Hi all,
Hope you enjoyed the presentations yesterday - those of you who showed up! Perhaps I'll reveal my ruthless authoritarian streak to ensure better attendance in the Autumn (for we'll have no lectures on June 21st - in September things will kick off again!)
I had to go off myself for a clinic before Prof Malone and Seamus McGuinness' presentation - I'd hope to have something online from them before too long. I hope you found Joe Little's presentation stimulating - it was perhaps more an overview of a journalistic career and the intersection with mental illness in various stories that he covered, rather than a more didactic lecture.
There was lots to think about as a result of the presentation - in particular the realisation that in Ireland we are not all that far away, either in terms of time or distance, from a long-term ethnic conflict which rumbled on for centuries. We tend to forget how ingrained trauma can become. I remember being told (sorry I have no more reliable source than this) that many of the population of Belgrade are still on benzodiazapenes following the NATO bombings of 1999. I was also reminded of another thing I was told (clearly I'm not in evidence based medicine mode today!) that one of the consequences of the Famine and the century-and-a-half economic malaise which followed in Ireland was that Irish males tended to either emigrate of stay around doing very little, setting up a dynamic of Irish males being either hardworking but absent, or feckless but present - which has had knock-on effects on their interpersonal relationships to this day.
The other thing I took from Joe's presentation was this tension between protecting people and respecting their rights - for instance when he talked about the exposé of illegal moneylenders in the 1980s, and the reaction from some quarters that people should be allowed go to hell in a handcart if that's what they desire. This is the sort of tension we see in compulsory detention, for instance, and perhaps it goes to the heart of psychiatry. Unlike most psychiatrists (I reckon) I tend towards the libertarian end of the spectrum, but on the other hand no one can spend much time in psychiatry without realising that there are lots of people who are vulnerable to scams and frauds and do need protection. For instance, a lot of those fraudulent lotteries and get-rich-quick schemes that most of us just delete from our Inbox or go straight to the recycling bin, and read and taken up by people with cognitive impairment or learning disability.
I guess this tension is increasingly at the heart of politics too - we have gone from a left-right dichotomy to a more libertarian-authoritarian spectrum.
Anyway enjoy the weekend, see the current students next week and see the rest of you in September!
Seamus
Friday, June 1, 2007
Tuesday, May 15, 2007
Wells for Zoe
I'd like to refer readers of Psychiatry and Society to the following page: http://wellsforzoe.wordpress.com/. It is well worth a look. I mentioned John and Mary Coyne in my previous post; this is their blog. John and Mary are both former teachers, and John a developer, and they and their organisation Wells for Zoe have attached themselves to SJOG in Mzuzu, Malawi, in the past couple of years. (Mary teaches here.) Wells for Zoe began as a pump-providing operation - providing clean water to villages in the Mzuzu area, so women or girls don't have to walk ten kilometres with ten litres of water in a bucket on their heads. They still sink pumps but it has recently expanded into microcredit and other things - the recent blog entries describe a project, which the Coynes recently took me and Sharon along to, to drain and reclaim unused bog-like land, previously unsuitable for cultivation, and cultivate it using organic methods. (Fertiliser is expensive, and environmentally dodgy, and unnecessary). There's a recent John Waters IT piece on the blog too.
I mention this partly because it's just worth mentioning... and partly because it illustrates quite nicely how psychiatry and society sometimes mix in ways that you would not expect. Had SJOG, a mental health service, not been in Mzuzu, the Coynes would not have come here (they would have gone somewhere, not here) and the women you see in this picture, http://wellsforzoe.files.wordpress.com/2007/05/malawi-1-may-2007-059.jpg, shaking hands with Sharon, Mary and me (I felt like the Queen) would not now be growing carrots and tomatoes and peas and Chinese cabbage for sale in the market to make money for soap and oil and school fees. And the village chief, beaming in the background, would not have handed over a huge plot of his own land (not without a fight!) to a group of local women: essentially we're talking a feminist agri-co-op. The chief is the only local man in the picture; there were four guys there that day and a dozen women. Physical labour and indeed providing for the family remains predominantly women's work. The chief is the guy in, if you squint, the Beckham shirt. Beckham in Malawi is another post entirely.
