Meredith Fendt-Newlin has just returned from a visit to Sierra Leone where she met with the nurses we trained in April to see how the Sababu model and intervention has impacted their practice. Here are her reflections on her visit.
“The training greatly helped me to know to connect myself and my clients to other people or organisations for support.” – Sierra Leone Mental Health Nurse
Developed over the past three years, Sababu is a culturally adapted mental health social intervention that we’re currently piloting with mental health nurses in Sierra Leone. Meaning “connections that may bring benefit” in one of the local languages, Sababu incorporates elements of enhancing a service user’s social capital such as building trusting relationships, communication skills with service users and families, assessing an individual’s assets in addition to their needs, and networking in the community.
Sababu Intervention model
In April we ran a five day training workshop with 20 mental health nurses, after which they returned to their posts in each of Sierra Leone’s 14 districts. Last week we brought the nurses back to Freetown for refresher training, supervision and a chance to hear how the Sababu model has impacted their practice.
Using case examples from the past three months we discussed ways in which the nurses have been using the Sababu model in their practice during a peer supervision activity. Splitting into small groups of three we asked one nurse to present a difficult case, one to play the role of the supervisor, and the third person to observe and provide feedback on what the nurse could do to improve.
Sierra Leone Mental Health Nurses presenting cases during peer supervision
This activity illuminated some of the many challenges currently faced by the nurses. In Port Loko, still an Ebola “hot spot”, fifteen young people experiencing mental health problems were recently found in a camp held by a local traditional healer, chained to small huts and with little opportunity to move or interact. Health authorities removed the individuals and the nurse in Port Loko is now working to reintegrate them back into the community. She spoke of skills learned in the Sababu training that help her to draw upon the local networks and build relationships to support the recovery of these young people. Her peers made suggestions about which services in the community she might be able to access and offered to be available for peer support as she manages this influx of difficult cases.
Disused signs from the former Ebola Treatment Centre at Jui Hospital, Freetown
Read more here about how the EVD outbreak has impacted our work in Sierra Leone.
One of the Mental Health Nurses, an EVD survivor, describing her recent experience with the disease
The role of traditional healers is still very strong in most of Sierra Leone, especially in the rural districts where they have been the main source of treatment for many years. One nurse based in an Eastern province struggled to be trusted by the community when she first arrived as a mental health nurse. During role play she shared the process she needed to take in her district to build relationships with the District Medical Officer, the traditional healers, and families by working in collaboration to support service users in the community. As we learned in April, giving the nurses an opportunity to practice new skills during role play is an effective way to translate theory into practice. And the nurses are brilliant actors!
Nurses during role play
With only 20 newly trained mental health nurses across the country the referral systems are yet to be fully established; in many areas more advocacy and promotion of services is needed. One of the nurses trained a small group of hospital-based general nurses in mhGAP and aspects of Sababu so they could recognise symptoms and refer to her as appropriate. The establishment of a skilled workforce through such ‘link nurses’ enables the mental health nurse to spend more time with service users and their families.
People have known for thousands of years that the best way to understand a concept is to explain it to someone else. “While we teach, we learn,” said the Roman philosopher Seneca. Feedback from the April training indicated the nurses wanted to have more experience, skills and resources to train others in the District Mental Health units (DMHUs).
Visiting the DMHU at Connaught Hospital, Freetown
With this in mind, we obtained funding from the University of York Learning and Teaching Forum to create a series of short training videos that will enable us, and the nurses, to teach others about Sababu and how to adapt evidence-based social interventions for use with service users from diverse cultural backgrounds. The training videos include interviews with the nurses and their supervisors role play and other training activities, and visits to DMHUs in Freetown.
Presenting nurses with Certificates of Attendance for the training; Researcher Meredith Fendt-Newlin wearing a dress that was a gift from the nurses for “Africana Friday”
The next stage of the research includes publishing the videos (check back on the ICMHSR blog for updates!), analysing and reporting findings from the evaluations, and looking at ways we can further adapt Sababu for use with social workers and Community Health Officers (CHOs) in Sierra Leone.