Christmas at MSP / Noêl à la MSP

Christmas is not a day like any other. Everyone would agree with this. At MSP, this is also true. Both of our residents and the personnel joined together to share our joy on this special day. Apart from the decorations which are found in every corner of the hospital, some residents joined the Brothers for the Eucharistic celebration at our parish. After the Mass, the kitchen service prepared for us a tasty lunch accompanied by drinks for the celebration.



On the next day, we celebrated the birthday of one of our staff member, Br Laurent. We are very grateful for his presence and his work at MSP. God knew it to make him see the first day the next day after the birthday of our Lord Jesus. This is an invitation to follow him in his footstep.



On Tuesday, the 28th December, we celebrated the 203th anniversary of the Brothers of Charity's congregation with a solemn Mass animated by our residents and the staff. During this mass, we offered our intentions for the Congregations and its services around the world. Both the residents and the staff shared a nice lunch accompanied by a fine drink.

We are looking forward to celebrating the New Year with the same spirit. Meanwhile, all our staff are working hard to make sure that we all start the new year with a new spirit.



Jean-Clement, RN, BSN

Meilleurs Voeux 2011- Best Wishes 2011

A l'occasion des fêtes de fin d'année, la Communaute des Frères de la Charité et le personnel de l'Hôpital Psychiatrique Saint Vincent de Paul de Yamoussoukro vous présentent les meilleurs voeux de bonne santé, de longetivité, de bonheur, de paix, et de joie.
Puisse Dieu vous bénir et vous accorde la grâce dont vous avez besoin pour accomplir la mission qu'il vous a confiée.
Joyeux Noêl et Bonne et Heureuse Année 2011.

Service de Laboratoire à la MSP

A l’Hôpital Psychiatrique Saint Vincent de Paul, nous faisons beaucoup d’examens biologiques dont NFS, GE et Widal et Félix et Glycémie surtout pour les patients ramassés dans la rue. Ces patients mangent dans les poubelles, dorment dans la rue… Nous avons constaté qu’il y a beaucoup de fièvres typhoïdes, et le paludisme et d’infections. Nous faisons des examens systématiques presque à tous nos patients ramassés dans la rue.

Nous avons noté également que le dépistage de nos patients pris dans la rue est important. Sur 7 patients dépistés volontairement, trois (3) sont infectés. Les facteurs favorisant la grande prévalence du VIH à l’hôpital Psychiatrique Saint Vincent de Paul de Yamoussoukro peuvent être :

- Le fait que les malades mentaux sont des personnes à risque : leur état de santé ne les permettant pas de faire un jugement droit, ils sont exposés à tous les immoraux de la société tel que les ivrognes, les gens de la rue (vagabonds), les toxicomanes qui sont eux-mêmes sujets à haut risque.

- Beaucoup de personnes vivant avec le VIH font au moins une décompensation psychiatrique au cours de leurs évolutions et la plupart traversent une crise psychologique grave.

- A cause de leur état, les malades mentaux comprennent moins ou ne font pas d’attention sur les appels lancés par les autorités et les agents de santé publique concernant la prévention du VIH. Ils pratiquent la sexualité dans leur innocence.

Face au grand nombre de malades atteints du VIH, l’équipe soignante de la MSP Saint Vincent de Paul de Yamoussoukro et l’équipe du service social ont besoin d’une formation spéciale concernant la prise en charge des personnes atteintes du VIH. Il faudrait explorer l’interaction médicamenteuse entre les ARV et les psychotropes de temps plus que ces 2 catégories sont souvent prescrits pour une longue durée. L’Hôpital Psychiatrique Saint Vincent de Paul de Yamoussoukro veut bien collaborer avec la Renaissance Santé Bouaké (RSB) pour pallier à ce problème.

Rehabilitation at MSP (2e Partie)

Interventions à 3 niveaux

1. Par rapport aux déficiences suite à la maladie même, il va de soi que les soins de base lors d’une admission doivent répondre à un certain niveau de qualité minimal. Cela implique par exemple l’administration précise de médicaments comme le docteur les a prescrits, l’établissement systématique d’une relation professionnelle de confiance et d’écoute entre l’équipe soignante et chaque malade, l’accompagnement individuel par un référent qui – ¬à base régulière – signale au reste de l’équipe ses observations précises et qui joue un rôle proactive dans le traitement de son patient. Tous ces points sont à renforcer.

La qualité des soins de base au sein de l’hôpital sont une condition de base pour que n’importe quelle initiative de réhabilitation puisse réussir. Néanmoins, la présence d’hallucinations ou d’idées délirantes, de comportements bizarres, etc. ne doit pas empêcher le commencement d’un accompagnement individuelle en matière de réhabilitation : ce ne sont pas tellement les symptômes cliniques qui comptent, mais surtout les habiletés et le fonctionnement de la personne – qu’est-ce que la personne arrive ou n’arrive pas à faire.

2. Renforcer la position du patient dans la société, combattre les conséquences indirectes de la maladie. La réhabilitation touche surtout nos résidents qui sont atteints d’incapacité grave et de longue durée. Néanmoins, obtenir la réinsertion sociale de n’importe quel patient après une admission pourrait également être considéré comme une forme de réhabilitation. De toute façon, préparer les patients à la sortie demeure un aspect de notre traitement qui demande encore à être renforcé, qu’on appelle cela la ‘psychoéducation’, le ‘travail social’, la ‘réhabilitation’, etc. Plus concrètement, il s’agit d’explorer les points suivants chez n’importe quel patient et de corriger par voie d’entretiens là où c’est nécessaire:
- perception et connaissances de l’individu par rapport à la maladie
- attitudes et connaissances par rapport au traitement
- aptitude du patient à accomplir les activités quotidiennes
- logement, activités professionnelles, loisirs
- situation sociale, attitudes et connaissances de la famille par rapport à la maladie
- point de vue et attentes de la famille par rapport aux différents domaines de réinsertion

Ce qui empêche surtout au docteur et aux infirmiers gradués de préparer chaque patient d’une façon systématique à la sortie est un manque de temps. Un volet de formation du personnel pourrait donc être l’accompagnement du patient à la sortie : pour cela, le soignant doit maîtriser certaines techniques d’entretien de base, doit pouvoir explorer et donner un compte-rendu au docteur de l’état psychiatrique du patient, doit pouvoir donner au patient ainsi qu’à la famille des explications par rapport à la maladie adaptées à leur niveau de formation et leur vécu (psychoéducation), etc. A plus longue terme, on pourrait penser à organiser des sessions de psychoéducation collectives pour des groupes de patients ou des groupes de familles. Outre des formations générales, un suivi plus individualisé de chaque membre de l’équipe pourrait être organisé. L’apprentissage pourrait alors s’effectuer à base de la pratique, c'est-à-dire en se basant sur les contacts avec les malades et leurs familles pour qui on est référent.

