Just over two weeks ago today (sob!) we were on our journey to Lilongwe driven by Joshua, a member of SJOG staff. Amy slept through a spectacular sunrise but became more social towards the end of the drive as we reached a more respectable time to be awake! We discovered that Joshua was a font of knowledge and explained that most people in Malawi can speak several languages. He was curious to know which languages are spoken in England and, like others we have spoken to, was surprised to hear that people back home tend to have fewer opportunities and less need to learn languages other than English. He was also interested in learning more about the NHS and explained that Malawi used to have a state healthcare system but that this has changed in recent years. People are expected to pay a fee for admission into hospital and are then given a bill at the end of their stay; if they do not have the initial fee friends and family will come together to try to support this. This discussion led us to reflect on the challenges faced by the NHS and how a different system would face even more challenges in providing equitable care. On our journey we dropped off another member of staff who was travelling to join an SJOG project which works into the prisons of Northern Malawi. From previous conversations we learnt that the prison environment is harsh and often overcrowded, with a focus on punishment rather than rehabilitation. SJOG are working hard to create space for counselling within the prison system – watch this space!
The upside of our very early start was that we were able to visit the House of Hospitality in Lilongwe, SJOGs inpatient unit which was officially opened by the vice-president of Malawi the week before. We joined clients in a presentation by a member of the pastoral care team, the theme of which was around the Creation Story. This is something which we would be unlikely to come across in the UK and we were curious to see how the clients engaged with this. It was great to see lots of staff supporting service users and we reflected on our experience of inpatient services in which nursing staff are expected to complete other tasks whilst groups are running. It felt helpful that the staff who spend the most time with patients were involved in these conversations and could continue them at other points. Although not explicitly said, we felt as though one message which could be taken from the way the information was presented and discussed was that the difficulties clients’ were experiencing could be related to them having sinned. In our work we truly believe that people’s difficulties are understandable responses to difficult events and that they are not to blame for these; we noticed that the narrative about sin may at times conflict with this. A message which was explicitly shared was that caring for ourselves allows us to care for others and that this is an important aspect of wellbeing and faith. We were reminded of one of the basic tenets of compassion-based approaches, which view self-compassion as a pre-requisite of compassion towards others.
With the day coming to an end we agreed to come back the next day to meet with the counselling team and spend time with patients. When we arrived on Friday morning we joined a ‘journal club’ meeting to hear about two research projects being planned by members of staff. We were interested to note that both presentations were about psychosis and one focused on alcohol induced psychosis; this seems to reflect the frequent use of psychosis as a diagnosis and the dominant narratives around alcohol and drug use leading to mental health difficulties. There are plans for SJOG to build Malawi’s second drug and alcohol rehabilitation centre in Malawi and we hope to have more conversations around this in the future.
We had learned that the ward counsellors were keen to spend some time with us and discuss and we manage situations in the UK. In particular they discussed the management of sexualised behaviours and offences and how this is often understood as being linked to drug and alcohol problems. This led onto conversations about the impact of trauma and how we conceptualise this and how this underpins the way we work with many mental health difficulties. The counsellors shared some of the difficulties they face when working within communities in which ritual practices which are now illegal in Malawi remain commonplace. We spoke about basic psychoeducation on the neuropsychology of trauma which we would share with clients and the counsellors were keen to learn more about this. We were disappointed that we hadn’t been able to visit Lilongwe at the beginning of our trip, as this would have provided an opportunity to plan a workshop exploring this further. We will keep in touch with the counsellors to continue these conversations and plan workshops around this during our next visit. We noticed that these conversations were responded to with enthusiasm and a sense that this was something which would evolve; it felt as though coming back a year on had shown our commitment to this partnership.
Our afternoon was spent with clients on the wards. Similarly to last year, we noticed that when clients seemed visibly distressed staff tended to move them away from us; we wondered whether this was to give them some space or to ‘protect’ other people from witnessing this. We were challenged to several games of bao, none of which we won despite (or because of?!) our opponent trying to help! We had noticed last year that playing games was a helpful way to connect with and engage with clients with whom we could not always communicate with words. We had brought along a game which was non-verbal and involved us playing separately but also needing to cooperate. Clients and staff were curious to learn a new game and were much quicker to pick this up than we were at bao! There was lots of laughter and we were once again struck by how connected you can feel to people despite not sharing a common language.
As always, such a wonderful trip came to an end all too quickly and we were preparing ourselves for the journey home. We both felt incredibly sad to be leaving what does truly feel like the warm heart of Africa, but excited about our plans for the future of our partnership here.