DR JOYCE NALUGYA SSERUNJOGI’S
COMMON WEALTH FELLOWSHIP REPORT 5TH OCTOBER 2009 TO 4TH APRIL
2010 HOSTED BY THE EAST LONDON NHS MENTAL HEALTH FOUNDATION
TRUST
REF: UGCP-2009-20
Introduction
As a consultant psychiatrist, this six-months professional fellowship has given me
great opportunity to experience a range of community and specialist child and
adolescent services in the UK, as well as to improve diagnostic and treatment skills
in a range of disorders in children of all ages with both the breadth and depth
required to train others, develop the planned Post –graduate Diploma in Child Mental
Health and provide the strategic overview and leadership required.
My placement has been related to the essential role i will fulfil on my return to
Uganda. I will be leading the development of specialist child and adolescent mental
health services at the Butabika National Psychiatric Referral Hospital and the country
at large. This is a big challenge but with team work and continued support through
the Butabika – ELFT link and the Uganda Ministry of Health as well as training others
in child and adolescent mental health i believe we shall be able to strengthen the
existing services.
This fellowship was timely and has given me great opportunity to improve on my
specialism in child and adolescent psychiatry as well as mental health of deaf people
and their families. I believe it will go a long way in helping us as we strive to
strengthen child and adolescent mental health services in Uganda.
Background to fellowship
Butabika Hospital – The State funded, National Referral Centre for psychiatric care in
Uganda is a founding partner of the Butabika Link, the training and development
collaboration with East London NHS Foundation Trust. This five year relationship has
been successful in creating training for all disciplines and in a range of clinical specialities
including post traumatic stress disorder and child and adolescent health. The Hospital,
itself is a hub for mental health development in Uganda providing experience and
teaching to all cadres of workers plus developing speciality expertise for wider use.
East London NHS Foundation Trust (ELFT)
ELFT is a UK mental health trust which provides services to the City of London, the
London Boroughs of Hackney, Tower Hamlets and Newham. The Trust also provides
forensic services to other London. ELFT provides a range of community, outpatient and
inpatient services for children and young people, adults and older people and operate
from 47 community sites, four main inpatient sites and have 660 inpatient beds. The
objectives of the trust include to ensure the meaningful participation of service users,
their carers and families in the shaping, delivery and evaluation of their care and the
future direction of services and to develop a highly skilled, motivated and culturally
capable workforce.
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My placement was at the Coborn centre for adolescent mental health in Newham, the
child and adolescent mental health East team (Emanuel Miller Centre) and the west
team at Greateorex street), Help4u (for looked after children) in Tower hamlets, the
paediatric liaison team at the Royal London Hospital and the John Denmark Unit in
Manchester for mental health services for deaf people.
REASONS FOR THE FELLOWSHIP
The main reason for the six months fellowship was related to the essential role i will
fulfil on my return to Uganda which is to lead the development of specialist child and
adolescent mental health services at the Nationaly focused Butabika Hospital and
the country at large.
Identified needs for child and adolescent mental health services in Uganda
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Need for Child and adolescent mental health policy and infra structure
Need for trained health personnel in child and adolescent psychiatry i.e.
psychiatrists, family therapists, psychologists, occupational therapists, social
workers- there is currently one child and adolescent psychiatrist
Need to establish community, rehabilitation and liaison services as well scale
outpatient and inpatient services for the children and adolescents
Education needs of the young service users need to be met
Research to inform policy makers is highly required
Need for access to the available services and to information
Study leave
I am so grateful to the Ministry of Health and the Jinja Regional referral hospital for
offering me a study leave for the six months.
OBJECTIVES OF THE FELLOWSHIP
Main objectiveTo acquire skills to enable me lead the strengthening of specialist child and adolescent
mental health services at the nationally focused Butabika Hospital.
Specific objectives:
a) Skill learning- to experience a range of community and specialist services as well as
develop diagnostic and treatment skills in a range of disorders in children and adolescent
assessment, medication, CBT, psychotherapy, behavioural management, family therapy
plus planning and evaluating interventions.
