Opportunities for Collaboration

We at Africa Mental Health Foundation thrive on partnerships and collaborations for development of innovations in mental health. We are always looking for opportunities to collaborate with like-minded individuals and organizations keen to see the realization of mental health for all in Kenya , Africa and the world over. We welcome you to work with us by:

  1. Sending your students whatever level (undergraduate to post-doc) for attachment with us or;
  2. Partnering with us to conduct research and service development in mental health. AMHF will be happy to host you! Or;
  3. Partner with us to disseminate our research findings through writing and publishing of research papers, or;
  4. Spend your sabbatical with us by opting to partner with us through one of our research projects or your own project.

We welcome inquiries in this regard. Please write to info@amhf.or.ke or call +25420

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Our Current Collaborators

Local:

Befrienders Kenya

Befrienders Kenya is modeled on the worldwide Befrienders originally founded in 1974 by Chad Varah (founder of the Samaritans), then recently launched as an independent charity in 2012.  Befrienders Worldwide is a dynamic and expanding global network of 349 emotional support centres in 32 countries, spanning 5 continents. These centres are staffed by more than 25,000 volunteers who provide vital support to an estimated 7 million service users each year.

Befrienders Worldwide centres provide an open space for those in distress to talk and be heard. This is via telephone helplines, SMS messaging, face to face, internet chat, outreach and local partnerships.

Our Work

Following the same model, Befrienders Kenya provides a listening service and emotional support to those in distress, despair and feeling suicidal. We believe in giving a person the opportunity to explore feelings which can cause distress, the importance of being listened to, in confidence, anonymously, and without prejudice. Our volunteers receive special training in listening skills to help in responding to vulnerable community members. We work closely with counselors and psychiatrists and refer cases to them where necessary. Volunteers are available 24 hours a day, all week to provide emotional support to anyone that finds life unbearable.

All our services are offered free of charge.

To volunteer or speak to a volunteer, contact us on:

Tel: 0707 633 692/ 0721 205 541

Email: samaritans.kenya@gmail.com

Alzheimer’s Association of Kenya

History and background

Alzheimer’s Association of Kenya (AAK) is a non-profit Alzheimer association that supports people with dementia and their families.  The association was registered in the year 2007 with most of the founding members being individuals who, affected by Alzheimer’s,   felt the need to come together and support others in a similar situation; especially care givers.  One such person was Elizabeth Kasimu, the current chair of the association, who was prompted to search for answers when her father was diagnosed with Alzheimer’s disease. Read about Elizabeth’s struggle with her father’s dementia (A link opening a separate page)

“It all started when my father, who we knew to have perfect memory suddenly became frighteningly forgetful, says Elizabeth. It happened that one day her father could not find his way home. “This was a cause for alarm as we always thought that my father had perfect memory. He could remember issues that dated back to the 1950s. We attributed his behaviour to stubbornness or “old age,” she says. At the hospital they were told that he was suffering from dementia, which Elizabeth and her family later discovered is a symptom of Alzheimer’s disease (AD). Elizabeth however says that it was difficult at first to tell what her father was suffering from with many tests being done on him and then getting treatment that did not seem to work. “He often got treated for the wrong disease. I started to wonder how many more families had received the wrong diagnosis,” says Elizabeth. It is during this time of so much anguish that Elizabeth decided to delve deeper into this condition that made her seek therapy due to the stress accumulated seeing her father suffering so much. Then pursuing her diploma in Counseling, she decided to write a paper on Alzheimer’s disease. “As I was writing about Alzheimer’s I realized that there were so many people who didn’t realize what it was,” she recalls. She also discovered due to lack of information on the disease, many people said that hivyo ndivyo wazee hubehave (that is how old people behave).

Elizabeth also did a survey of families that were affected and on asking the question whether caregivers felt angry as a result of how the ill person behaved they said yes. When she asked if these caregivers had any sort of support to care for the ill loved one, they said there was no support at all. “AD takes its toll on the family,” says Elizabeth drawing from her experience. “You quarrel with your family because there are those that feel they are doing more than the others adding that the illness goes to the extent of splitting families as a result of continuous quarrels.
Dad used to blame other people for making him look silly. For example, one Wednesday, believing that it was Sunday, he decided to go to church. Mum tried to stop him but to no avail. He got really angry and frustrated and broke into a rage. Another time, my cousin barred him from leaving the compound. He insisted that he needed to go for a walk, as he was restless. My cousin was beaten down by my dad for trying to lock the gate. He managed to leave the compound, but he lost his way. For almost three days, he found himself at a police station, where he reported his “lost” status. The police were amused that he actually realized that he was lost. They could not help him, though, because he could not remember any name or phone number that they could use to contact his relatives. We were told that he slept under cars. The next day, he was found on his way to Nairobi, where he used to live, from Mombasa. (Elizabeth sharing her experiences in a book Your A-Z in mental health published by the Africa Mental Health Foundation)