Pour nos résidents chroniques, les interventions concrètes par rapport à la réhabilitation sont les suivantes :

- travail thérapeutique : continuer à stimuler les résidents en leur invitant aux entretiens individuels, en faisant un bilan personnel de leur souhaits et objectifs, en continuant d’organiser des activités ergo, en développant certaines activités d’ergo spécialement adaptées aux malades chroniques, en organisant des activités d’ergo individuelles selon les intérêts des résidents

- travail social : contacter la communauté malienne, burkinabé, etc. Faire un suivi actif de leurs efforts pour retrouver les parents de nos malades. Encourager les résidents à participer aux activités culturelles de leurs communautés respectives à Yamoussoukro. Explorer les attitudes de la famille, donner des informations par rapport à la maladie mentale. Les attitudes négatives des familles ne doivent pas nous décourager. Même si on n’arrive qu’à organiser une rencontre unique entre un résident et un parent, cela est un acquis.

- occupations professionnelles : obtenir un aperçu des endroits où les malades pourraient faire un stage, apprendre un métier, suivre une formation, faire du bénévolat ; du coût de chaque activité, de comment organiser un transport en commun moins cher pour atteindre la ville ; d’où l’on obtient un micro crédit pour commencer un petit commerce, des partenaires locales qui pourraient parrainer certaines activités, des initiatives que la MSP peut organiser elle-même, etc. Le but serait d’obtenir au fur et à mesure un aperçu plus complet de toute la région de Yamoussoukro

- en fonction des problèmes qui se présentent lorsque les malades vont davantage sortir, organiser un entraînement des habiletés sociales, des entraînements individuelles (p.ex. comment prendre un taxi, comment s’orienter dans la ville, comment acheter quelque chose, etc.)

- logement : organiser la maisonnette d’une telle façon que 8 à 10 personnes peuvent y demeurer avec la plus grande indépendance possible et moins de soins qu’au sein de l’hôpital. Les résidents pourront graduellement acquérir plus de responsabilité et d’indépendance. Ils seront suivis par leur référent et – dans un premier temps – par le coopérant responsable pour la réhabilitation.

- si la famille du malade a les moyens, nous pourrions penser à accompagner le malade dans la location d’un petit studio en ville, etc.

- au niveau de la formation, nous pourrions appliquer le même système d’apprentissage individuel pour les référents

3. Au niveau de la société, les moyens mis à notre disposition afin de changer les choses sont limités. Les interventions ont déjà été décrites ailleurs (canevas de référence) : activités de sensibilisation sur la santé mentale par les médias, collaboration avec d’autres ONG et des acteurs académiques. Seul moyen auquel on n’a pas encore pensé sont les différentes paroisses, congrégations religieuses et tous les fidèles que nous pourrions atteindre par cette voie. Nous pourrions créer un dépliant qui explique d’une façon générale ce qu’est la maladie mentale, comment nous soutenir, les heures de consultation, etc. et le distribuer via les communautés religieuses. Nous pourrions également expliquer le contenu du dépliant en dioulla au sein des communautés musulmanes. Nous pourrions même demander à quelques malades de nous accompagner pour ce travail. Autre idée était de faire fabriquer des pagnes ‘St.-Vincent de Paul’ qu’on pourrait vendre lors d’une fête. Nous pourrions créer une ‘Boutique Espoir – St.-Vincent de Paul’ au bord de la route juste devant le centre où on met en vente l’eau glacée et les produits du centre (p.ex. jus de bissap, arachide, niamakoudji, œufs, maïs braisé, les œuvres d’art de l’ergo). Cela donnera une occupation à une des résidentes et nous offre également une occasion supplémentaire d’atteindre la population.

Jean-Clement, RN, BSN

Rehabilitation at MSP (1ere Partie)

Qu’est-ce que la réhabilitation ?

Une définition générale de réhabilitation serait d’ « aider les personnes atteintes d’incapacité psychiatrique grave et de longue durée à améliorer leur fonctionnement et leur satisfaction au sein des environnements de leur choix et cela, en bénéficiant d’une intervention professionnelle aussi réduite que possible ». Traitement médical et réhabilitation sont deux aspects du soin psychiatrique qui se complètent mutuellement. Mais, tandis que le but de l’approche médicale est surtout d’obtenir la guérison (c'est-à-dire la réduction des symptômes), le but de la réhabilitation est plutôt d’atteindre un rétablissement (c'est-à-dire dépasser les conséquences dramatiques de la maladie et recommencer à vivre une vie satisfaisante, utile et emplie d’espoir).

En partant des souhaits, des objectifs de la personne atteinte d’incapacité, un bilan personnel sera réalisé afin de décrire les habiletés et soutiens qui lui seront nécessaires par rapport à ses occupations professionnelles, son logement, ses contacts sociaux, ses loisirs, etc. L’accompagnateur et la personne apte à réhabiliter travailleront ensuite ensemble afin de remédier au fur et à mesure le manque d’habiletés d’adaptation professionnelle, d’habiletés sociales ou d’habiletés nécessaires dans les activités de la vie quotidienne. Dans la définition générale de réhabilitation est mentionné « aider à améliorer le fonctionnement ». Il est difficile de prédire de manière exacte le résultat d’une tentative de réhabilitation – résultat qui dépend d’ailleurs d’un grand nombre de facteurs (voir plus bas). Certains spécialistes disent même que parfois, le plus grand bénéfice pour l’individu est la préservation du niveau de fonctionnement actuel.

De nombreuses études confirment que même le fonctionnement en milieu hospitalier ne permet point de prédire la probabilité d’une réhabilitation réussie. Les objectifs déterminés doivent être réalistes, compte tenu du contexte social et économique et de la façon dont l’individu vivait avant la maladie. Par ailleurs, l’accent est mis non sur les défauts mais sur les capacités présentes de l’individu. La difficulté de prédire les résultats et l’attitude optimiste qui marquent la philosophie de réhabilitation nécessitent de temps à autre la prise de risques thérapeutiques : on ne conclut pas qu’une personne est incapable de mener telle ou telle activité à bonne fin avant de l’avoir vraiment essayée.