I mention this partly because it's just worth mentioning... and partly because it illustrates quite nicely how psychiatry and society sometimes mix in ways that you would not expect. Had SJOG, a mental health service, not been in Mzuzu, the Coynes would not have come here (they would have gone somewhere, not here) and the women you see in this picture, http://wellsforzoe.files.wordpress.com/2007/05/malawi-1-may-2007-059.jpg, shaking hands with Sharon, Mary and me (I felt like the Queen) would not now be growing carrots and tomatoes and peas and Chinese cabbage for sale in the market to make money for soap and oil and school fees. And the village chief, beaming in the background, would not have handed over a huge plot of his own land (not without a fight!) to a group of local women: essentially we're talking a feminist agri-co-op. The chief is the only local man in the picture; there were four guys there that day and a dozen women. Physical labour and indeed providing for the family remains predominantly women's work. The chief is the guy in, if you squint, the Beckham shirt. Beckham in Malawi is another post entirely.
Thursday, May 3, 2007
Computer games and mental health
Hi all,
I remember my first job in psychiatry was with a general adult, community based team in ... well, perhaps I better not say. Most of the multidisciplinary team were ladies of, well, a certain age. There I was, new to psychiatry and with the paralysing shyness that comes with lack of clinical experience, somewhat dazzled in the team meetings. Anyway, the point of this nostalgic rambling beginning is that I recall that the team members had a pretty dim view of computer gaming. They might refer to a client/service user/patient's son as being a pretty likely future client/service user/patient themselves, based largely on their long hours of playing Championship Manager or whatever (I think I'm showing my age here)
It has been argued - most entertainingly by a chap called Steven Johnson in a book with the great title of "Everything Bad Is Good For You" - that computer games are part of a new, cognitively complex media landscape, that is in fact increasing our IQ and cognitive flexibility. You can read about this here:
http://www.wired.com/gaming/gamingreviews/commentary/games/2006/03/70487
and here:
http://www.wired.com/wired/archive/13.05/flynn.html?pg=1&topic=flynn&topic_set=
and indeed, here:
http://www.socialaffairsunit.org.uk/blog/archives/000687.php
"Fearfighter" is a program which "delivers" CBT over the internet - which you can read about here:
http://www.fearfighter.com/index.htm
You can read a less complimentary view of computer games here:
http://www.slate.com/id/2164065/
There is also a lot of interesting research going on about social networking websites and the like. It is interesting that there is a definite generational difference here. I am just too old to really "get" myspace and the like (and definitely too old for Bebo!) whereas the majority of you guys are presumably beboing away like mad. Whether this will have long term effects on social interaction or not, I don't know!
I remember my first job in psychiatry was with a general adult, community based team in ... well, perhaps I better not say. Most of the multidisciplinary team were ladies of, well, a certain age. There I was, new to psychiatry and with the paralysing shyness that comes with lack of clinical experience, somewhat dazzled in the team meetings. Anyway, the point of this nostalgic rambling beginning is that I recall that the team members had a pretty dim view of computer gaming. They might refer to a client/service user/patient's son as being a pretty likely future client/service user/patient themselves, based largely on their long hours of playing Championship Manager or whatever (I think I'm showing my age here)
It has been argued - most entertainingly by a chap called Steven Johnson in a book with the great title of "Everything Bad Is Good For You" - that computer games are part of a new, cognitively complex media landscape, that is in fact increasing our IQ and cognitive flexibility. You can read about this here:
http://www.wired.com/gaming/gamingreviews/commentary/games/2006/03/70487
and here:
http://www.wired.com/wired/archive/13.05/flynn.html?pg=1&topic=flynn&topic_set=
and indeed, here:
http://www.socialaffairsunit.org.uk/blog/archives/000687.php
"Fearfighter" is a program which "delivers" CBT over the internet - which you can read about here:
http://www.fearfighter.com/index.htm
You can read a less complimentary view of computer games here:
http://www.slate.com/id/2164065/
There is also a lot of interesting research going on about social networking websites and the like. It is interesting that there is a definite generational difference here. I am just too old to really "get" myspace and the like (and definitely too old for Bebo!) whereas the majority of you guys are presumably beboing away like mad. Whether this will have long term effects on social interaction or not, I don't know!
