Stories From the Field:

UGANDA

Psychiatry Residency Program Collaboration in Uganda

Sam Boas, MD and Julie Cromwell, MD received MGH Global Health Travel Awards to visit Mbarara, Uganda to start a new international collaboration between MGH McLean Psychiatry residency program and the new Psychiatry residency program at the Mbarara University of Science and Technology (MUST).

From June 1, 2018 through June 18, 2018, we visited Mbarara, Uganda along with a McLean psychiatry attending Dr. Stephanie Collier in order to start a new international collaboration between the MGH/McLean Psychiatry residency program and the new Psychiatry residency program at the Mbarara University of Science and Technology (MUST).

Prior to the trip, our initial objectives were to to develop an international elective in psychiatry for MGH/McLean Psychiatry residents at the Mbarara Regional Referral Hospital, the teaching hospital affiliated with MUST. We planned to provider clinical as well as didactic teaching, along with peer mentorship during the trip in June. Drs. Gregory Fricchione and Scott Beach at MGH, along with Dr. Godfrey Rukundo at MUST were instrumental in setting the framework for this pilot visir. While in Uganda, we gained invaluable on-the-ground experience in global mental health and medical education, with opportunities to work with MUST residents in inpatient, outpatient and community psychiatry settings. Our plans for peer mentorship, research collaboration, and case conferences were abstract prior to our trip, but now after meeting all the people involved, seeing the resources and environment they work in, and getting a sense of their general education, we are much better equipped to make this collaboration fruitful and sustainable.

The international trip was a wonderful educational experience and helped to lay the groundwork for future collaboration between the two programs. Specifically, we stayed at the MGH Guesthouse and worked daily in the inpatient psychiatry unit and outpatient clinic at the Mbarara Regional Referral Hospital, and also traveled out to the countryside to work at a community clinic on Thursdays. In addition, we occasionally worked on the general medicine wards while doing consults, and we were able to participate in a mock dissertation defense for four of the MUST psychiatry residents on our last day in country, all of whom successfully defended their dissertations the next week. As requested by the MUST psychiatry residents prior to the trip, we delivered on-site lectures on diverse topics such as the biological mechanisms of PTSD, general treatment of anxiety, differentiating delirium from dementia, and case-based discussions of catatonia and alcohol use disorder. During our time there, we also observed specific struggles of providing psychiatric care in a resource-limited setting, including a limited pharmacology formulary, staff shortages, and difficulty with longitudinal follow-up.

We feel the pilot project will pave the way for future 3rd and 4th year MGH/McLean psychiatry residents interested in global mental health to have an international clinical experience. To develop this global health elective, we are currently working with psychiatry residents in the Global Health Track at the University of Virginia School of Medicine, who have already established a successful global mental health elective in Uganda. Other ideas we honed during the trip were to provide remote lectures from specialists on selected topics; to create a peer support system research projects via email and telephone conferences throughout the year, to have future MGH psychiatry residents work more closely with MGH internal medicine residents in the global health track while in Uganda (e.g. have psychiatry residents round one day on the medicine wards and the internal medicine residents round one day on the psychiatry wards while in country, given the notable overlap of the two disciplines); and to help the MUST residents and faculty in their ongoing effort to develop agitation and alcohol withdrawal protocols given the limited staff training and psychiatric medications available.

Overall, we are deeply appreciate of the support of the MGH Global Health Travel Award in making our vision of an internal elective and collaboration for MGH/McLean psychiatry residents into a reality over the past year. We would not have been able to go on the trip without this financial support.