Everybody knows the expression "trading guns for butter." But how about "trading rum for psychiatrists"? This notion may sound outlandish, yet there is really something to it.
During the 18th century, the sister Caribbean islands of St. Kitts and Nevis exported rum to the Canadian maritime province of Nova Scotia. Today the psychiatry department at Dalhousie University in Halifax, Nova Scotia, is exporting a handful of senior residents to St. Kitts and Nevis for three- to six-month periods to improve the care of mentally ill people there.
The program is the brainchild of Stan Kutcher, M.D., head of the division of international psychiatry at Dalhousie. As Kutcher explained at the recent annual meeting of the Canadian Psychiatric Association (CPA) in Halifax, the reasons for the program are many: The world is growing smaller; Canadians are "an incredibly lucky, wealthy group of people"; and Canadian psychiatrists have something to offer mentally ill people in developing countries.
The reasons why he decided to target St. Kitts and its smaller sister island, Kutcher added, are because Nova Scotia and these islands have had a special relationship for many years, and these islands—with their lush, mountainous beauty and tropical climate—would be enticing to psychiatric residents.
"Even though St. Kitts and Nevis are English speaking, there is a huge cultural difference between them and Canada and between them and the United States," Chehil told Psychiatric News. "I think a lot of people in Canada, as in the United States, see the Caribbean as being relatively developed. In fact, its institutional health structures are quite rudimentary. So that was one shock for me."
St. Kitts and Nevis have a population of about 44,000 people, yet the islands have only 12 psychiatric beds in a general hospital, a handful of community clinics, and a reconverted stable to house patients with chronic mental illness, she noted.
Another shock was that only one other psychiatrist worked on St. Kitts and Nevis during the six months that Chehil practiced there. "That was overwhelming—so many patients to see!," she exclaimed.
Then there was a scarcity of psychotropic medications, especially of the newer ones. Even those from which she could usually choose were sometimes out of stock. "For instance, I could put a patient in the hospital on a medication, and he or she would get better," she said, "but suddenly there wouldn’t be any medication anymore, and the patient would, of course, relapse."
Still another surprise for Chehil was that the islands’ citizens often believe that mental illness was caused by the person being hexed or possessed by a spirit. Such perceptions often deter the islanders from seeking modern psychiatric care, she learned.
Finally, stigma against mentally ill residents is enormous on the two islands, Chehil discovered. As a result, patients are often discouraged by their families from seeing a psychiatrist and from taking psychiatric medications. "So it was very difficult to treat people adequately," she lamented.
Nonetheless, "all of us residents saw patients who got better because of our care," Chehil said. "Just recognizing that the patients could be well enough to reconnect with their families or have some kind of vocation was a real revelation, not just to the patients, but to the nursing staff and hospital administrators."
"What we have also seen," she explained, "is that the nurses we worked with were very enthusiastic about learning more about mental health, and that as each of us residents has mentored the nurses, their skill sets have grown proportionately. That is a significant contribution that will continue to grow as we send down more residents."
And, indeed, more residents will be coming, Kutcher said at the CPA meeting. In fact, psychiatry residents from other Canadian universities are welcome to participate in the program, and it is being expanded to send residents to another Caribbean island—Tobago.
Dalhousie is the only Canadian university with such a program, Kutcher pointed out. However, two other Canadian universities—McGill University and the University of British Columbia—may be setting up similar initiatives. Also, the University of Toronto is sending psychiatry residents to Ethiopia to teach psychiatry residents there. ▪