Where is all of this going?

We have now moved to Wa, capital of the Upper West Region, and this was a six hour drive on dirt roads from our previous base in Bolgotanga.

Mental health development here is far behind many other parts of the country, mainly because it is so remote and infrastructure is so poor.

I’m conscious that in the past few entries I’ve talked at length about our day-to-day activities including some of the people and group’s we’ve met, but less about what we are trying to do.

One of the main objectives of our work is to help the Basic Needs team look forward and ensure their organisation remains relevant to the many aspects of helping the mentally ill. We are doing this by helping them develop their strategy for the next five years. For a team of three people with very little experience in working in healthcare (and none in my case), that has meant spending so much time just speaking to people and listening.

It is through this listening process that we have identified a number of themes and issues which we are now discussing with the Basic Needs team as to how they impact on the organisation going forward. Examples of themes include

* Fieldwork: continuing to expand the work in the field, such as encouraging the mentally ill to come together and form self-help groups. Our discussions in the Upper West Region highlight how far behind they are compared with, say, the Northern Region.

* Advocacy: working with the Government and the Health Service to encourage mental illness to be treated as a priority area and within the primary healthcare system.

* Sustainable livelihoods: treating the mentally ill is only one part of the equation – they also need to be re-integrated into their communities, for example by helping them gain employment to avoid them being always dependent upon others.

Examples of some of the issues that we are working on include

* There are only three psychiatric doctors currently operating in Ghana, principally because of a ‘brain drain’ to the UK, Germany and US (I heard a comment from the head of a hospital there are more Ghanaian psychiatric nurses in New York State than there are in the whole of Ghana!). Short of matching salaries with the developed world, can the country persuade doctors to return for a week or two a year, to attend clinics which Basic Needs could facilitate?

* There is a new law which comes into force at the end of the year which will require each Regional Hospital to have a ward dedicated to mental health with (if I recall correctly) 10 beds. I raised this with a hospital director who laughed at this – his hospital had no such ward and could not ever foresee one given his budget. It does represent an opportunity to take the government to task (it sets the hospital budgets, it also sets the laws), not necessarily to ‘win a test case’ but to raise the profile of the lack of mental health capacity.

These are just examples of the issues that we are discussing in order to shape the strategy for the next five years.

When we return to Accra at the end of next week, we will expand our work to cover the second of our two objectives: working with the Ghana Health Service to revisit a Community Mental Health and Development plan that was prepared in 2002 to ensure it is relevant to the new Mental Health legislation.

In the meantime we have also doing more training for Basic Needs’ partner organisations. Yesterday and today we ran a workshop for much of the day for organisations such as the health service (eg psychiatric nurses), the Department for Community Development, microfinance groups and a traditional healer. We covered the same areas as the training session last week (microfinance, business planning & project management, and cultural diversity), and whilst I am getting a bit bored of doing the same training sessions over and over again, they seem to be going down very well. Here is Jose-Luis talking about microfinance:

We’ve also been spending time doing more one-on-one coaching with different individuals we come across. It is very similar to coaching in the office environment, and the issues are often the same (such as ‘where do I go from here?’), just the context very different.

We will spend the rest of the week up in Wa, with a few more meetings (we will be seeing a traditional healer in action for the first time on Friday), but the rest of the time will be starting to bring the issues together with the Northern Ghana team. Next week we will then travel down to the Ashanti Region in the middle of Ghana before returning back to Accra in the South at the end of next week.

We are now about half way through this programme. When I look back on the last month, the most difficult time was probably the first couple of days when we first witnessed how some of the mentally ill are treated in communities beset by real poverty. The highlight? There are so many - from the warmth of the Ghanaians to the stories behind some of the individuals we have met. However, overarching this is the fact that I am working with a great team – Jose-Luis and Robbie are top guys and we’re having a lot of fun. This programme would be a complete misery if we didn't get on well, as we spend so much time together.

Finally here’s a picture from this weekend. We went with Adam from Basic Needs to a lake that had crocodiles in it – and forgot to shout “behind you!”