Winding up but not exactly winding down!

So these last few days are rushing by - so many leads to follow  and plans to make and it doesn't seem to be any cooler!
We got back on Monday from Kafue Park where we had spent a wonderful 2 nights - a mixture of excitement and serenity! Just for the avoidance of doubt for all our supporters any recreational time or activities is not seen as part of ZTA time! Though we did take some work with us!
Anyway a wonderful place -Mayukuyuku Camp  -and a very close sighting of lions and a bit too close of an elephant who chose to feed on the trees 3 feet from our tent at 2.0 am! Birds just amazing and a glorious evening boat ride. Really nice people with a wealth of knowledge and great food.
Back here we have caught up with key players in planning the next possible developments and looked through the art work and notes to start the process of evaluation which will go on at home. At UTH we had our final supervision session and were assured that the group will continue to meet as it fulfils a real need as support and learning for all their work.
The certificates were presented by Dr Paul, Head of Psychiatry who has been so supportive of the work and its continuation. At Chainama as well there is a determination to get a module designed to fit in the curriculums at the College, all very encouraging - more work!
We presented at a Seminar yesterday at UNZA School of Health Promotion who are very interested in creative communication approaches. Certainly when discussing the art exercise we gave them there was  a lot of communication going on!
It will be sad to leave Gossner where we have been so much at home and the mangoes here still are not ripe!  Off into the sunset!

Endings and what's next?

Just writing this today as we are off to Kafue tomorrow for a couple of nights hopefully to see some large cats  - but not too close - and for some out of town experience.  So we are just back from various meetings and an exciting visit to the bus station to get our tickets for the journey.
The heat makes everything very tiring to us northerners and just seeing the temperature at home is 9 degrees not the 34 we have here makes me quite jealous!

The week has been gratifying and busy. Lots of contacts about the future to follow up and time reflecting on the evaluations. There has been so much hard work and really interesting response from the trainees in both locations. A great deal about the change in relationship and communication, a real emphasis about how hidden stories emerge and how people find a voice through the  art . Also in writing about their own art making the trainees have shown great insight and honesty about what it has meant for them and consequently how important it is for their patients.

Tuesday was the day at Chainama to present the certificates and celebrate everyone's achievement. Dr Phiri the Senior Medical Superintendent, presented the certificates accompanied by senior staff from all departments. The art work and notes were on display and much interest was shown.
At the end - much to our surprise we were presented with a beautiful framed art work by Margaret who the very talented lady based in the OT department who has been our great support this year and last. Then in addition a wonderful Zambian dress each in the national colours again made by the tailors in OT Esther and Belita. It was very touching and I hope we were able to convey how much we have learned from all of them. There does seem to be a real determination to support and develop Therapeutic Art practice in various ways. We also had chicken and chips provided again for all.
We came home later to a wonderful meal of kapenta - tiny dried fish, nshima and vegetable relishes cooked by a friend who is staying here - Quite a day!
We had also to get ready for UTH and supervision and possibly presentations there and going through the evaluation with Dr Paul. We did not get the presentation done but got some really useful feedback and advice about the way forward from Dr Paul and an agreement to do the presentations next Wednesday as so many folk were not able to be around. The ongoing  Therapeutic Art supervision  group is a really informative process and the intention is to keep it going once we have left.
Thursday was continuing with planning, following up contacts and going though the work and notes. The day goes really quickly. You have to start early to make the most of the cool part of the day and keep yourself going through the heat with the help of fans and mangoes!
Today we had another follow up meeting with Sylvester at the posh shopping centre he uses as an office! Learning more about his plans and projects and seeing where our work overlaps. Very productive. So now we are packing - the forecast is that the rain will start but the bus journey promises to be hot.

