Alice and Sophie's first day in Mbarara university hospital
Today was out first day of clinical placement and we spent time on the psychiatric ward where they looked after children from the age of 2, with mental health problems ranging from schizophrenia, bipolar and depression. One of the biggest shocks was the fact that ADHD and epilepsy were classed as mental illness and both carried social stigmatisation. We were orientated to the ward and we saw seclusion rooms used as storage; large mixed aged dorms with no privacy and if you wanted to stay in your own room you have to pay 36,000 shillings a night which doesn't happen in the UK. There was no evidence of any locks on the doors including the nurses office and medication storage. Patients were free to walk around as they pleased. Their filing system was chaotic to say the least compared with the UK; they did have files that dated back as far as 1991; however, a nurse stated that it was hard to locate individual files based on when the client was last seen and with limited storage availability.
We got to attend an outpatient clinic with a senior psychiatrist who engaged well with patients and families and seemed knowledgable on the area of mental health and even questioned the status of epilepsy as a mental illness. We saw a range of clients and there were a lot of patients reviewing their medication, mainly antidepressants. The antipsychotics used were all first generation drugs which the UK no longer recommend due to extra-pyramidal side effects. The psychiatrist really made time for each patient regardless of time available and really seemed to want to help, however there was little regard to patient consent in regard to our presence. Confidentiality also did not seem to exist as patients were being discussed in front of other patients and professionals that we're not involved in their care.
After the out patient clinic we got to spend time on the ward, interacting with patients who seemed happy to have someone to engage with. Some of them tried to teach us the Ankole language, dancing and showing signs of respect for nurses. The patients stated they get bored as there are no ward activities except for a small television.
We observed a nurse starting a medication round with many patients sharing the same medication pot. No regard for infection control was witnessed as the nurse wore no gloves and handled the tablets. Medication charts were used and seemed similar to the UK. Some of the patients seemed happy and stated they thought they were getting better; however, some appeared to have extra-pyramidal side effects with slow movements and delayed reactions.
Overall our time on the psychiatric ward was a positive one, it opened our eyes to the fact that, although there are similarities to the UK, the Ugandan society still has some improvements to psychiatric care and the stigmatisation surrounding it. Tomorrow we will be on the surgical ward which is completely out of our comfort zone and should be interesting.
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