.....(Hal-ku-dhigyo Dhaxal-gal Noqday) = ..... President, C/raxmaan A. Cali: ''Jamhuuriyadda Somaliland dib ayay ula soo Noqotay Qaran-nimadeedii sidaa awgeed, waa dal xor ah oo gooni u taagan maanta (18/05/1991) laga bilaabo''...>>>>> President, Maxamad I.Cigaal:''Jiritaanka Jamhuuriyadda Somaliland'' Waa mid waafaqsan xeerasha u-degsan Caalamka! Sidaa darteed, waa Qaran xaq u leh in Aduunku aqoonsado''...>>>>> President, Daahir R. Kaahin: ''Jamhuuriyadda Somaliland waa dal diimuqraadi ah oo caalamka ka sugaya Ictiraafkiisa''...>>>>> President, Axmed M. Siilaanyo: ''Jamhuuriyadda Somaliland, Boqol sano haday ku qaadanayso helista Ictiraafkeedu way Sugaysaa! Mar dambena la midoobi mayso Somalia-Italia''.....[***** Ha Jirto J.Somaliland Oo Ha Joogto Waligeed *****].....

Tuesday, April 5, 2011

Rebuilding Hargeisa Mental Health Care.....By Saeed Abdi Elmi



The collapse of the Somali government in 1991, the lack of central government capable of rebuilding the destroyed infrastructure complicates the matter and the anarchy followed after the collapse of the state left Somalia without any health care facilities. Although, the rest of the country is still in turmoil, the Northern Somalia known as Somaliland, in 1991 after the collapse of the Somali state succeeded from the rest of Somalia. Since then, Somaliland has enjoyed peace and prosperity even though no government in the world recognized Somaliland as a legitimate country.

The above paragraph gives a short introduction of the long and complicated history of the collapse of the Somali government; Somaliland lacks modern health care facilities, especially psychiatric facilities capable of treating people with mental illnesses. A study done by the World Health Organization (WHO) in Somaliland in 2006/2007 shows that the country’s mental health system is not functioning because of the lack of mental health facilities. The study points out that “In Somaliland overall there are no well-functioning health and mental health structures. There is a Ministry of Health and Labor (MOHL) in Somaliland” (Warsame, 2006, p. 7).

Somaliland is a breakaway state from Somalia in 1991. Somaliland lacks modern health care facilities that will treat the victims of the civil war that roam around the streets of the cities. Mental health policies in Somaliland do not exist but the Somaliland government has created a small mental health unit in the minister of health and labor (MOHL).

There are no regulatory agencies that regulate the construction of a health care facility in Somaliland, “In Somaliland region of Somalia, there are no strong government mental health units at any level” (Warsame, 2006, p. 5). In Somaliland there is a shortage of qualified health care workers, medical equipment and medications and the government does not have the resources to regulate medical equipment or Medications but some of the local NGOs are committed to the improvement of the mental health system in Somaliland, and their efforts are already making a huge difference in the how the government views the health care system in the country. Some of their efforts resulted in the creation of the mental health Unit. One example of their effort is the relentless lobbying they do, “For example, GAVO with support from MOHL has successfully established two mental health care units in Mother and Child Care Centers” (Warsame, 2006, p. 5). Another great contribution to the healthcare system in Somaliland is the Adna Aadan hospital build by the Adna Aadan.

The rest of this paper will discuss my vision and dream for a health care facility Somaliland that one day will be built in Somaliland. This facility will be a not for profit psychiatric hospital and will be in the city of Hargaisa Somaliland and will serve the community of Hargaisa and its surrounding towns. Somaliland lacks modern health care facilities, especially psychiatric facilities capable of treating people with mental illnesses. This Facility will provide the needed mental health services to thousands of people affected by the long and protracted civil war and the ensuing power struggle between different tribes.

This facility will have long-term units, an admission unit and an outpatient clinic and a crises center. In addition to this the facility will have a laboratory, an in-house pharmacy, and a radiology department. There will be a separate building for administration and the information technology department (ITD). The ITD will provides secure, information processing services that will support the retrieval of data and information that will enhances the productivity of employees and the quality of health care provided. Health Information department (HID), will be responsible for maintaining and controlling the records of the patients served by the hospital. The Facility will have 100 beds for long-term patients, 30, beds for admission unit and 20 beds for crises intervention unit. The long-term units will house the treatment resistant patients and the patients with violent history. Because, the mental health system in Somaliland is barely functioning and the existing facilities are not equip to treat patients with mental illness this facility will also be used as a training facility for mental health workers.

The facility will include a training department and a nursing education department that will ensure a steady supply of well trained nurses and other mental health professionals for the facility. This facility will also provide mental health services to the ex-combatants straggling with post traumatic disorders without any adequate mental health services, due to the lack of mental health hospitals capable providing the needed mental health services. A research carried out by Nigel Wellman, and her colleague Trevor Lowe, pointed out that the “Emerging mental health services in Somaliland are struggling to cope with high rates of trauma-related disorders in ex-combatants caught up in years of civil war” (McMillan, 2005, p. 1).

This Facility will also be affiliated with Hargaisa University School of Medicine, the largest public University in the country and this relationship between the facility and the university will ensure the recruitment of psychiatrists from the university. In Somaliland the education institutions are growing faster than the other institutions in the country such as the health department and other government institutions. The facility will tap into this growing educational system to recruit competent health care leaders and health care providers who will take the lead in expanding the facility and building a world class mental health facility in a country where mental health system does not exist.

