In January I embarked on a terrifying yet simultaneously extraordinary journey to Dar es Salaam, Tanzania. Not only would this be my first time outside of Europe, it would be the opportunity of a lifetime to work on a busy acute psychiatric unit on the east coast of Africa.
At first I found Tanzania to be bewildering yet enchanting at the same time. This is a country experiencing huge poverty yet one with tremendous spirit.
”Tanzania reminded me of the heart and compassion required for mental health nursing that is commonly undervalued in this day and age”
Throughout my nurse training at Keele University I have been lucky to experience nursing within a number of high quality hospitals whilst gaining an education from one of the best universities in England. Tanzania didn’t teach me what skills to use with patients nor did it teach me how to coordinate patient care. Rather Tanzania reminded me of the heart and compassion required for mental health nursing that is commonly undervalued in this day and age - to love people when they are vulnerable, when it hurts.
The most significant aspect of nursing that a month in Tanzania taught me about was the importance of communication. I needed to learn the local language, fast.
Mental health nursing care in Tanzania is poles apart to care in the UK. Acute inpatient wards consist of cages where patients are detained. Acute admissions require sedation via intravenous injection. Restrictions include using material to tie patients to beds to prevent them from causing harm to themselves or others. Most days whilst on placement there was no electricity. It’s pretty scary entering a cage when you can’t see where the patients are.
“Those who receive support for their mental health needs experience a level of shame and humiliation”
Stigmatisation surrounding mental health is extensive in Tanzania. People who have mental health problems and mental health nurses are ridiculed, misunderstood and targeted. Those who receive support for their mental health needs experience a level of shame and humiliation.
The most common mental health illness in Tanzania is schizophrenia. Self-harm and eating disorders are unheard of and treated illnesses mostly consist of ADHD and epilepsy - which are perceived as mental illnesses.
Within two weeks of working in the hospital I was able to form constructive conversations with patients in Swahili. Even when I simply could not communicate due to a lack of understanding, non-verbal communication was key to maintain patient contact and build relationships. Breaking English down in order for it to be understood by patients who could speak English was fundamental to patient engagement.
”Breaking English down in order for it to be understood by patients who could speak English was fundamental to patient engagement”
I learnt an incredible amount from talking to nursing staff about why they practice in the way they do. Many nurses were extremely interested in the nursing practices of the UK and exclaimed in disbelief to hear that patients with a high level of risk in the UK are not kept in cages but rather are monitored using observations.
The experience of undertaking an international placement is something that will influence my career every day.
I am reminded of how lucky I am to work within the nursing sector in England where nursing practice is developing each day. We have the National Health Service which is something people from countries under-resourced can only dream of.
I have been able to reflect upon how essential it is to maintain and remember the fundamental elements of mental health nursing - simple things such as compassion, kindness and an ability to evoke trust.
I fell in love with the country of Tanzania and its people. I felt empowered to make a difference to the lives of people who cannot repay you for your work.
Jessica Cooper is a current mental health student nurse