Friday, April 20, 2007
"you may not be interested in politics, but politics is interested in you"
When I was a medical student and indeed intern, nothing seemed more boring than the interminable stuff about contract negotiations and the like that filled the Irish Medical Times and the like. However as time goes by, these are more and more relevant. The new consultant contract has implications not just financially and in terms of private practice - the two areas most covered in the media - but on the whole independence of medicine and the ongoing quality of the medical services we deliver. I think it is worth reading the IMO's material on the consultant contract issue here: http://www.imo.ie/view_categories.php?cat_id=624
This is obviously enough not directly relevant to this course or your exams, but is an example of how medical practice does not exist in a vacuum - multiple other factors, from the imminent general election to an anti-professional, anti-expertise culture in wider society, affect this particular issue.
This is obviously enough not directly relevant to this course or your exams, but is an example of how medical practice does not exist in a vacuum - multiple other factors, from the imminent general election to an anti-professional, anti-expertise culture in wider society, affect this particular issue.
Rescheduling of lectures
Hello,
The lecture from Prof Malone and Seamus McGuinness will now be held on May 31st.
Seamus
The lecture from Prof Malone and Seamus McGuinness will now be held on May 31st.
Seamus
Tuesday, April 17, 2007
First post
Hi,
It's a few weeks since Seamus asked me to give one of the Psychiatry and Society lectures (I'll be speaking in October about psychiatry in the developing world) and to contribute to this blog, so I guess it's about time I wrote something.
For a first post I'll just say who and where I am and broadly what's going on in Malawi.
I'm Niall Crumlish, I graduated UCD in 1997, and started training in Psychiatry (Tallaght / TCD) in 1999. In 2003 I was special lecturer in UCD and St John of God's (from now on SJOG), and went on to a research fellowship in Cluain Mhuire / SJOG with Prof. Eadbhard O'Callaghan. In 2005 the research fellowship took me to SJOG in Mzuzu, Malawi. After I spent a week here setting up an RCT, my partner (Sharon Brady, a nurse in the addiction services in Dublin) and I decided to come back and spend 2006 here. We extended at the end of 2006, but our term ends in June.
Mzuzu is a town in the north of Malawi (pop. 100,000 odd). Malawi is a hugely densely populated country, but the northern region is not so. This is good in terms of food security, and bad in terms of services provided by the government (there are two tarred roads, and only one north of Mzuzu). You can imagine what government-provided mental health services are like. (In the 2004 World Bank rankings, Malawi was the the poorest country in the world for which there was data, with a gross national income per capita per year of 170 dollars).
In the early nineties a number of SJOG brothers took a trip around Africa, visiting sites in several countries, and decided that of all the places they had visited, Mzuzu was the place most direly in need of SJOG-provided mental health services. (At this time, as an aside, Malawi was in the death throes of a thirty-year brutal dictatorship.) One of the SJOG brothers, Aidan Clohessy, became director of the new service - that is, he built it from nothing.
It was, literally, all fields around here. The nearest mental health professional was 800kms away, in a then-medieval psychiatric hospital in Zomba, in the south. (It has improved.)
Now, the St John of God Community Mental Health Service comprises an OPD, a domiciliary care team, a forty-bed inpatient unit, a counselling service, a recovery and rehabilitation service (training and supported employment), a programme for street kids, a school for kids with learning disabilities, and (courtesy of Sharon) an outpatient drugs and alcohol treatment programme, established in August of last year. There's a College of Mental Health Sciences, providing degree courses in psychiatric nursing and counselling, and in 2008 the College plans to commence a BSc in clinical psychiatry - training much-needed psychiatric clinical officers, who are the equivalent of registrars in a country that has almost no medical doctors and only one permanent psychiatrist, Felix Kauye, who is based in Zomba.
My work has been as a clinical lecturer - mostly supervising the clinical work of clinical officers, and training clinical officers and others in diagnosis, management, basic sciences, whatever, with a focus on evidence-based practice. I have continued to run the RCT that brought me here in the first place - a trial of carer education in schizophrenia, from which we are beginning to publish. And with others I have been trying to build a research infrastructure here - partly because we know almost nothing about mental illness in Malawi, which is an enormously complex and rapidly changing country of 12-13 million people; also because training in research methods fosters critical thinking and diagnostic precision, hence improves quality of clinical care.