To build and operate a health care facility in Somaliland one needs to obtain a building permit from the local government and register the facility with the Minister of health and labor. The method that will be used to plan and develop this facility is the planning process, which will start with a feasibility study The feasibility study will also include information of existing facilities, resources available such as utilities, and other support services and the availability of trained health care workers. The minister of health and labor will be consulted with, when selecting a site for the facility. One good location to build the facility is next to the Hargaisa University because the university has a medical school therefore building the facility near the university would be ideal.

The Material that will be used to build the facility will be exported from the United Arab Emirates because of their close vicinity to Somaliland and this will help cut down the cost of transportation. Because, there are no codes restricting the material used to build a new facility in Somaliland, cleanable wall covering will be used to help control the cost of repainting and when the walls became dirty and to help cut down glares, “Textured, cleanable wall-covering are often preferred, as they not only facilitate acoustic control but also diminish glare”(Piotrowski & Rogers, p 244, 2007).

In Somaliland there is a shortage of medical equipment and medications and the government does not have the resources to regulate medical equipment or Medications. As mentioned in the first part of this paper the facility will have a radiology department, a laboratory department and an IT department. The radiology departments will need modern medical equipment such X-ray machines and CT scan and will be used for diagnostic purposes.

The IT department will maintain the computers, printers, fax machines and the communication technologies such as the email, electronic medical charting, and the physician’s medical ordering system, which will be used to order medications to enhance the delivery of care. The main communication channel for the facility would be the email, because using email will enhance the delivery of care and the dissemination of information between the patient and the provider and between health care workers; “saving time for both the patient and doctor, particularly as email can be accessed from almost any were” (Email consultation could improve healthcare delivery, 2004, p. 26).

The electronic medical charting will contribute to the efficiency and the effectiveness of the nursing staff and other health care workers that will provide care to the patients. Using electronic medical charting will reduce medical errors do the hand written notes. This will also free nurses and doctors from chasing paper charts that take most of their time. Having access to electronic medical charting will allow doctors and nurses to input patient information at the bedside and look up patient information from the comfort of their offices without going back to the nursing station, “Having electronic access to patient information frees them from having to constantly return to the nursing station or hunt down a given patient’s paper chart and manually update it” (communication news 2008).

The laboratory department will have a phlebotomy unit for drawing and processing blood. Specimens will be sent out to the United Arab Emirates were the facility will seek a contract with facilities that has advance laboratory equipment and the results will be send back electronically. The facility will have a diesel electric generator for buck up, but the main electricity will come from the main electric plant that is run by the government. This plant is very reliable and generates the electricity for most of the city.

The facility after completion would be the first privately run not for private psychiatric hospital in the history of Somalia, and first of its kind in Somaliland. The estimated time to build the facility is five years with estimated cost of twenty million dollars. The IT and the radiology equipment and the CT scan will cost the most and the construction labor will cost the least, because of the availability of cheap labor in Somaliland.

The funding for the project will come from grants from the government and donations from the Somaliland citizens in the country and the in diaspora, from the NGO organizations that are already working in the country lobbying the government to improve the mental health system in the country. These organizations are committed to the improvement of the mental health system in Somaliland, and their efforts are already making a huge difference in how the government views the health care system. Some of their efforts resulted in the creation of the mental health Unit. One example of their effort is the relentless lobbying they do, “For example, GAVO with support from MOHL has successfully established two mental health care units in Mother and Child Care Centers” (Warsame, 2006, p. 5).

The planning process will begin with the feasibility study to explore the need and the construction of the facility; in addition, the feasibility study will include an economic analysis and a site selection. In addition to this, the feasibility study will take into consideration the existing facilities and the stake holders including the minister of health and the NGO agencies. A steering committee from the government and NGOs and the public will be formed to undertake the job of securing funding and the site selection.

The facility I designed is a long term locked psychiatric hospital that would serve the mentally ill people in Somaliland. Somaliland is a country that is reconvening from a long protracted civil war that destroyed every institution in the country including health care facilities. The mental health system in Somaliland and in Somalia is virtually none existent, therefore a facility like this would benefit the people of Somaliland, “Since the Somaliland region of Somalia government is not yet recognized by the international community, mental health facilities and service provision to those in need are very limited” (Warsame, 2006, p. 7).

Designing this facility was a challenge because of my lack of engineering and architectural education, never the less the software made the project painless. Despite the challenges in drawing a floor plan I was able to design and draw a floor plan using my imagination and my emotions. One interesting about this assignment is that after drawing the structure I realized that I was drawing from my emotion and the floor plan I came up with is the kind of mental health facility that I hope to see one day in my country of birth.

The backbone of any healthcare organization is the mental health and to create this system and the system to function as it was intended, the culture has to be just and the leaders must be willing to maintain and encourage a culture in which all people are respected and not punished for their mistakes but rather encouraged to learn from the mistakes. The responsibility of creating such an organization and a just culture where everyone is accountable for their assigned duties and no one is blamed for the mistakes of others lies ultimately on the shoulders of the leaders. The greatest responsibility, and therefore, accountability for a just culture resides with organizational leaders (Mayer & Cronin, 2008, p. p427)”.

An effective leader takes the responsibility of creating a faire system where everyone is held accountable for their action and that rewards and banishments are fair and just. To this end I, Saeed Abdi Elmi challenge, the leaders of Somaliland to make this dream a reality. As daunting as this may seem I have no doubt in my mind that the leaders of Somaliland can build such a facility and I do believe the leaders of Somaliland have the funds to build such a facility that would be an asset for the country, but the question is are they willing to invest the capital in this or are they going to follow the footsteps of these who come before them?. This remains to be seen. Anyone who is willing to help make this dream became true please contact me @ 707 205303


Saeed Abdi Elmi.

BS in Healthcare Administration,

License Psychiatric Technician.

PHD Industrial Organizational Psychology Student.


Source: Somalilandpress








No comments: