These last couple weeks have been busy, they have mainly consisted of finalizing everything we have worked on. The main objective in this internship was to work on normalizing mental health services in Kenya. The stigma surrounding mental health in Kenya is hard to get away from. People with mental illnesses are often looked down on and not treated with respect. Through the organization of many deliverables, we worked to tackle this issue. This problem has had a huge impact on select members of the community, we realize that it cannot be resolved in such a short amount of time. However, we have attempted to add onto the existing resources available in hopes to educate the public.
When we were initially getting ready for this internship I had envisioned a completely different outcome. I had initially wanted to make larger strides towards destigmatization of mental health and decriminalization of suicide. We had planned to collect statistics and implement mental health services where needed. This was hindered by the amount of time available and the resources we had at hand. To instil such a big difference in the community we needed to have access to resources and leaders that would spark a conversation. When we came to the realization that our plans would not be possible at the give time, we opted to make a difference in another way. Through the organization of many community focused initiatives we have worked on educating which could essentially lead to awareness.
This internship addressed mental health and the stigma surrounding it in a Kenyan context. I was given the opportunity to experience these issues first hand and have come to realize how serious they are. These problems have a big affect on the community, people in Nairobi tend to overlook mental health and disregard its importance. We came across many cases where the patient wanted to schedule a meeting out of office to avoid being seen receiving help. We have a long way to go until we see some real change take action. We must focus on targeting specific issues within mental health rather than trying to tackle everything at once. This program is playing a big role when it come to mental health resource reform in Africa. If we fine-tune our approach we have the potential to make change that will affect the future of East Africa as we know it.
The experience in Nairobi has been nothing short of wonderful; I have learned skills that will last me a lifetime. It has become easier for me to step outside my comfort zone to experience new things. In addition, I have developed a passion for public health. In the past couple months, we have completed a number of projects that I hope will help the general public understand that mental health is an increasingly relevant area of medicine. Although I originally envisioned making a bigger impact in the community, I have realized that it is a work in progress. Rather than attempting to make huge changes overnight, we can work day by day to create an environment in which people are comfortable discussing their problems and hardships. As a developing country, Kenya is on track to become an African leader in mental health initiatives. Based on what I have witnessed, I believe this program can lead the movement to destigmatize mental health. I am honoured to have played a part in this long journey.
The main focus has been finalizing and polishing the work we have submitted throughout the entirety of this internship. Taking Dr. Merali’s feedback into consideration, I am now trying to go over and edit the work I previously submitted to ensure that they are completed to a high standard.
This experience has been an amazing opportunity that has been eye-opening in many ways. In such a short amount of time I have come to appreciate what I have, such experiences make a huge difference in the way we perceive the world and people. It has made me more tolerable, accepting, and most importantly has taught me to always approach situations with an open heart and mind.
To end off my blog, I would like to share an article which I wrote; Understanding child and teenage mental health during the Covid-19 pandemic and Kenya’s response to such challenges.
The impact of COVID-19 on mental health has not been adequately addressed. People around the world are experiencing widespread lockdowns during the COVID-19 pandemic; children are out of school; and millions have lost their jobs, resulting in anxiety, depression, insomnia, and distress. Using 29 studies from around the world, which included 80,879 children, a meta-analysis was conducted and revealed that depression and anxiety symptoms doubled from pre-pandemic to epidemic levels – from 12.9% to 25.2% and 20.5%. This means approximately one out of every four children globally are experiencing depression symptoms while one in five report clinically elevated anxiety symptoms. Although the study does not prove directionality, it does suggest that COVID-19, anxiety, and depression symptoms, as well as poor physical health may reinforce one another. Further, lower socioeconomic status households often experience poverty, housing precarity, food insecurity, and other factors that can compound these difficulties. Despite this, the studies suggest that COVID-19 anxiety may be relatively common among children, but it is far from universal. When children encounter COVID-19 stress, the majority of them will prove resilient, and parents and guardians can foster a loving and supportive environment to increase the chances of their children processing the stress appropriately.
In addition to missing major milestones and coming of age moments, many older children and teenagers have also felt left behind by pandemic restrictions. It has been difficult for teenagers to connect with their friends and support their peers due to the pandemic, which has added to their frustration.
In the face of the COVID-19 pandemic, Kenya has attempted to institute a mental health response despite underlying organizational challenges. It is important to note that significant gaps remain. A formal mental health response plan does not exist in the country, psychological first aid is unmet, mental health care and psychosocial support are difficult to access during the pandemic, and mental health data regarding COVID-19 cannot be collected in a systematic way. Several strategies are proposed to strengthen the mental health response in Kenya in order to mitigate the harmful effects of COVID-19. An initial step would be to create a mental health response plan specifically for COVID-19 and allocate funding for it. To enable those in need to access support during the pandemic, community health workers and volunteers should be trained in psychological first aid. The third step is to expand mobile health services to increase access to health care. The final step would be to conduct systematic and continuous text message surveys to determine how the COVID-19 pandemic is impacting mental health.