For anyone interested in what's going on here, I suggest Googling "SJOG Malawi". You'll find the (somewhat out of date) homepage for SJOG Mzuzu, and you'll find links to Venture Malawi and Wells for Zoe. These are two charities / homegrown, ground-level NGOs that have built links with SJOG in the last few years. Wells for Zoe (www.wellsforzoe.org) is an amazing project, run by John and Mary Coyne - you may have read John Waters in the Irish Times writing about Wells for Zoe in January, and if you didn't, you may see something soon in the IT, as John Waters has spent the last week in Mzuzu with John and Mary Coyne and Bro. Aidan, before rushing back today to the alternative universe of the Eurovision.
OK apologies for the length of this entry. That's the problem with blogs - no editors.
My email is niall.crumlish@gmail.com.
Enjoy your rotations.
Niall
It's a few weeks since Seamus asked me to give one of the Psychiatry and Society lectures (I'll be speaking in October about psychiatry in the developing world) and to contribute to this blog, so I guess it's about time I wrote something.
For a first post I'll just say who and where I am and broadly what's going on in Malawi.
I'm Niall Crumlish, I graduated UCD in 1997, and started training in Psychiatry (Tallaght / TCD) in 1999. In 2003 I was special lecturer in UCD and St John of God's (from now on SJOG), and went on to a research fellowship in Cluain Mhuire / SJOG with Prof. Eadbhard O'Callaghan. In 2005 the research fellowship took me to SJOG in Mzuzu, Malawi. After I spent a week here setting up an RCT, my partner (Sharon Brady, a nurse in the addiction services in Dublin) and I decided to come back and spend 2006 here. We extended at the end of 2006, but our term ends in June.
Mzuzu is a town in the north of Malawi (pop. 100,000 odd). Malawi is a hugely densely populated country, but the northern region is not so. This is good in terms of food security, and bad in terms of services provided by the government (there are two tarred roads, and only one north of Mzuzu). You can imagine what government-provided mental health services are like. (In the 2004 World Bank rankings, Malawi was the the poorest country in the world for which there was data, with a gross national income per capita per year of 170 dollars).
In the early nineties a number of SJOG brothers took a trip around Africa, visiting sites in several countries, and decided that of all the places they had visited, Mzuzu was the place most direly in need of SJOG-provided mental health services. (At this time, as an aside, Malawi was in the death throes of a thirty-year brutal dictatorship.) One of the SJOG brothers, Aidan Clohessy, became director of the new service - that is, he built it from nothing.
It was, literally, all fields around here. The nearest mental health professional was 800kms away, in a then-medieval psychiatric hospital in Zomba, in the south. (It has improved.)
Now, the St John of God Community Mental Health Service comprises an OPD, a domiciliary care team, a forty-bed inpatient unit, a counselling service, a recovery and rehabilitation service (training and supported employment), a programme for street kids, a school for kids with learning disabilities, and (courtesy of Sharon) an outpatient drugs and alcohol treatment programme, established in August of last year. There's a College of Mental Health Sciences, providing degree courses in psychiatric nursing and counselling, and in 2008 the College plans to commence a BSc in clinical psychiatry - training much-needed psychiatric clinical officers, who are the equivalent of registrars in a country that has almost no medical doctors and only one permanent psychiatrist, Felix Kauye, who is based in Zomba.
My work has been as a clinical lecturer - mostly supervising the clinical work of clinical officers, and training clinical officers and others in diagnosis, management, basic sciences, whatever, with a focus on evidence-based practice. I have continued to run the RCT that brought me here in the first place - a trial of carer education in schizophrenia, from which we are beginning to publish. And with others I have been trying to build a research infrastructure here - partly because we know almost nothing about mental illness in Malawi, which is an enormously complex and rapidly changing country of 12-13 million people; also because training in research methods fosters critical thinking and diagnostic precision, hence improves quality of clinical care.
For anyone interested in what's going on here, I suggest Googling "SJOG Malawi". You'll find the (somewhat out of date) homepage for SJOG Mzuzu, and you'll find links to Venture Malawi and Wells for Zoe. These are two charities / homegrown, ground-level NGOs that have built links with SJOG in the last few years. Wells for Zoe (www.wellsforzoe.org) is an amazing project, run by John and Mary Coyne - you may have read John Waters in the Irish Times writing about Wells for Zoe in January, and if you didn't, you may see something soon in the IT, as John Waters has spent the last week in Mzuzu with John and Mary Coyne and Bro. Aidan, before rushing back today to the alternative universe of the Eurovision.
OK apologies for the length of this entry. That's the problem with blogs - no editors.
My email is niall.crumlish@gmail.com.
Enjoy your rotations.
Niall
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