De nombreux facteurs déterminent la réussite de la réinsertion des patients psychiatriques. Tout d’abord, il y a la déficience suite à la maladie même : un comportement irresponsable, bizarre ou agressif, l’absence de conscience de son état malade, hallucinations, idées délirantes, la dépression, etc. Règle générale pour les troubles psychotiques : plus le temps entre l’apparition des premiers symptômes et un traitement médical s’écoule, plus il sera difficile de faire disparaître complètement les symptômes.

Deuxièmement, il y a les conséquences indirectes de la maladie, qui rendent le malade davantage vulnérable qu’une autre personne dans la société :

- la personne rétablie peut rechuter à cause d’un environnement mal adapté, d’un entourage mal informé ou parce que la personne elle-même ignore comment gérer sa santé,
- suite aux périodes de maladie ainsi qu’au manque d’habiletés, le soutien social peut disparaître, les chances de trouver un emploi ou de garder son domicile peuvent diminuer, etc.
- la maladie grave ou de longue durée peut avoir empêché le développement normal de certaines habiletés. Il se peut que certaines habiletés se sont perdues. Bien que la maladie ne rend pas impossible l’apprentissage de nouvelles habiletés, elle complique souvent le processus, surtout quand il s’agit de transférer des habiletés nouvellement acquises d’un contexte à l’autre (p.ex. de l’hôpital vers un lieu de travail).

Finalement, le dernier facteur se situe au niveau de la société : pour qu’une réhabilitation soit réussie, l’individu doit également avoir l’opportunité d’accomplir une activité ou un rôle normale au sein de la communauté. Des attitudes négatives vis-à-vis les malades mentaux posent une entrave sérieuse à la réintégration, ainsi que la pauvreté et le manque d’un budget minimal pour accompagner les malades.

Ne manquer pas la 2e partie...

Jean-Clement, RN, BSN

Pour en savoir plus: LA PSYCHOSE

Dans la mesure de bien traîter nos résidents atteints d'une psychose, il est important qu’on parle à la famille de quoi il s’agit, de la cause d’un trouble psychotique, de comment on peut traiter ce trouble et surtout de quoi il faut tenir compte après la sortie. Voici un exemple qui peut vous donner des idées à comment informer les familles.

1. qu’est-ce qu’une psychose/la ‘maladie mentale’ ?
2. qu’est-ce qui cause une psychose ?
3. comment traiter la maladie ?
4. conseils pour après l’hospitalisation

1. Qu'est-ce qu'une psychose?

Une psychose est le résultat d’un problème au niveau du cerveau. Cela fait que les perceptions, les pensées, les sentiments et le comportement du malade sont dérangés. Très souvent, celui qui souffre de la maladie ne réalise pas qu’il ou elle est malade.

Perceptions : le malade peut entendre, voir ou sentir des choses qui ne sont pas présentes. On appelle cela des hallucinations : ce sont des perceptions que le malade ne peut pas distinguer de la réalité, ce qui peut lui faire très peur. Puisque nous ne percevons pas les mêmes choses que le malade, c’est parfois difficile pour nous de comprendre ou de prévoir son comportement bizarre.

Pensées : quelqu’un qui souffre d’une psychose a souvent des délires, c'est-à-dire des fausses convictions qu’il ne partage pas avec les autres, p.ex. « je suis le président de la République », « ma famille essaie de me tuer », etc. Il se peut aussi que le malade soit confondu, n’arrive plus à bien expliquer les choses, etc.

Comportement : pendant l’épisode de maladie, il se peut que le malade parle beaucoup, qu’il bouge beaucoup, n’arrive plus à dormir, est fâché voir agressif pour un rien.

2. Causes
(expliquez seulement ce qui est pertinent pour le patient)

Ne pas rejeter l’interprétation traditionnelle : p.ex. beaucoup de gens pensent que la maladie mentale a une cause mystique, que c’est le résultat de la sorcellerie; la science moderne a démontré que les facteurs suivants peuvent jouer un rôle :

a) vulnérabilité héréditaire liée aux événements de vie (p.ex. perdre ses biens dans la guère, disputes familiales, chômage, avoir l’impression qu’on est ensorcelé, une promotion, tomber amoureux, perte d’un être cher, un accouchement, etc.), p.ex. métaphore d’une maison, solidité des fondations, maison exposée au vent, pluie

b) une maladie physique : une infection (p.ex. fièvre typhoïde, paludisme, infection relatée au SIDA) mais aussi après une opération, à cause d’une déshydratation extrême, etc. – il se peut aussi que la maladie physique soit accompagnée par un événement de vie
c) abus d’alcool, de drogues ou de certains médicaments ; sevrage de certains de ces produits

Par rapport à la sorcellerie : il y a autant de malades souffrant de troubles psychotiques dans d’autres endroits où l’on ne trouve pas de sorcellerie : à travers l’Europe, l’Asie, l’Amérique, etc.

3. Comment traiter ?

a) Médicaments

Couramment les médicaments appelées les neuroleptiques. Ils peuvent entraîner certains effets dont:fatigue et tendance à dormir au début sont normale, vont disparaître après quelques jours ; tremblements, lenteur, beaucoup de salive ou une bouche sèche sont des effets secondaires normales, mais informez le docteur

N.B: le patient devra prendre les médicaments pendant longtemps après l’hospitalisation, même quand il se sentira mieux; ne changez rien au médicament avant d’en avoir parlé au docteur

b) Entretiens avec les membres de l’équipe médicale, sociale, etc.

c) Un environnement apportant le repos, être à l’écoute

d) Engagement et compréhension de la part de la famille, visites régulières pendant l’hospitalisation

4. Après l’hospitalisation : conseils

Engagement de la famille : n’importe qui peut se rétablir de la maladie mentale ! Mais ce but peut être obtenu que quand la personne atteinte est de nouveau accueillie au sein de sa famille. Si l’entourage réagit de façon agressive ou négative vis-à-vis du malade, sa maladie va encore s’aggraver. Toute la famille doit faire un effort pour comprendre. N’ayez donc pas peur de parler au soignant, au docteur et au pharmacien de tout ce que vous ne comprenez pas. Parlez également de ce qui c’est passé avec le malade.

