Candia Umar
Role Psychiatric Clinical Officer

I am from the Western part of Uganda - the West Nile region. I work at Arua regional referral hospital, about 350km away, as a government employee. I could be transferred anywhere in Uganda. Before this, I was working in a district hospital, close to the Sudanese border for about 5 years before going back to school. My education was disturbed by conflict - I was a refugee in Sudan for 6 years. I did go to school there but the standards were lower than in Uganda. When we came back to Uganda because of the SPLA war in 1986 and I rejoined education in Uganda at senior 1.  I couldn’t finish school, again because of conflict, so I joined a psychiatric nursing course at Butabika for 3 years. After that, there were no government jobs so I worked on private contracts for NGOs and local organisations for 4 years before joining the government in August 2001 at Arua district hospital. I decided to go back to school again a few years later and applied for the PCO course at Butabika. After the course, I eventually managed to secure a PCO position at Arua.

I trained as a PCO as there aren't many psychiatrists in the districts as I thought it would be positive for me to be able to provide clinical services locally. I work from 8 until lunchtime and then again until 5pm. The mornings are really busy with new patients or old clients or doing a ward round or discussing a difficult patient. Monday is new and review patients. Tuesday is the ward round with the psychologist and social worker and psychiatrist. After the ward round, we see review cases. On Wednesday, we focus on general meetings and any other emergencies. Thursday, is clinical meetings to discuss more complex cases. Friday, we have a ward round and then see patient reviews. On weekends, we have one PCO who covers over the weekend. We take it in turns.

I have just finished a degree course on health services management. It was a weekend programme that I fit around my work. I graduated this year and have now signed up for a correspondence masters in Public Health at a US university.

I saw CAMS as a striking opportunity. 4 of us applied from Arua and 2 of us were selected. I usually summarise the data that we have at the end of the month in the department. When I looked back at the data, I noticed that children made up a big number and there was no specific service for them. We only gave a short appointment to each child - but at the end of the appointments, we realised that we weren't providing a good service. When I saw the CAMS opportunity, I thought I could improve our service to children.

The course has two components; theory and practice. For theory, I travel 500km to Butabika every few months. For practicals, we go to different locations. This placement is at Gulu - it was difficult to get here from Arua - it involved bus changes and long waits. Road conditions are poor so I am sometimes a bit tired on the first day of training.

The training has helped me in many ways. My original training had some child focus but this has helped me to understand in some detail about how to work with children - giving a child all the time that he/she needs - in order to build an understanding - and assess the child fully. My practice has changed. I always advise clients that I need more time to spend with children - my attitude has changed. Secondly, my form of assessment has completely changed. If clients don't turn up, I call to find out how the child is doing, try to follow up, arrange another appointment or help over the phone.

We are finding that our Arua colleagues are referring children onto the two of us who are doing the CAMS training now. I like this. The training has enriched my knowledge, my experience and my courage to work well.

In my work, there are many challenges. There is a lack of resources for the children including toys or things to keep them busy while they are waiting, or during interviews with their careers. Also, find we are not able to follow up with clients who are in the community - the bond can break before you achieve objectives for the children. Another challenge is that we are away quite a bit, doing this training. We feel bad when clients come to see us and we aren't there - this may create mistrust. Communication between us in the same location is good but it can be difficult to communicate with distance supervisors. There are computers in Arua but often the power is out when we want to use them.

In relation to the training, there are challenges too. When we are in Butabika or Gulu, we are far away from family. We receive fixed amounts for transport, meals and accommodation but costs are high if we phone home to deal with home difficulties.

For the future, I am hoping that I am considered for the diploma. I would like to be a teacher in the future to share my skills with others. I would like to write a project proposal to look at community perceptions and realities of mental health to help develop some demand. I feel it would be great to move to the community to tell them all about children's mental health. I am hoping that when I finish my public health masters course, I might be able to find a better job at the national or international level.