Measuring in Inches

 

So I finally feel like I am starting to do some work here. It is tediously slow at times, however, and I find very hard to talk about what I am doing. Back home we measure things in what would be a big way, things that we could see and know that something has changer. Here progress comes in inches, rather than miles.

Fridays have become my favorite day, and one that I also come face-to-face with the realities of the world I inherit back in NY and what I am living in right now. On Fridays I travel to Nzara to meet with care team members there. I started coming down after the TOT training was completed and the plan is for me to come to the hospital every Friday to support the different health care workers and to start a real mental health program here, in the hope that it will be a full clinic when the time is right.

Dr. Maad, the head doctor here in Nzara, is young, hungry to improve the hospital he overseas, and eager to see his colleagues and fellow health care workers succeed and improve their care. I credit my ability to actually starting to really do some mental health care to him and his welcoming of me to his facility. We met my first week in South Sudan and quickly he is an ally in my work.

So on Fridays I get driven down to Nzara. I have yet to develop a rhythm with my visits but I think that is part of the work here. Some days I meet with Dr. Maad and other days I round to different units and write emails and notes for follow-up care. But each time I come down I face mental health cases and possible mental health cases and I get to round and see patients.

I have started to visit each of the main wards the house patients for longer than a "doctor's visit". I go to the inpatient medical adult unit and then to the inpatient medical pediatric unit. I also visit the maternity unit. Sometimes there are patients or family members one each unit who can use my help, or advice, and other times there aren't any known cases on all the units but a suspected case or two on one. 

The work fluctuates and flows. And sometimes I feel like I have been thrust against rocks with water crashing over me. There are times that it is not the patients who seem to need the mental health care, but rather the staff that seems to be struggling. Fortunately, my work here is not exclusively to work with patients so I am trying to also improve the mental health of those working in the hospital. 

I have the opportunity to train the CMMB staff who are humanitarian workers, which I try to do on Mondays during our morning meeting, and to help train and facilitate mental health discussions with different health care workers. I am attempting to start conversations with different groups and different people about what self-care is and how we practice and use coping skills. The process is slow and not everyone understands, but again, I am grateful that the conversation is starting.

This week I also saw my first patient independently. Since I do not have an actual client space to see patients in Yambio we utilized an ultrasound room in the maternity clinic at the PHCC. You make do with what you have. I evaluated the patient. There was certainly a language barrier but their family helped translate. I am not sure what he is suffering from. What I would give for diagnostic tools and US services right then, but alas I will make do, as best I can.

Since I work as an RN under the same scope, I work with at home I cannot formally diagnose like others do here. However, I did an assessment and did my best to advise how the family and patient could move forward to get the patient help. There is no formal outpatient clinic in Yambio. I would like there to be one as that would be where I would refer to but at least we are starting the assessments.

Another day this week I met with the psychiatric department at Yambio's State Hospital. Seems like if there was a psychiatric department, they would have services but the reality became clear when I got to the meeting. They are lacking pretty much everything, including funds. They have 2 volunteers that I trained in TOT and who have psychiatric training already but both are volunteers.

The hospital would like an inpatient unit but I feel that they need to have more outpatient services first. We also discussed doing more community training on mental health. Here in South Sudan when someone seems to suffer from mental illness, they may take the person to a traditional healer or to the church for prayer. While I won't discount that there are cases where this might help, we all agreed that we also need to educate the community, particularly those who are community leaders, when seeking the medical mental health facilities and care is more appropriate. This seems like one way I might be able to help them out.

I feel like my work is all over the place. Some days it involves more meetings, other days I am at the hospital, and sometimes I am sitting in a maternity ward. There is a variety to my work and I like that. I am glad more people are talking about the mental health here and that I am able to start doing more. These tiny progress markers are hard to overlook during my week, especially when I feel helpless, but I have to reflect and see that any progress is good.