South Sudan: RMF UNICEF Malnutrition Treatment and Prevention Program Jonglei State

Real Medicine Foundation: Psycho Trauma Support Training
Juba, South Sudan Nov 23-27, 2015
 
I. OVERVIEW
 
Real Medicine Foundation (RMF) contracted Elisabeth Scheffer & Associates, LLC (ESA) to provide a series of Psycho-Trauma workshops with a variety of audiences in Juba, South Sudan, between November 23^rd and 27^th of 2015. In sum, a total of eight workshops were presented, with a total attendance of approximately 56 professionals comprised of teachers, nurses, midwives, and clinicians.
 
Workshop topics were Psychological Care of Children, Psychological First Aid, and Post Traumatic Stress Disorder. A key component of the training was capacity building, resulting in many of the attendees receiving specific knowledge, skills and support in order for them to be able to conduct future training sessions at their own schools, hospitals, clinics, and villages.
 
II. WORKSHOP DETAILS
 
Workshop #1 – Psychological Care of Children
Participants: 18 individuals – 1 Headmaster, 1 Health Officer, and 16 Teachers from 10 local schools
Workshop covered a variety of issues related to Psychological First Aid and its application to children and those working with children. Key issues addressed included the psychological impact and expected progression during and after a crisis, normal developmental responses to a crisis, symptoms of distress, how to address distress in a child and self-care of the professional.
 
Workshop #2 – Train-the-Trainer: Psychological Care of Children
Participants: 6 individuals selected from attendees of Workshop #1
Workshop went in deeper exploration of the materials covered in Workshop #1, focusing on ensuring that the selected individuals had a solid grasp of the materials and would then be able to train others on the various topics. This workshop was more interactive, including role playing and brainstorming activities on how to breakdown the materials into digestible chunks that could be shared with other teachers in a meaningful manner, including short presentations and hallway conversations.
 
Workshop #3 – Psychological First Aid
Participants: 18 individuals – 1 Headmaster, 1 Health Officer, and 16 Teachers from 10 local schools Workshop covered a variety of issues related to Psychological First Aid, focusing on three key elements. The first was the five areas stress normally impacts an individual, the second was the three components of connecting with compassion, and the final was the critical importance of self-care to ensure they have the ability to help others. Also topics on resilience and teaching others coping skills, normal and abnormal responses to stress, distress in children, and vicarious trauma, burnout and self-care of the professional were discussed.
 
Workshop #4 – Post Traumatic Stress Disorder (PTSD)
Participants: 27 Nurses and Midwives from Juba Teaching Hospital
Workshop covered a variety of issues related to Post Traumatic Stress Disorder (PTSD), focusing on three key elements. The first area focused on the four symptoms of Post Traumatic Stress Disorder and what are expected normal responses to high levels of stress. The second element focused on four ways to build and increase one’s resilience skills/response. The last area highlighted in this workshop was on the topic of hope and its importance to recovery from PTSD. In addition, treatment of PTSD and the differences of PTSD in children were also discussed.
 
Workshop #5 – Psychological First Aid
Participants: 11 pre-selected RMF Nutrition Staff from Jonglei and Greater Pibor Area
Similar to Workshop #3, this workshop covered the same issues related to Psychological First Aid, focusing on three key elements. The first was the five areas stress normally impacts an individual, the second was the three components of connecting with compassion, and the final was the critical importance of self-care to ensure they have the ability to help others. Also topics on resilience and teaching others coping skills, normal and abnormal responses to stress, distress in children, and vicarious trauma, burnout and self-care of the professional were discussed.
 
Workshop #6 – Train-the-Trainer: Psychological First Aid
Participants: 11 pre-selected RMF Nutrition Staff from Jonglei and Greater Pibor Area  
Building off the information presented and discussions held during Workshop #5, this highly interactive workshop focused on two components, ensuring the attendees had a solid understanding about the Psychological First Aid information and then be able to train others on that information. This workshop was more interactive, including role playing and brainstorming activities on how to breakdown the materials into digestible chunks that could be shared with other nurses and professional colleagues in a meaningful manner, including short presentations, hallway and lunchroom types of conversations.
 
