Laura Bennison, MMHS Change Agent, is currently visiting Malawi with MMHS Trustees, Helen Sloan and Sharon McMenemy, as part of the African Alliance for Maternal Mental Health project..
It is now our fourth night here staying in St John of God psychiatric hospital here in Lilongwe. The hospital, on the outskirts of the city is down a long dusty bumpy road in a peaceful setting surrounded by colourful plants, the odd mango tree and some very noisy frogs.
A working lunch!
After arriving on Sunday afternoon (24 hours after we left Glasgow) we were straight to work on Monday morning with a 9am meeting to meet hospital staff and get an overview of the service they provide. We were struck by the scope and breadth of the psychiatric support they offer. This includes community based mental health services, drop in outpatient clinics, outreach clinics, domiciliary care, education programmes, school services and work place based mental health support. In addition they produce a regular radio programme on mental health issues and provide a service in prisons, police headquarters, youth centres and community groups.
Delivering Training & Helen and Sharon in action
Onsite where we are staying their have 49 beds including an acute ward and a rehabilitation ward. They run a range of creative and inspiring programmes in their residential services including vocational training for people in recovery such as carpentry, brick laying, hair dressing and cell phone repair. We visited their occupational therapy area full of old fashioned Singer sewing machines for tailoring and textile workshops for people in recovery, and where people recovering
from addiction were cooking meals for other patients. A holistic community development approach with a strong emphasis on preventative care seems to be at the heart of what they do. St John of God staff help to facilitate self help groups for women in poverty where they are given loans to collectively start up small businesses to increase their income and as a result the wellbeing of their family. St John of God also have a smaller sister hospital in the northie Mzuzu. Together these two St
John of God hospitals supply approximately 65% of all mental health care in Malawi Touring the hospital site on this day meeting staff and patients we discovered similarities and differences, the familiar white board at the nurses’s station listing inpatient’s medications, an ECT room and tight security.
Since 2016 St John of God hospital had admitted 15 women with perinatal mental health problems into their adult ward. Untypically at the moment there are 5 women inpatients with either postpartum psychosis or severe depression. Nearly all women bring a Guardian with them who also stays in the hospital and manages the care of the child while the mother recovers. We met one woman, an aunty of a woman being treated on the ward who was bringing the baby to the mother to be breastfed. As in our MBUs the mother increases the amount of care they deliver to their baby gradually as their own health begins to improve. Tuesdays focus was pinning down the desired outcomes on both sides from this newly developing partnership between Maternal Mental Health Scotland and St John of God hospital. With hospital staff including their programme manager Mwawi and financial director we explored a woman’s journey from conception to birth to postnatally and learned about the pathways for a woman in rural Malawi if she presented symptoms of a perinatal mental illness. Shockingly we learned that women in Malawi are required to provide their own birthing kit for labour in a hospital environment. This includes waterproof sheeting, their own bucket, a razor blade for cutting the umbilical cord and string to tie the cord with. The anxiety surrounding the costs of these items causes a lot of stress for women in the final stages of their pregnancy. On average a Malawiam woman has around 5 children in her lifetime and 80% of these women give birth in a hospital but are released within 24 hours.
The Hospital Chapel
Taking the lead from the hospital staff at St John of God we collectively decided on our priorities for this first year of our partnership. They need to be realistic, measurable and most importantly sustainable so we can realise our objectives over the next 5 years.
Priorities for the exchange
Strengthening women’s voices and capacity building (quality improvement)
A consistent checklist of standards for inpatient care across the different mental health hospitals
Staff training and train the champions using online learning modules
Other ideas of what to concentrate on in partnership:
Looking at follow ups/after care.
Training of psychiatrists-there are only 2 indigenous psychiatrists in Malawi
Screening women, identifying women that are high risk.
Establishing consistent standards of care for women.
Linking in with the Government.
Education midwives to identify problems.
In the afternoon we met with funding members of the African Maternal Mental Health Alliance for a broader continental picture of the challenges women with perinatal mental ill health. A recurring theme was witchcraft/doctors and stigma. We discussed the logistical issues of organising across vast distances and how Malawi can be the pilot African country that will lead by example. If a maternal mental health alliance can be further developed and strengthened in Malawi then other African countries can hopefully follow this model.
We have also met up with Dr Rob Stewart. Here he is in reflective mood! Also, Rob with Helen and Laura (wearing their very fashionable MMHS T-Shirts)
Our new colleagues and a beautiful flame tree
The African Alliance for Maternal Mental Health also shared an important and illuminating film that they have recently commissioned which focuses on the personal stories of two women in Malawi who were experiencing Post Partum Psychosis and who received treatment in Zomba Mental Health Hospital. We will share this film when we return. Importantly the film focuses on the stigma surrounding these women in the community and how they were directed to different faith healers in their community when they were experiencing serious symptoms. This film is a very useful learning tool that will be circulated around health professionals here in Malawi and can hoepfully greatly improve people’s understanding of this condition.
(I’m afraid we need dash to our meetings at Zomba hospital now! I’ll type up the next blog which will be about the training we delivered to staff at St John of God, 23 staff in total, this was a half day in depth session about perinatal mental health and the role of MBUs).
I’ll also write about our session with women with lived experience which I facilitated at St John of God, this was a moving but very positive session about models of peer support and where we discussed what they would like from a Group).