Une vie normale en famille : si le malade était dangereux ou bizarre avant l’hospitalisation, il ne l’est plus après. Ce n’était pas de sa faute, c’était la maladie qui causait ce comportement. Traitez le malade comme n’importe quelle autre personne – s’il y a des situations qu’il vaut mieux éviter, le docteur vous le dira. On doit stimuler le malade à reprendre une vie normale.

Importance des médicaments : il est possible que le malade devra encore prendre des médicaments pendant longtemps après l’hospitalisation. Administrez-les comme le docteur les a prescrit, même si la personne se sent mieux – sinon on risque une rechute. Si vous pensez à arrêter les médicaments à cause du coût ou des effets secondaires, parlez-en d’abord à votre docteur. Si vous faites l’indigénat, expliquez au docteur de quoi il s’agit exactement.

C’est normal que le malade réagisse d’une façon moins émotionnelle qu’avant, qu’il prenne moins d’initiative, qu’il communique moins : c’est un effet secondaire du médicament et une conséquence de la maladie – il ou elle ne le fait pas exprès. Signalez toute chose anormale au docteur.

N’hésitez pas à contacter l’hôpital ou rapprochez votre rendez-vous si les mêmes symptômes réapparaissent, si la personne souffre d’insomnie, anorexie, un comportement un peu bizarre, etc.

Pour en sovoir plus, contacter la MSP-SVP Yamoussoukro.

Jean-Clement, RN, BSN

November on its way!

As the new month is starting at MSP, we are also getting closer to ending the year. This is a good news. Yet, for some, this is not a good news. End of the year means another extra work: to prepare for the annual report! Mostly the work of the secretaries, but no one is left behind. For those in nursing services, it is also a month of evaluation. Every staff member is asked to rate him/her self and rate others. Good qualities are identified and encouraged.

Br Felicien, the Director, is back in the office after a month of holidays. We wish him again "Akwaba". It seems that he did enjoy well his holidays for he is now relaxed and he doesn't miss his good habit of doing rounds at the hospital at least twice a day!

The hospital is again starting to be populated after a period of presidential elections during which most of everyone was back home for the event. The staff was reduced to allow everyone to exercise his/her citizen rights.

Keep following us to know how things are going on with our staff and residents.

Jean-Clement, RN, BSN

Breaking News at MSP

All the staff at MSP are in union with the family of one of its members, Yvonne Zamble, who was involved in a car accident some days ago while traveling in town. Hopefully, Yvonne was taken at the hospital where she followed immediate care and she was able to go back home for recovery.

We wish her a good recovery and we miss her.

Jean-Clement, RN, BSN

Is that the way it is? – The role of the family in psychiatric care.

Most of the time, I get emotionally touched when families come in my office requesting for information about our services. Who wouldn’t? It is true that our Hospital is not very well known in the area. In addition to being referred to as “a place where mad people are treated”, it would make sense why people don’t know “exactly” what is going “in” there. Some family members, after giving the information about our services, the first question they ask is: “do you think my son/daughter can change?” This is a fundamental question not to ignore. And the parents are really serious when they ask this type of question.

Two weeks ago, I was exchanging with one parent who was telling me about his son who had turned into a drug abuser for more than 4 years. This poor mother had tried all means to help his son, but nothing had worked. Fortunately, she didn’t get hopeless. After hearing about our hospital, he turned to us hoping that we could “change” his son from being a drug abuser into being a good boy again. At the end of the exchange I told her something that she seemed not to like. “We don’t have magic power to change people”. Even though she didn’t like it, I couldn’t put it in another way to make it sound better. This is the reality. I continued telling her that “we don’t change people”; however, we “integrate them”; we help them realize their potential; we help them regain their capabilities; we provide them a milieu to set up new goals in life; last but not the least, we help them to correct what is “off beam” in their behavior and their way of acting and reacting.

For the last 6 years we have had another patient who kept coming back to our hospital because he couldn’t follow correctly his treatment. After a long investigation of his case, we finally figured out that the really problem lied in the family. His family had not arrived at a point of accepting this patient as the way he is. They had wanted their brother to change, but not to change themselves. What do you do when you can’t change it? May be you change the way you look at it, the way you think about it…He couldn’t be changed. They only needed to accept him, understand him, and integrate him. At the hospital, this patient was perfect; yet, at home, he was different. What did we do? No magic! We had to tell this family that they couldn’t change their brother; what they needed to do was to change their home ambiance: their way of loving him, of interacting with him, of talking to him, of listening to him…

Is that they way it is? – No, you can do something to make it better, accommodating, and acceptable. On the other hand, - Yes, at some point, you can’t change the way the person is. Sometimes we tell people, “this is the way we do it, go and do the same at your home, then you will see the change you need”. We have tried to find ways to involve actively family members in our care, to make them understand that we can’t do it alone. In psychiatry we don’t treat the patient, we treat the family. It is like a coin one side being the patient and the other, the family. You can’t take one side without the other. That’s the way it is.

Jean-Clement, RN, BSN

What matters - 2nd part

Little by little Mr Laposte became a person of attention to everybody, staff as well as residents. Everyone seemed to observe him, not that he was a really “stranger”, but mainly, because everyone wanted to be the first to observe the change in him. It was like a parent waiting to see his baby making his first step, or to hear the baby making his or her first word. It is a memorable moment. Time passed, and Mr Laposte was not showing any improvement. However, we remained patient.

After a certain period, Mr Laposte started showing some signs of improvement. Mr Laposte accepted to put on clothes. Though he could not do his laundry, he showed that staying naked was not an option. Obviously, he saw that everyone did the same; so, why not him. Mr Laposte was on medication called “Orap” a neuroleptic medication mostly given to chronic schizophrenic patients in this situation. Something that touched the staff was a certain behavior that could be observed on a daily basis. When everybody was away, after eating, Mr Laposte could come to the refectory to watch TV, alone! This was something. Nobody dared to disturb him. In addition, though he couldn’t eat together with others, he would bring his plate back after eating for washing.

