BLOG ARCHIVE 2015-19
The week has rushed past and Lesley and Simon are back from Chipata-they got a 5.0 am bus (7 hour journey) and actually managed to arrive by in time to join us at the Dutch Reform Church monthly Market yesterday and enjoy the array of wonderful things to buy. I have to say I have set myself a few packing issues for the return journey! They were even up for an evening at Modzi Arts listening to 70s Zambian music - some stamina.
The training has again been full of surprises and the trainees have used their wide experience to enrich the learning for us all. We have been using role play a bit more in some of the experiential art work and this has proved very fruitful for all.
As we are working with the ToT ( Training of Trainers) trainees we have had to apply more detailed attention to structuring the content of the training and this has proved to be a very valuable exercise but it has also been reassuring in that it seems as though it will be possible to produce a model that can be replicated without becoming too rigidly manualised.
We are getting to the stage in this trip when we have to start arranging all the meetings and feedback sessions to report to the Institutions and the Ministry so that planning for the next developments can start. The endings always seem to come in a rush.
Lesley has changed her return flight so she will be here to help with most of the evaluation and assessments. These again we have adapted in light of experience and in planning how it can be most effective in different settings.
We sadly say goodbye to Simon this week as he is off back to the Scottish winter. I am sure he will be posting about his impressions but another head and pair of hands has been a great asset.
So another week over. It goes so fast! We have had two weeks full training at both UTH and Chainama and continue to be completely absorbed by the directness of the responses to the training both from trainees and the patients who attend in Chainama. Simon as a newcomer has shown great resilience and taken over bits of training,spent a long time reconstituting the raw clay provided for us by one of the trainees and generally keeping Lesley and I focused.
The three people who have joined us in the Training of Trainers piloting have already contributed ideas and responses. This included a wonderful energiser exercise which had the whole UTH group and trainers moving round in a circle rhythmically chanting and having to incorporate spelling our name when picked on. There have been days when the rain has been heavy and prolonged in a way completely different from at home, Simon - who despite advice - did not bring an umbrella very nearly didn't get any breakfast as it was too heavy to get from his room to our house! One training group at Chainama managed to get to the OT building but it would have been impossible to get patients across so the morning was spent very productively in art exercises, reflection and case sharing. Lesley has been gallantly working on the revisions required by the Ethics body and got them submitted - hopefully we will hear on Monday - this for using the feedback data from trainees for analysis and publication. Apart from work we have had an evening in a bar listening to music from a friend's band - great sounds! - a meal with another friend at the wonderful Lebanese restaurant nearby and last Sunday we went out of town a way and saw the orphaned baby elephants at the David Shepherd rescue park. They are entrancing and the long process of re-wilding them once they are fit is impressive. so we are managing our work life balance. Next week Lesley has some work in Chipata and it seemed a good opportunity for Simon to see something of the country - so they are off on the bus on tuesday and Simon is going to spend a night at South Luanga Park. Meanwhile I am left running the training! with the help of the 3 ToT trainees, actually midway through as we are the routine and course content is quite well established. But time will tell. A postscript - I started posting this blog on Friday, only now has the internet connection allowed it!
And quite a week! It has been really good meeting again so many people, friends from before and new people interested in what we are doing and wanting to join in. Meeting the new trainees both at UTH and at Chainama Hospital is always fascinating. They are so prepared to share their responses and experience and we learn so much from them.
We are working with three great ex trainees who are shadowing us this year to help us look at how the first stage of Training of Trainers can be shaped and already in the first week they have contributed new ideas.
The OT department at Chainama is familiar territory now and we were made welcome and furniture and the technology was all provided. It was great during our first practical session with patients to see 19 people all working completely silently absorbed in their art making.
Today we have met again with MHUNZA and ZAFOD, two key psycho-social, intellectual and physical disabilities rights organisations to learn more about their current work and update them on our plans.
