I am currently a fourth year Triple Board resident training in Pediatrics, Adult Psychiatry, and Child and Adolescent Psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. I am planning to travel to Eldoret, Kenya through Mount Sinai’s partnership with AMPATH, a nonprofit organization which represents a long-standing collaboration between Moi Teaching and Referral Hospital (MTRH) and Moi University School of Medicine in Kenya and a consortium of North American academic institutions. I will be collaborating with a US-based pediatrician and child and adolescent psychiatrist to conduct educational sessions on child and adolescent psychiatry topics, as well as case consultations, for psychiatry and pediatrics residents at MTRH. There are no child and adolescent psychiatry training programs in the country and few in the sub-Saharan African region, which significantly limits trainees’ exposure to child and adolescent psychiatry. We aim to serve as a resource to our colleagues in Kenya on the management of psychiatric disorders in youth.
I also plan to work with faculty in the US and Kenya to adapt a battery of mental health screening tools culturally and developmentally for use with Kenyan adolescents. Most of the mental health screening tools that are currently available were originally developed in western settings. It has been observed by our colleagues at AMPATH that use of translated versions of these tools does not seem to adequately capture Kenyan youths’ experiences of psychiatric symptoms. Through cognitive interviews with youth and collaboration with Kenyan and US-based mental health and pediatrics professionals, we plan to develop Swahili versions of screening tools for depression, anxiety, and PTSD that have been adequately adapted for use with Kenyan youth in clinical settings. This would allow for the earlier identification of youth struggling with psychiatric disorders and earlier connection to services.
Children and adolescents in western Kenya will be the primary population to benefit from our projects. By providing education and consultation services to our psychiatry and pediatrics colleagues in Kenya, we will help to increase their exposure to and comfort with the diagnosis and management of psychiatric disorders in youth with the expectation that they will then be able to carry this experience forward into their practice. Youth will directly benefit from the guidance we are able to offer their providers during case consultation sessions. By developing a set of adapted and translated mental health screening tools that can be used in clinical settings, children and adolescents served in AMPATH clinics will benefit from earlier identification of mental health challenges they may be facing, as well as earlier connection to mental health services.
Pediatrics and psychiatry trainees will also benefit from the educational and consultation sessions. AMPATH clinicians and researchers will benefit from the availability of mental health screening tools that have been specifically adapted for youth in Kenya.
While AMPATH serves youth from a variety of backgrounds and with various medical conditions, the organization’s network of clinics have long been a significant resource to children and adults living with HIV in the region. We know that youth living with HIV face a number of mental health challenges and that these same challenges negatively impact their morbidity and mortality. Having access to mental health professionals with more training in child and adolescent psychiatry, as well as clinics that can effectively screen for and detect those youth struggling with psychiatric disorders, would have a positive impact on the outcomes of the youth living with HIV served by AMPATH.
Through our work, we expect to directly assist our pediatrics and psychiatry colleagues in Kenya by offering consultations on child and adolescent psychiatry cases, as well as educational sessions on child and adolescent psychiatry topics. We expect this will have a positive impact on the children and adolescents these clinicians serve. We also expect that the adapted mental health screening tools we develop will assist both clinicians and researchers seeking to improve the care of children and adolescents in western Kenya.
Following this experience, I plan to take what I have learned from our projects and from collaborating with our Kenyan colleagues and the youth we serve and use that knowledge to inform ongoing work aimed at improving the mental health of youth living with HIV in Kenya. Specifically, we hope to complete a research project in the future to validate the adapted measures that we develop and use these measures to facilitate the development of effective mental health interventions for youth living with HIV in western Kenya.
Given the significant impact of culture on how individuals understand and describe their psychiatric symptoms, I know I will learn a great deal from our Kenyan colleagues about how cultures in this region might influence the practice of child and adolescent psychiatry in this area of Kenya. A better understanding of this will be essential as I seek to continue to do global mental health work through AMPATH in Kenya.
Overall, my trip to Eldoret, Kenya this past month was a success, and I sincerely appreciated the opportunity to reconnect with my colleagues at AMPATH, the Moi University School of Medicine, and the Moi Teaching and Referral Hospital (MTRH).
My supervising attending and I did encounter significant barriers to carrying out our original plan of providing child psychiatry education and case consultation sessions to the Moi psychiatry and pediatrics registrars, as the timing of my trip happened to coincide with a lecturers' strike at the medical school. At the advice of our local partners, we shifted our focus to providing mental health-related education sessions to the staff at the hospital's adolescent medicine clinic, the MTRH Rafiki Center for Excellence in Adolescent Health. I was also able to join a support group at the clinic for adolescents living with HIV and assist clinic staff in teaching youth about coping skills and relaxation techniques, as well as participate in discussions with youth in the group around coping with living with HIV. These activities provided me with greater insight into the mental health services available to adolescents in Eldoret and some of the barriers youth encounter in attempting to access them. Meeting with one of the local psychiatrists who has an interest in working with adolescents and observing her in her outpatient psychiatry clinic also provided important insights.
My other goal was to work with my Mount Sinai and Moi mentors and their research team to translate and adapt a set of commonly used mental health measures, such as the PHQ-9 and GAD-7, culturally and developmentally for youth in western Kenya. While in Eldoret, I was able train the team on the measures we are adapting and the protocols we will be using for adaptation, as well as provide them with additional background on clinical presentations of depression, anxiety, and PTSD in adolescents and young adults. We translated each of the included mental health measures to Swahili through an iterative process of translation and back translation, making initial modifications towards adaptation along the way. Cognitive interviews with youth are now underway to assess the face validity of our translated measures and identify other changes that will need to be made to adequately adapt the measures for adolescents and young adults in Kenya. At the end of this process, we hope to have a set of tools that can be used clinically and in research projects to screen youth in Kenya for common psychiatric disorders.
While my month in Eldoret went by quickly, I will continue to collaborate with the in-country team to complete our cultural adaptation project, as well as assist with my institution's ongoing efforts to support our psychiatry and pediatrics colleagues at Moi. As I continue to work towards building a career in pediatric global mental health, I hope to remain involved with AMPATH and continue to collaborate with my colleagues Eldoret.