Reflections on Time Abroad

"I was fortunate to receive the Yale Global Mental Health Scholarship to work with partners in Imo State, Nigeria. It is a continuation of the HAPPINESS project with the project lead and faculty leader of Global Mental Health program, Theddeus Iheanacho. I travelled to Nigeria and co-facilitated mental health training to primary care workers using the World Health Organization mental health gap intervention guide (mh-GAP IG). It was a true gift and a highlight of my residency. Although I was there to teach, I ended up learning more from the physicians and nurses. It was truly a marvel to see the power of the Nigerian community.

Additionally, we started a pilot longitudinal post-graduate diploma in community mental health. This is in partnership with Imo State University, School of Public Health. I was able to present our work at the World Congress of Psychiatry Conference 2022 in Bangkok, Thailand and 2023 in Vienna, Austria. It was heartwarming and fulfilling to work with and learn from Dr. Iheanacho who is passionate about helping his home community in Nigeria. After residency graduation, I hope to do the same with my home community in Thailand."

Dr. Sirikanya Chiraroekmongkon, Yale Psychiatry Resident

"I was fortunate to receive the Yale Global Mental Health Scholarship continue working with partners in Danang, Vietnam. During my CASE (research block), I had a short stint at Danang Psychiatric Hospital, one of the largest mental health hospitals in Vietnam. We continued our psychosocial intervention combining psychotherapy and microfinance for low-income women. In addition, we completed a new study examining correlates of adolescent mental health. I was able to present our work at the APA Annual Meeting and the AACAP Annual Meeting. We continuing our work with these underserved populations."

Dr. Kunmi Sobowale, Yale Psychiatry Resident

"While at Yale, I have been able and encouraged to pursue my GMH interests which I came into the residency with. The program leadership has been incredibly supportive in providing logistical support and exposure to help develop projects in GMH. During the last couple of years, I have been able to use time and GMH award funding during CASE (research block) to do a course in Leadership in Mental Health at Sangath, Goa, India; and have also been able to attend conferences locally such as the inaugural Open GMH day in Boston and our own Yale GMH talks (with lots of refreshments!). I intend to continue to work with the leadership to further develop the Yale GMH program and include some GMH components within the residency curriculum."

Dr. Nikhil Gupta, Yale Psychiatry Resident

Having the opportunity to return to Changsha, China during my PGY 2 year was not just a rich cultural experience but has broadened my views on the impact of culture in understanding behaviors. Culture affects our understanding of clinical approaches, priorities, and research. My experience in the Yale Global Mental Health Program has motivated me to continue to collaborate and work in global mental health.

During my 3-month research rotation, I had the opportunity to continue and expand upon some of the research I had done as medical student in Changsha, China. I had previously spent a year at Xiangya Medical School teaching medical English and developing a project to understand cultural differences in the acceptability of childhood discipline techniques. During my PGY 2 year, I was able to return to Changsha to explore cultural definitions of childhood physical abuse. As part of the project, I had the opportunity to interview faculty, staff and students at Xiangya, as well as collect surveys from undergraduate and graduate students. During my time in China, I was able to visit several inpatient psychiatric units and discuss with other clinicians differences in approach and resource allocation in mental health.

This experience and the continued collaboration have been invaluable in my academic development. I have learned incredible lessons on the process of getting approval for research both in and outside of the US. I have experienced the importance of collaboration in not only understanding the nature of child abuse but in how to approach research and other possible interventions in a culturally specific way. This experience has opened my eyes to the role of my cultural background in framing my clinical and academic work. This knowledge has opened the door to understanding and appreciating different approaches and viewpoints to complicated issues. This experience has also helped me to see the difficulties of promoting child safety and mental health with limited resources in a complex political, social and economic system with a diverse and rich culture and history.

Dr. Brady Heward, Yale Psychiatry Resident

"Traveling to Chiapas, Mexico was a marked experience in my professional and personal lives. Meeting and connecting with the local residents and working with young men and women that practice at the forefront of Global Health prompted me to engage in a constructive and reflective process. Also, learning about a completely different system of care, in which a copious amount of urgent needs forces you to be mindful of available resources and to work on new ways of approaching problems, has given me a new perspective about the health care system in the United States. Today, I feel confident about focusing my non-clinical interests in community psychiatry and policy making."

Dr. Guillermo Valdés, Yale Psychiatry Resident

"Through the CASE rotation as a second year resident, I had the opportunity to continue the work I started as a medical student, focusing on the mental health needs in the Kono District of Sierra Leone. Civil war raged in Sierra Leone between 1991 and 2002 and during that time, many children were raped repeatedly and forced to take drugs to reduce inhibitions against committing violent acts. One of the predominate drugs used to enforce these violent acts was brown-brown, a mixture of cocaine and gunpowder. As such, during my time in Sierra Leone I witnessed many young men, who currently still use this substance, portray symptoms consistent with psychosis. As a result of their substance use and associated symptoms, many were shunned away by people in the community. During my most recent visit in March 2013, I wanted to further characterize the symptoms of these individuals and understand the stigma surrounding mental illness in general, in hopes of developing strategies/treatments to integrate these young men back into the community. Through my experience, I really appreciated the desperate need for skilled clinicians to work in areas were people are too often neglected and in crucial need for help. As there are no practicing psychiatrists in the country, many people have taken liberties in treating the mentally ill. It was not uncommon that I encountered men tied to trees or locked in rooms for months without outside contact, to prevent 'evil' spirits from running loose. I had to do away with my Western ideas/teachings of mental illness and understand the perspective of the Sierra Leonean community. By approaching many people without judgement and motivated by the need to genuinely help, I relied on my expertise thus far, to not only diagnosis, but treat the young men afflicted with the 'evil' spirit.

