So these are the last days of this trip. As always the last sessions are fascinating with the evaluations of the training by the trainees and the assessments. We used a simpler evaluation process this year with a view to its being more replicable. The trainees used post its to make responses to a series of questions about what changes there might have been for them over the training. Interesting responses and discussion - the main outcomes being positive changes in communication, observation and interpersonal skills as well as powerful reflections on the value of art making for them and their patients.
With the assessments safely out of the way we shared the marking with the ToT trainees for their learning of the process. Then came the really stressful bit that I had been left with - writing everyone's names neatly and accurately on the Certificates! This done they have all been safely delivered for presentation, a very satisfactory set of outcomes.
The outcomes of the trainings have been reported to the Institutions and plans confirmed for the next steps. It has been great to get such positive feed back and enthusiasm for maintaining the practice.
I met with the three ToT trainees to check out their feelings about what they have learned in stage 1 of the training and to consolidate the next stages and what we have to do together to refine and adapt the contents of the manual.
I have been looking at some of the photos I took in Zambia and realising what a partial view they offer. As I was going through them, I kept thinking “if only I had a shot of that view” or “it didn’t look like that at all” or ‘why didn’t I get that”. That’s the nature of a short visit; you think you’re seeing a lot but there are so many gaps in the view and you have to beware of making judgements based on such a limited experience. Zambia presented me with equal measures of stimuli and confusion so it could be easy to leap to mistaken conclusions.
Much of my time at the beginning was spent in trying to sort out what was happening, attempting to understand what people were saying and not knowing where I was or where I was going. Like any new place, it took a while to orient myself. This was my first experience of working in a developing country and had I not been able to work alongside two experienced trainers, Lesley and Joanna, I would have been completely lost. The people I met were unfailingly courteous and helpful but I struggled to follow conversations and to pick up the keys to what was being said. Although the official language is English, Zambians also use many other languages and often used Nyanga, Bemba or another local language as well. The subtleties of gesture and non-verbal communication in Zambia meant I must often have missed something or, worse, just appeared plain rude.
The teaching sessions were accordingly difficult at first but gradually began to make a comprehensible pattern and it became apparent that the course we delivered really did offer a useful toolkit for the Zambian mental health workers who took part. Now that Zambian ethical approval has been obtained to conduct an evaluation of the work, it will be possible to gather data and information about the impact we are having and to test out the outcomes of the training more rigorously. Health systems in Zambia are very different to those I am used to in Scotland and evaluating what we do is correspondingly more challenging but equally important.
It has been good to find out that the skills and knowledge I had acquired over my years of practice in Scotland were valid and useful in Zambia and could be shared with workers there. I still feel that I have only just begun to understand the differences and similarities in Zambia and in the Zambian health system compared to Scotland, and I have a lot more to learn. It was good to come back to Scotland and find that the Scottish Government is focusing on Zambia as one of its partners for international development work and will announce a new funding initiative in early March 2017. ZTA will hopefully be able to get involved in this new strand of work and to continue its contribution to mental health systems in Zambia.
The last couple of weeks always seem to come upon us in a rush. To start with there seems to be plenty of time to get everything done and where does it go!
Both training programmes are virtually ended now - so making sure all the course content has been covered has been a major concern. In both training sites the quality of the discussion has been great with people really trying to work out how within the very real constraints of resources and structures they can carry on using this approach.
Lesley has finally got Ethical approval for the use of trainee data for analysis, quite a marathon - it is a very rigorous process.
We had an encouraging meeting at the Ministry of Health and it does seem as though the roll out of Training of Trainers will be supported as far as possible by the Institutions, the Districts and the Ministry. We have made good progress with the ToT trainees at reviewing what we have offered them and clarifying the requirements for the future and for the next stage. Also good progress in structuring the course contents.
Sylvester and Pierre from MHUNZA organised a meeting of their members to reflect on the possible use of a Well Being measure. To check its relevance and language and the feedback has been very useful, Two of the ToT trainees attended that meeting and we will hear from them on Monday. This is something that might be useful in the future as part of getting service user responses to therapeutic art practice and we are grateful for their help with this.
Tomorrow we start the evaluations and assessments and introduce the ToT trainees to this part of the process. Lesley leaves on Thursday and I will be finishing the assessments and holding feedback meetings to keep people updated.
We have just had three days without rain but earlier in the week there continued to be really heavy downpours every day, driving is a real skill in these conditions and the patience and courtesy shown by Zambian drivers is a lesson to many of us!