Mirembe Mental Health Hospital, Tanzania.
We arrived at Mirembe hospital to the warmest welcome by our colleagues, who had gone a long way to seal our partnership by ensuring our safety and comfort. The hospital, built by the British in 1926 was named after a local traditional healer called ‘Mirembe’ who used to treat patients in the nearby rocks. The name Mirembe was therefore carried forth in respect of the healing context created and acknowledged by the local community.
The hospital grounds are perched in the west of Dodoma town in a vast expansive land where staff and service users work in a wide range of horticultural therapies. These impressive, innovative horticultural projects were set up as a result of the feedback that service users had given to staff about their need to develop activities and skills that would be helpful to them upon their discharge back in the community. These enterprise projects are now mushrooming out, and service users can now sell their produce and supplement their diet within the hospital.
I am here on a scoping visit to Mirembe to evaluate professional development needs for nurses, gather insight to the context of care delivery processes, and to develop our Buddy project (Professional-Friendship Project) , by meeting with key staff and through clinical participation and observation.
My colleague Chris Bumstead is here to evaluate the TMVA Training program which has been running for 2 years and to talk to key professionals about the next proposed development for establishing community mental health services in the Dodoma region.
The hospital wards are busy, over-occupied but clean with a total patient population of 700 patients and minimal staff, however nurses as everywhere else in the world have a way of getting on with the tasks and here in Mirembe Hospital do just that. Of the 90 trained nursing staff, only 20 of them are trained as Mental Health Nurses. This in turn impacts on retention of staff, capacity for professional development, delivery of care and service provision.
The clinical presentations are wide and complex with patients often presenting for treatment when they are very unwell. Clinicians are managing cases of Malaria, Typhoid, HIV co-infections, alongside other mental health disorders. The Mother and Baby unit manages patients who are admitted with their children but also manages vulnerable, elderly patients, children and adolescents with epilepsy and mental disorders.There are also some social admissions with some long stay patients who are not able to return home due to family rejection and stigma. Some of these patients turn into ‘trusted service users’ who are occasionally called upon by staff with difficult situations.
There are a wide range of patient focused initiatives and learning opportunities that I am keen to take back to CNWL NHS Trust, given the common grounds of care delivery in resource constrained environments such as maintaining motivation and resilience in the face of changes and challenges. There are opportunities here to develop CNWL’s capacity for cultural competency experience and training, and the team here at Mirembe are willing to help us develop these competencies.
In our Nursing focus groups today, the first in many years, nurses and their leadership had an opportunity to share their experiences in managing patients under poor resources, their aspirations and visions for their professional development, their curiosity on how mental health presents itself in the west and how we manage cases in our trust. Their testimonies were highly moving.
The hospital management and senior staff have recently strengthened the capacity for better care delivery through recruitment and training however they recognise too that nursing professional development could benefit from further input and are therefore welcoming of our shared ideas.
We are due to visit a local village at the weekend where families are managing mental health patients within their homes, to gather more insight into the cultural context of mental health care and its meaning within the local community. Now that the TMVA training programme is almost complete the next phase will be to see how the benefits already achieved can be sustained. Mirembe staff have expressed a wish for refresher training and to ensure that all staff are trained in TMVA techniques. This will involve training more trainers which could potentially result in Mirembe Hospital being seen as a centre for expertise in managing violent and aggressive behaviours in all health care settings in Tanzania.
We are very grateful to Dr Erusmas Mndeme – Mirembe Hospital Superintendent, Mr Jovin Lyimo – Mirembe & Isanga Matron, Sister Regina Ringo – Mirembe Matron and all the patients and carers who carry the heaviest burden.
Tribal Sands 2014