Salama, Leah

School of Public Health - International Health

MSPH

Uganda

HealthRight Uganda: Maternal Mental Health

Across the world, mental health is critical for women during pregnancy and after birth. Unfortunately, 16% of women in developing countries suffer severe depression and anxiety during pregnancy, and 20% experience this after delivery. In post-conflict settings, posttraumatic stress symptoms are found in 15%. These mental health problems cause suffering and reduced functioning in women. They also carry risks for the next generation: maternal mental disorders are linked with higher chances of worse birth outcomes, impaired growth, suboptimal immunization, higher rates of malnutrition, and worse outcomes for child development and health (e.g., higher rates of diarrheal diseases and fever).

The main aim of the program is to develop and implement an innovative, relevant, acceptable, feasible, and sustainable mental health care model for women facing high levels of stressors, but living in areas with few resources. Mother's mental health is seen as a critical turning point, where the transmission of adversity across generations can be halted.

Rural post-conflict communities in Uganda are characterized by high levels of mental health needs, but limited means to address these needs. The program is therefore designed as a stepped care model, meaning that women are first provided with more accessible, basic, but effective supports. Only if distress persists are women referred to increasingly more specialized care. Furthermore, to facilitate implementation in low-resource settings, the program builds on the principle of task sharing, that is, the implementation of mental health supports by trained and supervised health workers without formal mental health training.

PI Mentor: Wietse Tol

As I boarded my flight to Kampala, Uganda this past July, I felt waves of nervousness and excitement. Nervous because this would be my first time working in public health in a low-income country, excited because doing so was an opportunity that I had been working toward for a long time. Finally I would be able to apply the lessons I had learned and skills I had gained during my first year at JHSPH, deepen my understanding of what this work looks like in practice, and explore a topic of particular interest to me. 

Soon after landing in Entebbe, I was surrounded by people who helped me settle in and feel comfortable. My driver pointed out each crop we passed on the trip from the airport to Kampala (tea fields, papyrus shoots, matoke trees), the guard at my new home took me to get a local SIM card and taught me my first few words of Luganda, and the assistant at my new office sent me turn-by-turn directions and photos of the office exterior to make sure that I got there without issue on my first day. Within a few weeks, I was getting my lunch at the stand across the street from the office and spending weekends taking matatus to explore nearby Entebbe and Jinja.

My practicum placement was with HealthRight Uganda, formerly the Peter C. Alderman Foundation. The plan was that I would primarily work to support the organization’s maternal mental health project and that my capstone research would be geared to adapting an intervention for use in this project. However, as often happens, this plan quickly changed. And ultimately, I am glad that it did. While I did work extensively on the maternal mental health project – drafting grant reports, attending supervision visits to field sites, supporting on trainings for community health worker – the adaptation work that was intended as my capstone became a lower priority for the organization and was pushed to the following year. Instead, I was allowed the flexibility to explore some of the other exciting work that was developing at HealthRight while I was there.

         Although most of my time was spent in the Kampala office, I travelled for a couple weeks at a time to the organization’s field sites in northern Uganda. Having an experience that spanned both settings proved to be really valuable. I learned how the work of the organization was understood and experienced by each group – how a budgeting decision made in Kampala was later felt by community health workers in Lamwo, and how the community health workers’ response ultimately impacted the treatment follow-up numbers we were seeing back in Kampala. My time in the field also underscored for me the power of investing in local staff and the importance of integrating services. This is perhaps particularly true when treating psychological distress, which can be stigmatizing and very personal. 

         Overall, this was an encouraging experience for me. It confirmed that I really like the process of developing and implementing effective mental health services in low-resource settings and find the challenges and questions that arise through this work exciting. While I’m still learning how specifically I want to contribute to this field, I have a lot more data to work with thanks to my time working in Uganda and the great insights of the mental health professionals with whom I worked.

Kampala staff conduct supervision with field staff and community health workers at a participating health center

A health center participating in the maternal mental health project and women and children awaiting the start of a vaccination day

Field staff conduct supervision with community health workers recently trained in Interpersonal Therapy (IPT)

 

The road to the Kampala office

 

The view from the stands of a football match between Uganda and Malawi (Uganda won 2-0!)

People

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs
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April 2020

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