This pilot project aims to introduce access to care for people with schizophrenia and people with epilepsy at the community level in the Union of Comoros. Three levels are targeted:
- Patients need to be identified and encouraged to go visit the community health center for treatment. This step involves increased levels of education to remove misconceptions about these two diseases and reduce the stigma surrounding them
- General Practitioners and nurses working in the primary healthcare centers need to be trained to care for the patients
- Specialists need to be brought closer to the community by means of telemedicine in order to avoid costly travel for patients and to overcome specialists’ paucity
Increasing mental health literacy in the community
The Comoros healthcare system already employs field workers in each district, to spread awareness on several issues like HIV/AIDS and Malaria. This project, within an integrated approach, aims to train these “Community Healthcare Workers” (CHWs) about epilepsy and schizophrenia.
Reducing stigma in the community through community healthcare workers
Community healthcare workers will strive to achieve three main goals:
- Inform the population using I-E-C tools
- Identify new patients and directing them to care
- Support patients and their families via home visits
In order to guide their activities, 3 nurses (already working in the healthcare system) have been employed as Coordinators and will be responsible of following up on the plan.
Increasing mental health literacy in the primary healthcare centres
Training General Practitioners and other primary healthcare professionals
4 General Practitioners and 7 nurses, in 8 community healthcare centers and 1 district hospital have been trained. The training program consists of 5 half-day sessions during one week and is conducted under the supervision of the Comorian health school and by project team specialists.
The content of the training focuses on key concepts based on the interactive version of the mhGAP-IG and videos of clinical cases and interviews. Participants are also trained in the use of tablets so they can use tablets during their sessions.
The participants have had a pre-test to know of how much they were aware of mental health illnesses, then the training. After the training there is a post training test or evaluation. If a trainee reaches 80% of mark, it means he/she is qualified or else disqualified fewer than 50%.
Identifying new cases of schizophrenia and epilepsy
During the activities phase, the healthcare professionals will be responsible for managing cases of schizophrenia and epilepsy. Patients will either be new cases identified by the community healthcare workers or those currently receiving care at the national hospital.
Implementation of telemedicine to extend specialist reach
Telemedicine is used when primary care health workers require advice from a specialist; Skype is used to facilitate patient cases. Through telemedicine, patients are able to avoid long and costly travel to see a psychiatrist.
A usage protocol will be developed to aid the discussions and build mutual trust and understanding between all the providers.
Finally, in order to aid the Comorian specialist with complex cases, external advisors, Dr. Ratsifandriahamanana, (Madagascar), Pr. Raharivelo (Madagascar), and Pr. Martin (France) will participate in the telemedicine sessions.