Workshop #7 – Post Traumatic Stress Disorder (PTSD)
Participants: 11 pre-selected RMF Nutrition Staff from Jonglei and Greater Pibor Area  
Similar to Workshop #4, this workshop covered a variety of issues related to Post Traumatic Stress Disorder (PTSD), focusing on three key elements. The first area focused on the four symptoms of Post Traumatic Stress Disorder and what are expected normal responses to high levels of stress. The second element focused on four ways to build and increase one’s resilience skills/response. The last area highlighted in this workshop was on the topic of hope and its importance to recovery from PTSD. In addition, treatment of PTSD and the differences of PTSD in children were also discussed.
 
Workshop #8 – Train-the-Trainer: Post Traumatic Stress Disorder (PTSD)
Participants: 11 pre-selected RMF Nutrition Staff from Jonglei and Greater Pibor Area
Building off the information presented and discussions held during Workshop #7, this highly interactive workshop focused on two components, ensuring the attendees had a solid understanding about the Post Traumatic Stress Disorder information and then be able to train others on that information. This workshop was more interactive, including role playing and brainstorming activities on how to breakdown the materials into digestible chunks that could be shared with other nurses and professional colleagues in a meaningful manner, including short presentations, hallway and lunchroom types of conversations.

III. HIGHLIGHTS & FUTURE DIRECTIONS
 
All workshops were well received, with numerous positive comments about the training and praise for the need for this type of content in their professional work and personal lives. Many individuals made it a special point to thank the trainer (Dr. Ron Palomares) personally for presenting the materials and a sincere appreciation for coming to their country to engage with them in this capacity building work.
 
Of the three groups attending these workshops, I observed that the last group (the 11 pre-selected RMF Nutrition Staff from Jonglei and Greater Pibor Area) seemed especially capable of taking their newly gained knowledge and sharing it with other professionals in a broad and meaningful way.
 
The selected Teacher group of six is also expected to work with others to spread the knowledge and skills, but after reflection, it would seem that they were not as prepared as the latter group of 11 Nutrition Staff at the end of their training due to the limited time (3 hours) available for their train-the-trainers workshop. There are also several additional factors that would account for this observation. First, the Nutrition Staff group knew ahead of their arrival that they were hand-selected for this training and were to train others upon their return home. Arriving with the expectation upfront that they were expected to train others seemed to focus them and their discussions on practical activities they could engage in upon their return to their health centers and clinical outreaches in the field was more in-depth and thoughtful. Second, their selection criteria appeared to have included a high level of professionalism and training, as well as advanced fluency in English, thus all 11 were able to understand and absorb the information more quickly and easily. The Teachers did not appear to have been aware that some would be selected for advanced, train-the-trainer training and also seemed to struggle a little with the language. However, they did ask many questions and the trainer was able to clarify language issues with them.
 
Another issue that was apparent in the large group of teachers and the Juba Teaching Hospital nurses and midwives group was a general lack of prior mental health training. The training materials were designed for professionals, and although they absorbed the material well, the materials seemed to be slightly advanced for these groups, requiring the instructor to take time and discuss basic mental health concepts and issues several times.
 
This raises the issue of the need for some basic mental health training for these and other health professionals, across the general population. Additionally, with a small but active group of Arabic professionals, there were requests from the nurses/midwives group to have key components of the handouts printed in Arabic as well. Finally, there were requests from several of the groups to have received a Certificate of Training at the conclusions of their workshops, allowing them to share with others their successful completion of the various workshops.
 
Suggestions for Further Development: Future directions would include having a basic mental health training workshop, covering basic concepts of mental health, prior to engaging in the crisis focused psychological first aid training. Additionally, the consideration of an Arabic translator or workshop held in Arabic would benefit those whose first language is Arabic. Finally, as previously mentioned, the two-day training the RMF 11 Nutrition Staff group completed, versus the half-day training the 6 Teacher group received, seemed to be most beneficial when the groups have two days for training, allowing them an evening to think through the material and be better prepared to gather a deeper understanding of the materials, as well as think through a wider range of opportunities to share it at their own healthcare centers and other settings.
 
IV. SUMMARY
 
Overall all of the workshops appeared to be highly successful. Of particular note, the training of teachers, nurses, midwives and clinicians appears to be a critical component of the success because these professionals are ‘on the frontlines’ dealing with psycho-social trauma across the South Sudanese population. Contributing to the success of the workshops is the fact that all participants were able to recite the key objectives from each set of training materials verbatim and demonstrated a sense of pride in their new knowledge at the end of each workshop. Follow-up training could help improve the knowledge base of these individuals, as well as include basic mental health components to broaden their mental health services to a population in dire need of this attention.