While researching for her Alzheimer’s project, Elizabeth then met a number of people who had had personal experiences with the disease. Through association, they were able to meet Prof Ndetei who offered space for meetings. From her experience, Elizabeth notes that as a result of experiencing stress caring for the ill loved ones and the stress manifesting as anger, withdrawal and exhaustion, counseling should be provided to the caregivers. “Most of them go through depression because they feel that they are losing a loved one. They feel that the situation has been forced upon them, so they need a listening ear. They need someone to give them hope that they can cope with the situation,” she writes.  Among other recommendations, Elizabeth feels that there should be more rest homes in Kenya, where patients can get specialized care; there must be public awareness, especially for the police, on how to handle such patients, in case they end up in police stations after losing their way; patients should have bands on their hands, which have names of family members and their phone numbers, should they wander away from home; A support group needs to be established, in order to help affected caregivers in addition to giving counseling for caregivers. “Through AAK we hope that we can give a helping hand to caregivers and their ill loved ones; and in turn improve their quality of life,” says Prof D M Ndetei. Alzheimer: the facts People with dementia are often isolated, or hidden, because of stigma or the possibility of negative reactions from neighbours and relatives and behavioural and psychological symptoms, writes Dr. Jacob Kuriakose the chairman, Alzheimer’s disease International. According to a research carried out for the World Alzheimer Report 2009, in the year 2010, there were an estimated 35.6 million people with dementia worldwide. It is projected that this number will increase as the world’s population ages, reaching 66 million by the year 2030 and 115 million by 2050. It is noted that the main increase will take place in lower and middle income countries with more than 70% of cases of dementia occurring in these countries by 2050.

Aims of the association

Our primary aim is to support people with dementia and their care givers.

Our work

Advocacy

We conduct advocacy through:

  1. Creating Public awareness for Alzheimers through:
    • Newspapers- Articles on members’ experiences
    • Television – Televised interviews with caregivers
    • Brochures – Explaining the disease and services rendered by the Association (Translated in different local languages to reach different communities)
    • Wrist bands to identify members and patients
  1. Providing public education on Alzheimers

Target groups:

  • The police
  • Nurses
  • The general public ( via public transport)

We focus on educating on:

  • Signs and symptoms of Alzheimer’s
  • Referral mechanisms/procedures

 

Support for caregivers

We offer support to caregivers by:

  • Encouraging and allowing them to talk about what they are going through
  • Assisting with counseling if required (for the caregivers)
  • Home visits for people with Alzheimer’s patients for moral support

Resource centre

We are developing a resource centre to provide more information about Alzheimer’s

Research and documentation

In collaboration with Africa Mental Health Foundation, we are engaged in research and documentation of Alzheimer’s in Kenya to inform policy and practice as well as advocate for the provision of services for the affected.

Africa Mental Health Foundation donates office space and supports all of AAK activities in Kenya.

To contact Alzheimer’s Association of Kenya:

Tel: 0723 471 096

Email: lizkasimu@yahoo.co.uk

The Woodley Clinic and The Peter C. Alderman Foundation Psychotrauma Clinic

History and Background

Woodley clinic is a health facility in Dagoretti District, Nairobi City County. The clinic is one of the oldest clinics in the city and was started in 1948 by the colonial government as a child welfare clinic for their families. After Kenya got its independence it became a public facility to serve Woodley Estate community (an estate for elite city administrators). In 1983 it was upgraded to a health centre to offer extended services. With the development of better estates for the elite in the city, it was handed over to the council to offer services to the general public. The clinic serves a bigger part of Kibera slum. Kibera is the largest urban slum in Sub-Saharan Africa. It is congested with shanty houses and houses a big population of people. Kibera houses almost 1 Million people.  The slum is inhabited by people of low social economic status, has poor sanitation, and high criminal rate due to unemployment, commercial sex work and illiteracy. The community living in this slum is cosmopolitan and composed of many tribes with diverse political affiliation, one of the reasons that fuelled the post election violence in Kenya. The clinic serves a wide catchment of the slum.

Services offered in this facility are family planning and cervical cancer screening, antenatal and postnatal services, HIV testing and Counseling and Child welfare clinic services that include immunization, growth monitoring and nutrition counseling. The clinic has six nurses who are government employees.

