Mental Health Clinic Opening!

Mental Health care in South Sudan is hard. I feel like I am starting from nowhere with no guidance on where to go most days. It has been hard over these last 3.5 months to create and execute a plan on how to tackle the mental health needs here. There are so many.

The first thing I had to come to terms with was the fact that I am not going to be able to help everyone, and realistically the scope of what I am able to do in the time that I am here is going to small. There is so much work to be done but no resource, or very few. And for the most part there is just me to do the work.

Sometimes it is hard to sit here and feel like I am doing work. Sometimes I feel like in the 3 months I have been here I haven't done any work. Sometimes I think I am throwing myself a pity party or something, because the work I am doing is frustrating in a way that work is not at home. I have never tried to build something out of virtually nothing at home, not something medical at any rate.

There are many logistical and random challenges that I come across in my work. Sometimes I see a patient and they think that mental health services will help them locate jobs or find money. I haven't quite figured out why they believe this but it happens more than I would like. I also have trouble getting people to follow up. I think not having access to regular healthcare and regular clinics means that people don't always understand the concept of following up. Another thing I am trying to figure out.

Generally, there are other challenges that I have to find creative or persistent ways around. There is often a lack of trust for the work I am doing. Part of this is because the work is new and that mental health is not fully understood. Part is due to the fact that I am white and not from this culture. Other challenges are the lack of resources and other mental health counterparts that I can work with.

I am virtually alone in many of the things I am doing. There are very few people that are trained in mental health care. I am probably the most skilled in psychiatric and mental health care for the entire state of WES. This makes it hard to find people I can problem-solve various issues with in real time. Sometimes I have to use best judgement and safe practice and go from there. 

The cases I talked about in my post before show how challenging some of the clients I am seeing are. Since I am alone in some of the work and since I am limited on services I can offer, sometimes I feel like I have not many ways of helping. But I try and listen, if nothing else, and teach self-care and coping skills. They are little things, but they are baby steps forward.

But this Month, as we start to celebrate Mental Health Month (All of May!), I am taking a huge step towards one of the goals I set myself when coming here and one huge step towards addressing mental health in South Sudan. On Wednesday May 10th 2023 "my" mental health clinic opened.

It has been months of hard work to coordinate, train, prep and start to facilitate the beginning of this clinic. It is located in a semi-temporary space in a newer building at St. Theresa's Hospital in Nzara. Together with Dr. Maad we have been working for weeks to put together the launch of the facility.

The opening of the clinic came with a ceremony in which the director general for the state, other important community members, different religious leaders, and other officials, like members of the military, showed up. There were a series of speeches. I even had to give one but I kept mine short.

Overall, it was a bizarre and exciting experience. Bizarre for me because I still have not gotten used to how the meetings run and ceremonies like this run here. I am still trying to understand of the formalities and the procedures that they use to run something like this. But of course, seeing something I worked so hard to start actual happen, was incredible!

There had been a series of false starts to this clinic. We had proposed and planned for the clinic opening for weeks and then had to keep postponing. Finally, we were able to settle on a date, plan, invite, and prepare the space for the opening.

Of course, on the day of the opening we arrived late but I was so excited to have several of my favorite staff members beside me. Plus, they are my friends. Veronica, my project manager, Norine, the head of HR, and Taban, the midwife I shadow maternity with, all came to be a part of the opening with me. It truly meant a lot. Sister Margaret and Sister Winnie were also there. I really like both of them and was so pleased to have them be a part of the day.

So, this was a huge success and a huge day for me. It is just the start and I really hope that the clinic manages to be successful. I told Dr. Maad that this clinic is "my baby" so after the ceremony Dr. Maad came up to me and said that he promises the hospital will be a good "foster parent" to "my baby." Over the next few weeks, I will transition the staff to run the clinic so that when I leave, they can do it on their own, and reach out to me when they need help.

While the clinic is starting off "small" by Western standards it is a huge step here. It is the first one in WES. It will run 1 day a week with outpatient services, but the hospital has 7 staff members trained as mental health staff, alongside their regular rolls. We are hoping it can grow from there, and during the opening ceremony we talked of plans for the future and how we hope to expand. The fact that this program and clinic have the support that they do is amazing.

While all of the work that I have been trying to do it hard and has caused me a lot of stress over the last months, finally taking this very significant step forward makes all of the work worth all of the stress and anxiety. The work won't stop. I have patients to see, more educations days to plan, and other projects still to go. But for a few moments we will celebrate this success.