Life at Gossner continues to be peaceful and refreshing. I have not been here before when everything has been so green and lush - it is all very different from the baking heat of my last visit. I am writing this listening to the steady fall of rain on the veranda and dripping off the leaves.
We have managed to feed and entertain ourselves after work but I think I speak for all of us when I say this first week though productive and encouraging has left us pretty tired every evening.
After a fraught series of flights and lost luggage, we three ZTA trainers (Lesley Hill, Joanna Pearce and Simon Willoughby-Booth) have arrived in Zambia to run two training courses at University Teaching Hospital Department of Psychiatry (UTH) and at Chainama Psychiatric Hospital between 10th January and 21st February 2017. We spent the first 4 days going over the teaching materials and course documents to refine and update the course content. We have had meetings with key staff at UTH, Chainama and the Chainama College of Health Sciences. There will be 20 trainees at UTH, a mix of neuropsychology and mental health nursing students and we have 3 potential people starting the next stage of the course to become trainers themselves. At Chainama the course will also have 20 trainees drawn from nursing, medical, clinical officers, psychologists and ward assistants. At Chainama we hope that we will have potential trainers able to start second stage training later in the year. Our aim is that we will be able, over time, to train sufficient local trainers in Zambia for the Therapeutic Art training to become self-sufficient and no longer dependent on outside trainers. We are staying at Gossner Mission in Lusaka again and it is an ideal base for both planning and relaxing during the training. Lesley and Joanna are experienced Zambian hands but this is Simon’s first time here (so they are having to hold his hand a lot of the time). For a first time visitor, Zambia is confusing, noisy and pretty hard to understand, superficially very like many parts of the European experience but at the same time, so totally different. Having said that, our contacts in health services here have been preparing for the work to begin and are really enthusiastic about its impact it has already had for staff and patients. Our first training session starts tomorrow.......
We suddenly realised that looking at this Blog you would think we have done nothing over the year since Lesley came back from Lusaka - we have however been pretty active. It was clear from what she came back with that there was support for consolidating the training through Training of Trainers (ToT) but that we still had a lot to establish and to learn about delivering ToT.
We also needed to explore funding both for more feasibility work and the longer term plan that hopefully would emerge. As part of this I attended an All Party Parliamentary Group on Global Health ( Mental Health ) meeting in February which was focusing on how to make INGOs aware of the importance of Mental Health in sustainable development- really useful material in the report and in the paper "10 things you need to know about mental health". In some ways it was reassuring to find that larger well established INGOs were finding it hard to attract funding for mental health - not just us!
I linked us to MHIN ( Mental Health International Network) and the recent launch of MHIN Africa which hopefully will help to keep us in the loop!
ZTA is also now a member of Zambia UK Health and Workforce Alliance (ZUKHWA) and Lesley joined their conference in May ' Measuring Effective Partnerships',
We joined a THET webinar on Training of Trainers. These events have provided us with some useful models and learning from other programmes which we will be able to put to good use in our future plans and inputs.
We are expanding too - Simon who joined as Trustee and has - thank goodness taken over the role of Treasurer has been generally making us more organised technically and he is looking forward to being part of the January trip. We have also met up with another Art Therapist with good relevant experience who is interested in in joining us in 2017 later in the year.
We arranged a full Board meeting in August borrowing a lovely chalet in Aviemore - situated in woodland by a burn and where we were rewarded by sight of a red squirrel leaping past the window!
Sadly Beverley had car issues at the last moment but was able to join us on skype particularly to share her experience of different training and assessment approaches.
Lesley and I gave a presentation and workshop for the Art Psychotherapy trainees at QMU Edinburgh which was very interesting as we focused on how the most simple art making activity seems to open communication, good feed back from them and useful for us!
We have stayed in close contact with our colleagues in Lusaka, helping to plan how we go forward - great support as always from Sylvester in MHUNZA- and getting things set up to deliver training at UTH and Chainama in the New Year.