The staff spoke to him, but he never showed a sign of understanding what they were talking. However, they never got discouraged. They tried to speak in all possible local languages to see if he could get any word. But, silence was the reign! He was once shown a room where he could sleep, but he had refused to stay in. At some point, during the day, he could walk around the building to explore inside through the windows as if something was interesting in there. As we observed all these actions, we were getting really excited that Mr Laposte was becoming another person. Hope started showing up. What we didn’t know was that Mr Laposte was going to reveal his real name, to speak with his comrades, and to be the person to join others in the refectory, to have a bed in the room, and to do his laundry. How it happened?

Read our 3rd part to find out.

Jean-Clement, RN,BSN

News at MSP

Most everyone at MSP today is rejoicing, but not everyone of course. Due to the presidential elections expected this Sunday, the 31st October, this Friday was declared a paid holiday on the whole territory of the country. Which means, no work! What else can we rejoice for? In addition to this Friday, Monday is another holiday of the Church, the All Saints. For some staff members, the weekend will take 5 day without without working. We wish them a wonderful break.

However, break is never a break, especially for the Brothers who are permanent at the hospital. There are always people knocking at the door, bring patients who can't wait for this long weekend to be over. We try to do all to accommodate them even if we can't provide full care.

During this month of October, the MSP has been grateful to welcome 4 novices from NDI (Notre Dame de l'Incarnation) sisters who were doing their practical training following their canonical year. We wish them a fruitful formation.

We are expecting Brother Felicien, the Director, to be back by the next week to take over his responsibilities after a month of holiday.

Jean-Clement, RN, BSN

News from MSP

Everyone is doing fine at MSP. Apart from the rain season that is beating us now, everyone is doing his best to provide the best care. Br Felicien is attending the training in Belgium and we wish him all the best.

What matters

Mr Laposte, as he was named because he was found near a post office, was one of our residents who inspired MSP in its delivery of care. When Mr. Laposte was brought to MSP no one has thought that he would later on reveal his really name, his family and become part of his family again. This process took more than five years, five years of transformation, five years of patience, and five years of love.

Mr. Laposte was found naked near the post office, in the city of Yamoussoukro where he has been rooming for a period that no one knows. According to the public, he was first seen since his younger age. Mr. Laposte could have been grown up in the street where he was left by his family who didn’t want of him. Left alone with no one to take care of him, he became vulnerable of any danger from diseases to accidents that he was not able to avoid. While young, a vehicle passed over his arm which was left broken.

As he arrived at MSP, Mr Laposte was given a full shower (which he didn’t enjoy at all) and was given clothes to cover his body. Few minutes later, he removed all clothes because he preferred to remain naked as he has been for long in the streets of Yamoussoukro. This was his norm. He never dared to join other in the eating room. Eating normal food was only for aliens. He preferred uncooked food. From his side, I guess he looked at us as strangers; on the other hand, we looked at him as a stranger. He refused to enter into any room; he refused to eat any cooked food; he refused to put on any clothe; and, finally, he refused to speak any word to anybody.
Inside Mr. Laposte there was a human being who needed care, love, and patience to reveal himself.

Follow us next for the 2nd part

Jean-Clement RN, BSN

Service Nursing à la MSP -1-

L’équipe de nursing répond à trois types d’activités :

1. Fonctionnement de service médical et paramédical

Ce sont les membres de l’équipe Nursing qui font tourner le service surtout la gestion quotidienne. L’équipe prend en charge le fonctionnement et l’organisation du service en se préoccupant des dimensions humains et scientifiques (gestion des lieux d’hospitalisation, la logistique en produits de nettoyage, l’intendance et l’accueil (secrétariat), administration des soins nursing et médicaux, des rapports humains et interpersonnels, hiérarchique institutionnels.

2. Activités et intervention globale

Les membres de l’équipe nursing assurent la prise en charge de l’accompagnement psychosociale de toutes les personnes hospitalisées dans la MSP sans aucune distinction. Il s’agit d’une prise en charge collective de personnes ponctuée. Les soignants gèrent la vie des résidents attentifs aux situations individuelles des personnes hospitalisées. Cela se manifeste dans leur esprit d’écoute et d’observation des résidents en vue de dépister à temps les effets secondaires induits par les neuroleptiques. Toutes les interventions pour le bien des résidents doivent être rapporter dans un cahier d’échange d’information pour une meilleure continuité de prise en charge et d’assurer la cohérence dans l’information. Les informations sont communiqués oralement ou par écrit (affichage).

3. Les activités et innervation de soins individualisés

Les membres de l’équipe nursing appliquent aussi des prises en charge plus individualisés dans le cadre de l’application du système de référence et de recouvrement de rôle ; c’est une dimension thérapeutique centrée sur la relation particulière soignant – soigné initiée dès l’admission du patient.
Dans le cadre de cette fonction, le soignant prend en considération individuellement la personne (résident) dans son circuit hospitalier, l’apprendre les bonnes manières facilitant son adaptation dans ce nouveau milieu.

En grosso modo, la personne au référence est une interlocuteur privilégié pour la personne hospitalisée, son entourage (famille) et surtout fournir les informations à l’équipe de nursing et pendant la réunion pluridisciplinaire.
Aussi le référent joue un rôle intermédiaire entre la famille et les partenaires sociaux du résident ; ce qui maintien un relais institutionnel pour faciliter les formalités administratives et financières.

A continuer...

What makes psychiatry challenging, but also exciting...

Tuesday, the 28th September, 2010

It is Tuesday, holah! I love Tuesday for the main reason that I can have extra 30 minutes of sleep. As you can realize now, I love sleeping, something normal for a new grad. Anyway, on Tuesday I wake up at 6h30 am, do my morning prayers for 15 minutes before breakfast, which at this time takes about 20 minutes before morning change of shift staff. It is almost the same game every Tuesday morning. This Tuesday is a little special though. I have on my agenda two delegations to make: sending blood sample to the lab and renewing a prescription of one patient who is usually followed by another clinic. I have in my mind the person I have to send; however for some reasons, this person is not there. For confidential reasons, I have to do it by my own. In addition to the appointment I have planned to meet with some parents, I am trying to see how to accomplish all those plans in my morning schedule.

After the staff I usually have my meeting with the nursing staff to give the tasks and assign patients. After the staff, I delegate one nurse to do blood draw as I do the rounds to patients.

At 9h30 AM, I am off to the clinic for blood analysis and renewal of the prescription. This is somewhere 12 km away from our hospital. The interesting and at the same time sad part is that it took me the whole morning to be ready with those two activities. In some general clinics, you have to wait till you get tired! Emergency in your eyes is not always emergency in his/her eyes.

