First two days

Image via WikipediaArriving

So you've got five days to teach the whole of psychiatry to a group of Sudanese doctors who you have never met before - how is that going to work and and how would I know? Well the first difficulty to overcome was getting into Sudan through immigration where it appears they did not have an original copy of my entry visa so I had to re-apply on the spot before they would let me in. This encounter however highlighted one of the major themes of being in Sudan and that is the relaxed outlook and friendliness of the people. Even the senior officer in immigration offered me a seat in his office whilst they tried to work out what to do with me and they reprocessed my visa. Can't imagine that happening in Los Angeles or Heathrow. An hour later and out into the 40 degree heat of a Sudanese Saturday afternoon and a three hour drive south from Khartoum in an air conditioned WHO 4x4 with three delightful Sudanese ladies two of whom, Freme (a clinical psychologist) and Najla (a psychiatrist), I would get to know well as the co-facilitators on the course. We arrived at about 5 at the Imperial Hotel at Wad Medani to meet up with Sophia the volunteer who had been here the week before and will be my teaching partner for the next week. Teaching runs from Sunday to Thursday so after a brief shower it was straight into planning for the next day whilst having an evening meal.

Sunday Day 1

The day gets off to a slow start with students not arriving until 9.30 although we had expected to start at 9. There was also it seems some confusion with the numbers as we were told to expect about 40 students but on the first morning there are only 17 present. The students are a mix of medical officers - doctors pre-specilialisation - and doctors in family practice. I understand that they are all doing a Masters Degree of which this teaching forms a part.

The room where we do the teaching is air conditioned - good - but the air conditioning is achieved by six fans and four air conditioning units which create a lot of noise making it difficult to hear and interact with the students. It's not impossible and I just have to remember to use the microphone. There is a data projector which we can link our laptops to and a raised platform where we can do the roleplays. There are also occasional power cuts so I always have to be aware not to rely on the PowerPoint presentations. On the first day Sophia bravely takes on most of the teaching whilst I do history and mental state examination. I introduce the students to a mnemonic BOAT PIS to remember the mental state examination which I think they find useful. A recurring theme is that despite the tsunami of emails and files associated with the course we have to spend a couple of hours each night editing the 'first draft' teaching material to ensure it is 'fit for purpose' and making sure that it is consistent with the MhGap curriculum.

A topic that came up today was about haloperidol in breast milk. A useful web sites is ToxNet from the US National Library of Medicine which contains a peer reviewed and comprehensive database on safety of drugs in breastfeeding.

Monday Day 2

Start the day with two hours on psychosis before breakfast at 11. Seems to go ok and the students are good at getting used to the language around delusions and hallucinations. A role play with Sophia helps to reinforce some of the lessons. After this trip to "police" hospital where the students divide in two and I meet Artif a middle aged man admitted two weeks previously after a violent episode at home. He is clearly hypomanic and has the students laughing along with him. He is currently on haloperidol 35mg a day (sic) but no mood stabiliser - he has these hypomanic episodes most years and puts them down to cerebral malaria (they are not). In the afternoon we focus on drugs and alcohol. It seems phenergan is used in the Sudan for extrapyramidal side effects.

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