We have had further support from MAITS ( Multi Agency International Training) who have agreed yet again to give grants to us all which helps greatly towards our flights and without which this January trip would be impossible.
MAITS Capacity-building for Disability and Mental Health
Anyway we have flights booked for January, rooms booked at Gossner Mission - managing to secure the same 2 bedroomed small lodge so we can use that as a good working base - back to sitting on the veranda to review the days progress. At least it won't be so hot this time - maybe a bit wet still but that is always good for the emergence of interesting wild life of the creepy crawly variety. The future is generally looking really positive and we can now see how the next few years could pan out.
Having spent the last few months in the UK taking stock of our work so far, having our AGM, meeting up with other ZUKHWA (Zambia UK Health Workforce Alliance) members and generating enthusiasm and support from several quarters, we are now in the process of planning our next steps for the Zambia Therapeutic Art training programme.
As an NGO we are very keen always to learn from our Zambian partners to ensure that our development plans can be both practical and sustainable. (Too often we hear of programmes biting the dust because of a lack of really addressing what is needed and what is possible).
Hence the reason for my (Lesley's) current 3 week visit to Lusaka to explore the best ways forward. Finding the best and cheapest route to get to Lusaka is the first task. In the past direct flights to Lusaka from London with BA or direct flights from Amsterdam with KLM were possible, but these have been cut, meaning that a change is always needed somewhere en route. Emirates turned out to be the best option this time. This was a new experience for me flying via Dubai - very interesting to see from the air; but not a place I felt inspired to visit.
Lusaka in June is also a new experience. This is the 'cold' season - and Zambians are shivering with the contrast from the norm. Indeed at night it gets cold enough to put on a fleece, but otherwise its mostly sunny and warm through the day 20 C at least - so coming from Scotland its on the par with pretty good summer weather - and with no chance of rain. June is also avocado season so the thump of falling avocados on the tin roof overnight, guarantees breakfast - delicious and unlike the under-ripe efforts in supermarkets at home.
Zambians are due to go to the polls on August the 11th so there is much political activity in Lusaka and despite the occasional loud throng getting a bit over heated, Zambia is keeping to its excellent reputation of peaceful elections.
Linking up with our partners at the hospitals has been very straightforward and all have been most welcoming and immediately recount both how useful the training has been and that they are using art in their everyday practice with patients and clients. In one interaction I was shown a picture done that morning by a boy whose drawing clearly showed that his sense of insecurity was derived from multiple changes of care givers, and that his best friend at school was his most consistent in his life. This information helped the doctor guide the family in the need for consistent care from now on and also the importance of keeping him at the same school as his friend.
I have been able to set up a number of meetings for the planning discussions. A key element of the discussions is our wish to 'train trainers' so that the Therapeutic Art course can be delivered by Zambian mental health professionals and be rolled out more widely. Already it is looking that we can start training trainers on our next training visit which will be in January 2017. So far so good....
So these last few days are rushing by - so many leads to follow and plans to make and it doesn't seem to be any cooler!
We got back on Monday from Kafue Park where we had spent a wonderful 2 nights - a mixture of excitement and serenity! Just for the avoidance of doubt for all our supporters any recreational time or activities is not seen as part of ZTA time! Though we did take some work with us!
Anyway a wonderful place -Mayukuyuku Camp -and a very close sighting of lions and a bit too close of an elephant who chose to feed on the trees 3 feet from our tent at 2.0 am! Birds just amazing and a glorious evening boat ride. Really nice people with a wealth of knowledge and great food.
Back here we have caught up with key players in planning the next possible developments and looked through the art work and notes to start the process of evaluation which will go on at home. At UTH we had our final supervision session and were assured that the group will continue to meet as it fulfils a real need as support and learning for all their work.
The certificates were presented by Dr Paul, Head of Psychiatry who has been so supportive of the work and its continuation. At Chainama as well there is a determination to get a module designed to fit in the curriculums at the College, all very encouraging - more work!