It is noon already and I am back at the hospital. As I arrive, two parents are waiting for me to discuss about financial difficulties they have. At the same time, I am tired and hungry as my lunch time is nearing. It has been hard to make it always at the table. After receiving the parents I close my office off to take my break. It is about 1PM.

At 2:30PM I am back in my office. Together with the pharmacist, we are creating a program to facilitate a good inventory of medications. As I mentioned ahead, one of my responsibilities is to supervise our pharmacy, to make sure that everything is being done in order.

It is already 4PM, and in five minutes I have a staff meeting together with the day shift and night shifts to exchange the activities of the day. Today, the meeting goes on till 4:30PM and everyone is getting ready to go home. As I return to my office, I remember that I had to go the general hospital to take the results of the labs and then pass to the pharmacy in the city where to usually take our medications. This usually doesn’t take too much time.

At 6:25PM I am back at the hospital with medications. As I enter the pharmacy, one nurse comes to me to inform about one patient who had refused his evening medication and aggressive and now who is being held in the isolation room because of an attempt to escape. The nurse asks me what to do…I prepare myself to call the physician and ask her to prescribe something. As the phone is on the voicemail, I inform the nurse to continue the observation for another 2 hours to see if the patient will calm down.

It is 7:15PM; I am sitting at the table starting my supper. Five minutes later, the nurse on the night shift calls me for another patient who can’t be found anywhere. So what? He just escaped! It is night and nowhere can he be found. As opposed to what we usually do, this time we can’t do any miracle. Usually, in cases like this, we try to trace out and mostly we succeed to catch the patient before he/she goes far. But during the night we are limited. I just can’t do anything more.

At 8:00PM I am watching news on TV getting ready for my sleep, the only break I have for the day. How I wished the night was longer! Anyway, I just have to go.

Good night everyone.

Jean-Clement, RN, BSN

Journal of a new grad-nurse in a psychiatric hospital

First two months after graduation (June and July)

School is over! What a joy! After four years of uncountable nights and days, there is only one day that I am eagerly expecting: graduation day. On this day, the past is forgotten and the future is even not thought of. The only moment is now, to celebrate and to enjoy. The day after graduation day, I am realizing that things are taking another lead. Passing the NCLEX-RN exam comes into the equation, even before thinking about a carrier or where to work. Two days after graduation I am again on the school desk preparing for NCLEX-RN exam. It is not only about getting the title RN after my name, but also the overall evaluation. Everyone sends me messages of good luck and courage despite the fear and anxiety. Four weeks passes preparing and revising, and the day comes to show that I deserve the title.

The 26th June, 2010, on a Saturday morning, I am very anxious to see my results. I can’t even sit to calm myself down. As I open the computer, and login, I get a surprise! Oyeeeeee! I passed! So what?

Three weeks after passing the NCLEX-RN exam, I find myself in a psychiatric hospital acting as a nurse manager. This is something I had never thought of. Can you believe it; I can’t neither. But it is happening. My days at the hospitals are full of stories, challenges, and discoveries. Writing them on the paper can make up a book heavy to carry and long to read. However, some stories deserve to be written down and to be shared.

The following events happen almost every day, during weekdays.

It is 5:30am, on Monday morning. Ding! Ding! Ding! My alarm clock is always earlier than me. Luckily! It is 5:30am and I have to wake up to get ready for my morning prayers at 6:00am. I always take 30 minutes to take shower and to get ready. It sounds more, but I do take time on myself. It is the only time I have to physically do my self-examination. It makes sense. I do assess others almost every day, why not me.

At 6:15am I am in the church for the Eucharistic celebration. Why not start my day with spiritual food? I guess it is important. Actually, there is no guess, it is obvious!

At 7:15am I am on the table taking my breakfast as fast as I can (eat fast, obviously more). This is an important meal of the day; therefore, I need to make sure that I take something in at least before starting my day.

By 7:30AM I am at the hospital for the morning change of shift staff meeting. This is an important meeting of the day during which programs and activities of the day are exchanged between teams. Most of the times we get to speak about some hospitalized patients who require special observation. Depending on what is to be exchanged, the meeting can take about 20 minutes or more.

At around 8:00AM I am back in the nurses’ office for another meeting during which tasks are shared between nurses. It is during this meeting that care plans are communicated. It usually takes less than 5 minutes. After this meeting, most of the things goes unpredicted.

Jean-Clement, RN, BSN

The Social Services at MSP - Yamoussoukro

Today, I am presenting you the social services at our Psychiatric Hospital. Mr Rene, the social assistant, is our person of interest here, and he is the only staff member with a small office. Fortunately, he doesn’t complain about it. He knows, as well as all other staff members, that his office is not limited at the hospital. It is in the society, the villages surrounding the hospital, even out of the country's boarders. In the fact, he is the staff member with a big office! As he explains it, his job starts when the patient enters the hospital the first day. While the nurse follows the patient while in the hospital, Mr Rene goes beyond the hospitalization period and follows the patient even at home. Everyone knows him because he knows everyone.

At MSP, 95% of all hospitalized patients have social issues that necessitate a special attention toward their successful recovery. Most of the time, these patients come from broken families, poor families with no financial means to support the recovery process, or have problems related to employment and relationships. As a patient comes at the hospital, he is received first by the welcoming team which takes the preliminary information and prepares him for consultation. The social assistant works in concordance with the welcoming team to get the first glance of information needed to conduct his activities. After consultation with the psychiatrist, the patient is sent to the nursing team who takes over with different therapies or prepares him for hospitalization. It is when the patient is to be hospitalized that the social assistant starts his intense inquiries with the family and the patient. It is always crucial that the social assistant gets most of the information on the first day when the family members are present. In cases when no family member is available, as it happens sometimes, the social assistant relies on the information provided by the patient and other interviews done where the patient was found (in the city, market…). In the long run, most of patients provide reliable information that helps the social assistant to track their families and relatives. In other instances, after the first day, some families disappear from all contacts with the hospital. It is the role of the social assistant to do follow up in search for these families to remind them of their responsibilities.

It is always important to work with families throughout the period of hospitalization and to involve them in the therapies as much as possible so that the process continues even after the hospital. The analysis at MSP has shown that most of patients who get re-hospitalized are due to the failure of the family involvement in the after-care.