So again this week has rushed by - I had determined to write up on Friday which was supposed to be home based day reflecting on all the amazing evaluation and assessment data we had gathered from both training sites earlier in the week -BUT an early morning and somewhat cryptic series of communications from Sylvester - from MHUNZA - we found ourselves rushing to a symposium to mark Dignity in Mental Health Day held at Chainama. I've never seen Lesley move so fast as she switched from domestic to public dress! It turned out to be a really useful and informative day and included a chicken and chips lunch! We were welcomed with true Zambian generosity as we were not on the official guest list.. There were presentations from the Ministry, Care providers and Users and from the Hospital itself. We got a picture of the planned developments in the service and the Hospital but also a perspective from the staff side, the area health providers and from Human Rights, service users and Legal Aid perspective. All in all we gained a much more rounded picture of the present position of the service and its aims and aspirations. So much hope is pinned on the passing into law of the Mental Health Act which is due for its first reading this year and which will provide the framework to support the planned growth of the service. The day also gave us the opportunity to meet with some of the key people we had on our list to contact -including two senior staff we had worked with last year- and so were able to confirm a planning meeting to discuss the future of the work in Chainama. So we got home late afternoon too overwhelmed to do much but reflect, cook and sleep!
Then yesterday the solar power system had a relapse and we were without power for most of the day. We spent our time struggling with our plans for the future - trying to define our aims and make best use of all the support we are receiving here. We rewarded ourselves with a walk to the road end, short minibus ride and a meal at the wonderful Lebanese restaurant with a friend who is staying here briefly and some newly arrived VSO workers.
To go back to earlier in the week - Monday was the last patient group in Chainama. A good and productive session again with a range of patients and ways that the time is used. Tuesday was full on! all the Chainama trainees turned up and we spent about 2 hours on the reflective evaluation which ends with trying to arrive at what they consider the most important changes for them and the patients. So much material. The Hospital sent someone to video the process but in our group we were so absorbed we barely noticed him. We will see the result next week! Most trainees chose to take the short written assessment and we spent the afternoon marking them which turned out to be not so daunting as the system we had worked out did seem to be effective..
Wednesday at UTH as well as a supervision session we went through the same process of evaluation and assessment . Ending the afternoon with a somewhat exuberant art group! The scribble warm up technique has really grabbed the imagination! More marking!

It is worth saying here that the temperature has dropped significantly by a good 15 degrees in 24 hours so we have had to resort to socks and digging out the fleeces. By the end of the week it had climbed back up to a pleasant mid to high 20s - but no real rain just one heavy shower.
Thursday was again full on and we were only able to survive it because of the lower temperatures. We had a productive follow up meeting at the Ministry of Health - more planning to do! We found a small print shop in a market area where they do colour and can print on card - so we sat in a café and finalised the wording for the various certificates then this poor guy spent over 3 hours getting the printing sorted.

We sat there for a while tantalised by the smell of all the food being prepared on the stalls around us but we had to leave him to finish as we had to go to the University Medical School to meet with a Lecturer in Public Health who Lesley knew of through her research. He was very enthusiastic and helpful with information and contacts and signed us up to do a presentation at one of there weekly seminars. So you can see why Friday was  so needed as a consolidation day! What will next week hold.

Making good progress

  Well, already we  are over half way through the training and it it so good to see how the trainees are really grasping how useful art is for  helping communication and understanding.  Hospitalized patients frequently express their appreciation in having the opportunity to  join in the art group  ---  away from the ward for an hour  or so, and with some 1.1 time with a staff member. I particularly feel for the younger ones  who may come --  teenagers who are missing home and school. At least in the group they have the chance to do something familiar  - drawing and writing.


 Groupwork  has been part of some of the trainees experience - they were amazed they could create a whole town plan in 20 mins --  and recognised how ideas can be generated better in a group and  that different  individual priorities could be a focus for reflection.  

 We are now turning our focus to the end  of the training  - which  will be on us before we know it! -- so have been fine tuning the evaluation  process and the  assessments . Gathering data for the research arm of this work  is also to the fore.  We want to measure the efficacy of this training  so that it can be put to best use, here in Zambia. Many health and development programmes fail  simply because they  do not listen  enough to what is needed and adapt their inputs accordingly.  Our approach is to continually reflect on  our work and adapt  the training accordingly. While their are obviously some cultural and language  difficulties in communication, we do our best to minimise these effects.

 Home life is therefore a tapestry of  discussions and writing, as well as eating and sleeping -- with an occasional walk round the garden once the temperatures drop a bit later in the day. Our office space is the dining table ---, but we do long for a printer.. as getting any printing done is dependent on their being  power on at the local post.net at Kabalonga or hospital resources  - which often have shortages of ink.

  Yesterday we had a morning out  -  at the Dutch Reformed Church monthly market. Due to our lack of exercise through the week we started early and walked  the 20 mins to the nearest minibus pickup. Thankfully our journey - squeezed in with everyone else in increasing temperatures was short. The market is a rich array of  crafts, furniture, beautiful bedding and clothing made from bright chitenge material, vegetables and fruits and  a wide range of  food and drink ---  and a shady place to sit under the trees. Christmas presents were on our minds, and with a fair bit of bartering -- we managed to pick up  some nice things.

 Overall  a good week of training  - with some useful leads as to how we  may be able to make this training even more widely available.....

week 4

Another action packed week. I had meant to write something earlier but technology has been playing up and also life has been very full.