We presented at a Seminar yesterday at UNZA School of Health Promotion who are very interested in creative communication approaches. Certainly when discussing the art exercise we gave them there was a lot of communication going on!
It will be sad to leave Gossner where we have been so much at home and the mangoes here still are not ripe! Off into the sunset!
Just writing this today as we are off to Kafue tomorrow for a couple of nights hopefully to see some large cats - but not too close - and for some out of town experience. So we are just back from various meetings and an exciting visit to the bus station to get our tickets for the journey.
The heat makes everything very tiring to us northerners and just seeing the temperature at home is 9 degrees not the 34 we have here makes me quite jealous!
The week has been gratifying and busy. Lots of contacts about the future to follow up and time reflecting on the evaluations. There has been so much hard work and really interesting response from the trainees in both locations. A great deal about the change in relationship and communication, a real emphasis about how hidden stories emerge and how people find a voice through the art . Also in writing about their own art making the trainees have shown great insight and honesty about what it has meant for them and consequently how important it is for their patients.
Tuesday was the day at Chainama to present the certificates and celebrate everyone's achievement. Dr Phiri the Senior Medical Superintendent, presented the certificates accompanied by senior staff from all departments. The art work and notes were on display and much interest was shown.
At the end - much to our surprise we were presented with a beautiful framed art work by Margaret who the very talented lady based in the OT department who has been our great support this year and last. Then in addition a wonderful Zambian dress each in the national colours again made by the tailors in OT Esther and Belita. It was very touching and I hope we were able to convey how much we have learned from all of them. There does seem to be a real determination to support and develop Therapeutic Art practice in various ways. We also had chicken and chips provided again for all.
We came home later to a wonderful meal of kapenta - tiny dried fish, nshima and vegetable relishes cooked by a friend who is staying here - Quite a day!
We had also to get ready for UTH and supervision and possibly presentations there and going through the evaluation with Dr Paul. We did not get the presentation done but got some really useful feedback and advice about the way forward from Dr Paul and an agreement to do the presentations next Wednesday as so many folk were not able to be around. The ongoing Therapeutic Art supervision group is a really informative process and the intention is to keep it going once we have left.
Thursday was continuing with planning, following up contacts and going though the work and notes. The day goes really quickly. You have to start early to make the most of the cool part of the day and keep yourself going through the heat with the help of fans and mangoes!
Today we had another follow up meeting with Sylvester at the posh shopping centre he uses as an office! Learning more about his plans and projects and seeing where our work overlaps. Very productive. So now we are packing - the forecast is that the rain will start but the bus journey promises to be hot.
So again this week has rushed by - I had determined to write up on Friday which was supposed to be home based day reflecting on all the amazing evaluation and assessment data we had gathered from both training sites earlier in the week -BUT an early morning and somewhat cryptic series of communications from Sylvester - from MHUNZA - we found ourselves rushing to a symposium to mark Dignity in Mental Health Day held at Chainama. I've never seen Lesley move so fast as she switched from domestic to public dress! It turned out to be a really useful and informative day and included a chicken and chips lunch! We were welcomed with true Zambian generosity as we were not on the official guest list.. There were presentations from the Ministry, Care providers and Users and from the Hospital itself. We got a picture of the planned developments in the service and the Hospital but also a perspective from the staff side, the area health providers and from Human Rights, service users and Legal Aid perspective. All in all we gained a much more rounded picture of the present position of the service and its aims and aspirations. So much hope is pinned on the passing into law of the Mental Health Act which is due for its first reading this year and which will provide the framework to support the planned growth of the service. The day also gave us the opportunity to meet with some of the key people we had on our list to contact -including two senior staff we had worked with last year- and so were able to confirm a planning meeting to discuss the future of the work in Chainama. So we got home late afternoon too overwhelmed to do much but reflect, cook and sleep!
