9 July 2025

Having completed a nine-and-a-half-hour road journey from Kahama in mid-west Tanzania to Dodoma in the centre of the country, you begin to appreciate the breadth of Tanzania. You also see how many people live in rural areas of Tanzania, and how difficult it is to get from one place to another. Road travel in Tanzania is not a comfortable experience and you can feel every bump and pothole in the road, and especially the man-made bumps which are designed as traffic calming measures.

As you enter every built up area or small village, there are road bumps (“sleeping policemen”) which you have to slow down for to almost 5 mph. Otherwise you risk destroying your suspension or throwing your passengers through the roof. These are often accompanied by a series of the equivalent of cattle grids, but instead of just making a noise as you pass over them they are raised ribs of tarmac which rattle your bones!

Going by Government Land Cruiser makes the journey a bit smoother and quicker because they do not keep to the speed limits and are able to pass through police checkpoints, often a great speed, without ever being stopped. But to get to different regions is still a long journey. This is particularly important for Mirembe in developing their community-oriented service because Mirembe acts as a national mental health referral hospital, taking referrals from all over the country. For patients, the prospect of a long journey to Mirembe from the far ends of Tanzania is not only daunting but unaffordable, resulting in many people not getting the mental health care they need. This is compounded by the lack of mental health resources at Regional and District levels, and a lack of knowledge about mental and substance use healthcare.

That is why Mirembe is now focusing on upskilling the staff at District hospitals so that they are more able to identify and respond to the mental health care needs of people who come to them for help. Mirembe has also embarked on a national mental health awareness programme “Afya ya Akili ni Afya” (Mental health is health) to attempt to educate the general public about mental health and well-being and tackle the rampant stigma and lack of knowledge surrounding mental illness.

The trip to Kahama was to attend the first-ever Tanzania Mental Health Summit, which attracted several hundred delegates from all over Tanzania, from Government healthcare facilities and NGO’s. What was significant about this summit conference was that the majority of the audience were young people under 30, very talented and committed people who are the future hope for the development of mental health services in Tanzania. There is an urgent need for all these statutory and NGO organisations to be collaborating with one another to make best use of the limited resources.

Sadly, my visit to Tanzania is coming to an end. I hope to return later this year together with some colleagues from CNWL to deliver some training in managing violence and aggression, and electroconclusive therapy (ECT). These have both been identified as priority areas by Mirembe. I will then continue some more training of staff at District hospitals in other regions of Tanzania together with Mirembe colleagues.

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