Yesterday was Independence Day and for the last few days more and more Zambian flags and banners have been appearing everywhere- we actually spent the day a bit out of town through the drying landscape at a beautiful area called Monkey Pools. Here a small river has been dammed and pools made for swimming under the trees. The water was wonderfully cool though Zambian friends thought it far too chilly. There were huge dragonflies and bright scarlet smaller ones, butterflies of all colours, purple water lilies and fleetingly a flash of a brilliant kingfisher. We ended the day in a busy Ethiopian restaurant full of Independence Day revellers where the food was delicious- so it is not all work!
The groups at Chainama went very well this week - with us realising from the recorded observations that we needed to be a bit more pro-active in explaining the importance of fuller descriptions of the art work itself. There were some really interesting and positive reactions from the patients. One gentleman being "overwhelmed" by what he found in the room. Trainees are showing real insight as to how they can see the approach being useful in different situations. Another session with the Trainee Clinical officers on Tuesday afternoon - a smaller group as some on practical placements and some interesting feedback though it is of its nature a much less in depth training. The walk across the hospital to the College was not so overwhelmingly hot this week!
In Chainama  this year we are quite rightly being expected by management  to justify the value of our training.
The group at UTH brought some very interesting case work to the supervision group and the discussion was very general with group members showing real insights into the process. As well we did some interesting work on enabling stories to emerge in the experiential work. We had two half days this week with the 1sr year neuro-psychology Masters students. A lot of them come from a special education back ground which added a new dimension to the work and lead to some interesting discussion. This again is a very short introduction and I think some of them were disappointed they were not  at this stage receiving the full practice based module.
We are learning a lot from the trainees about the systems here and how issues of child abuse and "defilement" are approached and managed. We are always trying to keep our approach as open and responsive as possible which necessitates endless rewriting material and thinking on the hoof!
Lesley has been following up research support and on Friday after treating ourselves to a leisurely lunch we set off to a meeting with the director of MHUNZA ( Mental Health Users Network Zambia). Sylvester Katontoka. We have met before and he is a mercurial character with a burning passion for the cause. He has been and is involved in Government and International level negotiations, representing the  service users. We ended up, after an interesting taxi ride, meeting him near where he is staying as currently he is only getting round with the aid of crutches. It was a useful if far- ranging discussion and we have his support and co-operation for any feasibility work we can get funded.

So Friday found us pretty exhausted but pleased! During the week friends staying here had come to supper and a couple of evening saw 
us sharing a beer of two.  The purple of the jacarandas has been gradually replaced by the staggering brilliance of Flame Trees and though the ground is getting drier and drier the range of blossoms is still amazing and the scent of the Frangipani is wonderful. The tree next to where I am sitting is hung with still small hard mangoes. I don't think they will ripen before we leave sadly but I am really hoping to be  here long enough after the rains start to see the changes that will bring

week 3

So another week and so much has happened. The work started at Chainama Hospital in the big OT room and despite the usual nailbiting wait to see if anyone would show a very good selection of about 20 staff turned up. A really good mix of professions and experience, We had arrived far too early as Mr Manda who has been driving us wasn't sure of the traffic which can be horrendous. The drive passes through Ntendere which is crowded settlement area and at that time in the morning it is packed with children going to school, stalls opening, delivery trucks, mini buses and everything under the sun all crowding on to the bumpy dusty road. Some very impressive smart lady police trying to keep things moving, Zambian drivers in town seem mostly very accommodating and responsive allowing the traffic to move as best it can and negotiating roundabouts and junctions. Hooting is only used as a thank you, a gentle warning or a "Do you want a mini bus?"
Anyway back to Chainama - there was a long delay before the promised projector and screen arrived - thanks to the Physio department and we got  it fixed up. We had to do some rapid adjustment to our running order but the general tolerance and the interest got us through. The practical exercise as always really grabs people. We hopefully ended the morning with some arrangements for the practical work and some enthusiasm to get going. We were very hot and  I think the waiting and the uncertainty had taken its toll - we were exhausted and by the time we had had some printing of handouts done - everything take so long as there is often limited paper and ink and by the time we had fetched ours we were drooping badly! We did summon the energy to get Mr Manda to stop at Pick and Pay for some much needed beer!
The next day was to be a full day with the first practical group in the morning and the first of 3 sessions for trainee clinical officers in the afternoon. The practical session was as usual busy and fascinating - 2 new trainees turned up so that was a bit of a distraction but good stuff and patients clearly getting a  lot out of the experience. The midday heat walking across the dusty short cut to the college was quite a trial but taken slowly we arrived and found a lively chatty student group, very responsive and engaged. Wednesday is the full day at UTH with case feedback and art work and some theory which will be the pattern for the next 2 weeks. Interesting and thought provoking,
We have signed up to do a very brief introduction to the 1st year Neuropsychology intake on Thursday and Friday morning next week. The rest of the week was spent going through the work - refining material and starting to kook at grant applications for the next stage!
The nearest shopping centre is a 40 min walk and if you leave early enough it is manageable but a pick up to get home is essential - just too hot. Gossner where we are has successfully installed solar power so we are now not so off on and can keep the beer cool! We took an evening stroll round the vast and fortress like edifice which is the US Embassy just up the road and were horrified to see the fumes coming out from their vast diesel powered generators. Why don't they have a solar powered system? I am contemplating writing to Al Gore! Out for supper last night with some of amazing msumbos (Europeans) who have made their lives and work here - oh and on Friday we went to a fantastic food festival - delicious! So it is not all hard work and there continue to be wonderful birds in the garden.

