Who am I:

I am a Masters trained Occupational Therapist (OT), graduated from the University of Western Ontario, and have been working in mental health for the past 10years.  

Occupational therapy helps solve problems that interfere with your ability to participate in the things that are important to you, your daily occupations. When illness, injury or disability limit your ability to take care of yourself, participate in home, work (paid and unpaid) or school,  and enjoy your leisure time, occupational therapy supports you in learning new skills or doing things in new ways for the job of living your everyday life.

I have worked on 2 Assertive Community Treatment Teams (basically a hospital on wheels and without walls), supporting people living with schizophrenia, bipolar disorder and schizoaffective disorder. I made my first effort for community development by providing a proposal to increase occupational therapy services in the agency I worked for.  In March 2013, I took my community knowledge into a tertiary mental health hospital and now support individuals re-integrate into the community.

Doing an international volunteer trip has been on my career bucket list since I was completing my degree.  When this opporutnity was brought to me by Dr. Sujay Patel, I couldn't resist. I am excited to use my skill set at a macro and grassroots level, building my community development skills, and am ready for an eye-opening experience.

Background Information:

Guyana is the fourth-smallest country on the northern mainland of South America (about the size of England and Scotland combined). It is a Caribbean country that has a population of 800,000 people.  It is the only South American nation that has English as the official language. A majority of the population, however, speaks Creole.  It is one of the poorest countries in the world. It is primarily an agricultural society.  Most of its economy tied to the sugar industry, which supports about 80% of the population. These are low-paying field-work jobs in which minimum wage is 50 cents per day. This means that many people find it hard to pay to get to and from work.

The scenery in Guyana is amongst the most beautiful in the world.  It is home to Kaieteur Falls, the largest single-drop waterfall in the world (based on volume), with a drop of 741 feet. In comparison, Niagara Falls is only 167 feet.

The Mental Health System:

The life expectancy for the Guyanese is 60 years for men and 67 years for women at birth. Addictions, poverty, and gender-based violence are contributing factors to the mental health rate.  Suicide was listed as the 7th cause of death in 2014, but its rate is ranked the highest in the world. 

The World Health Organization report (2008) identified that the mental health system is fragmented, poorly resourced and not integrated into the general health-care system. The mental health care is structured off of the Mental Health Ordinance of 1930, which fails to protect the rights of individuals.  Stigma against mental illness is pervasive and runs rampant through the public, health professionals, the police, and policy makers and administrators.  Mental illness is misunderstood – symptoms are attributed to witchcraft. These are part of the main barriers to the development of modern mental health services.

No formal mental health plan or policy, or treatment guidelines exist.  A suicide prevention strategy was only launched in September 2015 after some training from a Canada Mental Health Team in 2014 (see below).

The National Psychiatric Hospital operates primarily on medication, and it only has at least one psychotropic medication for each therapeutic class available (i.e, anti-psychotic, anti-depressant, mood stabilizer, anxiolytic, and antiepileptic). Despite this, there are no guidelines or protocols for the use of psychotropic drugs nor has there been any training in the rational for their use.   Doctors in training only receive 20 hours of education in their 4 years of schooling; there is no psychiatry residency training program.  There is no psycho-social rehabilitation for those living with mental illness.  There is a shortage of specialized mental health care professionals: 3 psychiatrists, 2 other medical doctors, 3 nurses, 3 social workers – no psychologists or occupational therapists. This means there are only 0.5 psychiatrists per 100,000.  Needless to say, the mental health services are inadequate.

Occupational Therapy in Guyana:

Guyana’s main challenge is human resources. They do not have specialized skilled professionals.  They try to relieve the human resource issue by training rehabilitation assistants. In their terms, a rehab assistant is someone who is trained in physiotherapy, occupational therapy and speech therapy, and provides a basic level of rehab services.   All rehab services are based on physical health.

There are no training programs for occupational therapy or any practicing occupational therapists in Guyana. After doing some digging, I discovered that at present there is only 1 occupational therapist in all of Guyana, and she is a volunteer from the Netherlands providing support in physical health matters (i.e., training rehab assistants).

Previous Canada-Guyana Mental Health trip:

In November 2014, a group of 20 multi-disciplinary health care volunteers went to Guyana to support the development of Guyana’s mental health care system.  Their focus was to implement an ECT (electorconvulsive therapy) service (fundraising went to provide an ECT machine and provide training on its use), provide direct medical care through outpatient psychiatric clinics at public hospitals, help create a Guyanese National Prevention Strategy via “train the trainer”, and taught medical students/nursing students/general practitioners on a variety of subjects in mental health, including de-stigmatization.

You can view more pictures and details of the trip on Rev. John O’Connor’s blog (a volunteer minister in Guyana since 2002).  http://revjoc.blogspot.ca/2014_11_01_archive.html

Also, you can look up “Transforming Guyana’s Mental Health System” on Facebook or “Guyana Mental Health” on youtube.

Our next trip:

This year, our group is small, consisting of a general practitioner/Lutheran pastor, 2 psychiatrists (one a practicing psychotherapist) and an occupational therapist.  Three of us will be going from Monday April 4, 2016 to Saturday April 9, 2016, while the fourth is staying an extra week.

This is the first time Guyana will have an occupational therapist in mental health at their disposal, as well as a psychotherapist.  

We will primarily be in Georgetown (Georgetown Public Hospital and/or St. Joseph Mercy Hospital) and hopefully New Amsterdam (National Psychiatric Hospital).

 The goals of this trip are:

1. Teaching Guyanese psychiatrists, general practitioners, medical students, and nursing students about holistic mental health treatment guidelines through the use of case studies. This may include providing support in inpatient/outpatient clinic and multi-disciplinary rounds.
2. Education about de-escalation, code white response, and patient safety device use for individuals with physical/violent responses to all parties mentioned above. We plan on providing some patient safety devices for the Guyana Ministry of Health to use in its hospitals.
3. With having a trained psychotherapist on our team, providing education about psychotherapy, its modalities, how to conduct some forms of psychotherapy including interviewing, and providing several resources to leave behind on this topic.
4. As being the first occupational therapist in mental health to go to Guyana, providing education on what occupational therapy is, the role it plays in mental health, support/offer a multi-disciplinary perspective to case scenarios during clinics/rounds, and assessing the mental health rehabilitation programming status. As occupational therapy has a generalist role, I would also provide education about the physical health role occupational therapy plays within mental health (e.g., medication side effects on gait, mobility issues when coming into a program).  Based on the needs assessment, a list of recommendations of how to enhance psychosocial rehabilitation (the basics) can be offered.  My hope is to find some resources such as textbooks/reading material and leave them for continued learning of the appropriate staff.

Donations:

Donations will go towards the above-mentioned resources that the team is planning on purchasing and bringing to Guyana, last-minute supplies (medical or non-medical), to incidentals of the team, and possibly expenses that occur while we are in Guyana.

Thanks for reading! 

**** Please note that this is NOT a registered charity, and therefore, tax receipts cannot be given out****