Sylvia’s journey

May 17, 2021

Told by a YBU social worker, a young Ugandan woman, passionate about her work and her country

I met Sylvia at the national mental hospital here in Kampala, Uganda, after I was told she needed help to get ready to move on and get back to her family. Nurses at the hospital told me that they felt her family might have given up on her and want her to stay in the hospital for many months or even years.

Assessment

In clinical language we call this first meeting an ASSESSMENT of Sylvia’s personal, family, social, and medical profile. It is when we get to know each other. I learn about Sylvia’s life and struggles, and I show her that we care about her, her dignity as a person, and her right to belong and feel wanted and cared for in the community, as she recovers from severe mental illness. Sylvia tells me that she is 44 years old. The doctors have told her she has bad depression, is addicted to alcohol, and probably has liver disease. Also, she has been having visions (psychotic episodes with violent outbursts). She has 5 children from 2 to 25 years old. Her abusive husband left her with 3 children and she has 2 other children by different men. None of these men care for their children. We talk for an hour and I can feel her depression and the pain in her life from years of brutal beatings and abuse, abandonment and sorrow. I tell her that we are with her to help her get back home to her two young children and to recover.

Family mapping

I introduce Sylvia to FAMILY MAPPING — a tool developed by YouBelong Uganda (YBU). She draws her own family map. She says “Tom (her eldest son) and Jacki (her landlady) care for me and are very important persons in my life”. The next step in family mapping is to get Sylvia’s key family members/friends to draw their map. I made arrangements to go to the village and meet with Tom and Jacki. It is a long journey to the village, but these meetings, before Sylvia leaves the hospital and comes home are a very important part in helping Sylvia in her recovery.

Tom is suspicious and reluctant. “My mother won’t change. It has been too long”. And he wonders if she has been bewitched and evil spirits have entered her. But it is clear that he loves his mother and will come around to support her if we are involved in her care. Jacki, the landlady is a very caring person, and has been looking after Sylvia’s two small children while Sylvia has been in the mental hospital, but she is scared of the “crazy talk and smashing things”. I get Tom and Jacki to do their version of a FAMILY MAP. Comparing Family Maps
As I compare their map with Sylvia’s I see a major difference. Sylvia has left out of her map, a “drinking group” of men and women with whom she has been spending most of her days. They drink local alcohol. It’s nasty and can do a lot of harm to health. And I am told that two of these men have fathered her last two children. I quickly see that this group is a destructive force and Sylvia will need to separate from them.

Preparing for return

As we speak, I feel that Tom and Jacki are becoming more willing to have Sylvia back home. So, I start to do some education about mental illness, alcohol addiction, and the importance of taking medication every day. We talk about how to manage difficult behaviour and solve problems. They are responsive, so I go further, and suggest that we come up with a plan to support Sylvia back home.

When I go back to see Sylvia, she says “I left out the drinking group because I was embarrassed. They cause me trouble but they are friends.” I tell Sylvia that true friends don’t cause harm. We talk and develop goals to help her settle back home. This is called PRE-DISCHARGE ASSESSMENT, which is important, because if there is no preparation, people discharged from hospital are often quickly rejected by their family, relapse, and return. Sometimes they are just abandoned to the streets. Our work is to do all that is possible to empower Sylvia and her family to avoid relapses or return to hospital.

Returning home

When we take Sylvia back home in the YBU minibus, she is excited. Tom and Jacki welcome her back, neighbours in the village come around and clap. Support from the village community is very important. Things are going well until the drinking group also arrives with alcohol and sits next to Sylvia who looks very uncomfortable. But Jacki, who owns the house, takes them outside and explains that Sylvia wants to get better, and not drink. They grumble but go away.

We talk and plan what we can all do to support Sylvia, and her personal goals, which include:

• educating her children
• stop drinking
• getting her old business back to make some money
• having her own home
• seeing relatives
• Post-Discharge plan

We call this goal-setting and planning the POST DISCHARGE EMPOWERMENT PLAN. We agree that Sylvia will help her landlady for the next few months with domestic work, to keep busy and well-connected with Jacki.

Follow-up and recovery journey

For the next few weeks I travel to the village and meet with Sylvia, Jacki, and her young children. Sylvia had one drinking session in the first week home, but she is really motivated to stop alcohol and I think we have broken the link with the drinking group. Jacki got neighbours in the village to help keep the group away from Sylvia.

It is likely that Sylvia may have a few more relapses, but the recovery journey has begun. Besides visits, I have phone support calls with Sylvia and Jacki, who is providing support and monitoring of medication, stress issues, and behaviour. I need to move on to other patients in the mental hospital who need our support, so I connect Sylvia to local health services, for ongoing care. Training localhealth care centres is important for long term care. A few months have now passed, I phone to see how Sylvia is going. She said “I am now doing much better and have my business back. I am working well and I haven’t had any drinking session as yet. My depression is going down. I take my medicine. People like me more.”

No other organisation in Uganda, is doing the type of work that YouBelong Uganda is engaged in, as seen in Sylvia’s Story. This is ground breaking work: a new pathway for mental health care in Uganda, and for East Africa, is emerging. We build a bridge of support between the hospital, the family, the local village community, and local health centres, and produce integrated care. We are working to scale up a sustainable model of mental health care in low income countries, and we are beginning in Uganda.