b) Gain understanding of multi agency working and child welfare issues- attending
weekly referrals meetings, professional and multiagency meetings as well as child
protection conferences
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c) Management skills- attend clinical and managerial sessions with consultant child and
adolescent psychiatrists
d) Develop the planned post graduate diploma in child mental health and provide
the strategic overview and leadership required- Develop teaching materials for teaching
and service development
e) Mental health and deafness orientation – start a mental health service for deaf
children and adolescents
How objectives were achieved (planned activities)
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Induction training
Academic PMs at the
Family therapy training
Workshops (family therapy, trauma workshops, CBT)
Conferences ( child protection conferences)
Attend court sessions
Planned placements ( inpatient, community, paediatric liaison teams and John
Denmark Unit for deaf mental health services)
- Liaison with schools e.g. Phoenix school for autistic children, liaison with social
care,
- developing materials for post graduate diploma
- visit a mental health unit for deaf people
Progress with activities
(i) Induction training at the Trust headquarters at East One (22 Commercial street,
E1 6LP)
This was a two weeks induction training including information on structures and policies
of the trust. Areas covered included the following:
- Working with service users
- Human resource development and staff motivation
- Communication skills
- Defensive media management
- Safeguarding adults and domestic abuse
- Trust policy and legislation
- Safeguarding children levels 1,2,3
- Risk management techniques
- Health ,safety and security
- The care programme approach- the frame work of multidisciplinary care
- Fire safety
- Infection control
- MAPA training ( break away skills at unit 8 kings wharf)
- Mental health act training 1983
- Part 3 of the mental health act 1983
(ii) Academic programs at the Institute of child health, 30 Guildford street, London
WC1N 1EH
I attended academic afternoons with the specialist psychiatric registrars (SpR) at the
institute of child health 30 Guildford Street. We discussed a wide range of topics as
follows:
- Drug treatment in autism spectrum disorders
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Chronic disability- learning disability(Dr Mosun Dorgu consultant child and
adolescent psychiatrist )
- Chronic disability – mental health and deafness ( by Dr Nicoletta Gentili consultant
child and adolescent psychiatrist national deaf child and family services, corner
house inpatient unit)
- Eating disorders in children and adolescents ( Dr Dasha Nicholls consultant
child and adolescent psychiatrist)
- Childhood disability: chronic illnesses , on call supervision( Dr Birgit Westaphal
consultant child and adolescent psychiatrist)
- Psychopharmacology1
basic
principles,
including
psychodynamics,
pharmacokinetics, and prescribing in child and adolescent psychiatry
- Attachment theory and attachment disorders (Dr Margret Dejong Consultant child
and adolescent psychiatrist)
- Long term sequalae of preterm birth (Prof. Neil Marlow , Prof of neonatal medicine
UCL)
- Base line investigations in psychopharmacology
- Developmental assessment (Dr Mirsada Smailbegovic- Consultant community
paediatrician)
- Giving feedback ( Dr Helen Stewart Consultant child and adolescent psychiatrist)
- Perinatal psychiatry (Dr Charles Musters consultant perinatal psychiatrist)
- Fostering and adoption ( Dr Margaret Dejong)
- Basic Psychodynamic theory ( Jill Hodges- Consultant Child psychotherapist)
Barts Academic afternoons
I had opportunity to attend academic afternoons at the Robin Brooke Center St
Barthlomews Hospital as outlined below:
1. communication in psychiatry- understanding communication essential for managing
behaviour problems associated with mental disorders; do deaf people hear voices?,
psychotic illness in people with hearing impairment; dangerous behaviour as
communication: a forensic case study; the pathoplastic effect of ASDs on the
presentation and management of psychosis
2. Trust Research and development day
3. Culture and psychiatry
4. Cultural consultation process- person centred interventions for culturally diverse
societies
(iii) Placements
The placements enabled me acquire a wide range of clinical as well as management
skills. The psychopharmacology meetings every three months where consultant child
and adolescent psychiatrists meet to discuss developments in psychopharmacology
and drug management of complicated cases e.g. conduct disorders, ASD etc were
very helpful. In addition research days at St Bartholomew’s university hospital and
CAMHS research days exposed me to research opportunities. More to that i
benefited from the wealth of knowledge and expertise from the consultants whom i
worked with for example attending Prof. Scott inaugural lecture with Dr Alyson Hallcan we improve parenting and benefit society- parenting interventions, Family court
session at East Croydon where DR Alyson Hall was giving expert witness as well as
working on the post graduate diploma. I describe here below the various placements:
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,
The Corbon Centre for Adolescent mental health (cherry tree way, glen road,
Plaistow, London E13 8SP) with Dr Rafik Reefat, Dr Navina Evans and Dr Ereni
Skouta
This unit was established in 2001 operated at tier 4 level. It has a 24 hour inpatient
service, operating a Psychiatric intensive care unit (PICU), a day service and acute
patient unit and a school. It’s a 12 bed unit with about 2 new admissions per week. Its
well equipped for the school programmes, occupational therapy, music and art therapies.
