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Arrival in Zanzibar is possible every Wednesday.

Review by Kerstin

My Internship at the Mental Hospital in Zanzibar

I was in Tanzania for six weeks in February and March of this year, and I did a four-week internship at the Mental Hospital in Zanzibar. In the following report, I would like to provide some information about my internship and share the experiences I had during this time.

The Mental Hospital, Zanzibar

The Mental Hospital in Zanzibar is located a bit far from the main hospital on the island. However, it is very centrally located, directly opposite the city market, near a large and busy bus stop where all the dala-dalas (small buses that serve as the main means of transportation on the island) depart. From there, you can reach the clinic in about five to ten minutes by dala-dala.

On my first trip, Sula, the coordinator of World Unite!, accompanied me and introduced me to the director of the clinic, Mr. Suleiman. I was greeted very warmly and informed about the clinic's situation in a lengthy conversation. For example, I learned about the number of patients admitted to the hospital and outpatient clinic, the number of staff employed, and the scope of their tasks. Mr. Suleiman assured me that I could turn to him anytime if I had questions or concerns of any nature. This conversation made me feel in good hands and extremely curious about what lay ahead.

That same day, I met a Cuban psychiatrist who had been working at the clinic for two years under a development and exchange program of the Cuban government. During my internship, this doctor was my contact, and I was able to be present in all her consultations with patients. The Cuban doctor was a very warm and open-minded woman with a lot of experience from her long career as a psychiatrist and psychotherapist in Cuba. This was evident not only in her words but also in her interactions with the patients, which impressed me greatly. Despite often difficult circumstances that did not always allow for first-line treatment, the doctor remained very flexible and understanding of the patients' needs, doing her best despite the lack of medication.

Hospital Routine

The weekly routine at the hospital was as follows: the outpatient clinic was open three days a week. On these days, patients came from all over Zanzibar to check their weekly progress and receive treatment. In most cases, these treatments with the patients lasted over several weeks. The Cuban doctor dedicated the remaining two days of the week to inpatients. During ward rounds, interviews were conducted with all patients hospitalized in the clinic, most of whom were housed behind closed doors.

During the consultations, besides the psychiatrist, other hospital employees were present, including another African doctor and several psychiatric nurses. The conversations were conducted in English. If a patient could not speak or spoke very little English, which was often the case, one of the African staff members would translate into English for the Cuban doctor and translate her responses into Swahili for the patient. Since everything was spoken or translated into English, I could easily follow the content.

I was always introduced as an intern to the patients; I felt important and could take part in all the conversations. All the patients accepted my presence, and I did not feel that it was perceived as unpleasant. Instead, I had the impression that the patients were glad to meet people in the clinic who took them seriously, despite their "mental problem," which still has a long way to be accepted by society in their culture, contrary to the West.

There were usually one to two other interns with me—medical or psychology students. After each interview, the psychiatrist would explain certain symptoms and the context of the disorder to us. The psychiatric work involved both diagnosis and therapy, which I found very interesting. My role was more passive, as an observer.

For me personally, this type of learning was very rewarding. I learned a lot by observing the work of the Cuban doctor and other staff and through subsequent conversations. In discussions with the Cuban doctor, we interns were also asked our opinions on individual diagnoses, allowing us to apply our knowledge. Sometimes, I even took on small practical tasks with the other interns. For example, we conducted a few small tests to assess the abilities of a child who had visited with his mother due to learning difficulties in school. This was led by the Cuban physician and carried out by me.

Reflections

A four-week internship suited me perfectly. I can imagine that a longer internship would have given me more practical experience. One must not forget that there is a huge cultural difference, which is especially reflected in therapeutic conversations. Therefore, I believe that even for a short duration, one must read up on the local people, learn, and experience their beliefs and culture before working intensively on a therapeutic level. Any suggestions and ideas from a trainee will be welcomed, and hence, the responsibility is very significant.

Now I will describe some of the diseases and disorders that occurred in the patients. The predominant psychiatric disorders were alcohol and drug addiction and psychosis. Some patients visited the clinic due to depression symptoms or anxiety disorders. Many patients also had neurological disorders such as epilepsy or migraines. Children often came because of learning difficulties. Patients with eating disorders were uncommon, and I was told that they do not exist there. Patients treated for drug problems were often admitted to the hospital and held for several weeks. Most of them were young men seeking a way out of poverty through drugs.

Psychotic patients with schizophrenia often complained of delusions influenced by their cultural beliefs, such as seeing ghosts. It was fascinating to see how much a mental disorder is shaped by cultural beliefs.

During my time in Zanzibar (about two months), the power supply on the island was not working, and many people came to the clinic because they suffered from fears about the future, developing depressive symptoms as a result. For the people in Zanzibar, this was a very difficult time economically, as many patients' discussions revealed.

Finally, I can say that the internship was an extremely valuable experience for me. During my time in the clinic, I learned more about the people there and their culture. I hope that my presence and interest conveyed appreciation to many of them, which they probably do not yet receive in their culture. Through clinics such as the Mental Hospital in Zanzibar, and the active support of professionals like the Cuban doctor, I hope that with more education about mental disorders, people with mental illnesses will have a higher status in society in the future.

In retrospect, I would have liked a little more time. I can definitely recommend this internship to anyone interested in psychiatric work and wanting to understand people from a different culture from this perspective.