There’s no getting around it, no pretending otherwise, I’ve done it now; I’ve crossed over to the other side. I may, inadvertently, be dressed like a student in my chinos and white collar shirt that matches the uniform of the male students here on campus. However, none of them are an obruni (white person) or going thin on top. It must therefore be true that during my two weeks at Ghana’s Kintampo Rural Health Training School (KRHTS), I will be someone’s teacher.
Of course, I’ve taught before during my ten years of psychiatry, particularly since I began leading seminars for junior doctors and medical students as a Specialist Registrar. That though has usually been for an hour or so and incorporated enough into my clinical duties to convince myself that I was only sharing information with less experienced colleagues.
Now I’m teaching at the start of a specialist 18 month degree programme for Medical Assistants (MAs) to become Medical Assistants in Psychiatry (MAPs) on a course that KRHTS are running in collaboration with Hampshire Partnership NHS Foundation Trust (HPFT) and the University of Winchester. The programme has been in development for over two years (see The Road to Kintampo blog) and their first cohort of students could – as the Project’s UK lead, Mark Roberts, puts it – be at the forefront of the country’s psychiatry service in a few years time. As in much of Africa, Ghana’s psychiatry services are extremely limited, in part due to a ‘brain drain’ of emigrating skilled workers. But if the MAP’s role becomes established, their numbers will soon overtake the 15 psychiatrists working in the country and they could potentially become a significant force in their own right.
All the MAs on our course have for some years been performing a doctor-like role of assessment and management with prescribing rights since completing their original 18 month, MA training at KRHTS. In some ways they do more than UK doctors as they often act without seniors, seeing medical and psychiatric patients of all ages. Some MAs who work in Ghana’s three psychiatric hospitals, all based on the south coast, complain (see Recognition for MAPs blog) that the term Assistant doesn’t accurately describe what they do. Those based in primary care clinics closer to Kintampo, which lies near the centre of the country on the Greenwich meridian, are less critical. It turns out though that all of my students are older than me, with families to support and during the week will dutifully attend classes between 7AM and 6PM, while sharing a student dorm with two others. Thus, it’s a significant undertaking and leap of faith for them to attend when it remains unconfirmed which institution will be awarding their degree.
Of course, I’m not doing it all alone. My fellow teachers are Clinical Psychologist, Tess Maguire and Community Psychiatric Nurse, Patrice Fugah; both working with HPFT. Since being recruited internally, this is their first visit on the Project though Patrice is originally from Ghana’s Volta region. They’ve been released from their duties to support this initial two week programme and may return for further teaching later in the course. As I was due to be in Ghana already on an Out of Programme Experience during my Specialist Registrar training – a placement arranged with the Royal College of Psychiatrists and Challenges Worldwide – I was invited to join them during these two weeks. Thus last Monday morning we introduced ourselves to our new class of seven students – including to Tess’ delight, one woman! – as mental health professionals who have been involved in continuing professional development throughout our careers. During my preceding ten days at Pantang Psychiatric Hospital, I saw the conditions that some MAs work under, often as the lead clinicians for scores of in-patients and more daily out-patients. Most MAs working in psychiatry have previously been psychiatric nurses and although they seem familiar with their work, from my initial observations, the standard and depth of their practice was variable.
Furthermore, in a country that emphasises its hierarchy, the MAs have to contend with a less than supportive relationship from actual doctors, who don’t always see them as colleagues. Their witnessing of their medical counterparts taking advantage of doctor-privileges like cutting out of full waiting room clinics, means that they haven’t always been led by example, or at least good practice. Some MAs in turn appear more dedicated to demonstrating their privileged status than their medical skills.
So far it’s been the psychiatric skills of the MAs working at Pantang and Accra Psychiatric Hospitals that my preceding colleagues from St George’s Specialist Training Programme in Psychiatry have supervised while on three month placements over the past three years. Its why I’m at Pantang as part of an ongoing UK presence to leave a sustainable legacy of knowledge, as well as my own training experience. And with classes at the Kintampo Project starting as well, it’s logical that I should come here to KRHTS.
In the days that follow, I’ll give presentations on psychosis and schizophrenia, mood disorders and psychiatric assessment which link in with Tess’ introduction to psychological concepts and Patrice’s account of community psychiatric services. I will reference these to the psychiatry that I’ve seen here already and Ghana’s more medical approach to mental illness. Similarly my presentation on critical research – a requirement for their later course work – uses photographs of Ghana’s direct roadside advertising; where houses are painted with the corporate colours and logos of mobile phone companies. It was agreed by all that they and their patients already have considerable expertise in distinguishing biased information! We also go on a field trip to visit a traditional healer and an Evangelical Pastor, the latter who treats his patients with shackles, starvation and prayer. Later, Tess and I will be invited from the audience of a campus seminar on ethics, to sit with an eminent panel on elevated chairs and speak to 80 young, future health officers. We will receive appreciation from our MAP students for our teaching methods of interaction and reflection. I will have been a teacher.
Still the question our students – who increase by two during the second week – most want to know is what will happen when we go next week? I question myself, are we Evangelist psychiatry colonialists coming with our own misplaced faith and plans to cut and run? Here, the purpose of our involvement is clear; to develop a sustainable teaching course that will continue to receive UK support during and after the MAPs graduate, before withdrawing when the Project is self-sustainable. Ultimately though, its future and those of our aspiring MAPs may well depend on whether the tutors respond to the input that our senior colleagues gave last week and if our students, with encouragement, can develop their own practice of life-long learning.
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