Bosaso: The first Mental Health intervention
Bosaso: the first mental health intervention in Puntland
In May 2003, GRT’s work in Somalia has been enriched with the first mental health intervention in Bosaso, in the northeastern part of Somalia.
Thirteen years after the end of the civil war, the situation GRT’s staff found in Bosaso when they first got there was disarming. The signs of the war were still very evident in the psyche of people and so were the consequences of the violence. The uncertainty feeling was constant and people could not live their lives normally. The complete lack of minimum social security structures, the presence of a system that constantly abuse of its power, the drought together with the insecurity of an impoverished country that mainly lives with remittances from abroad, were counterbalanced by the extraordinary strength of the common people who lived and survived in the arid lands of the north of Somalia.
When GRT’s staff arrived in Bosaso, they found chained people all around them, in the houses, at the markets, in the IDPs camps or under trees. Mentally ill people’s hands and ankles were chained with heavy metal chains, impossible to break. Women and men were chained in the same rooms for one, two, eight or twelve consecutive years. Chains were not used with a punishing function or for their potential healing virtue, but because there were no other means to cope with uneasy and unpredictable mentally ill people.
GRT’s staff has talked and listened to those people and tried to give voice to their frustrations, dreams and hope. Thanks to GRT’s intervention, a mental health ward was built at the hospital, families of the patients were involved in the process of finding alternative solutions to the use of chains, and possible methods of reintegration of patients in the community were discussed. GRT’s approach has taken into consideration the local traditional medicine and established a mutual exchange of information with the local communities.
Thanks to the mental health ward built with this project, thousands of mentally ill people have found support to their healing path with qualified local staff that has daily listened to them, interacted with them and negotiated their treatments with their families, religious leaders and traditional healers. Two different wards have been built within the hospital, one for women and one for men, to allow each patient to receive appropriate support. Moreover, no patients have been sectioned for life, but only for the time that was necessary for them to heal, followed by follow-up visits from the staff.
Hawa, AbdiKalif, Ali, Ayan and many others, with their stories full of love, suffering, tension and strength. With all of them, every day, GRT has built a vital and alternative healing path, thanks to the local staff we have been lucky to work with.
Project Implementation Methods:
GRT’s qualified personnel, a psychologist and a psychiatrist, did the training of local staff both at theoretical and practical level.
The psychologist (project manager too) has carried out periodic training sessions addressed to the whole staff and specific sessions for the social workers. The trainings were focused on the approach to psychiatric patients, the management of family conflict and the practices of psychosocial rehabilitation intervention.
Practical training, on the other hand, was carried out daily with the assisting method, which envisages an active and progressively autonomous participation of the local staff during clinical visits, social activities, home visits and interviews with patients and their families.
The psychiatrist (project consultant) has carried out field missions for the specific training of local staff, in particular doctor and nurses. The theoretical sessions were oriented to the detailed study of the clinical notions of general psychopathology, psychopharmacology and transcultural psychiatry. On the other hand, practical training included coaching during clinical visits, management of the ward and the management of emergencies and crises.
Training supervision sessions and group work were also carried out, aimed at consolidating the concepts and practices learned and the management of internal dynamics of the working group in relationship with patients and mutual collaboration.
Thanks to this project, a mental health service has been established, and it has been recognised by the local populations as adequate and useful. The health and educational staff has become extremely active and skilled in managing also challenging cases and the possibility of developing a project directly in some remote villages was also opened.