BackgroundThe lack of trained mental health professionals has been an important barrier to establishing mental health services in low income countries. The purpose of this paper is to describe the development and implementation of child psychiatry training within a graduate program in mental health for non-physician clinicians in Ethiopia.MethodsThe existing needs for competent practitioners in child psychiatry were identified through discussions with psychiatrists working in Ethiopia as well as with relevant departments within the Federal Ministry of Health Ethiopia (FMOHE). As part of a curriculum for a two year Master of Science (MSC) in Mental Health program for non-physician clinicians, child psychiatry training was designed and implemented by Jimma University with the involvement of experts from Addis Ababa University (AAU), Ethiopia, and Ludwig-Maximillian’s University, (LMU), Germany. Graduates gave feedback after completing the course. The World Health Organization’s (WHO) Mental Health Gap Action Program (mhGAP) intervention guide (IG) adapted for Ethiopian context was used as the main training material.ResultsA two-week child psychiatry course and a four week child psychiatry clinical internship were successfully implemented during the first and the second years of the MSC program respectively. During the two week psychiatry course, trainees learned to observe the behavior and to assess the mental status of children at different ages who had a variety of mental health conditions. Assessment of the trainees’ clinical skills was done by the instructors at the end of the child psychiatry course as well as during the subsequent four week clinical internship. The trainees generally rated the course to be ‘very good’ to ‘excellent’. Many of the graduates have become faculty at the various universities in Ethiopia.ConclusionChild psychiatry training for non-physician mental health specialist trainees was developed and successfully implemented through collaboration with other universities. The model of institutional collaboration in training mental health professionals in the context of limited resources provides a useful guide for other low income countries where there is scarcity of psychiatrists.
BACKGROUND: Acute loss of vision needs urgent attention and treatment. We report on a young Ethiopian woman who experienced acute bilateral blindness. In the presence of normal ophthalmological findings psychogenic blindness has to be considered. CASE DETAILS: A 21 years old woman was admitted to the psychiatry clinic at Jimma University specialized Hospital, Jimma, South West Ethiopia. She had not been able to see for a few days. Ophthalmological and neurological examinations showed normal findings. No severe psychopathology was found. Stressful life events had preceded the appearance of the symptoms. An attitude of accepting the perspective of the patient of a seemingly organic disease is a precondition for a successful intervention. Treatment aimed at a gradual return to normal functioning. The patient regained her sight and fully recovered. The final psychiatric diagnosis was psychogenic blindness. CONCLUSION: The psychosocial intervention was successful and encouraging for the patient and clinicians.
BackgroundEthiopia is a country in which child and adolescent mental health needs are often not met. In order to promote capacity building, a Collaborative International Exchange Programme has been established between Jimma University at Jimma, Ethiopia, and Ludwig-Maximilian University in Munich, Germany. The programme focuses on training non-physician health professionals in mental health speciality. One of the courses in the training programme, child psychiatry, involves a child psychiatrist and a children’s nurse supporting the management of a patient described in this case report. Its conceptual framework is based on the section “significant emotional and medically unexplained complaints” of the “WHO mental health GAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings”.ObjectiveThe purpose of this case report is to promote confidence in mental health professionals when managing patients with similar conditions, and to stimulate further evaluation of the conceptual approach in developing countries.PatientThe subject of this case report is a 14-year-old adolescent girl admitted to the psychiatric clinic at Jimma University Teaching Hospital. She was admitted for intractable retching, inability to eat, weight loss, and inability to walk. Challenges included the combination of medical and psychiatric symptoms, and the significant impairment of functioning in this adolescent. The first aim in the management of this patient was to guarantee vital functions. In a problem-oriented approach, different domains were addressed to restore nutritional, social, emotional, and motor functions. Treatment consisted of various elements of psychosocial interventions. The patient improved in 2 weeks and the final diagnosis was conversion disorder.ConclusionPsychosocial interventions can be developed in cooperation, and applied in a setting where little child mental health expertise is available. Case-based learning relying on local expertise is suitable in meeting local needs and in developing mental health services for children and adolescents.
Background: In Ethiopia, as many other low-and middle income-countries, health professionals, particularly of mental health workers are scarce. The purpose of this paper is therefore to describe the process of developing, establishing and evaluating a training course for child psychiatry within this program.Method: Cooperation between local and foreign institutions and instructors used to offer the course in child psychiatry between 2010 and 2019. The core elements of the course were to train mental state description from locally produced video examples, make decisions on possible disorders, do occupational activities and design psychosocial interventions. Patient-oriented method of teaching was implemented. The basic structures of course development were a phase of preparation, a focus on case presentations during the course, mutual feedback and evaluation, and a workup after the course. The concept in the method of teaching was adapted in an iterative process according to the needs of patients and evaluations of participants and teachers overtime. Results: From 2010 to 2019 eight courses were organized. A total of 71 trainees took part in the courses successfully. The initial step was to establish collaboration with guest lecturers and implementation of the teaching program. Each course contributed to expand the course materials subsequently. Main modifications were to elaborate on the mental state description successively to get a feeling for children's’ problems by age and severity. The second period was a phase of transition from guest lecturers to local trainers. At the request of graduates, a refresher course was held in 2017. Relying on an OSCE format, clinical abilities could be updated within one weekend. Capacity building was a major aim of the program. Three graduates developed to be trainers in child mental health and they subsequently continued the course on their own. Alongside the teaching program, an outpatient clinical service for children established by the lead author is now running at Jimma University.Conclusion: The establishment of the training program was time consuming. The long-term commitment of local and guest teachers enabled them to develop culturally appropriate solutions for the local context. A similar approach could be applied to other settings.
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