Posted on: 13 March 2023

CNWL received a small grant from Health Education England (HEE) last year to help Mirembe Hospital, Tanzania’s national mental health hospital, develop a community based mental health care service.

Chris Bumstead, Coordinator for CNWL International Healthcare Partnerships, is out in Tanzania until April, delivering training and advocating for the resources and policies required to build this initiative. This is the second of several blogs Chris will share about his progress in Tanzania. 

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March 2023 

The HEE grant funded project at Mirembe has officially been finalised. I now need to complete the report for Tropical Health and Education Trust – the work continues!  

My CNWL companions, Paulina Diaz-Barriga Yanez and Sara Edwards, have now finished supporting me to train staff at Mirembe Hospital. This involved four-day training with our 16 “champions”, four days with 13 Mirembe staff, and two days at Kongwa and Kondoa District hospitals, attended by a total of 22 multi-disciplinary staff. Paulina and Sara returned the UK (and the cold!) on 17 February. 

The feedback has been excellent. Trainees really valued the expertise from Paulina and Sara, and the champions enjoyed training their colleagues, both at Mirembe and District Hospitals. The District Hospital staff were crying out for more training!  

Subsequent interviews with three champions assured us that the training had been pitched at the right level and that they’d learned more than they had expected to. This particularly applied to areas such as care planning, risk assessment and management, and the concept of working in and with the community – this is all very new to them and had not been mentioned in their professional training. 

Before leaving, Sara, Paulina and myself visited the Hombolo rehabilitation unit – so much had changed since my last visit in 2018. There are now four staff, who are accommodated in new housing.

The residential area for the six patients has been improved slightly and there are plans to refurbish existing buildings and build new accommodation for the patients. The unit is designed primarily for patients who do not have an alternative home to go to once they are discharged. This is often because they have no family or their family has rejected them as a result of their mental health or substance use problems.  

The focus of the unit is now geared towards economic sustainability and skills development for the residents. There are plans, once the new accommodation is ready, to introduce a number of new residents, which will expand the work that can be done.  

They have increased their livestock to include more cows, goats and chickens. The cows milk is sold at the new Mirembe shop, and there’s a field of sunflowers which, when harvested, will provide an income for the residents through the oil production. We were delighted to see residents becoming more self-sufficient in food production. Additionally, they now have proper electricity and a water supply, which can be supplemented (for irrigation) by the nearby lake. 

Now that Paulina and Sara have returned to London, they are still in touch to help with the ongoing work. The task ahead is to help Mirembe design and develop the community-based service. Eight new champions have been recruited including two doctors, two pharmacists, a psychologist, a physiotherapist and two nurses.

Four working groups have been formed to look at issues of documentation (initial assessments, care plans, risk assessments etc), referral criteria for the community service, team coordination and operational issues, and the ongoing training programme. These will form the basis of mentoring groups which we will run online with CNWL volunteers. 

In the final few weeks that I’m here, I will work with the working groups, arrange meetings with the Mirembe senior management team, meet with representatives from the Ministry of Health to hopefully get their buy-in, run some more workshops with Mirembe staff, and conduct a couple of focus groups with staff and patients to find out their needs. 

This is not a short-term project and is likely to take at least a couple of years before it is really established. We have to start slowly ensuring that everyone at Mirembe is “thinking community” and preparing their patients for discharge.  

We want to engage the key players at Mirembe and at the ministerial level and support the District hospitals through training to support patients so that they do not have to be admitted to Mirembe.

We want to provide more public education for patients, carers and the communities, and most importantly ensure that the needs of patients are foremost in everyone’s thinking. This will be the focus of the ongoing work of the Tanzania Link for the next phase of our partnership. 

We will be setting up mentoring groups to assist in the work ahead, so if anyone is interested in being involved in this please contact me at c.bumstead@nhs.net 

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