"As the stigma attached to both mental illness and substance use is so intense, I often found myself making house calls in the middle of the night or early morning to prevent others from noticing the "white woman," who visited the house. Oh yes, I am in fact Black American, however I quickly learned that any person from the US/Europe, based on their style of dress and dialect was considered a white woman! Not only did I experience a true cultural shift, much different from anywhere else in the world I've visited, but my usual understanding of how I perceive myself as Black woman in society was challenged. Overall, the experience in the global mental health project in Sierra Leone, has undoubtedly changed my life and worldview, not only on how psychiatry is practiced, but how medicine on a whole is approached throughout the world. I look forward to continuing my project this upcoming January 2014, as it is sure to be an unforgettable and worthwhile experience. Psychiatry indeed is a life long experience in learning and I am so grateful to have been able to participate in my Sierra Leonean project. I am now convinced my clinical practice and research endeavors, will undoubtedly include some facet of global work!"

Dr. Ayana Jordan, Yale Psychiatry Resident

During the summer of 2012, I spent 6 weeks at London School of Hygiene and Tropical Medicine working as a research collaborator with the PRogramme for Improving Mental health CarE (PRIME) on a study looking at best strategies to integrate mental healthcare with primary care in Nepal . My prior experience in anthropology and global mental health was centered on data gathering and fieldwork, but I did not have any experience doing data analysis or writing up my findings. This project not only allowed me to develop these skills, but gave me the opportunity to become a part of a research community dedicated to developing culturally appropriate mental health services based on needs and input of local stakeholders.

For my project, I conducted a thematic analysis of qualitative data on mental health delivery and recovery. Data was collected in Chitwan, Nepal and consisted of interviews with focus groups and key informants, including health professionals, traditional healers, community leaders, religious leaders, policy makers and service users. When I returned to New Haven, I wrote up the findings, which contributed to a report on the Results of Qualitative Study among Stakeholders in Nepal, to share our methods and findings with other members of PRIME. The ultimate goal of our work is to use the findings to develop mental health programs in Nepal that improve health and socio-economic outcomes. I cannot wait to visit Chitwan and see our work put into action.

Dr. Anna Fiskin, Yale Psychiatry Resident

"I still remember the moment when I first learned of the earthquake in Sichuan, China on May 12, 2008. Sichuan is my home province . The deadly earthquake took more than 80,000 people’s lives. Fortunately my family survived, but I cannot possibly imagine how much they were traumatized by this unbelievable disaster. When I heard many school students died in the earthquake, I decided to go back home to help. With support from former program director Dr. Kirwin and present director Dr. Rohrbaugh, I took a three-week vacation to go back to Sichuan with Dr. Heather Goff, an assistant professor at YPH. We decided to hold workshops for 'school-based post-trauma intervention' in three cities with the most severely damaged areas. Workshops were sponsored by Professor Lin Chen, the director of the National Key Laboratory of Cognitive Science in the Chinese Institutes of Academy.

"We fortunately had support from well-known PTSD experts at Yale, Dr. Southwick and Dr. Marans, in the Child Study Center. Taking their advice and guidance, Dr. Goff and I constructed the syllabus for the workshop. Our goal was to help school teachers understand the psychological needs for their students, normal and abnormal reactions to earthquake, and basic counseling skills. Our team included one coordinator from Professor Chen’s lab, local government staff and two voluntary translators. One of them was a third-year medical school student from Cambridge University in London who came back home for summer vacation. In three weeks, we had trained a total of 268 middle school and high school teachers. At the beginning of each workshop, we asked everyone to say a few words about themselves. Without exception, everyone talked about their experience during the earthquake. Although I learned much information from the media before I went back to China (my parents compiled two volumes of earthquake news from a variety of newspapers and magazines), I was still shocked by the magnitude of the tragedy. I was deeply moved by stories told from people’s own experiences. One day, when we were in a workshop, several teachers suddenly jumped up. Neither Dr. Goff nor I realized that it was an aftershock until someone shouted 'Earthquake! Earthquake!' Desks and lamps were shaking for seconds. Nobody left, the workshop continued. Heather and I used it as an example to teach feelings, thoughts, and behaviors.

"Three years passed by since my trip to Sichuan. Many people and their stories are still in my mind. The person whom I miss the most is a 7 year-old elementary school girl. This little girl survived from the school building collapsing. However, some of her friends died. She came to the workshop with her mother and quietly sat in the classroom playing with her mother’s cell phone. During the break, her mother told us that her daughter had changed to a different person since the earthquake. Prior to the earthquake, she was very happy and outgoing, the most popular girl in the school. She became quiet, shy and fearful, and could not be alone for any second after the earthquake. Her mother had to take her to the workshop. She asked her mother to buy her a bottle when they were shopping together, which made her mother worrisome. We did not get a chance to talk to her or her mother as we tried to cover as many subjects as we could. The next day, the little girl, wearing a bright yellow skirt, came with her mother again. By the end of the workshop, she told her mother, 'Mom, I am normal. I am not crazy. I just acted younger than I am.' She approached Dr. Goff and I and asked to take a picture together. Before I went back to Sichuan, I doubted whether or not I could help people who were deeply traumatized and suffered so much from their loss. This little girl gave me courage to complete our mission. She taught me that people, even as young as 7 years old, could be resilient.

"It was an unforgettable experience from my residency training and my professional life. I learned more from those earthquake survivors than any textbooks and papers that I have read. I am always grateful to everyone who helped me accomplish this workshop. My thoughts are with those dedicated teachers and their young brave students."