Every day, the social assistant is the last person to leave the hospital. Given the amount of responsibilities he has, he plays a crucial role in the recovery and rehabilitation of our patients. One thing he is proud of telling when you talk to him is the stories of his traveling when he goes to visit families of our patients even in places where there is no transport. How he goes there? It is his secret.
To get more of other services, don't miss our next article!

By Jean-Clement, RN, BSN

Hôpital psychiatrique St Vincent de Paul : Une main tendue aux malades errant dans la ville

A Yamoussoukro, les malades mentaux ne sont pas abandonnés à eux-mêmes. Sur un fond religieux, l’hôpital psychiatrique Saint Vincent de Paul leur ouvre les bras afin de les soulager et leur offrir une chance de retrouver une vie normale.

«Nos ressources sont limitées, vu que la plupart des parents ne paient pas, alors que nous ne pouvons pas abandonner un malade sans soins», commente frère Félicien. Il insiste sur le credo de l’institut : « Notre devise : Deus Caritas Est (Dieu est Amour). Notre joie, c’est de voir la population comprendre que la maladie mentale peut être soignée et qu’un malade mental est une personne…».
Lisez toute l'article ici

Ecrit par "Ousmane Diallo" à Yamoussoukro

Continuing Education at MSP

At MSP, every once a month, all the medical staff takes at least 2 hours of continuing formation in mental health. Thanks to Dr Diomande, the visiting psychiatrist at MSP, we get to discuss and get more of the mental health issues that we come across in our daily activities. This last Friday, the 20th August, the theme of the discussion was on “Psychosis and paranoid personalities”.

Continuing education is one of the objectives set up by MSP to make sure that all the staff is updated in both knowledge and skills needed to provide competent and professional care to our clients.

Two weeks ago, the 13th August, the team of ergo-therapy took the lead to expose to the staff the new schedule of their activities. At MSP, Ergo-therapy occupies an important role. It provides activities and therapies such as occupational therapy, physical therapy, rehabilitation, education, relaxation, etc. In the future, the team plans to involve actively parents and family of our residents for sessions and family therapy.

Click here for photos

Jean-Clement, fc
MSP Yamoussoukro

City of the "insane" or city of "hope"?

Coming at MSP during the day is like going to the moon. Probably you would say that you want to have the first ticket. “Going to the moon?” I would be the first too. Perhaps, it is not as really exciting as you would imagine. MSP is located outside of the city, a place where public transport is not accustomed to go, like to the moon…It makes sense. But this is not the moving part of the story. The first time I was taking the taxi from the city I asked the taxi-man to take me to MSP which is on the way to Oumé. The taxi-man seemed not to understand what I was saying. I thought that it was my “French” which was not understandable. So, I repeated the same thing, “I want to go to MSP, how much?” The guy looked at me and told me, “is it that place where they treat crazy people?” Grudgingly, I said, “yes”. From there I was able to discuss the price with the taxi-man without any problem. Since then I came to understand that MSP was publicly known as the “city of crazy people” or “where crazy people are being treated” (là où on soigne les fous). Hopefully, the taxi-man did not think that I was also a crazy man who wanted to go there for treatment; otherwise he would not have taken me.

In reality, when you leave the city during the night taking the road toward MSP, some miles before the hospital, what you see is an isolated type of city, surrounded by bright lights, in the center of a forest. As you drive along the road, no other light you see other than the ones at MSP. As you approach the city, you start seeing everything clearly: beautiful buildings surrounded by large gardens with lights everywhere. Only those who have been inside these buildings know what city it is all about.

Me, I call it the “city of hope”. This is the place where everyone who comes in goes out transformed. They call them crazy people when they come in, but you have to wait till they go out to see how joyful they are. This is a place where these individuals are given “back” what they have lost out there: dignity, ability, love, but mostly, hope. One resident who was admitted with suicidal ideation shared with us a week later that he was no more thinking about killing himself, because he was “loved more than he has been even at his own home”. He loved the care, the ambiance, the atmosphere, and the place. Being here, he realized the really joy of living. When his parents came to visit him later, they jumped with joy.

Yet, our “city of insane” as the public calls it, still has a long journey to go and challenges to surmount. The foremost is community sensitization. We want to spread the city of hope out of the walls of MSP. This hope that those who come at MSP go out with should be kept even when in the community. It is always devastating when we receive former residents who come back due to failure to carry on their hope. The most reason that is given is that the community was not compliant and supportive to their recovery. It is only when the community understand what its members are living that the stability of health can be achieved.

The MSP is elaborating a program to work with parents of our residents because they are the ambassadors of our mission. These are the individuals who understand the really challenges we face because they share them for the big the big part. Parents will be the first missionaries to bring out the message that what lies behind the walls of MSP is not a city of insane where “crazy people are treated”, but a city of hope where “individuals are given back their dignity”.

Jean-Clement Ishimwe, fc

Welcome

The MSP is glad to welcome its new personnel, Jean-Clement Ishimwe, who will be working as a nurse manager for the psychiatric nursing department. We wish him good luck in his service.

Akwaba!

Ergo-therapy

One of the challenges met at MSP is finding activities to keep the residents active and focused on therapeutic goals. At MSP, ergo-therapy plays an important role in fulfilling this role. Since the beginning of the hospital, ergo-therapy has been given an important place and it includes activities such as crafts, plays, and meetings. Lack of competent personnel in this area at MSP was one of the reasons why most activities were kept as ergo-therapy instead of being taken separately (this was the case of group therapy such as meetings).

During ergo-therapy, patients learn more than doing; they also learn how to be together, to form relationships, to take responsabilities, to have plans and dreams for their future, learn skills, and to be distracted from certain concerns that occupy their mind (hallucinations...).

On photos are some of the crafts that have been made by clients. These and other goods are sold when possible and the revenue received can be used to help clients start new projects once out of the hospital. It is important to mention that most of clients have been successful after hospitalization due to the skills learnt at MSP.

Mental Health services of the Brothers of Charity (part 2)

Specific traits of our mental healthcare model

1. Our institutes should be excellent
It is not just about providing care, but providing managed care in an excellent environment, with competent personnel.

2. The focus is on love, charity
Expertise is fine, but not enough - love is as important. Christian-inspired institutes should uphold love as their central value, the highest value lived in a radical way.

