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POSTNATAL DEPRESSION Raising Awareness and Developing a Model of Care in Vanuatu

POSTNATAL DEPRESSION Raising Awareness and Developing a Model of Care in Vanuatu. Naumu Josy Stephen 1 , Jane Allnutt 2 , Trish Boss 2 , Sue Webster 2 1 Lenakel Hospital, Tanna Island, Vanuatu 2 Australian Catholic University, Sydney. VANUATU…AN OVERVIEW.

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POSTNATAL DEPRESSION Raising Awareness and Developing a Model of Care in Vanuatu

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  1. POSTNATAL DEPRESSIONRaising Awareness and Developing a Model of Care in Vanuatu Naumu Josy Stephen1,Jane Allnutt2, Trish Boss2, Sue Webster2 1Lenakel Hospital, Tanna Island, Vanuatu 2 Australian Catholic University, Sydney

  2. VANUATU…AN OVERVIEW • Vanuatu has 83 islands of which about 63 are permanently inhabited • These islands are grouped into 6 provinces. • 2009 census recorded a total population of 245,000 people • Capital is Port Vila (Pop. 30,000) • Official languages English, French and Bislama; with 113 indigenous languages • Adult literacy rate = 57% M 48% F • 33% of the population is aged under 15 years of age

  3. HEALTH SYSTEM OVERVIEW Nursing & Medical Training • Nurses- VCNE • Doctors (90%)– FSM, Fiji National University (Medical training) Model of care • 5 Hospitals • 20 Health Centre clinics • >25 dispensaries • >20 Aid-Post HW demography • 46 doctors • 279 Nurses

  4. CHALLENGES OF MEETING HEALTH CARE NEEDS • Cultural influences • Shortage of human resource • Lack of skills or specialized nurses • Lack of resources (finance) • Geographical distribution

  5. WHY THE NEED FOR MENTAL HEALTH SERVICES IN VANUATU? • There is increase in mental disorders • Social practices contributing to mental health problems (high consumptions of kava, marijuana, alcohol) • Unemployment • Population increase

  6. VANUATU MENTAL HEALTH POLICY Mission: To improve mental health of all people in Vanuatu through raising awareness, developing services through training of professionals in mental health and involving the community in the process of prevention, promotion and care. Areas for Action: National Mental Health Committee, Financing, Legislation and Human Rights, Service organisation, Human resources, Essential medicines, Information systems, Quality, Advocacy, Evaluation.

  7. MENTAL HEALTH IN VANUATU.MENTAL HEALTH POLICY • With support from PIMHnet developed Vanuatu Mental Health Policy and Strategic Plan 2009- 2015. • Launched on 9th October 2009.

  8. VANUATU MENTAL HEALTH POLICY Vanuatu Mental Health Policy and Strategic Plan 2009-2015 The vision for Vanuatu is for awareness at all levels of community and Government of the importance of investing in the mental component of health as defined by the World Health Organization, to realise to a mentally healthy nation, and commitment to equity and accessibility for humane community care for the mentally ill.

  9. HOW ABOUT MENTAL HEALTH IN VANUATU NOW Currently There are about 46doctors but there is no psychiatrist to look after mentally ill patients and so, the physician normally looks after the patient with two nurses implementing mental health services in the referral hospital. 9 nurses implementing mental health services in 2 Referral Hospitals and 4 provincial hospitals. Only three trained 3 months training overseas 6 underwent 1 months training locally. 1 Ni- Van Doctor has an interest in mental health and is looking forward to commencing training in Psychiatry next year.

  10. MENTAL HEALTH TODAY Continued…. One Ni- Van completed studies in mental health law. 1 RN currently studying mental health nursing in Fiji. At the moment no psychiatric nurse, no Psychiatrist in Vanuatu despite 9 years pleading. There is a 2 bed unit within the medical ward at Vila Central Hospital, and one bed in Santo not operational full time.

  11. WORKFORCE FUTURE PLANS By 2014, Vanuatu aims to have: • 2 psychiatrists • 4 specialist psych nurses • 45 SRNs with 3 months local training plus ongoing mentoring and support • 21 doctors with 1-3 months local training plus ongoing mentoring and support

  12. Lenakel Hospital Tafea Province • Total number of beds= 48 • Total number of staff =36

  13. LENAKEL HOSPITAL TAFEA PROVIENCE VANUATU STAFFING • One(1) Doctor • Six(6) Nurse Practitioners • Three(3) Midwifes • Sixteen(16) Nurses • Six (6) Nurse Aids • Total – 36 (for a population of approx 33,300)

  14. TOTAL POPULATION BY SEX/ ISLAND IN TAFEA PROVINCE

  15. POSTNATAL DEPRESSION RAISING AWARENESS AND DEVELOPING A MODEL OF CARE IN LENAKEL HOSPITAL TANNA VANUATU

  16. TRAINING IN MENTAL HEALTH • July to October 2011 had an Aus-aid funded scholarship at ACU North Sydney • Theoretical units done at ACU • Clinical attachments in various settings, including public and private hospitals, a rural inpatient setting, Aboriginal Health, perinatal mental health service, and Ambulance.

