different standards and expectations on things. Also, using the MOH material ensured that it was more fit for the cultural considerations here. The material is actually designed by the WHO, who I am shocked, considered Epilepsy and Intellectual Disability to be mental health disorders that mental health specialists should be treating. I understand the original rationale for this but it seems that the material may be outdated a bit.

I ended up learning some different things throughout the training. We discussed what drugs were called which names here in Western Equatoria State, how grieving was for different tribes, and some of the ways that the staff interact with people they suspect are mentally ill. It was good that I attended the training to learn some new things about the culture I am serving in.

There were several times when they have made fun of the Khawaja for the expectations white people have. I just sit there and listen. There are some times when I agree, because I thought some of the things that they were talking about, like there would be better access to internet for most people. So many people do not have any access to internet. There are other times that they make dun of white people and the technology that exists or does not exist here, without realizing that there are some of the same issues in the US with technology, that there are here.

Overall, the training was very good, once I adjusted my expectations. It is a combination of needing to adjust my standards and lowering them at times to meet the realities of some of the situations here. Other times I think that I will also need to challenge some of the expectations and standards of care to try and encourage improvements here for the staff. If they want to improve then some things need to change. But overall, I found the week to be a success.