3. This love is given a specific hue among the Brothers of Charity because of their preferential love for the less privileged

4. All our commitment and care have but one aim: the promotion of man in all his facets
Mental healthcare by the Brothers of Charity employs a Christian vision on man, inspired by their values which are aimed at caring for the whole human person.

5. Together we can do much
The multidisciplinary model can be sustained only if all staff are ready to form a close-knit team. The Brothers of Charity believe strongly in it, basing themselves on the conviction that healthcare is a matter of concern for every caregiver and an area where everybody can actualize himself/herself fully.

Adapted from "Ethos", Brothers of Charity, 2006

L'O.N.G "Lumière et Vie" collabore avec la MSP à Yamoussoukro

L’O.N.G LUMIERE ET VIE est une ONG qui œuvre pour la promotion de la santé mentale et la réinsertion des malades en voie de stabilisation. Pour le lancement officiel de ses activités le samedi 13 mars 2010, elle a choisi le cadre de l’Hôpital Psychiatrique Saint Vincent de Paul de Yamoussoukro. La cérémonie, parrainée par le Père Jacques Kouassi (Curé de la paroisse Visitation de Yamoussoukro), a été honorée de la présence d’illustres personnalités dont Madame la représentante du Maire, Messieurs le représentant du Préfet de Région, le Directeur départemental de la santé, les chefs coutumiers (Baoulé, Wè, CEDEAO). Débutée aux environs de 10 heures avec l’arrivée des officiels, la série des allocutions a très vite emboité le pas au cours de cette cérémonie.

Pour Madame la représentante du Maire, cette cérémonie est un moment où seul le cœur s’exprime, une cérémonie qui vient à son heure pour nous rappeler combien l’amour du prochain devrait être quotidiennement au sein de nos préoccupations ; la solidarité agissante qui se manifeste derrière l’acte de cœur que pose l’ONG LUMIERE ET VIE mérite d’être salué à sa juste valeur.

A sa suite, le Directeur de l’hôpital psychiatrique, le Frère Félicien, a souligné qu’il s’agit d’une occasion pour louer le Seigneur et d’exprimer la gratitude de la congrégation des Frères de la Charité. Pour lui, l’ONG LUMIERE ET VIE se lance dans un travaille qui n’est pas facile. Mais avec Dieu tout est possible car il n’est pas rare de voir des anciens malades totalement restaurés. Remerciant toutes les entités qui lui apportent une assistance quotidienne, il estime en tant que Frère de la Charité, être dans le charisme de leur fondateur qui depuis 1815 a installé et développé un nouveau modèle de soin pour les malades mentaux, un modèle basé sur l’amour et la compétence et c’est cet amour qui est aussi développé au sein de l’hôpital psychiatrique Saint Vincent de Paul de Yamoussoukro. Chaque action envers le malade étant placée dans la perspective de la résurrection. Le malade revoit la lumière de sa vie, il revit.
Faisant l’historique de la création de cet hôpital, il mentionne qu’il est né de la volonté du district autonome de Yamoussoukro. Inauguré le 6 novembre 2002, il a commencé à recevoir les premiers patients dès le 2 janvier 2003. Cette maison dont la mission est d’accueillir les malades se fonde sur des personnes inspirées, formées pour guider les malades vers un avenir dans lequel ils peuvent trouver leur place dans la société. Et à travers le don que fait l’ONG LUMIERE ET VIE, elle se place aussi dans cette perspective de redonner vie aux malades.
Depuis son ouverture à la consultation jusqu’au 31 décembre 2009, 10306 patients ont été consultés.

CONTINUE LA LECTURE ICI

Jean-Clement, fc

Mental Health services of the Brothers of Charity (Part 1)

Mission of the mental health sector

The spirituality of the Brothers of Charity as realized in their care-giving for psychiatric patient is no monopoly of just the religious but a treasure in which all co-workers of this healthcare have a share. Therefore, the Brothers of Charity make great efforts to formulate their spirituality in order to see it lived together with their staff. Within psychiatric healthcare, we have done so recently so that the objectives and the mission of the Congregation in our time have been clearly delineated. This Mission Declaration runs as follows:

Moved by charity for the psychiatric patient,
we, working in the sector of mental healthcare of the Brothers of Charity,
want to deliver optimal services in an expert and inspired way,
in the spirit of our Founder, Peter Joseph Triest.
We care for acute and chronic patients,
indiscriminately of their origin, gender, or belief.
Moreover, we try to find feasible solutions for those who,
because of the inadequacy of the current facilities,
call on our care-giving.
We want to give the best possible care,
in a holistic way, to all patients.
We commit ourselves to making it financially feasible for every patient.
Together with the patients and their milieu,
we strive after the promotion of mental healthcare.
We want to reintegrate them with a lifestyle that suits them best.

We intend to spread this text among all our co-workers and to uphold it as a charter and guide for the future development of our care-giving. This text will also be an evaluation instrument for all our works in order to help reorient them if needed.

Extract from "Ethos" of the Brothers of Charity, 2006

Volunteering program at M.S.P

Volunteers are like a golden gift to our center because they give without measure, without any expectation of a return, and with a heart full of love. For some years, the MSP has encouraged the program of volunteering because it is part of our mission to increase awareness of mental health within the community. For the majority of the population, whenever one comes across a mentally challenged patient, the first reactions are that of resentment and avoidance. A mentally challenged individual is mostly characterized as “aggressive”, “dirty”, “untouchable”, and many other definitions you don’t want to hear now. So many ways have been tried to change this mentality. People may listen to lectures, read books and literatures, but there is no one best way of learning that can be compared with direct contact with the real world.

MSP welcomes volunteers of various ages, gender, responsibilities, and from across the world. Some of the activities that volunteers participate in are: ergo-therapy, sitting and talking with patients, playing games such as soccer, table games, and participating in various occupational therapy (OT) activities offered at the center. The majority of volunteers have been adults, some coming from religious institutes, others from the neighboring parish community such as prayer groups and scout troops. Our goal is to extend the program to target the younger population such as elementary and high school age population with the plan to instill mental health awareness at a younger age. In addition, we are planning to establish a permanent program for volunteers who wish to commit themselves for a longer period. YOU CAN BE ONE OF THEM. WE WILL BE GLAD TO HAVE YOU.

By Jean-Clement, fc