Then yesterday the solar power system had a relapse and we were without power for most of the day. We spent our time struggling with our plans for the future - trying to define our aims and make best use of all the support we are receiving here. We rewarded ourselves with a walk to the road end, short minibus ride and a meal at the wonderful Lebanese restaurant with a friend who is staying here briefly and some newly arrived VSO workers.
To go back to earlier in the week - Monday was the last patient group in Chainama. A good and productive session again with a range of patients and ways that the time is used. Tuesday was full on! all the Chainama trainees turned up and we spent about 2 hours on the reflective evaluation which ends with trying to arrive at what they consider the most important changes for them and the patients. So much material. The Hospital sent someone to video the process but in our group we were so absorbed we barely noticed him. We will see the result next week! Most trainees chose to take the short written assessment and we spent the afternoon marking them which turned out to be not so daunting as the system we had worked out did seem to be effective..
Wednesday at UTH as well as a supervision session we went through the same process of evaluation and assessment . Ending the afternoon with a somewhat exuberant art group! The scribble warm up technique has really grabbed the imagination! More marking!
It is worth saying here that the temperature has dropped significantly by a good 15 degrees in 24 hours so we have had to resort to socks and digging out the fleeces. By the end of the week it had climbed back up to a pleasant mid to high 20s - but no real rain just one heavy shower.
Thursday was again full on and we were only able to survive it because of the lower temperatures. We had a productive follow up meeting at the Ministry of Health - more planning to do! We found a small print shop in a market area where they do colour and can print on card - so we sat in a café and finalised the wording for the various certificates then this poor guy spent over 3 hours getting the printing sorted.
We sat there for a while tantalised by the smell of all the food being prepared on the stalls around us but we had to leave him to finish as we had to go to the University Medical School to meet with a Lecturer in Public Health who Lesley knew of through her research. He was very enthusiastic and helpful with information and contacts and signed us up to do a presentation at one of there weekly seminars. So you can see why Friday was so needed as a consolidation day! What will next week hold.
Well, already we are over half way through the training and it it so good to see how the trainees are really grasping how useful art is for helping communication and understanding. Hospitalized patients frequently express their appreciation in having the opportunity to join in the art group --- away from the ward for an hour or so, and with some 1.1 time with a staff member. I particularly feel for the younger ones who may come -- teenagers who are missing home and school. At least in the group they have the chance to do something familiar - drawing and writing.
Groupwork has been part of some of the trainees experience - they were amazed they could create a whole town plan in 20 mins -- and recognised how ideas can be generated better in a group and that different individual priorities could be a focus for reflection.
We are now turning our focus to the end of the training - which will be on us before we know it! -- so have been fine tuning the evaluation process and the assessments . Gathering data for the research arm of this work is also to the fore. We want to measure the efficacy of this training so that it can be put to best use, here in Zambia. Many health and development programmes fail simply because they do not listen enough to what is needed and adapt their inputs accordingly. Our approach is to continually reflect on our work and adapt the training accordingly. While their are obviously some cultural and language difficulties in communication, we do our best to minimise these effects.
Home life is therefore a tapestry of discussions and writing, as well as eating and sleeping -- with an occasional walk round the garden once the temperatures drop a bit later in the day. Our office space is the dining table ---, but we do long for a printer.. as getting any printing done is dependent on their being power on at the local post.net at Kabalonga or hospital resources - which often have shortages of ink.
Yesterday we had a morning out - at the Dutch Reformed Church monthly market. Due to our lack of exercise through the week we started early and walked the 20 mins to the nearest minibus pickup. Thankfully our journey - squeezed in with everyone else in increasing temperatures was short. The market is a rich array of crafts, furniture, beautiful bedding and clothing made from bright chitenge material, vegetables and fruits and a wide range of food and drink --- and a shady place to sit under the trees. Christmas presents were on our minds, and with a fair bit of bartering -- we managed to pick up some nice things.
Overall a good week of training - with some useful leads as to how we may be able to make this training even more widely available.....