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Date: 2015-10-30
Title: The Division of Global Psychiatry Builds Collaborations in Somaliland

Pictured on left: Dr. Ereg, Dean of the Faculty of Medicine at the University of Hargeisa, Essa Kayd, Dr. Fricchione, and Dr. Henderson discuss the collaboration

Six members of the Chester M. Pierce, MD Division of Global Psychiatry visited Hargeisa, Somaliland from September 12-16, 2015. Drs. Henderson, Fricchione, Borba, Chemali, Essa Kayd and Lindsey Parnarouskis went to help launch the next phase of a mental health collaboration in the Horn of Africa. Somaliland is recognized as an autonomous region of Somalia, but has been fighting for international recognition as an independent nation for the last 24 years. Somalilanders have strong social and community ties, and are proud of their continued ability to keep peace, in contrast to other areas in the region. However, the country faces many health challenges, particularly regarding effective care for neurological and psychiatric illness.

The Division’s collaboration in Somaliland began in January 2014 after a trip to Hargeisa and stems from the vision of Essa Kayd, Supervisor of Electromyograpy (EMG) at Brigham and Women’s Hospital and a Somaliland native. After living in the United States for many years and witnessing the challenges his family members faced in accessing quality neurological care in Somaliland, Essa returned to Hargeisa in 2009 to establish Hargeisa Neurology Hospital. It is the first and only facility in Somaliland with capacity to treat patients with various neurological ailments such as seizure, stroke, hematomas and brain masses. The hospital has a neurosurgeon and primary care internists on staff supplemented by a visiting neurologist who consults with the team. As part of the project with the Division of Global Psychiatry, the hospital is hiring a full-time psychiatrist to provide hands-on care and better address the needs of patients presenting with psychiatric problems.

During the visit in September, professionals from various backgrounds came together to discuss the current state of mental health care in Somaliland and potential solutions. Collaborators included representatives from the University of Hargeisa Medical and Nursing Schools, Somaliland Ministries of Health and Planning, Hargeisa City Council, and London School of Hygiene and Tropical Medicine.

One fruitful discussion during the visit regarded the planning of an integrated neurology and psychiatry residency program at the University of Hargeisa. This innovative curriculum will focus on illnesses of the brain rather than segmenting disorders into the two fields of neurology and psychiatry. Training will focus on observed needs of the population, including training on epilepsy, psychosis, depression, substance abuse, etc. so that trainees feel comfortable addressing the diverse patient needs they will encounter.

In response to the dearth of data on health and mental health needs in Somaliland, the team has also been working to develop an electronic collection system for clinical data at Hargeisa Neurology Hospital. The team will use this technology for care quality improvement and as a starting point for mental health research infrastructure in Somaliland.

An energy of hope and excitement permeated the visit. Collaborators are committed to building and implementing effective, culturally relevant training programs, sustainable quality clinical care, and research to improve conditions for people living with neurological and psychiatric illness in Somaliland. Though there will be various challenges along the way, the team will continue to evaluate and improve the programs to best fit the needs of this vibrant and resilient population.