Totally Different; The Psychiatry Elective Experience in Kenya
I completed the first part of my elective at Port Reitz District Hospital in the mental health and substance abuse department. This was an interesting experience and very different from home. Despite it being the second largest psychiatric hospital in Kenya the facilities were extremely limited in terms of staff, medications and other necessities.
While here I spent my time mainly contributing to the ward rounds, handing out medications and taking histories from the patients. The vast majority of patients had been admitted due to the effects of drugs and it was very interesting to hear all of their stories. I spent the first week very confused about who were students and who were members of staff. I then realized it was in fact nursing students who were just starting their psychiatric placement who were running the outpatient clinic. There were perhaps two qualified nurses working at any one time for approximately 60 inpatients.
I was able to meet the only public psychiatrist in Mombasa region and arrange further meetings. This allowed me to see the medical side of treating the patients and we had many interesting discussions about the difference between psychiatry in the United Kingdom and Kenya. He worked in a large number of roles ranging from forensic psychiatry, running a methadone clinic and seeing general psychiatry inpatients. I have been interested in forensic psychiatry for a long time and I spent 2 days with the psychiatrist while he decided whether suspected criminals were fit to stand trial. It amazed me how quickly this could be done. It also allowed me to see some fascinating cases; including terror and murder suspects.
The methadone clinic was something which could be directly compared to the United Kingdom. It is a relatively new government run programme and so unlike most of the health care in Kenya it is available free of charge. When the patients are first seen a general and specific history is taken by the nurse and then they are tested for many substances including: heroin, cocaine, methadone, cannabis, barbiturates, benzodiazepines and amphetamines. This to my opinion is a single most recent show of effort by the Government to improve the health services.
I spent approximately a week of my elective in the Emergency Department of Coast General Provincial Hospital where I was mainly in Minor Injuries. It was clearly characterized by chronic shortage of staff and extremely busy. The majority of the work involved changing dressings, draining abscesses and suturing. Before my elective I had not done any suturing and so I gained a lot from this. While I was in A&E the most fascinating and worrying thing I saw was a male patient who had had his foot run over. The accident had happened a few days previously and his family had brought him into minors to have his dressing changed. The patient was unable to walk and appeared delirious. He was clearly very ill and in the UK would have immediately been treated for sepsis, one of the staff however thought he had "hysteria". After the discussion among the staff we convinced him this was not the case we were finally able to admit him.
The rest of my elective I spent in pediatricians with emphasis on neonatology. The most difficult aspect here was the inability of parents to pay for their children's medications. A 9 year old female diagnosed with encephalitis was unable to be treated with IV acyclovir as her mother could not afford it. The contrast of this to my pediatrics placement at home was vast. A baby who had transposition of the great arteries was in a similar difficult situation, the closest place she could be taken for the operation was India, and again this was far more than the parents were able to afford.
I really enjoyed my time in Kenya and I am extremely glad I chose to do my elective there despite many people discouraging me from the idea. It was an amazing experience and one which I learnt a lot.