There are 2 consultant child and adolescent psychiatrists, 40 nurses and administrative
staff, teachers, psychologists, a family therapist, a pharmacist, occupational therapists, a
social worker. There are SHOs and specialist psychiatric registrars (SPRs). Each patient
is allocated a primary nurse who is responsible for his well being. All the staff have
access to information from the trust wide intranet which also makes communication
much easier. The activities include: hand over of patients at 9.00am every day, clinical
review meetings (equivalent to ward rounds in my country); Care program approach
(CPA) meetings, management meetings, patient tribunals, professionals meetings,
mental health assessments for the young people, community meetings, case
discussions.
I had good experience in managing psychosis, bipolar disorders, depression, attachment
disorders, emerging personality disorders, self harm, eating disorders, OCD, etc
Working at this unit helped me improve my clinical skills, management skills, managing
staff, proper documentation and data management as well as reporting, application of
the mental health treatment act, appreciate importance of school programme at the
inpatient unit, team work and linking with the various community teams, continued
training for all the staff, the CAMHs research day gave me opportunity and new ideas in
research.
Tower Hamlets CAMHS East, Emanuel Miller Centre, 11 Gill street with Dr Dorner
Hanspeter
This is a multi disciplinary tier 2/3 mental health service working with children and their
families. The service provides comprehensive assessment and treatment to children and
young people from a wide variety of cultural and ethnic backgrounds and with a high
level of deprivation.
The team includes two psychiatrists child psychotherapist, clinical psychologists, family
therapists, psychiatric nurses, social workers and administrators and interpreters.
Working with this team gave experience in assessment and management of key
conditions in child psychiatry including ADHD, ASD, emotional and affective disorders,
early onset psychosis, conduct disorders, etc as well as working with families.
I had regular weekly clinical and educational supervision with DR Dorner which involved
providing a good standard of practice and care, using results of clinical assessment to
ensure effective patient management, managing emergencies, maintaining good medical
practice, working with colleagues and writing reports. We put much emphasis on the
standards for better health that include: safety, clinical and cost effectiveness,
Governance, patient focus, accessible and responsive care, care of environment and
amenities and public health. The availability of a National service frame work and
National Institute for Clinical excellence (NICE) were very helpful.
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I had good exposure at working with Help 4 U a service for looked after children,
attending child protection conferences, attending family court sessions, home visits and
school visits as well as management of referrals.
Tower hamlets integrated service for disabled children (Wellington Way Centre, 1A
Wellington Way, Bow E3 4NE)
This is an integrated service for disabled children in the borough provided by
professionals from health, education and social care services building an effective joint
working process to meet the needs of disabled children and their families in a timely
manner.
This service is made up of : the children with disabilities team( provides social care
service to children and families), the portage team ( a home based teaching service for
children under 5 who have special needs, the child development team( provides
assessment and advise on care management of children with developmental difficulties
from birth to 19 years, the physical impairment team (consists of teachers who provide
education support service to young people with physical impairment or severe medical
condition) and the community children’s nursing team( specialist children’s nurses
provide nursing care to children and young people with nursing needs in partnership with
their parents), the school medical service(provided by community paediatricians and
school nurses- they assess school children who have health and developmental
problems that may impact on their ability to learn.
The Paediatric liaison team with Dr Birgit Westaphal (Royal London Hospital)
This team is made up of child and adolescent psychiatrist, child and adolescent clinical
and neuro-psychologists, child and adolescent social worker, clinical nurse specialists,
family therapist and bilingual co-worker (Bengali).
The team sees young people from age 0 to 18 years who experience psychological
difficulties adjusting to and managing medical conditions. The neural psychologist
specialises in the link between neurological conditions and a child’s development
learning and behaviour. Young people who present at hospital having self-harmed or
attempted suicide are managed by this team. This team like all others works closely with
other health teams and professionals. While at this placement i attended the paediatric
neurology clinic (manages epilepsy and other neurological disorders), HIV clinic with Dr
Anna who worked in Uganda for 3 years, feeding clinic, attended neuro- psychology
meetings, school visits, referrals meetings. i witnessed management of epilepsy and
complicated cases for example Rett’s syndrome, psychosis in cushings syndrome,
Duchene muscular dystrophy (DMD), Xeroderma pigmentosa and many more. The
importance of working with siblings of children with chronic illnesses is emphasized.
Adolescent Mental Health Team (Greateorex Street) with Dr Ruma Bose
This is a specialist tier 3 service comprising of a community multidisciplinary team
responsible for assessment and treatment of psychiatric and neuro developmental
disorders for young people.
These include psychosis, depressive disorders, ADHD, ASD, tourettes and complex tic
disorders, self harm and suicide attempts, eating disorders, OCD, anxiety disorders,
mental health problems secondary to abusive experiences, mental health problems
associated with physical problems and somatoform disorders. I was happy to follow up
young people i had seen at the Corbon.