  17. RESOURCES DEVELOPED TO RAISE MENTAL HEALTH AWARENESS

  18. TRINK TUMAS KAVA I KOSEM PROBLEM BY: EZEKIEL DANMELIP (RN), NORTHERN PROVINCAL HOSPITAL SANTO (2011) KATEM DAON NAOIA BIFO HEMI HOLEM NEK MO SAREM WIN BLONG YU Hemi tumas sipos yu trink bitem 6 sel evri nite • DRINK EVERY NIGHT. • KAVA I KOSEM PYSICAL PROBLEM • olmasel I slack • skin I drae mo rough • problem blongae • problem blongliva mo kidni • KAVA I KOSEM MENTAL PROBLEM • Tingting I sik • Tingtingi no wok gud • KAVA I KOSEM SOCIAL PROBLEM • Famli problem • Financal problem • komitem crime • drugs & substains abuse SIPOS TRINK TUMAS KAVA,HEMI PROBLEM BLONG YU? TOKTOK WETEM HELT WOKA LONG ERIA BLONG YU NAOIA. This poster was completed to meet the course requirements of NRSGXXX for Australian Catholic University , Mackillop Campus, completed through an Ausaid ALA Grant. The support of Ausaid, The Australian Catholic University and the Vanuatu Ministry of Health is gratefully acknowledged. REFERENCES: CHRIS.K.(1996) KAVA:Medicine Hunting In Paradise.park street press. Pictures from Googles images

  19. WHY POSTNATAL DEPRESSION? Previously in Vanuatu there has been very little awareness, focus on the issue on mental health in pregnancy due to lack of qualified mental health work force. Since 2009 Vanuatu has increase a lot of awareness on mental health disorders, I was interested in depression in prenatal and post natal depression.

  20. REASONS WHY PRENATAL AND POSTNATAL DEPRESSION Depression one of the widespread illness needs to be address so that women should be aware of the early signs and symptoms ,treatment and understand it is treatable.(WHO 2012) The number of mental health disorders are on the increase in Vanuatu in particular depression and anxiety. Facts about few mothers killing their babies in early 2000 in capital port Vila

  21. MY AIM • Full training in mental health nursing. • Educate mothers onpost natal and antenatal depression. My aim

  22. MY AIM cont…. • To be able to educate other nurses midwives about mental health issues in pregnancy. • Promote and Educate mothers on other support groups,where there is no professional attention.

  23. ESTABLISHING MENTAL HEALTH CLINICS IN TANNA • Mental health clinic sited next to GOPD where it is affordable for every patient. • Operates Wednesday and Thursdays, clinic days • Patients referred from GOPD, Wards and from dispensaries and health centres.

  24. OUTCOMES • Received a lot of positive feedback from antenatal and postnatal mothers after awareness. They learned something new have never heard this message before . • So far four ante-natal mothers and three post-natal mothers have come into the mental health clinic seeking assistance. • Increase number of patients 1-2 to 3-4. • Main conditions depression and anxiety.

  25. RECOMMENDATIONS • Vanuatu Government, through the Ministry of Health, should improve training and start full time clinical services in the Provincial Hospitals. • Work together with RNs and midwives bringing more attention, focus on mental health issues of pregnancy.

  26. RECOMMENDATIONSContinued…. • Ongoing local training for midwives and nurses to be able to diagnose correctly and provide right treatment accordingly. • Ministry of Health to push hard to have a Psychiatrist appointed in Vanuatu • More training overseas opportunities training for nurses to gain more experience until Vanuatu Mental Health services fully developed.

  27. Any comments or contributions from colleague nurses from the south Pacific to assist my colleagues and I in Vanuatu to improve mental health services in prenatal and post natal depression will be appreciated.

  28. CHALLENGES ENCOUNTERED IN DELIVERING MENTAL HEALTHCARE SERVICES • Insufficient resources • Inadequate funds to run programs • Limited staff to implement mental health services. • Attitudes/Behaviors • Cultural beliefs • Smoking/Kava consumption • Non compliance

  29. CHALLENGES ENCOUNTERED IN DELIVERING MENTAL HEALTHCARE SERVICES cont’d • Poor Reporting/Referral System • Geography of place • Political instability

  30. RAISING AWARENESS ACTIVITIES • CME – 2days presentation on postnatal depression with Nurses and Midwives • Awareness and distribution of cards to Ante-natal mothers on first visits • Awareness and distribution of cards to post-natal mothers

  31. Activities Cont…MENTAL HEALTH DAY CELEBRATIONFor The First Time 10th/10/2012Theme: “ Depression A Global Crisis”

  32. ARRIVAL OF INVITED GUESTS HANGING OF SALUSALU PRESENTATION OF PRIZES SPORTS COMPETITION

  33. FUTURE PLANS • Continuous local training for health professional especially midwifes in identification of cases • Creation of additional posters/brochures…etc for awareness • Improvement in reporting/referral systems • Development of an appropriately trained and resourced work force • Improved availability of resources • Good budgeting and planning to run programs

  34. ConculsionUnited we stand, Divided we fall”.

  35. Thankyou for Listening.

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