Psychotrauma

The post election violence in Kenya after the disputed presidential election in 2007/8 was characterized by rape, forced evictions, assault, malicious destruction of property, theft and retaliatory attacks. According to police reports more than 1500 persons lost their lives and over 200,000 persons were internally displaced. These persons were subjected to homelessness, squalid living conditions, poor health, unemployment and poverty, and had to deal with the brutality of rape and murder. The post election violence saw the burning of wares and merchandise in stores in the biggest market in the slum that was offering employment to many slum dwellers.

Surveys carried in the area thereafter showed an increased number of persons presenting in the health facilities in the area with signs of mental illness and worsening conditions to those who had previous mental diagnoses. It is on this premise that Africa Mental Health Foundation (AMHF), the Peter C. Alderman Foundation (PCAF) and the Ministry of Health-MOH (Kenya) formed a collaboration to create a mechanism to offer psychotrauma care to these persons. This was done through establishing a Pyschotrauma clinic in Woodley clinic to integrate mental health services into its routine services. The goal of the clinic is to meet Peter C. Alderman Foundation’s mission which is to heal the emotional wounds of victims of terrorism and mass violence. It therefore offers care and help to the victims of post election violence in Kibera slum which was one of the areas worst hit by the violence. The clinic is strategically located to ensure easy accessibility by the community members in the area. Peter. C. Alderman officially opened the clinic in July 2012 as the first such clinic in Kenya.

Operation

The psychotrauma clinic was started to operate on a task shifting model; an innovative model that entails the use of primary health care workers in offering mental health services shifting this role from mental health specialists who are rare in the country. This was aimed at increasing the accessibility, affordability, acceptance and delivery of mental health services in an area where there is a shortage of specialists and without involving costs to these persons. This model integrates mental health services in primary health care services in public health centres and dispensaries.

Dispensaries and health centres are run by enrolled community nurses or registered clinical officers, an equivalent to a physician assistant. This model employs the use of the community strategy. The community strategy was developed five years ago by the Ministry of Health and was aimed at using community health workers (CHWs) in reducing the burden of cholera, malaria and improve the uptake of maternal and child welfare services by the community. Community health workers are high school graduates who have basic training on health matters and operate under a trained enrolled nurse attached to the units called a community health extension worker (CHEW).The community is divided into devolved units called community units each with a number of CHWs.  They offer health education, are informed at identification of persons with symptoms and signs of disease and offer appropriate referrals to the health facilities. They thus link the community with the health care workers.

Our psychotrauma clinic is served by a number of CHWs whose main tasks include offering psychoeducation to the community, identify social support for our clients, ensure that our clients have good support from the families and the community at large and ensure that they are accepted by the community and are thus engaged in community activities. They also ensure compliance to the management, do home visits for the clients and appropriately refer clients to the health facilities.

The clinic is being run by a PCAF nurse assisted by a clinical psychologist and a visiting psychiatrist from AMHF. They screen, diagnose and treat persons with mental illness. They also offer psychotherapy to the clients, monitor treatment outcomes and supervise the community health workers.

Other than the referrals from the CHWs, other clients seen at the clinic are either self referral, referred by community health extension workers, by nurses working in other departments in sister health facilities or privately owned healthcare facilities in the area.

The clinic receives supplies of psychotropic drugs from Mbagathi District Hospital pharmacy (a district pharmacy that supplies drugs to the health centres) and operating on a fixed quota to the health centres.

Patient flow

On arrival to the clinic, clients are registered in the clinic’s general permanent register and then sorting is done.  Clients are then sent to various departments in the clinic depending on need of the client. From these departments, clients in need of mental health services are also referred to the psycho trauma clinic. At the clinic the PCAF model is employed and involves taking socio demographic history, psychiatric history, performing mental status examination, filling Traumatic Event Checklist, filling the Self Reporting Questionnaire, filling Harvard Trauma Questionnaire, screening for alcohol dependency and substance use using the CAGE Tool and assessment of functioning. After administering these to the patient a provisional diagnosis is made and management planned according to the diagnosis. A follow up date is then given to the client and drugs dispensed by the nurse. A CHW is then assigned to the client for follow up on compliance and with the aim of doing a home visit. Where any difficult arises a psychologist or psychiatrist is engaged.

Daily activities that the PCAF nurse is involved at the clinic are scheduled as below;

 Monday: A general health talk is given by the nurse to all the patients on mental health. New mental health patients are there after seen at the psycho trauma clinic by the PCAF nurse and the clinical psychologist. Other services given to the clients involves family planning, screening for cervical cancer, antenatal and postnatal checkups, immunizations and growth monitoring of children under five years, HIV counselling and testing.