Article written by: Mohammad Almaradweh
Ahmad, S. (2023). Coping with COVID-19 [electronic resource] : the medical, mental, and social consequences of the pandemic (1st ed.). Philadelphia: Wolters Kluwer.
Findings on COVID-19 Reported by Researchers at Moi Teaching & Referral Hospital (Mental health response to the COVID-19 pandemic in Kenya: a review). (2020). In Mental Health Weekly Digest (p. 495–). NewsRX LLC.
Jaguga, F., & Kwobah, E. (2020). Mental health response to the COVID-19 pandemic in Kenya: A review. International Journal of Mental Health Systems, 14(1), 68–68. https://doi.org/10.1186/s13033-020-00400-8
Moustafa, A. A. (2021). Mental health effects of Covid-19 (A. A. Moustafa, Ed.). London, United Kingdom ;: Academic Press, an imprint of Elsevier.
Update + Places to Explore in Kenya
As part of my placement position, I have been working on a revised set of objectives for the past couple of weeks. I have created a mini-series titled “Don’t stress & Do your best”. In this continuation of posters I tackle the different types of stress, their effects, and how to counter-act them. As a result of my mentor’s feedback, I was inspired to expand on the work that I had done in previous weeks. Below, I have attached two posters from this series to give a little more insight to the work that’s being completed on my end.
Apart from creating posters, I have also written articles for the Nairobi newspaper. The articles in this collection deal with mental health issues within a Kenyan context. To date, I have finished the first, which discusses the effects of Covid-19 on children and teens. The next few weeks will be dedicated to finishing and finalizing 2-3 articles that I have been working on for quite some time. Aside from work, I have had the opportunity to explore many parts of Nairobi, which I have captured in the images below.
Objectives and Deliverables
The last month has been an exceptional learning experience that has been unparalleled to anything I have ever done before. The experience of traveling to a completely different place has forced me out of my comfort zone. It’s all new and captivating. I am always eager to learn new things and open to new concepts and ideas. In the process, I have become more tolerant and open towards new cultures and people. Connecting with locals and other like-minded people from around the world is a great experience. My ability to strike up a conversation with someone from a different background has given me a more profound understanding of them and an appreciation for their differences. I have acquired a higher tolerance level and have learned to appreciate and value cultural diversity, traditions, and appearances. Being immersed in a less developed or unfamiliar locality seems to open us up to new experiences.
As of late, I have continued to strive towards my goals in this internship which is to eliminate the stigma surrounding mental health. The republic of Kenya has severely suffered from the rise of mental health illnesses as a result of covid-19. Not to say that there were not prevailing issues before the pandemic. Covid-19 has opened people’s eyes to the importance of mental health, resources are slowly but surely becoming available to the general public. Throughout this internship we have worked on a variety of posters and E-lectures aimed at educating the public about these arising issues. We have tackled many important subjects such as:
- Types of Stress
- Steps to Eliminate Stigma Surrounding Mental Health
- How to Identify if you are Struggling with a Mental Illness
- Steps to Improving Your Emotional Health
- Stigma of reaching out
- Practical Tips to Take Care of Your Mental Health
- Intro to Eating disorders
- and more
Below I will attach two of my favourite poster as of date in hopes to spread awareness on such topics.
Some additional research that I have conducted focuses on Covid-19 and the rise of mental health issues.
In our society, mental health disorders still have a stigma and discourage people from receiving help. For mental health disorders to become less stigmatised, it is vital to engage the entire population in early, direct conversations about the disorder rather than attempt to label and diagnose a small group of individuals.
Anxiety and depression can adversely affect;
- work performance
- social isolation
- suicide risk over the long term.
As a result, mental illnesses place a significant socioeconomic burden on society. Symptoms may persist due to a wide range of reasons;
- Lack of awareness of treatment
- Denial of the issue
- Fear of social stigma
In primary care, screening accurately identifies depressed patients, and treatment helps decrease clinical morbidity. Whether routine screening should occur depends on three things;
- The availability of appropriate screening instruments
- The effectiveness of follow-up treatment
- The efficacy of screening
In situations where the results of the assessment screen indicate possible depression, it is recommended that these individuals receive further psychological evaluation to determine any psychopathology.
A person suffering from depression may suffer from symptoms similar to those of other disorders including;
- Memory loss
Signs and symptoms vary but can narrowed down;
- Feeling sad or down
- Reduced ability to focus/concentrate
- Fluctuations in mood
- Excessive fears
- Withdrawal from friends and hobbies
- Inability to cope with daily stress
- Excessive alcohol/drug consumption
- Changes in eating habits
- Suicidal thinking
Across the pond
Once it came to booking a flight to Nairobi, I knew it wouldn’t be complete without an extensive layover in an extravagant city. After days of contemplating, I figured that 12 hours in Paris was the perfect amount of time to explore La Ville Lumière (the city of light). This was single handedly the best decision I had made in a while, in this blog post I will share a quick itinerary detailing the locations I visited in such a condensed amount of time.
