Back to Scotland

It feels like such a short visit for me at least, Lesley is still in Zambia with more meetings for the M and E and planning but I am back to the sleet and snow of a Scottish Easter.

Evaluation exercise

The last week was again full. The training at UTH was completed with interesting points coming out of the evaluation and comments on the training. All those who completed the course passed
and the certificates have been
presented. I certainly learn so much each time I am involved in the training.

congratulations!

Monica in delivering this training is now recognised as a Trainer in Therapeutic Art alongside Wala who completed in November last year. There are definite plans now to fit in the delayed training in Ndola where Susan can complete her training. This is to be in  our June/July visit. We have been in discussion with UNZA nurse training and Chainama College and the plan is to be able to programme training for some of theses students. We have to recognise our limits as a small group of trainers with a very limited budget and plan to make best use of our resources. We have got funding to include a new UK trainer in our next trip so we are hopeful that our team will grow enabling us to get more Trainers into the system.
We are now also able to confirm that we have been awarded a Scottish Government Small Grant for 2018/19 which is wonderful and we are grateful for their belief in what we are trying to achieve. The purpose of this award is to strengthen our capacity as an organisation and also to support the coordination and sustaining of the training and practice of Therapeutic Art in Zambia so it can develop as an integral part of the Mental Health system.

lunch break

On 26th of March we were pleased to be able to arrange a meeting of some of the major stakeholders who have supported the programme and begin the discussion of how we proceed. It was good to get feedback and learn more about the developing Mental Health systems as well as the training schedules of the Institutions/Universities. The meeting was called at short notice and we were grateful that so many people were able to make time to attend; the plan is to hold a further meeting in July to build on these discussions. We need to spend time finding out a lot more from all the experts!

FIRST FULL WEEK

We gather it is still snowing back home. We watched the rugby match at Twickenham yesterday with an Irish friend and as we sat in the warmth listening to a live band it was strange to watch the snow falling and see everyone huddled in their anoraks! Anyway to more serious matters. The week has been full as always. Joanna has been delivering the training at UTH  alongside Monica who is completing her Training as a trainer. It is a large and varied group and as we are delivering it in a new structure over 2 weeks instead of 6 there are always adaptations to be made along the way. The group are very involved and the responses have been interesting and thought provoking.

Lesley's focus has been on the M and E, organising follow up interviews with the trainee trainers and contacting MHUNZA about the experiences of those involved in Taster Session last year. Another focus for both of us has been exploring the opportunities for further training venues, this is an important part of our ongoing Training of Trainers programme as well as of embedding the practice. We have also had a lot of support in arranging a stakeholders meeting where we can feedback and start the process of exploring the issues around sustainability. The plan is to follow this up later in June/July with a full stakeholders meeting to present the results of our Feasibility Study in full and move on with the next step.
To our friends in the UK we offer sympathy about the return of winter and please get rid of it quickly!

Back In Lusaka - away from the snow!

So finally given so many varied hurdles Lesley and Joanna are back safely at Gossner. The awful cholera outbreak was clearly the main reason for not being here any earlier and it is good to find that it is easing though there are still many issues around it to be worked through. Our departure was rendered a bit nerve wracking given the extraordinary blast of extreme winter conditions that struck the UK generally. But we made it!

We discovered

just as we were leaving that our arrival coincided with a 3 day holiday period and we are very grateful to our colleagues from UTH who agreed to meet us despite this so we were able to confirm the practicalities for the training starting next week.
We do seem to have exchanged the heavy snow for some dramatic rain and thunder which as always has knock on effects on power and internet connection (hence delayed posting!) but everything is looking very green and lush. We are also delighted to announce the publication of the first collaborative article about our work in The Health Press. Zambia.
 http://znphi.co.zm/thehealthpress/the-zambia-therapeutic-art-course-an-innovative-approach-to-increase-the-psychological-skills-of-zambian-mental-health-professionals/
Comments welcome!

