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.

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!

"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.

Rescheduling of lectures

Hello,

The lecture from Prof Malone and Seamus McGuinness will now be held on May 31st.

Seamus

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

Forthcoming lectures

Over the next couple of months, the lectures will be:

April 19th - Professor Malone and Seamus McGuinness - Suicide

May 10th - Patrick O'Sullivan and Margaret O'Reilly-Carroll. Spirasi Ireland,- Mental Health and Asylum Seekers/Survivors of Torture

May 31st - Joe Little, RTE Religious and Social Affairs Correspondent - Mental Health and The Media

Note that Joe Little's presentation is conditional on the date of the general election being prior to the date of the lecture - I will keep you updated.

Spirasi Ireland are a group working with refugees/asylum seekers/survivors of torture and conflict situations - their website is www.spirasi.ie

Seamus