The morning started early as we landed at Paris Charles de Gaulle Airport at 8:45 am. By the time we had gotten past security, it was 9:30 am. We quickly changed into a fresh pair of clothes after which we hopped into a taxi straight to the Eiffel tower. Traffic was terrible, it took approximately 50 minutes to arrive to our destination. A pro was the fact that taxis in Paris had set pricing as opposed to a metered approach which would have run up quite the tab.
After grabbing a variety of images with the famous monument, we embarked on a 25 minute walk to the Arc de Triomphe. We spent around an hour exploring the various boutiques that lined Avenue Des Champs-Élysées.
Once the clock struck 12:45, we made our way to the closest subway station where we were able to get a day pass for as cheap as 10 Euros. About six stops and 15 minutes later, we were at the Louvre museum where we got to experience the atmosphere and walk around. We spent no more than half an hour here as we were on a tight schedule. Once we felt satisfied, we picked up on our journey once again, this time heading towards the Notre Dame.
Our final stop of the day was at the world famous Roman catholic church Sacré-Cœur. The walk up the hill was exhausting but rewarding once we reached the top. We spent our time here walking around, taking pictures, and having lunch.
At this point our legs started to give out and we decided it was time to catch a taxi back to the airport in order to have plenty of time to check in and make it to our flight. We had another long flight (7 hours & 35 mins) to Nairobi, Kenya which further exhausted us.
Once we had arrived to Kenya, we made sure to convert some money into shillings we could use towards food, transportation, and to purchase a sim card. Our arrival was met with some difficulty as we did not have the proper form filled out (to verify our vaccinations), thankfully the guards were nice enough to let it slide upon inspection of our Canadian vaccine certificates. We also had to deal with another instance where one of our checked bags was subject to a “random security check.” Upon finding some vitamin supplements, we were asked to pay an additional fee of $50, which we were also able to avoid once the guards had realized we were here to Intern at Aga Khan University Hospital. At this point, we were free to leave the airport. We quickly flagged down our assigned driver and made our way to the residence. Once we arrived, we slept for hours upon hours in hopes to recover from the past two days of travel.
Work in progress!
At this stage of the internship, it has more so shifted from working on my objectives and deliverables to ensuring that I safely arrive in Nairobi. As I am writing this, I am in the midst of packing and gathering essential documents for my travel. The past week has flown by, I went from working on a new set of E-lectures pertaining to stress management to genuinely becoming stressed in the process of getting things together. With this in mind, I figured I would share a series of steps that I have put together for one of the E-lectures that might help improve your day-to-day mental health.
STEP 1: Reflect and Accept
⁃ Acknowledge where you are and how you feel about your current situation
⁃ If you are unhappy about something in your life, recognize and reflect on it
⁃ Take notes on your feelings
STEP 2: Analyze the Situation
⁃ After identifying parts of your life that are distressing or in need of change, begin to question them
⁃ Figure out who, what, where, when, and how
⁃ At this stage you are just gathering facts
⁃ You do not need to produce solutions
STEP 3: Step Out of Your Comfort Zone
⁃ Change your experience by going out and trying new things
⁃ You could check out a networking event
⁃ You could volunteer in something that interests you
⁃ The important part is that you do something different
STEP 4: Change Your Thoughts
⁃ By enhancing and expanding your experiences, you are creating new ways of viewing your life.
⁃ These new perspectives will ultimately help you determine what makes you happy and how you can continue that contentment.
Additional methods that work in strengthening our mental health:
⁃ Practices such as meditation and deep-breathing are known to effectively reduce stress and improve mental health.
⁃ Learning to limit stressors can lead to better mental health. Do not stress about things that are out of your control.
⁃ Make sure to take some time to recharge your brain.
⁃ We ultimately choose what we think about. The benefits of positive thinking can improve mental health
⁃ Building a schedule to follow on a daily basis can help alleviate anxiety
Starting to make a difference!
The first few weeks of this internship consisted of gathering information, signing agreements, and getting ready to leave to Nairboi, Kenya. As of date, we have had many meaningful discussions with our mentor Dr. Merali concerning our deliverables and objectives. Once we had outlined everything and made a plan, we started working on the first requested topic for our E-Lectures “mental and emotional health.” Given that May was mental health awareness month this was perfect, however, we are still awaiting feedback and the chance to present the lecture which has been pushed back due to many unforeseeable complications. In the meanwhile, Ariana and I have focused our time on getting a start on the next requested topic “Steps to mental Well-being.” Communication with our mentor has been an ongoing struggle, these issues do not simply arise from a bad connection, but rather inefficient time planning.
May 27th 2022: May is mental health awareness month, I place emphasis on how we must reduce the stigma surrounding mental health and illness by sharing our own experiences in the E-lecture.
On May 27th, we officially received confirmation that our internship permits have been approved. Since then we have been hard at work ensuring that we are prepared to leave for Kenya within the next 2 weeks. This includes;
- Getting the Yellow Fever Vaccine (received on May 31st)
- Booking plane tickets (June 12th – Aug 5th)
- Preparing appropriate clothing and housing arrangements
- Ensuring that we have transportation to and from the airport upon arrival to Kenya
- Confirming work hours and placement details