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Improving Psychiatric Care in Rural Zanzibar

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I had been working as a volunteer doctor in rural Zanzibar for over three months but still hadn’t got used to the early morning ward rounds in the blistering heat... Despite its idyllic setting and thriving tourist industry, Zanzibar remains one of the world’s poorest countries... Unsurprisingly, the public health system does not come close to meeting the countries needs with 1 in 12 children dying in infancy and a doctor:patient ratio of 1:20,000. (figure 1) In 2006 the UK based charity ‘Health Improvement Project Zanzibar’ (HIPZ) was established to try and combat this... This model of an African government handing over control of a state hospital to a Western charity is the first of its kind... It has however proven to be very successful, so much so that in 2012 the President of Zanzibar requested that HIPZ repeat the process in the largest rural hospital on the island at Kivunge... By the time I arrived in Zanzibar in October 2014, fresh out of FY2, the Nurse Psychiatrists had completed their training and had already begun to operate the clinic independently... However, on closer inspection a number of problems had arisen... There was no data to support any of the claims, we had no evidence that patients actually found the new system beneficial and, most importantly, the financial incentives and official recognition promised by the Government to the Nurses had never materialised, resulting in several dropping out of the programme... A sample of 100 patients was taken and several criteria measured, including diagnosis distribution, correct prescription and risk assessment... The results proved that the training had indeed been a success and that the Nurse Psychiatrists were operating at a high level. 100% of patients had an mhGAP recognised diagnosis, 93% were prescribed the correct medication and 94% had a Risk Assessment completed... Firstly, the hard work and achievement of the Nurse Psychiatrists had to be recognised... She was discharged and given a follow up appointment at the new clinic... Unfortunately however she did not attend.

No MeSH data available.


Meeting at the Zanzabari Ministry of Health. 2nd from left - Dr. Mohammed Jiddawi (Permanent Secretary Health). Centre - Newly recognised Psychiatric Nurse Specialist, Pandu.
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Figure 0004: Meeting at the Zanzabari Ministry of Health. 2nd from left - Dr. Mohammed Jiddawi (Permanent Secretary Health). Centre - Newly recognised Psychiatric Nurse Specialist, Pandu.

Mentions: Firstly, the hard work and achievement of the Nurse Psychiatrists had to be recognised. I designed and organised an exam and graduation ceremony in the hospital, ensuring it was attended by local government officials and the national press. The ceremony received a full page in the weekly newspaper (figure 3). I then organised a series of meetings with the Minister of Health. In them, all of the achievements of the new service were presented as well as the plans for the future and of course, the many potential opportunities for positive publicity to those who were attached to it. In the end, the Ministry agreed to provide both financial and political backing for the service as well as formally recognising the role of ‘Psychiatric Nurse Specialist’ for those who undertake the training. (figure 4)


Improving Psychiatric Care in Rural Zanzibar
Meeting at the Zanzabari Ministry of Health. 2nd from left - Dr. Mohammed Jiddawi (Permanent Secretary Health). Centre - Newly recognised Psychiatric Nurse Specialist, Pandu.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4920490&req=5

Figure 0004: Meeting at the Zanzabari Ministry of Health. 2nd from left - Dr. Mohammed Jiddawi (Permanent Secretary Health). Centre - Newly recognised Psychiatric Nurse Specialist, Pandu.
Mentions: Firstly, the hard work and achievement of the Nurse Psychiatrists had to be recognised. I designed and organised an exam and graduation ceremony in the hospital, ensuring it was attended by local government officials and the national press. The ceremony received a full page in the weekly newspaper (figure 3). I then organised a series of meetings with the Minister of Health. In them, all of the achievements of the new service were presented as well as the plans for the future and of course, the many potential opportunities for positive publicity to those who were attached to it. In the end, the Ministry agreed to provide both financial and political backing for the service as well as formally recognising the role of ‘Psychiatric Nurse Specialist’ for those who undertake the training. (figure 4)

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

I had been working as a volunteer doctor in rural Zanzibar for over three months but still hadn’t got used to the early morning ward rounds in the blistering heat... Despite its idyllic setting and thriving tourist industry, Zanzibar remains one of the world’s poorest countries... Unsurprisingly, the public health system does not come close to meeting the countries needs with 1 in 12 children dying in infancy and a doctor:patient ratio of 1:20,000. (figure 1) In 2006 the UK based charity ‘Health Improvement Project Zanzibar’ (HIPZ) was established to try and combat this... This model of an African government handing over control of a state hospital to a Western charity is the first of its kind... It has however proven to be very successful, so much so that in 2012 the President of Zanzibar requested that HIPZ repeat the process in the largest rural hospital on the island at Kivunge... By the time I arrived in Zanzibar in October 2014, fresh out of FY2, the Nurse Psychiatrists had completed their training and had already begun to operate the clinic independently... However, on closer inspection a number of problems had arisen... There was no data to support any of the claims, we had no evidence that patients actually found the new system beneficial and, most importantly, the financial incentives and official recognition promised by the Government to the Nurses had never materialised, resulting in several dropping out of the programme... A sample of 100 patients was taken and several criteria measured, including diagnosis distribution, correct prescription and risk assessment... The results proved that the training had indeed been a success and that the Nurse Psychiatrists were operating at a high level. 100% of patients had an mhGAP recognised diagnosis, 93% were prescribed the correct medication and 94% had a Risk Assessment completed... Firstly, the hard work and achievement of the Nurse Psychiatrists had to be recognised... She was discharged and given a follow up appointment at the new clinic... Unfortunately however she did not attend.

No MeSH data available.