Looking back at our time in Zambia

Joanna and Simon have been back in Scotland for nearly 5 weeks and there has been time to reflect on what happened during our work in Zambia and to get started on the next stage of planning for the completion of our Feasibility Study (which is funded by a Scottish Government International Development Small grant). In particular we are applying for further funding to strengthen ZTA for the future and have starting planning for the next phase of work in Zambia in early 2018.

First, our time in Zambia resulted in several successful outcomes; including people trained, models of training tried out, contacts made and contacts renewed. Three training courses were delivered during September and October 2017 and 30 people successfully completed the course: ten staff at Livingstone General Hospital, Southern Province, nine staff at Chainama Hills Hospital, Lusaka and eleven student nurses from the Chainama Hills College of Health Sciences. One of the local trainers completed her training and is now certified as a Therapeutic Art Trainer in Lusaka. She is the first of the Zambian trainers on whom the future sustainability of the ZTA training in Zambia depends. Four new trainee  trainers began their first stage training, and will hopefully complete their work over the next 12-18 months. This will mean we are well on the way to having a pool of Zambian trainers who can deliver the course. 

We evaluated three different models of training delivery during thus visit, in response to local conditions. At Chainama Hills Hospital the training was delivered in six 3-hour sessions over a period of 5 weeks; at Livingstone General Hospital the training was delivered over 4 ½ days and for the students of Chainama Hills College the training comprised 10 sessions of 2 hours each. Whilst each of the 3 courses worked well and participants were able to complete them successfully, we felt that delivering a shorter, more intense training was a way to make better use of trainers and participants’ time and we will focus on this in future courses.

During our visit we were also able to make progress with the monitoring and evaluation of the training, to fit with the plan for our Feasibility Study. We met with Margarate Munakampe from SCHEME, Department of Public Health, University of Zambia. Margarate is the M & E expert working with us to evaluate the ZTA training model and she has quickly grasped our approach and begun work on an evaluation model. We are enormously grateful for her help and advice and that of Professor Charles Michelo, the head of  SCHEME.

We were also able to meet with mental health and nursing personnel from the  Zambian Ministry of Health, to keep them informed of our work and to build our links with the wider health system in Zambia; with Dr Ravi Paul, Head of the Department of Psychiatry, University of Zambia Medical School at UTH Hospital in Lusaka and with senior staff at Chainama Hills Hospital.

We met with Sylvestor Katontoka, the Chief Executive of Mental Health Users Network Zambia and with his help and support, delivered a “taster” session to his members in Kanyama, a compound in southeast Lusaka. We had planned to deliver a second session but this had to be cancelled due to circumstances beyond our control in Kanyama. The response to the first session was very positive so it was disappointing not to be able to follow this up but we met with the MHUNZA Chief Executive again to discuss whether they might offer therapeutic art sessions in future.

All in all it was a very busy but successful seven weeks and the thirty successful participants in the three training courses gave us very positive feedback on the experience. During the evaluation sessions we conducted, participants commented on how their views of patients had changed for the better, how their skills and confidence had increased and how working with patients was a positive experience for them. A frequent comment concerned the importance of a mutually empathic and understanding relationship between patients and staff and how art making facilitated this.

Since our return to Scotland we have been taking a critical look at our capacity as an organization both at home and in Zambia and can now focus on developing this to ensure the sustainability of the training and practice within Zambian health systems. We have submitted our new grant application, have begin to plan for future training courses, and to look at how to develop ZTA and the Therapeutic Art training model in Zambia!

LAST FEW DAYS

Partly it feels as though we have been here for ever and partly that we have just arrived! As always the last week or so builds up to a rush of final meetings and reports. It is intensified at this time of year for us by the deadline for Scottish Government Small Grants application coming at the beginning of November. So a lot of international communication has gone on while we firm up our ideas for the best way forward with our partners here, building on what we have learnt from this Feasibility year so far. Consolidation and capacity building seem to be where we are at - both at home and in Zambia.
With the help of our trainee trainers we have finished the training courses at Chainama Hospital and College. As always for us the most interesting part is the reflective evaluation where trainees record what has changed for them. A great emphasis this year on the power of simple art making to open up communication  and the shared process to improve relationships. Assessment marks have been very positive too - so between us we seem to be getting the message across! We had productive meeting with Sergio Mainetti, who is the CBM/Basic Needs lead in the area to see where our approach might fit with what they are doing.
Just a couple of busy days to go and then seeing if all the things I wasn't going to buy but which have somehow appeared in my cupboard, are going to fit in my modest bag. Then it will be goodbye to Gossner which provides such a peaceful base and back to the cold.

