Joanna and Simon have been back in Scotland for nearly 5 weeks and there has been time to reflect on what happened during our work in Zambia and to get started on the next stage of planning for the completion of our Feasibility Study (which is funded by a Scottish Government International Development Small grant). In particular we are applying for further funding to strengthen ZTA for the future and have starting planning for the next phase of work in Zambia in early 2018.
First, our time in Zambia resulted in several successful outcomes; including people trained, models of training tried out, contacts made and contacts renewed. Three training courses were delivered during September and October 2017 and 30 people successfully completed the course: ten staff at Livingstone General Hospital, Southern Province, nine staff at Chainama Hills Hospital, Lusaka and eleven student nurses from the Chainama Hills College of Health Sciences. One of the local trainers completed her training and is now certified as a Therapeutic Art Trainer in Lusaka. She is the first of the Zambian trainers on whom the future sustainability of the ZTA training in Zambia depends. Four new trainee trainers began their first stage training, and will hopefully complete their work over the next 12-18 months. This will mean we are well on the way to having a pool of Zambian trainers who can deliver the course.
We evaluated three different models of training delivery during thus visit, in response to local conditions. At Chainama Hills Hospital the training was delivered in six 3-hour sessions over a period of 5 weeks; at Livingstone General Hospital the training was delivered over 4 ½ days and for the students of Chainama Hills College the training comprised 10 sessions of 2 hours each. Whilst each of the 3 courses worked well and participants were able to complete them successfully, we felt that delivering a shorter, more intense training was a way to make better use of trainers and participants’ time and we will focus on this in future courses.
During our visit we were also able to make progress with the monitoring and evaluation of the training, to fit with the plan for our Feasibility Study. We met with Margarate Munakampe from SCHEME, Department of Public Health, University of Zambia. Margarate is the M & E expert working with us to evaluate the ZTA training model and she has quickly grasped our approach and begun work on an evaluation model. We are enormously grateful for her help and advice and that of Professor Charles Michelo, the head of SCHEME.
We were also able to meet with mental health and nursing personnel from the Zambian Ministry of Health, to keep them informed of our work and to build our links with the wider health system in Zambia; with Dr Ravi Paul, Head of the Department of Psychiatry, University of Zambia Medical School at UTH Hospital in Lusaka and with senior staff at Chainama Hills Hospital.
We met with Sylvestor Katontoka, the Chief Executive of Mental Health Users Network Zambia and with his help and support, delivered a “taster” session to his members in Kanyama, a compound in southeast Lusaka. We had planned to deliver a second session but this had to be cancelled due to circumstances beyond our control in Kanyama. The response to the first session was very positive so it was disappointing not to be able to follow this up but we met with the MHUNZA Chief Executive again to discuss whether they might offer therapeutic art sessions in future.
All in all it was a very busy but successful seven weeks and the thirty successful participants in the three training courses gave us very positive feedback on the experience. During the evaluation sessions we conducted, participants commented on how their views of patients had changed for the better, how their skills and confidence had increased and how working with patients was a positive experience for them. A frequent comment concerned the importance of a mutually empathic and understanding relationship between patients and staff and how art making facilitated this.
Since our return to Scotland we have been taking a critical look at our capacity as an organization both at home and in Zambia and can now focus on developing this to ensure the sustainability of the training and practice within Zambian health systems. We have submitted our new grant application, have begin to plan for future training courses, and to look at how to develop ZTA and the Therapeutic Art training model in Zambia!