Tuesday and Thursday: Patients with mental health issues previously seen at the clinic are seen and the nurse is involved in primary health care services offered at the clinic. On the same day the PCAF nurse visits African Mental Health to give a report of the activities and data collected at the mental clinic.

Wednesday: Previous patients with mental health issues are seen and the PCAF nurse in involved in provision of other services at the clinic. In the afternoon does outreach services by paying a home visit to selected mental health patients and their family.

Friday: Community Health Workers accompany identified new mental health patients to the clinic where they are seen in the clinic. They also report any issues they have noted about a client as well. They give a report of their activities and develop a working plan with the PCAF nurse which they implement in the subsequent week. A similar report is taken by the PCAF nurse to Africa Mental Health Foundation office.

Progress

The clinic was started with an aim of integrating mental health services to primary health care under one roof. This model has developed a smooth blend of mental health services into routine services in the cilinic.

This model was started by a training in June 2012 by Africa Mental Health Foundation involving a few nurses and community health workers. The nurses were acquainted with a detailed description of the need for establishing a trauma clinic in Woodley to assist healing the emotional wounds of victims of the post election violence experienced in 2007/2008. The nurses were trained on patient screening, identification, taking a psychiatric history, mental status examination, making a psychiatric diagnosis, appropriate treatment, follow-up and referral. They were also trained on their role in reducing stigma associated with psychiatric illness.

The CHWS were trained on client identification and referral to the psycho trauma clinic based on the PCAF model, on home visitation and social support systems.

From January to December 2012 the Woodley clinic registered a total number of 52,380 patients, of those screened 93 were treated in the psycho trauma clinic.

In July 2012 staff from the psychotrauma clinic and from AMHF participated in the annual PCAF psychotrauma conference in Tanzania.

A major training on psycho trauma by Africa Mental Health Foundation was held in August 2012 and involved the training of nurses from the clinic, nurses from neighboring health facilities serving the slum population, clinical officers and community health workers from the region.

In November and December 2012, the PCAF nurse attended a training in Uganda on general psychiatry and data management based on the PCAF model. He was also trained on the PCAF reporting system.

In the first quarter of 2013 (January, February and March) a total number of 196 patients were seen in the psycho trauma clinic with 86 being new clients and 40 ongoing patients.

Local Partners 

Some of the notable local partners to our clinic are;

  • Africa Medical Research Foundation (AMREF) which hosts a rehabilitative centre for the rescued street children, Joseph Kang`ethe Social Home for the street children.
  • Medicine San Frontiers (MSF) – Belgium who have two rescue centers in the larger Kibera slum for the victims of sexual assault and domestic violence.
  • Maryland University who are involved in cancer screening by providing the required equipments and reagents and have employed a case manager for HIV/AIDS mothers and children. She is also in-charge of support groups who normally meets on a monthly basis.

 Major achievements

  • There is positive and increasing trend on the number of clients seen in the client since its inception
  • Community health workers and community health extension workers are increasingly playing a vital role in community mental health since their training and inception of the model.
  • The PCAF Nurse – a trained enrolled who able to see patients, make a diagnosis and manage patients after a six week training through administering a screening tool and questionnaire acts as a good model for other nurses and has changed the perception of other nurse in the area towards integrating mental health in primary health care.
  • There is increasing willingness of other nurses and community health workers to get similar training as those already trained, a number that can be instrumental in covering the entire region.
  • There is improved reporting and data collection since training of the nurse on the use of the PCAF tools.
  • Recruitment and re-training of community health workers has eased follow up and integration of persons with mental illness into the community which is vital in improving treatment outcomes of persons with mental illness
  • The PCAF nurse uses public health talks to sensitize the community on mental illness . This has helped reduce stigma and discrimination and increased the number of persons seeking services at the clinic.
  • A regular dialogue meeting between community health workers and the provincial administration represented by the area chief has helped in addressing issues of mental health and drug abuse through public gatherings (barazas).
  • In our current setting the psychotrauma clinic sees a good number of patients with HIV cormobidity. Some of them acquired HIV through sexual assault during the port election violence after the disputed elections of 2007/8 or through commercial sexual work due to widespread unemployment. HIV services are also offered at the clinic.

