Over kinderen, hun psychische problemen, hun ouders en hun behandelaars.

A day in the life of a visiting child-psychiatrist in Addis Ababa – part 3

Henrikje Klasen took six months leave from her job as Head of Training in Child Psychiatry in The Hague, Netherlands, to move to Ethiopia with her family. There she supports the Psychiatry Department of the University of Addis Ababa in the development of their child mental health services. This week, she tells about some of her experiences in three posts on De Kennis – Blogs.

HK 03As my own projects and teaching have not started yet, I decide to spend the afternoon at the academic department at the Black Lion University Hospital, where a group of Canadian academics are teaching today. It is a fasting day today (there are more than 200 fasting days a year in Orthodox Christian Ethiopia) and most of my colleagues have brought their own packed fasting lunches. Therefore, I walk down to Arat Kilo Square by myself to get half a pizza on the way (another bit of Italian heritage).

The air and weather are unrecognizable compared to this morning. The sky is bright blue, the air crisp and clear, there is a slight breeze and it is, oh, so sunny. It is like the perfect summer day on the North Sea and the weather is like this almost every single day. I love this little walk around lunchtime, passing the National Museum, where 3 million year old Lucy reminds us that Ethiopia truly is the cradle of humanity, on to St Mariam’s Church, where people cross themselves on passing and all shapes and manners of Ethiopian crosses are being sold. I catch a mini-bus just before reaching the busy corner where newspapers are rented out for 10 minutes at a time to avid job seekers and others who cannot afford a paper of their own.

Addis Ababa University 50th anniversary

It is a brisk walk up-hill from the bus stop to Black Lion, past the heavily armed Libyan Embassy and the Red Star monument, commemorating the Derg (“Red Terror”) dictatorship during the 1980’s. The walk still leaves me breathless as does the climb to the six floor, where the psychiatry department is located (all lifts are out of order again) – The 2,500 m altitude need some getting used to. The department of psychiatry at Addis Ababa University will soon celebrate it’s 50th anniversary and is quite a success story. A Dutchman, Professor Giel from Groningen, who remains much revered, established it. For many decades it was staffed by a handful of dedicated psychiatrists who were either expatriates (often Dutch) or Ethiopians trained abroad. They did well in research and, starting in the 1960’s, participated in many international multicenter (mainly epidemiological) studies. These were the days when psychiatrists doubted the universal existence of illnesses like “psychosis” and wondered about the existence and expression of mental health problems in other cultures. They soon found out that while the expression and even course of disorders might show cultural variation, many severe mental illnesses and their epidemiology were surprisingly similar in much of the world. These studies put Ethiopia on the map of global mental health research and has remained at its heart ever since. The present PhD program is popular and successful; the department currently has 16 PhD students from various disciplines. At the moment the main concern is the huge mental health treatment gap, the difference between those in need of mental health treatment and those actually receiving it. At the moment this gap is about 90% in many low and middle income countries and WHO programs like the mental health global action program (mhGAP) try to address this. Ethiopia is one of the forerunners in its implementation and research on this method. Unfortunately they are only implementing the parts of mhGAP dealing with adults; children have been left out so far. Including children in the mental health care provision in this country, particularly in the mhGAP program, is very close to my heart; if I could contribute to this, I would feel very happy.

Psychotherapy is developing

Apart from research, the development of their psychiatric postgraduate training scheme has been a great achievement for the department. This started about 11 years ago and the training is supported by Toronto University, that send a team of two consultants and one resident three times a year to teach at the department for one month at a time. They also assist with curriculum development and the exams. They are here at the moment and the topic this month is psychodynamic psychotherapy and post-traumatic stress treatment. At the beginning of their involvement they were teaching large parts of the curriculum, now they focus on topics where few teaching resources are available in Ethiopia. Psychotherapy is one of these areas. I decide to attend a few of their teaching sessions to get an impression of the style and level of teaching. As the psychiatric teaching program is well taken care of, I am concentrating on developing child mental health teaching for pediatricians. There are many more pediatricians than psychiatrists; if all of them had a good base in child mental health, that would go a long way.

My journey back

I leave the hospital around 5 pm, as I have two minibuses to catch and want to be home before dark. The journey back is uneventful. I even get to sit in the front seat during my second bus ride – a rare treat. Back home my husband and daughter eagerly await me. My daughter joined the drama group at school and because they had started practice before our arrival an additional role was created just for her in the “Christmas Carol” – she is happy and excited about this. But Christmas is not the only event that is keeping us busy now, in late November. Sinterklaas has arrived in the Netherlands and our daughter begs to see his daily news online. Of course we oblige and so, after dinner, we watch the show on the iPad. During the final minutes we have a power cut. Thankfully the iPad is still working and we get the candles, before settling our daughter in bed. The power is quite reliable, but about once a week we have a couple of hours of candlelight in the evenings – quite romantic really.

Without electricity there cannot be any more work, so we just sit and reflect about the experiences of the day. My partner enjoys his new role as househusband after 38 years in the Dutch Navy and he has his own stories to tell: of night-guards, who want to read him their poetry; of school-children trying to practice their English with him, and of helpful Ethiopians making sure he doesn’t get ripped off in the market. We feel very grateful about being here and sharing some time with these wonderful people in this fascinating multi-faceted country. Just over one month gone and four months to go.

This article was also published in IACAPAP Bulletin 40 (February 2015).

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