Posted on: 25 April 2024
On Thursday 11 April 2024, four visitors from Mirembe National Mental Health Hospital, Tanzania, rounded off their 6-week trip to London with an afternoon of presentations and celebrations.
Dr Paul Lawala, Dr Sadiki Mrisho Mandari and Nurses, Pasinai Kivuyo and Jane Mosha, came to London in early March. Their mission was clear: to gain insight from CNWL's community-based mental health and substance use services with the goal of establishing similar community services in Tanzania.
The dedicated cohort, and dozens of staff from across the teams they visited, gathered in The Gordon Hospital’s Hope in the Community space to mark a significant milestone in the longstanding partnership between CNWL and Mirembe. Many others tuned in for the presentations on:
- Cultural and belief influences on mental health care – An East African context
- Trauma: Post-disaster mental health response – Based on the December 2023 landslide in Hanang district
- Importance of partnership working: CNWL/ Mirembe – History, current situation, and aspirations
Our partnership began in 2010 with a shared vision to encourage a two-way learning experience through constructive dialogue with a keen on focus on enhancing and expanding mental health and substance use services in Tanzania. At the helm of this endeavour are Chris Bumstead, Coordinator for International Healthcare Partnerships and Tariro Gumbo, Senior Community Partnerships & Engagement Lead.
Dr Paul Lawala reflected on their visit saying: "I am very glad to have come here. It was fascinating to witness the operational community-based mental health program at CNWL, driven by commitment, collaboration, and motivation. We are inspired and eager to implement similar initiatives in Tanzania."
Located in Dodoma, Tanzania's capital, Mirembe National Mental Health Hospital has been a key establishment in the country's mental health landscape since its establishment in 1927. Serving as Tanzania's national referral psychiatric hospital, Mirembe has faced numerous challenges over the years, including overcrowding and resource limitations. Despite these hurdles, the hospital has remained steadfast in its commitment to delivering essential and improved mental health services.
With a modest staff of six psychiatrists and a total of 350 staff, most of whom are not professionally trained, Mirembe has grappled with the daunting task of providing care for a high patient population that results in strained resources and overcrowded wards. In fact, for every 20-40 patients, there is only one trained nurse and two healthcare assistants.
However, recent efforts, including staff recruitment and initiatives to reduce bed occupancy, have boosted Mirembe's capacity to provide improved services and establish meaningful connections with patients.
In Tanzania, the absence of community-based mental health services has allowed a troubling trend of repeated hospital admissions that leaves patients stranded in a cycle of instability and inadequate support upon returning to their home communities. Recognising this pressing need, Mirembe Hospital embarked on an initiative to pioneer a new form of mental health care delivery, despite challenging constraints in resources.
The presenters described the difficulties plaguing Mirembe’s development, including the social stigma associated with mental health that exists on both an individual and community level. People and their families will often seek traditional medicine over healthcare. Moreover, mental healthcare receives very little in financial resources despite grievous efforts by mental healthcare workers like our visitors.
With no additional resources available, apart from those from the Ministry of Health, the team at Mirembe Hospital is challenged with redistributing existing hospital-based resources and upskilling health colleagues in district hospitals across Tanzania—an endeavour that demands creativity, innovation, and unwavering commitment.
Dr Sadiki’s poignant presentation described the recent Mount Hanang landslide and the overwhelming need for mental healthcare that followed. Although aid was provided by some international charities, the focus was heavily placed on physical health leaving mental health largely neglected because of the limited resources that Mirembe could provide and there being virtually no mental health services locally.
The landslide devastated survivors and deeply impacted mental healthcare workers who had to tackle such a pressing issue with minimal support – a stressful experience that lingered with the audience.
However, change is on the horizon. Recent mandates from the Ministry of Health, such as making mental health mandatory in medical and other healthcare student curricula, show a growing recognition of necessary mental health care in Tanzania.
Jenny Lanyero, Team Manager for Brent Health Matters, commended the Mirembe team’s resilience in the face of adversity: “you are doing amazing work considering the landscape, lack of resources and entrenched stigma. It's very similar in Uganda [Jenny’s native country] and we strive for continued education to change mindsets.”
The event symbolised the collaborative spirit and shared commitment of CNWL and Mirembe Hospital to make transformative change in mental health care provision. The visitors thanked all the teams at CNWL who graciously welcomed and hosted them.
CNWL teams have banded together, hosting social visits including Emirates stadium, museums, parks, restaurants and a boat ride down the Thames River. We certainly gave them a CNWL London experience to remember. Here are some photos of their various experiences, both social and professional:
Tariro Gumbo, Senior Community Partnerships & Engagement Lead, thanked all the CNWL colleagues for their overwhelming support throughout this fellowship program. She encouraged CNWL colleagues to get involved with her team’s core mentoring programme which links staff from Mirembe with different services so “we can continue to share learning and the solutions which we implement in our teams. The presentation on how culture impacts mental health is relevant for us as a trust, given how we serve a multi-cultural community. There is a lot to share for a mutual benefit.”
As CNWL and Mirembe Hospital continue their journey, the shared goal of transforming mental health care in Tanzania remains steadfast. The event served as testament to a decade of cross-cultural partnership and a future brimming with hope and possibility.
You can contact Chris (c.bumstead@nhs.net) or Tariro (tariro.gumbo@nhs.net) to learn more.