Major challenges

  • The psycho trauma clinic is facing inadequate supply of psychotropic drugs. This is because the increasing number of patients comes with a bigger need for these drugs and the fixed quota of drugs supplied from the district pharmacy is inadequate.
  • Unchanging poverty and unemployment means inability to address basic needs in families resulting in underweight infants. The parents and the infants are psychologically traumatized. This is a stressor that may affect the treatment outcomes. Some of the clients referred may not have bus fare to attend to the clinic as scheduled since they come from a distant location from the clinic.
  • The political atmosphere that prevailed before the just concluded elections was tense and marred with uncertainty. This affected them psychologically and tension in the election months affected the clients turn out to the clinic.
  • Due to poor drainage and sanitation in the slum it is difficult to conduct home visits especially in the rainy months of March and April and November and December
  • A large number of the relatives are on casual employment and prefer going to work than taking care of the patients or bringing them to the clinic.
  • A good number of community units in the slum have not yet been covered since CHWs in these units have not been trained.
  • The PCAF nurse is unable to pay home visits to all the mental health patients attending the psychotrauma clinic due to the distance from where they come from and the clinic due to the poor infrastructure in the slum. There is also a challenge of narrow paths that a vehicle cannot navigate through.

Major goals

  • Increase the number of patients attending the clinic to 500 per quarter since the region is very expansive and highly populated and not fully covered.
  • To have at least one of our neighboring health centres in full operation as per PCAF guidelines.
  • Engage the neighboring health district so that they can fully incorporate provision of mental health services in their routine primary health care activities as part of trying to cover the entire slum.
  • To engage a wider area served by community health workers other than that covered by our District to ensure a bigger coverage.
  • Engage more partners dealing with health issues in the slum so that they can smoothly refer more clients to our clinics
  • Engage partners dealing with socioeconomic empowerment in this area so that they can assist our clients in formation of self help support groups so that our clients can engage in income generating activities like garbage collection, car wash services, embroidery e.t.c to reduce the burden of poverty in our clients- seen as one of the factors that could be affecting our treatment outcomes
  • We have four other large slums in the city in addition to the Kibera slum, Korogocho, Mathare, Kangemi and Mukuru kwa Njenga. It is also worth noting that similar circumstances that occurred in Kibera occurred in these slums and that many psychotrauma patients may be living in these slums. Mukuru kwa njenga is special in that it is also situated next to a oil pipeline which had fuel spill in 2011 and more than 100 people died and more than 120 people survived with severe burns. A significant number lost their livelihoods and homes. These persons may benefit from this model and its expansion to cover them may thus be very helpful.

International Collaborators:

USA

 

  1. Harvard University –  Prof. David Ndetei, the Founding Director at AMHF serves as Faculty and Collaborator, The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School.
  2. The Global Mental Health Program (GMHP), Columbia University, New York – A 5-year MOU for collaboration in the development of research training in culture and mental health.
  1. New York University School of Medicine and the Institute for Healthcare Improvement (IHI) – AMHF is a an early adopter member of “A Billion Minds and Lives”, a new initiative partially funded by NYU School of Medicine and implemented by the Institute for Healthcare Improvement (IHI) that aims to reduce the mental health treatment gap in low and middle income countries by ensuring that the one billion people who need treatment for mental illnesses in these countries receive treatment by 2020 http://www.abillionminds.org/ .
  2. Washington University at Missouri – Collaboration on the study: Identification of Psychosis-Risk Traits in Africa. Funded by: National Institutes of Health (NIH – R21 grant)
  3. University of Vermont – Collaboration in a study titled “Mobile Substance Use Intervention for HIV PreventionFunded by: The National Institutes of Health (NIH – R21 grant)
  4. The Peter C. Alderman Foundation (PCAF) – AMHF collaborates with PCAF to run the only psychotrauma clinic in Kenya located in Kibera (place a link here to direct to where we are talking about the clinic). We also work together to convene the Nairobi editions of the Annual Pan-African PCAF Psychotrauma Conference.

CANADA

  1. University of Toronto – The KIDS and TEAM projects funded by Grand Challenges Canada
  2. University of British Columbia – The eData K project funded by Grand Challenges Canada
  3. Schulich School of Medicine & DentistryWestern University – The CREATE Project funded by Grand Challenges Canada

GERMANY

  1. University of Konstanz – A study titled “Sustainable and Adapted Treatment Strategies to Restore Psychological Functioning and Mental Health among Displaced Somalis: Preparation of a Multicenter Treatment Study“. Funded by the German Federal Ministry of Education and Research (BMBF)

AUSTRALIA

  1. Deakin University, Australia – Study on mental health care in Kenya: investigating strategies for capacity building in primary health care settings.

UK

  1. London School of Hygiene and Tropical Medicine– Setting up a hub for mental Health in Africa

NETHERLANDS

HealthCom Global Network – We have a signed MoU geared towards fundraising for research activities.