Work Update!!!

         Okay time for a little bit of a work recap. I feel like it has been a while since I gave an update on what I am getting up to with my work. And a lot of it is kind of hard to write about because it is complex and confusing but I will write what I can.

Not sure where I left off with work updates but I will start with my supervision of those I helped train in TOT for Mental Health. I am overseeing people in 4 counties in W.E.S. I have 4 focal persons that I try to reach out to every few weeks, some I talk with more, about how each of their colleagues is doing with the training. The 4 focal persons come from each of the 4 counties. It is easier for me to oversee the two nearer me but the other two I rely on the focal people to keep me updated.

As of now things seem to be going well with those who have been trained. We utilize a secure group chat to connect and talk. Sometimes participants share information and advice to the group. Other times people reach out with questions and we are able to discuss cases and questions in a timely manner. We make sure not to share sensitive information but present enough of the cases to talk about what we need to discuss and problem solve.

Some of my participants are really diving into their mental health training, alongside their other duties, and others still need more education and assistance. I try to provide what I can. It is challenging, especially with the farther counties, to know what challenges they are facing or what further education they need, but I am pleased that there is progress.

There are only 2 people who solely focus on mental health, out of all of the people I train and that is challenging. For them it is especially challenging because they have so very few resources, even less than me. At one point they invited me to a meeting with other people from their facility. During the meeting it became clear that they were hoping I was going to provide them with the resources they need to build their mental health department. Either they wanted me or my NGO to provide the support. Unfortunately, neither me nor my NGO are in a position to support their proposal, but I am glad that they are seeking to create a better mental health department in W.E.S. It is greatly needed.

At least once a week I travel to Nzara to see patients. I have a long-term patient there who has developed some mental health complications, who I regularly see and am trying to treat. It is a challenge because the patient is very resistant to trying any of the things, I want to do with them, and the care team (I tend to agree) feel that putting them on medication is not advisable at this time. So, each week I try new ways of giving them help. Some weeks things go better than others.

I see other patients too while I am there. I have worked with mothers who have lost their children, a family whose daughter was dying following delivery complications, families whose children are dying, a family who had a child in the hospital for and extended stay, and a pediatric rape case. Every single case I face is challenging in its own way. Some are harder, emotionally, for me as well. Some people want to talk to me and others decide they do not want my help.

It is all a process, and I often rely on other staff to translate what I am saying and what the patient is saying. In the US we would use specific people for translation and there tends to be rules about how translators translate things, like that they have to translate verbatim. Here I hope that the person I am working with is translating fully. There are certain people that are better about this than others. Some, especially those who are not as comfortable with mental health, tend to not translate as fully. Often, I have to encourage a better dialogue. It is all part of the challenge of this work.

I really like when I get to see patients and work with them but my resources are so limited. Many times, I will only see a patient once so my goal is to see if they are in acute crisis, suicidal or homicidal, and what their needs seem to be. Then I try and do education, especially on coping skills and self-care, which many people see to struggle with, and refer if possible.

Along with traditional mental health cases I often see epilepsy cases, because in much of Africa, epilepsy falls under mental health as it is an umbrella category known as MNS (Mental, Neurological, Substance). That is a new challenge for me. Many of those patients that I see for epilepsy are young adult males that seem to suffer from epilepsy in conjunction with another mental health issue or a traumatic brain injury. Those cases are challenging, so prioritizing care and referring is very important.

Soon I hope Nzara's hospital, St. Theresa, will open up the mental health clinic. At this time, we decided it will only be a once-a-week clinic. If the need grows, I hope they can expand it, but for now, even having one day a week when anyone in the community can come and get mental health care is huge. I am hoping it will be successful. I will continue to support it while I am here, and do what I can for it once I leave. I also have to work on getting mental health education and the existence of the clinic out to the community. More small projects for me to work on. 

This week I also identified my next larger project. I will be working at one of Tindoka Vocational Training Institute (VTI). There the institute supports many CAAFAGs (In the US we know them as Child Soldiers). The program aims to train those who participate in useful trade skills that they can use. Most of the participants are in their mid to late teens. There are both girls and boys there. They learn skills like mechanics, carpentry, and sewing.

This week I went with a social worker and counselor to the site. I was given the opportunity to talk with a group of about 30 participants about mental health. We talked briefly on a variety of topics and issues. The big one presented was trauma. I tried to encourage the teens that it is okay to talk about mental health and to have mental health struggles.

The best part of the conversation was when several of the participants started speaking up about their different mental health struggles. One even mentioned a significant trauma. By these participants sharing what they experienced it allowed for a very real dialogue to start. Not everyone was willing to share so openly but I was so happy that a few did. This helps.

Going forward I plan on going once a week to work individually with different people from the VTI. Several people shared that they were unwilling to share so publicly but they were willing to talk one-on-one. That is perfectly fine with me. I want to do that with them. So, we are creating a plan for a day of the week when they can expect that I will be in the VTI and that whomever wants to meet with me and work with me can do that.

I will continue doing staff training as well. I try to do a general staff education at least 2-3 times a month at our Monday morning meetings. I also want to do more specific staff training. I plan to educate the midwives in the different clinics I work in, as well as with the social workers and counselors so that they have more tools when they come across mental health cases. There will probably be others I train in the future too.

The work is hard and often I feel frustrated with how little I can do, especially with certain cases. But I am celebrating my "small" victories. In the end they are not so small but, in the moment, they can really seem that way. It is also hard being the only mental health provider who is specifically doing just mental health care, to the extent that I am, in W.E.S. I am an island on my own. But we have to start somewhere so this is where the work is starting.

That's all for the work update for now. I'll share more later.