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MENTAL HEALTH AND DEAFNESS SERVICES (Supported by Rodney Clark
Chairman Sign Health UK)
Sign health UK is supporting mental health and deafness services in Uganda
through sister organisation Sign Health Uganda.
The deaf world exhibition at Southampton Rose Bowl cricket square
I attended this exhibition together with Paul the development manager sign health
Uganda. Paul was doing his two weeks induction with Sign health UK. The exhibition
provided exposure to a total of 40 exhibitors dealing with different aspects of
deafness in one stop centre. We were exposed to a wide range of assistive devices
for deaf people e.g. Hearing Aids, fire alarms, door bells, loops and vibrating clocks
offered by Deaf plus and the Royal National Institute for Deaf (RNID). In addition we
interacted with people who offer services for deaf in education and family support.
Hampshire deaf association:
This organisation has various projects which include Fun for you which organises
play days for children and their families including hearing children in a school setting
during holidays; Happy Tots which is a project for deaf parents with hearing children
and hearing parents with deaf children. The parents get together and share
experiences; Deaf features project- supports young deaf people aged 16- 25
organising workshops to develop their life skills; Role model project- gives
opportunity to young deaf children to meet successful deaf adults and many more.
The National Deaf Children’s Society (NDCS):
This aims at creating a world without barriers for deaf children and young people,
campaigns for the rights of all deaf children and young people, working with parents,
teachers and other bodies they also produce materials for deaf friendly teaching,
parenting etc.
We attended Sign health and Sign Translate workshop on web based access to
health services for deaf people where the deaf can access interpreter services on
line.
The National Centre for mental health and deafness, John Denmark Unit
(Greater Manchester West Mental Health NHS Foundation Trust (Bury New
Road, Prestwich, Manchester M25 3BL)
Here i worked with Dr Hilary Vowels and the MDT that included deaf staff (Nurse and
psychotherapist and occupational therapist as well as hearing staff who are fluent in
sign language. I visited a sign health house at Urmston (community rehabilitation
centre for deaf people), attended clinical review meeting for the inpatients, shadowed
CPN on community visit, attended video conference with Dr Hilary, had sessions
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with psychotherapist and the sex offenders team, attended a paper presentation on
influences of maternal depression on early child development- a global perspective. I
also had orientation at the Gardener unit - forensic service for adolescents in same
hospital with Dr Andy Clark – consultant child and adolescent forensic psychiatrist.
Deaf Chid Worldwide and NDCS:
I was so happy to meet Julia Pecket and Katy McCoy with whom we discussed in
detail how to work with parents and families of deaf children.
Lessons learnt from deaf services:
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Like any other human deaf people also have mental health needs
We need to learn sign language in order to integrate mental health needs of
the deaf and their families into the existing mental health services in Uganda.
Deaf people can be trained to become professionals in health(Nurses, social
workers, occupational therapists, psychotherapists, etc)
There is need to develop and integrate deaf mental health services into the
existing services
Other activities:
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Butabika link activities: i participated in all Butabika- ELFT link activities
including work on the PCO BID which was successful; attending and
participating in link meetings, At the Butabika exhibition we were visited by the
minister for international development and we briefed him about child and
adolescent mental health services in Uganda which article was published in
one of the local news papers.
Common wealth activities:
The welcome day programme for common wealth scholars and new award
holders(9th November 2009) at west minister followed by a reception at
Lancaster house ( great opportunity for me to meet chairman Prof T Urwin,
Mike Bray, and others, interacting with other fellows, helped me discover my
hidden abilities.
The common wealth observance day observance at Westminster abbey
(Monday 8th March 2010). In the morning we had in-depth discussions of our
awards together with our award administrators at the British council. I was so
happy to meet and interact with Mike Bray, Mariken Schipper and Deborah
Benet from the common wealth scholarships commission as well as other
fellows most of whom had joined in January 2010.
The Cerebrations were very eventful, with songs of praise to God and prayers
from various religious denominations, attended by the Queen of England and
the Duke of Edniborough and other dignitaries and the promotion and
recognition of science and technology
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Leisure activities
Despite the busy schedule we often had time in the evenings and weekends to
visit some places and touristic attractions as well as meeting friends.
