On a mission

Thomas Hoare on his voluntary work in Nigeria.

I’m a clinical psychologist from Swansea and completed my training with the NHS in Wales. Earlier this year, I returned from an 11-month mission with Médecins Sans Frontières (MSF) at the Noma Children’s Hospital, in Sokoto, north-western Nigeria. It’s the only hospital in the world dedicated to noma, a rapidly progressive, polymicrobial, often gangrenous infection of the mouth or genitals. I led the psychosocial unit, supporting patients and family members during admission and helping them deal with the consequences of stigmatisation.  

MSF’s project supports surgical, nutritional, nursing and psychosocial care, and the recruitment of specialist plastic and reconstructive surgeons, anaesthetists and operating theatre nurses for two to three weeks at a time throughout the year. Within the team, every patient would have an assigned counsellor working with them throughout their stay. I supervised these counsellors in their activities, and trained and coached them.

My work involved individual and group counselling sessions, joint parent–child psychosocial stimulation sessions, including music, craft, toy-making, colouring, dancing, etc., supporting children through painful procedures (e.g. dressing changes) and familiarising them to the hospital environment. Many of them are from remote villages and so the hospital is
a completely alien environment.

I’d never come across noma before, and it is quite shocking when first encountered due to the extent of the disfigurement it causes. Patients suffer profound social and psychological effects. Many children miss out on long periods of schooling, and they’re stigmatised because of the way they look. They often cover up or are hidden by parents to protect them from the hostile reactions of the community.

I have a lot of very positive memories from my time in the mission, especially around living and working with a fantastic team of diverse staff who are very committed to supporting patients to have a better quality of life. Furthermore, the introduction of the psychosocial unit by MSF has been praised by the rest of the team and the surgeons attending the project, who have noticed a considerable difference in the emotional wellbeing of the children – they seem happier, less anxious and better-prepared for surgery.

One adult patient had been in the hospital for a considerable period of time as he needed multiple surgeries. Collaboratively we were able to think about giving him a role in the hospital, creating a garden for him to manage. The vegetables grown were used in the hospital kitchen, giving him a feeling of being part of a team, rather than someone who is a patient in hospital awaiting surgery. It’s just an example of the ways in which we sometimes try to think creatively about how to engage patients.

I missed a lot of things whilst I was away, including spending time with family and friends and doing all the things you often take for granted, such as my favourite sports, going cycling or to the cinema. I missed lots of my favourite foods – a typical dinner there would be meat such as goat, beef or chicken, some greens, lots of plantain and yam. Delicious, but I still missed my favourite food from home from time to time!

I’m going on another MSF mission to Ethiopia in the summer, which will focus on supporting the mental health of refugees from Eritrea and South Sudan. But it will be fantastic to keep hearing about how the work is progressing at the noma project; when you’re somewhere for almost a year, you do form an attachment with it, so I’ll always be curious to know how it’s all going.

MSF is currently looking for Mental Health Specialists to join its register. For more information on the recruitment criteria and the application process, please visit www.msf.org.uk/job-profiles/mental-health-specialist

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