Psychiatry And Society

The Irish are amazing: You find them everywhere; These are two special ones.
Tuesday, April 17, 2007
First post

Hi,

It’s a few weeks since Seamus asked me to give one of the Psychiatry and Society lectures (I’ll be speaking in October about psychiatry in the developing world) and to contribute to this blog, so I guess it’s about time I wrote something.

For a first post I’ll just say who and where I am and broadly what’s going on in Malawi.

I’m Niall Crumlish, I graduated UCD in 1997, and started training in Psychiatry (Tallaght / TCD) in 1999. In 2003 I was special lecturer in UCD and St John of God’s (from now on SJOG), and went on to a research fellowship in Cluain Mhuire / SJOG with Prof. Eadbhard O’Callaghan. In 2005 the research fellowship took me to SJOG in Mzuzu, Malawi. After I spent a week here setting up an RCT, my partner (Sharon Brady, a nurse in the addiction services in Dublin) and I decided to come back and spend 2006 here. We extended at the end of 2006, but our term ends in June.

Mzuzu is a town in the north of Malawi (pop. 100,000 odd). Malawi is a hugely densely populated country, but the northern region is not so. This is good in terms of food security, and bad in terms of services provided by the government (there are two tarred roads, and only one north of Mzuzu). You can imagine what government-provided mental health services are like. (In the 2004 World Bank rankings, Malawi was the the poorest country in the world for which there was data, with a gross national income per capita per year of 170 dollars).

In the early nineties a number of SJOG brothers took a trip around Africa, visiting sites in several countries, and decided that of all the places they had visited, Mzuzu was the place most direly in need of SJOG-provided mental health services. (At this time, as an aside, Malawi was in the death throes of a thirty-year brutal dictatorship.) One of the SJOG brothers, Aidan Clohessy, became director of the new service - that is, he built it from nothing.

It was, literally, all fields around here. The nearest mental health professional was 800kms away, in a then-medieval psychiatric hospital in Zomba, in the south. (It has improved.)

Now, the St John of God Community Mental Health Service comprises an OPD, a domiciliary care team, a forty-bed inpatient unit, a counselling service, a recovery and rehabilitation service (training and supported employment), a programme for street kids, a school for kids with learning disabilities, and (courtesy of Sharon) an outpatient drugs and alcohol treatment programme, established in August of last year. There’s a College of Mental Health Sciences, providing degree courses in psychiatric nursing and counselling, and in 2008 the College plans to commence a BSc in clinical psychiatry - training much-needed psychiatric clinical officers, who are the equivalent of registrars in a country that has almost no medical doctors and only one permanent psychiatrist, Felix Kauye, who is based in Zomba.

My work has been as a clinical lecturer - mostly supervising the clinical work of clinical officers, and training clinical officers and others in diagnosis, management, basic sciences, whatever, with a focus on evidence-based practice. I have continued to run the RCT that brought me here in the first place - a trial of carer education in schizophrenia, from which we are beginning to publish. And with others I have been trying to build a research infrastructure here - partly because we know almost nothing about mental illness in Malawi, which is an enormously complex and rapidly changing country of 12-13 million people; also because training in research methods fosters critical thinking and diagnostic precision, hence improves quality of clinical care.

For anyone interested in what’s going on here, I suggest Googling “SJOG Malawi”. You’ll find the (somewhat out of date) homepage for SJOG Mzuzu, and you’ll find links to Venture Malawi and Wells for Zoe. These are two charities / homegrown, ground-level NGOs that have built links with SJOG in the last few years. Wells for Zoe (www.wellsforzoe.org) is an amazing project, run by John and Mary Coyne - you may have read John Waters in the Irish Times writing about Wells for Zoe in January, and if you didn’t, you may see something soon in the IT, as John Waters has spent the last week in Mzuzu with John and Mary Coyne and Bro. Aidan, before rushing back today to the alternative universe of the Eurovision.

OK apologies for the length of this entry. That’s the problem with blogs - no editors.

My email is niall.crumlish@gmail.com.

Enjoy your rotations.

Niall