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The Stonehenge, eidnibrough castle, museums, west minister, Queens
palace, London eye, etc
Some parks and squares in London such as Piccadilly square, oxford circus
etc
The opera at the Lawry centre in Manchester and national theatre,
Shopping centres
Visiting friends in London, Shrewsbury, Edinburgh, Homewood park in Bath,
Leicester, Dartford, Barking, Bristol, oxford and many others
Feedback i got from my mentor and other Colleagues
This fellowship helped me discover my hidden potential! I could not believe when my
London colleagues described my professional expertise from my Uganda
experience, my approach to families and young people with calm, respectful and non
judgemental attitude and hard work and willingness to learn more was very
encouraging. I was liked by all teams which i also felt during my stay with the
different teams and always felt that i needed more time with the teams.
Changes i hope /expect to see in the service as a result of my fellowship
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A full time child and adolescent mental health service at the Butabika National
referral hospital
More trained health personnel in child and adolescent psychiatry at National
level
Decentralisation of services to the regions and districts through
implementation of integration of child and adolescent mental health services
into existing health services
Integrating mental health services of deaf people into the existing services
Multi disciplinary teams including paediatric liaison
Family support and groups formation
Access to information by staff (IT library) and to service users/families (flyers)
Ongoing support supervision
Ongoing research
More advocacy for funding from the government and partner organisations
Challenges:
The biggest challenge ahead of me is how to apply the skills and expertise from a
wealthy country to a country with limited resources! England has very good health
service which is accessible even by the poorest communities. The human resource
with the wide range of specialism and training of staff at all levels of care (tiers 1 to
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4), the salaries for health professionals, the good access to information and
technology, and the wonderful referral system facilitated by the good transport
network, ambulance, and policies in place have always left me wondering about the
implementations of services in our country. However with continued support from the
Uganda Government and other organisations i trust that the experience i have
gained from the UK will be very helpful as we work towards improving the existing
child and adolescent mental health service in Uganda.
Recommendations/ plans (short term and long term)
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Training more child and adolescent psychiatrists, clinical psychologists, family
therapists, social workers, occupational therapists, child and adolescent
psychiatric nurses and others from Uganda
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Continued support for the Butabika- ELFT link.
Follow up with the people i worked with in the UK after my return to Uganda
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I am so happy that there is an established Butabika- ELFT link which is
growing stronger
I will continue working with my UK colleagues through email and ongoing
consultation and reports, i have great hopes that the Butabika hospital
website will be utilised.
There is possibility of collaborative research and programs through the link
Overview of how the fellowship went
This fellowship was timely coming at a time when Uganda needs the specialism in
child and adolescent psychiatry. I was impressed by the assessment and
management of the common child and adolescent disorders skills in
psychopharmacology, teamwork, liaison and community as well as management of
the services.
Comments on the travel arrangements/ accommodation
I commend the British council staff in Uganda and the UK for the smooth travel
arrangements. I had no trouble with the UK boarder agency or the health department
and received money on my arrival at the airport with no problems. My award
administrators Mike Bray and Mariken were always helpful. My award coordinator
(Mr Cerdic Hall) was exceptionally good.
About accommodation i would have preferred an independent accommodation.
Other comments
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My fellowship came at good time for me to taste and experience three
seasons starting with end of autumn with the leaves turning orange and later
falling off from trees, and then there came the long awaited winter which
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locals described as the worst in the past 30 years! And the beginning of spring
with the daffodils’ and blossoming of the trees.
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I got a fair impression of preserving nature of all kinds
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The good transport network of all kinds: Air including air ambulances, Water,
Road and rail net works is amazing.
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Access to services including health, education, security by all communities is
worthy mention
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Despite all this many people live stress full lives with minimal social contacts,
there is excessive smoking on the streets, many don’t believe in God and
most church buildings are mostly touristic attractions with most religious
activities i attended were dominated by Black British.
Acknowledgements
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British council- for the financial and welfare support, the pre departure briefing
from the Uganda British council staff and information on the flash disc and
was particularly helpful
Association of commonwealth scholarships commission – for nominating me
East London NHS mental health foundation trustThe ministry of health- Uganda, Butabika and Jinja hospital management
My award administrators (Mr. Mike bray and Mariken Schipper)
Mr Cerdic Hall for the good coordination of the programme
My mentors (Dr.Dorner Hanspeter and Dr Alyson Hall) and all Consultant
Child and adolescent Psychiatrists and teams where i worked during my
placements.
My relatives and Uganda friends in the UK especially James, Faith, Carol,
Moses, Hilda, Vanessa and Hulda may God bless you
The Seventh Day Adventist churches at Holloway, Stratford, Becton
Mr Rodney Clark and the Sign Health Staff
Dr Hillary vowels and the staff at John Denmark Unit
The families of Alyson and Ferelyth for all the support
Last but not least my husband Josiah and children Dorcus, Deborah, Dan for
your continued support and encouragement throughout the fellowship.
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