Medical education and professional training for Charikot Hospital's medical team over a 12 month time period. Specifically this would support training fees, housing, travel, and accommodations for off-site training for Psychosocial Counseling, Anesthesia Assistant training, Skilled Birth Attendance training, Implant & IUCD training, Comprehensive abortion care training, general management training, and attendance at the Annual Rural Health Worker Conference at the Nick Simons Institute in Kathmandu.
With support from America Nepal Medical Foundation, we were able to train one of our Charikot Hospital-based community medical assistants, Ms. Sunita Jirel, to become a psychosocial counselor in FY2018. Two additional staff members from Bayalpata Hospital in Achham were trained, as well. The six-month long training, led by The Relief Trust, included a combination of theory in the classroom setting and field visits for practical learning. Course modules covered a range of topics from human development and behavior, gender-based violence, psychosocial support, and various forms of counseling.
Following the training, participants were equipped to work in various settings with different populations as a counselor, in both individual and group settings. Following her training and based on her success, Ms. Jirel was promoted to senior psychosocial counselor within one year of her training. This training was critical to the success of our integrated mental healthcare program during the last year of implementation.
12 Nov 18
A preliminary report from Possible on the importance and impact of the psychosocial counseling training that ANMF supported in the last year:
We have piloted an integrated mental healthcare program that includes primary care providers (PCPs), on-site psycho-social counselors (PSC) and a remote psychiatrist, with the following roles: PCPs identify mental health problems, counselors use therapy rather than unwarranted medications, and a psychiatrist reviews all treatment plans to ensure high quality care.
To meaningfully equip staff at every level to provide quality care, PCPs are trained by a psychiatrist who visits the hospital every 3 months for additional on-site training. PCPs evaluate patients and send them to PSCs who conduct a full psycho-social evaluation and provide psychotherapy. After thorough evaluation, patients are sent back to the PCP and medications are prescribed by PCP only if it is necessary. To ensure high- quality services, every week PSCs consult with the psychiatrist and ensure every case receives appropriate care.
Most programs use on-demand consultation, but such systems do not address errors that are unknown to the PCP or PSC. Our pro-active panel review looks at every patient's care to make sure that the psychiatrist agrees with the diagnosis and treatment. Because remote training is not enough, we also provide regular supervision via panel reviews and on-site training from the psychiatrist.
Patient outcomes are measured via validated tools like PHQ-9. We assessed changes in PHQ-9 scores for patients with moderate to severe depression, from our catchment area between September 1, 2016 to August 31, 2018 and 52% patients' demonstrated clinical response. These rates are similar to what is seen in well-funded, closely monitored clinical studies conducted by world-class research universities in high-income countries.
Overall, since we initiated mental health services at Charikot Hospital in Dolakha in August 2017, we see a significant change in attitude and treatment among healthcare providers and encouraging results from patients' scores.
