“The war has traumatised an entire population. We need to train our health workers and teach them how to deal with mental illness,” says Caguor Adong from the University of Bahr el Ghazal, Sudan.
Mr. Adong is working on strengthening the mental health sector in his home country by coordinating the Norwegian University Cooperation Programme for Capacity Development in Sudan (NUCOOP) project “Capacity building in the field of mental health in South Sudan”. This also involves the University of Oslo and SINTEF Health (Norway), Stellenbosch University (South Africa) and Ahfad University for Women (Sudan).
Violence at the core
January 9 this year marked the fifth anniversary of the Comprehensive Peace Agreement in Sudan. Africa’s longest-running civil war, lasting for more than 20 years, led to the death of two million people. Bahr el Ghazal also borders conflict- ridden Darfur, which lies to the north.
Mr. Adong says: “South Sudan was at war for so long that the people got used to violence. This has caused a lot of damage. They have been displaced, lost family members and dear friends and suffered from illness, hunger and starvation. Children might have experienced abuse or trauma and a lot of people are suffering from mental illness. In people’s minds, violence is the only solution – this is what we need to change. That’s why this project is really in its place – it is time to start the healing.”
HEALTH WORKERS | Medical assistants, nurses and midwives receiving training in the city of Wau in May 2009. PHOTO | The University of Bahr el Ghazal.
Many need help
According to him, the ordinary Sudanese are the real beneficiaries of this NUCOOP project, launched in 2008. There are two levels of training. At institution level there are scholarships for a certain number of students that must be from the area.
“They are all from Greater Bahr el Ghazal. We don’t want them to go away with the knowledge; this is their homeland and they should be committed. So far we have two medical doctors at PhD level, one of which is training to become a specialist psychiatrist. We also have four Master’s degrees and one bachelor student in psychology. We hope to have two more PhD students soon,” Mr. Adong says.
At community level, medical personnel from the Ministry of Health are trained so they can give counselling and advice to hospital patients who are struggling with mental problems. Nearly 40 health workers received training through the project during 2008 and 2009. After they’ve finished their training, the candidates typically go back to their hospitals, better equipped to deal with the patients’ mental illnesses.
“Medical assistants, midwives and nurses regularly encounter these problems. Even when the project itself comes to an end, these people will continue to reach out to the community. A lot of people need help,” Mr. Adong says.
Lack of knowledge
Mr. Adong and others involved in the project are encouraging both Sudanese hospitals and the Ministry of Health to establish special units for mental health. In some cases they have been struggling for support.
Mr. Adong explains: “Even though the field itself is accepted, it is undermined by lack of knowledge and understanding. We need politicians and government officials to come in with their full authority and support it.”
GRADUATION DAY | Participants at the Wau 2009 training receive their certificates. PHOTO | The University of Bahr el Ghazal.
He adds: “The health workers have all encountered patients with mental problems without knowing how to deal with it or that there was a reason behind it. They are very happy to learn more.”
A future goal is to establish a school of Psychology and Psychiatry at the University of Bahr el Ghazal.
“If we manage to train enough people, it’s possible,” Mr. Adong says.
A difficult task
Edvard Hauff, Professor II at the University of Oslo’s Institute of Psychiatry, is the project’s Norwegian coordinator. With more than 25 years experience working with international health, transcultural psychiatry and clinical research, he has been involved in several similar projects in Asia and northern Sudan, through collaboration with the University of Khartoum.
”When NUCOOP called for proposals, we had an advantage in that we were already involved in a collaboration in the northern part of the country. This also allows us to do compare data from north and south,” he says.
With extensive experience in the field, Mr. Hauff and his colleagues at the cooperating institutions knew from the very beginning that the project was daunting, and that they would be starting from scratch. Sudan is the biggest African country and has an estimated population of more than 42 million. The country has 19 universities, primarily teaching in Arabic. Education at secondary and university levels has been seriously hampered by the war and the requirement that most males perform military service before completing their education.
Mr. Hauff says: “We knew this would be hard to carry out and that the circumstances in Sudan were uncertain. The University of Bahr el Ghazal announced their interest and it became clear that the project could contribute to their much needed capacity building.”
Despite the difficulties, the collaboration has been fruitful so far, according to Mr. Hauff.
“We’re also pleased that the collaboration between the University of Bahr el Ghazal and Ahfad University for Women seems to be going very smoothly,” he says.
“Globally, mental health has been under-prioritised in most countries – even in developed and high-income economies. For developing and lower income economies, the situation is unison; scarce economic resources are directed towards other health issues. Looking at the World Health Organisation’s Global Burden of Disease (GBD), however, it is clear that mental illness represents a heavy burden for society. The stigma still associated with mental illness also prevents it from being put on the agenda,” he adds.
Hoping for peaceful solution
Sudan is now preparing for the national elections in April and a referendum on southern independence in January 2011. The 2005 peace agreement is fragile and analysts say the threat of a return to open warfare in the south is constant. Twelve candidates will run for president in Sudan’s first democratic election in 24 years, among them the incumbent president, Omar Hassan al-Bashir.
“The political instability in Sudan remains a challenge to the project. Whatever the result of the 2011 referendum turns out to be – if the process is peaceful – we will be able to carry out the project,” Mr. Hauff says.