In Livingstone and Lusaka

Joanna has spent the last 
week in Livingstone, 200 miles south of Lusaka at the Livingstone General Hospital following an invitation from Dr Sheikh supported by the SMS Dr 
Kachimba, delivering training to 10 hospital staff in the mental health unit there. Participants included medical staff, occupational therapists, clinical officers, a nurse and a physiotherapist. The Occupational Therapy department welcomed us with training space and enthusiasm and it was a privilege to work with such a close knit team. They even managed to come up with some clay which was well used! This was the first time the training has been delivered over a concentrated 5 days and worked very successfully. At the end of the course all ten participants passed and their feedback and evaluation of the course was very positive. " Did not know clients can open up that quick. Art has made it possible."- "How I feel and think about patients has definitely changed. After developing significant rapport with the patients as am able to look at them as human being with potential to develop themselves and achieve their aspirations."
We hope that this model of the training will be useful in similar hospital settings elsewhere in Zambia as it could be an efficient use of both trainers and participants time and resources.

Meantime, Simon has been coordinating the training at Chainama Hills College Hospital in Lusaka for both hospital staff and student nurses and student clinical officers.

These courses are now nearly finished and will end in the next week when participants have completed their final evaluation and assessment. The course for hospital staff has been led by Wala Nalungwe, one of our new Zambia trainee trainers, as part of our plan to establish the sustainability of the training within the resources of the Zambian healthcare system.

We are now in the final two weeks of our time in Zambia and are trying to hold meetings with key players within the health system here to embed the ZTA training within the wider system of training for health professionals in Zambia and to carry forward the monitoring and evaluation programme for the work. It is going to be a very intense few days as we try to round off the trainings and meetings. We still hope we may be able to do a second workshop with MHUNZA members before we leave on 27^th October. The second planned workshop had to be cancelled because the hospital where it was to be held had no water or power.

All this to do and the temperature is climbing again to the mid 30s this coming week. The sun is almost directly overhead at this season, so the only thing to do is not to go out in the midday sun!
All very well for him here in comparatively cool Lusaka but I had to walk to and fro to the Hospital in Livingstone in a seriously high midday sun!

HALF WAY IN

This week has gone really quickly. The training at Chainama, both Hospital staff and College students are warming up, as is the weather! Actually we had some heavy rain, briefly yesterday evening which felt really good.
On Monday we held a Taster session for the Kaynama MHUNZA group and staff from the Hospital there. Though not as many people turned up as we had hoped it was really interesting and got positive responses. sadly the follow up session planned for Friday - where more people were coming was cancelled at the last minute because there was no power or water at the hospital. The plan is to reschedule for when I am back from Livingstone.
We are having half way catch ups with the trainee trainers, both stages 1 and 2. As we are trialling this training model their feedback is really important and has been helpful in developing the monitoring structures.
In the training the use of clay always sparks things off and we have seen it used in many different ways by trainees and patients. The nonverbal communication exercise always causes a lot of laughter as well as reflection.






On Thursday we got a lift with Heidrun and Felistus to the First Night concert of the Lusaka Proms Festival, "Night on Broadway". Some amazing voices and jazz musicians - a wonderful evening.

In the house next to us here at the moment is a group from Western Province, Liangati Mubula Project, who are
trying out making products, jams etc from fruits from their region. Their plan is to try them out around town at the end of the week. I was allowed to taste one of the jams - it was delicious. Watch this space - good things to come!
All in all a mixed but busy week