At Elective Africa, we know that one of the most rewarding and enriching experiences while in your medical school or mental health nursing program in undertaking your clinical rotation overseas. For those looking into undertaking psychiatry or mental health nursing placements, our psychiatry placements abroad give you an opportunity to get immersed in a unique healthcare system at Port Reitz District Hospital in Mombasa, Kenya.
Kenya’s mental health policy estimates that about 25% of outpatients and about 40% of in-patients suffer from mental health conditions. The most frequent diagnosis of mental illnesses made in general hospital settings are depression, substance abuse, stress and anxiety disorders. Mental health in Kenya is grossly underfunded, forcing most of those suffering from it to seek private treatment which is very costly. In cases where they cannot afford to seek treatment, they continue to suffer from the debilitating effects of mental illness. Kenya is among countries listed by WHO as lacking a separate health budget for mental health. (Hapa Kenya.Com, 2018)
A brief profile of Port Reitz Hospital
Port Retiz hospital is located in Mombasa, Kenya and is the second largest mental health speciality facility after Mathari Mental facility. The hospital has a 250-bed capacity distributed across the various specialities with a staff capacity of over 250 staff spread out across all cadres.
The mental health and substance abuse department has a capacity of 80 beds, with the approximate number of patients per day being 20 including the clinics for injections and medication
The taboo of mental illness in Kenya
For those who chose to undertake their psychiatry placement in our Mombasa, Kenya location, The system is also unique as you interact with a new culture, this way you get to learn how culture affects the delivery of healthcare. A good example which you will most likely to come across during your placement is that in countries like Kenya and Tanzania, mental illness is not really perceived as an illness by most communities. It is a belief that someone has been bewitched and therefore instead of most people seeking treatment from the hospital they turn to their religions for help.
“As people treat mental illness as a spiritual rather than a medical disorder, many victims go untreated”
It’s a sunny Sunday morning in Garissa, northeastern Kenya. Abdirahman Abdi Olow wakes up to check if his brothers made it home last night. Dressed in a white vest, he makes his way to his brothers’ makeshift room made of dry grass just metres away from his house.
“The chances of finding them in their room are unlikely,” says the 28-year-old as he opens the tiny iron-sheet door. “Sometimes, I find dogs sleeping in there since they’ve gotten used to its emptiness.”
This time, however, he finds one of his brothers, Aden, fast asleep. He turns him on to his other side and closes the door behind him. He heads back to his house and alerts his wife to prepare breakfast for Aden.
His two brothers, Hussein and Aden, have been suffering from mental disorders for nearly a decade.
‘It’s a medical problem’
Hussein, an agricultural studies graduate, was the breadwinner of his family before he was diagnosed with the illness.
One day, nine years ago, Hussein started to complain of headaches and of “hearing too many sounds”. Some days later, the 35-year-old stripped naked outside of his house.
“That was when we concluded that our brother was mentally ill. All this was new to us,” Abdirahman says, explaining how quickly the family was stigmatised. “People judged and made us outcasts.”
Aden became the family’s breadwinner, working night shifts as a security guard. But then, in 2011, he too fell ill.
“He started complaining of people disturbing him. This was followed by him talking to himself,” Abdirahman explains. “That was when I suspected that something was wrong with my brother.” Poor and helpless, the family started asking traditional healers to pray for the two men.
They had plans to take them to the Mathari Mental Hospital, the only public referral hospital for the mentally ill, but they could not afford it. “I know my Somali people stigmatise such people and don’t believe it’s a medical problem,” Abdirahman says. “I respect the religious way, but I cannot leave out the option of taking them to a hospital.”
“I wish I had money,” he adds, explaining how hard it is for the family to raise enough to pay for treatment.
Adopted from Aljazeera.com, featuring article “The taboo of mental illness in Kenya”
This is just one of the many cases that you are going to encounter while on your placement in a developing country and more so at the Port Reitz district hospital.
Sophie Turner, from Queen’s University Belfast shares her Psychiatric hospital rotation experience at Port Reitz District Hospital.
‘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, in 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 the 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 paediatricians 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 paediatrics placement at home was vast. A baby who had transposition of the great arteries was in a similarly 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.
If you are looking into undertaking a psychiatry placement reach out to us at electiveafrica.com/apply/ and one of our placement advisors will contact you and guide you through the application process