week 2

So a week on and it seems like an age. A lot has happened both in the work and in just being here. Sitting here in the cool of the morning outside our bungalow it would be easy to just think we were on holiday! The garden is lovely despite the grass being burnt pretty dry. There are numerous birds that I have been somewhat fruitlessly trying to identify - long beaked sunbirds - little bright blue insect eaters and so many more. I just saw what was either a stork or a crane fly over and on our way to UTH ( university Teaching Hospital) on Wednesday the sky was quite full of large kites presumably finishing the nightly clearup. To add to the unfamiliar bird song we have neighbouring geese and peacocks over the wall!
We have spent a lot of time working on teaching materials, adapting our content to the new groups of trainees. We did our first day for the group at UTH on Wednesday. 20 mixed highly qualified professionals who are practising as psychologists, teachers and nurses and half are in the second year of their neuro-psychology Masters.. The course is a big commitment for them in their already busy schedule but there was a general enthusiasm to start using the practice gradually with their patients/clients. This week they will start bringing this work back for discussion and supervision in the group which is big part of how the skills are transferred.
We start our programme in Chainama tomorrow. Chainama is the main Psychiatric Hospital for the country and we worked there last year. This year we have very different trainees. 10 professionals working on the wards, nurses, social workers and Clinical officers and 10 nursing assistants and OT staff. In addition we are doing a shorter programme for trainee Clinical officers. The practical work in Chainama is in groups held in the big Occupational Therapy building where we worked last year.


So this week will see us trying out a full programme and adapting as usual as we go along! Power is a real issue, the regular power cuts seem to becoming increasingly random. Getting material printed and photocopied takes time - the local Post Net's printer and copier has not been working for over a week so this means another taxi ride to another shopping centre. Also we try to avoid using these for printing as Lesley already has had one stick corrupted and last year the same happened twice to me.
Beside all the working we have taken advantage of a Zambian / German/French musical week. Some of the visiting musicians have been staying here. Last Sunday was an amazing concert in the university chapel of sacred music from European and African traditions. Wonderful even though we got stranded after in the dark waiting for a driver as we rang the wrong number and ended up dragging someone away from his Church work party ! He forgave us! On Friday was a performance of the Magic Flute as you have never seen it. The snake was wonderful red and dragon like! Some glorious singing, quite an evening.

Blog 1    We flew into in Lusaka on 29th September – in the very early hours and following a long journey from Edinburgh to Amsterdam and finally Nairobi to Lusaka. Our purpose? - To take forward the Therapeutic Art training programme (a staff training programme we have developed over the last few years) - at UTH and Chainama Hospitals. This is the first time we have been in Zambia at this time of year – the hottest time! A lot of the areas of green in Lusaka have already turned brown and dusty – but the jacaranda is a sight to behold with its flowers burgeoning in a kind of misty purple haze.


Gossner Mission where we are staying is a haven and just now is feeling freshened after a dramatic thunder and heavy rain fall- releasing amazing scents from the earth and the many blossoms still around. This week we have been doing plenty of meeting and planning with the hospitals, and it really seems that we are personally welcomed and appreciated here with plenty of participants keen to join our training workshops and gain skills in Therapeutic Art. We are used to adapting our timetables to fit with Zambian staff and trainee schedules – And with some changes we have been able to finalise 2 training courses in 2 main Lusaka hospitals, which will train trainee psychiatrists, trainee neuropsychologists, nurses, clinical officers, social workers, ward assistants, physiotherapists and occupational therapy assistants over the next 6 weeks. We have a research arm of our training this year - well supported by the head professionals here -which is exploring how best our programme can be validated and then rolled out and sustained. We therefore have our work cut out and as is needed in training, therapeutic and research work, we need to have our eyes and ears open wide, to listen well and to be open to the challenges and joys of the unexpected….. This is what makes this work our passion – and it so refreshing again to meet the openness and enthusiasm for new approaches. We will try and keep track of this journey through this blog.

The view from our verandah