The Program

I had a very good meeting on Monday with the committee in charge of implementing a MS in Psychiatric Healthcare. They were very impressed with the curriculum I wrote for them. I did most of it before traveling to Uganda, as I knew I would not have access to reference material here. They had a few more questions regarding credits per course, clinical hours required, and staff qualifications. Of course, they don’t have the degreed instructors i.e. MDs, PhDs, and NPs that we do in the U.S. but will use locals with lots of clinical experience. The challenge will be for them to get funding for the psychiatric program. This will not be easy, as many sources within the US have dried up. Sweden provides quite a bit of support, sending doctors, financial aid and medicine. However, there are so many programs which are competing for financing, making the situation more difficult – not to mention the worldwide recession.

Aside from delivering the curriculum, I took a tour of the outpatient psychiatric clinic and the inpatient facility. Locals were lined up waiting for evaluations or follow-up visits. In patients are all in one dorm-style room with men and women separated. Most were being treated with Haldol, an antipsychiotic, to calm them down. The other drug used is a mood stabilizer, carbamazepine. Needless to say, they do not have the financial capability of providing SSRIs or many of the Atypicals we use in the U.S. In fact, there are only about 100 medications available in Uganda to treat all diseases, as opposed to thousands we have. This is consistent with the medical coverage. There are 7 psychiatrists in Mulago and 9 in Batabika Hospital (see below). A total of 28 in the entire country.

Most of the psychiatric patients are suffering from PTSD and depression. These patients do not have to pay for their drugs, unlike those with non-psychiatric conditions i.e. HIV, hypertension, strokes, cancer, etc. Patients arrive at the hospital due to an emergency situation, are evaluated based on whatever tests they can afford (if any)and prescribed medication, which most can’t afford to buy. They are then discharged to live as long as they can without treatment. So sad! The system here makes ours look like the gold standard!

I also visited another National Mental Hospital , Batatika, about 40 minutes east of Kampala. It is a beautiful facility in the country and seems to be very well run. The patients have access to the expansive grounds which are secured by high fences and guards placed strategically around the hospital. They all wear bright green shirts which protects any patient who is able to find a way out of the hospital. The police know not to arrest anyone attired in the green shirt but to return them to the Hospital. The average stay is 4 weeks, as most are compliant in taking their medications.

I was given a tour of the ward which houses the most acute male psychiatric cases and received 2 marriage proposals in short order. In fact, one of the men led me to his bed, hoping to consummate the anticipated union on the spot!!

Next entry: Time off to trek in Bwindi to see the gorillas.