In this week's edition of Health Promotion, we caught up with Endi Ezengwa, the executive director of Kiara Group, an organization based in the UK, to share his opinion about mental health in the sub region.

Kaira Group is a consortium comprising of several agencies; notably Kiara College, Active Support and Care (a community based organization), Kiara Personnel (a domiciliary care agency), and Kiara Homes Care (home for the elderly and people with mental health issues).Collectively, the group has presence in the UK, USA, Rwanda, Nigeria and The Gambia.

Kiara College, Endi Ezengwa said, primarily trains health care workers and also people in other sectors; such as customer service, business administration, retail skills, Information Technology and child care. The college also supports teaching and learning in schools, gives counseling and guidance and other support services including adult literacy, adult numeracy and basic IT trainings.

Director Endi Ezengwa further revealed that the College is contracted and funded by the UK Skills Funding Agency to enhance the skills of their workforce. "Employability skills for the unemployed are also offered. The College is licensed by the UK Border Agency to recruit and train international students in the United Kingdom. They will use this opportunity to offer training primarily not only for health care managers but also managers from other sector skills mentioned above. This will enable them gain experience that will support their roles when they go back to their respective countries," he said.

Speaking on the reason to specialise on mental health, Ezengwa said his inspiration is drawn from the fact that people with mental health are marginalised in society, as many African communities associate their conditions to witchcraft, evil spirits, etc. "We tend to see physical illnesses as more serious while people with mental health issues suffer continuously in addition to the stigma attached to the illness. There are little or no services available for them in most communities in Africa," he noted.

He went on: "I have always been intrigued by the mind, and as a musician, I am aware of the effect of music on the mind and that was why I was having the 'music therapy' sessions with the inmates at the Tanka Tanka psychiatric hospital" . According to him, during the time he was living in The Gambia, he was not only focused on people with mental health issues, but also taught music to the pupils of School for the Blind in Banjul, inmates of the juvenile wing of the prisons in Old Jeshwang, started a school for children with learning difficulties in Kanifing, helped to set up an orphanage in Welingara and also established a music school, noting that he focuses on mental health mainly because that is the area attestation is most needed.

Concerning the plans of his group for sub Saharan Africa and Gambia in particular,Ezengwa disclosed that they intent to transfer the bulk oftheir operations from the UK to Africa which they thought are mostly needed. "Our branch in Rwanda will address issues in East Africa, South Africa will address issues in Southern Africa and the branch in Abuja, Nigeria will address issues in West Africa", he revealed, whilst noting that based on the research that they had just concluded, there are three main areas where they feel that their expertise will be useful in Africa. These areas are: Vocational/work-based learning approach to education that will produce skilled workers for the growing economies in Africa, capacity building of health care workers (especially mental health) and developing/ supporting community-based mental health services.

The Vocational/work-based learning approach that produces skilled workers, he revealed,may be more relevant to employers than graduates with knowledge based degrees with limited skills. "Unfortunately having a degree seems to be a sign of status for most of us even if it does not lead to employment. The growing economies in the East are more practically oriented, hence the current success with their economies. Square pegs should be in square holes and round pegs in round holes. That is what the vocational/work-based learning approach will address" he explained.

He further remarked: 'There is a need for supporting living, and accommodation for people with mental health issues in various communities. This will not only prevent relapse because of early diagnosis and intervention, but will also alleviate the undue pressure on tertiary psychiatric hospitals located in the cities. To do this, there is need to first build the capacity of the community mental health workers.

Community mental health workers will also alleviate the pressure on psychiatric nurses and doctors. There are countries that do not have full time psychiatrists in the whole of the country and sometimes only one psychiatric nurse. The result is that some of the clients in some hospitals will have to be chained to their beds because of lack of human resources to meet their needs".

According to Endi Ezengwa, one does not have to be a nurse or a psychiatrist to work with people with mental health issues. "My first qualification in the UK - a diploma in community mental health from City and Guilds, enabled me to get a job as a deputy manager in a mental health organisation and eventually became a service manager after gaining an HND in health and social care management.

A good doctor or nurse does not automatically equate to a good health care manager. There are principles to health care management and that is something we may need to look into in Africa", he stressed, adding that their first action point after this research is to train 300 community mental health workers in Nigeria (180), Sierra Leone (60) and The Gambia (60) over the next 3 years.

Speaking on his visit to Tanka Tanka psychiatric hospital and Body and Mind Care, he observed that it was a pleasure to see that the clients at Tanka Tanka are being managed in a better environment. "The previous psychiatric hospital was old and no longer suitable. Special thanks to Sister Anne Marrie who worked so hard to see this change.

It is rare to find someone with that level of commitment in this field and I encourage everyone especially Gambians at home and abroad to contact her and offer some support. There is still a lot of work to be done there. The highlight for me was one of the clients remembering me after 12 years" he stated.

Body and Mind Care home, he revealed is a result of his 'music therapy' sessions at the previous psychiatric hospital and it needs a lot of support as well. The Kiara Group, he disclosed still supports the care home to the best of their ability. "The nurse there has done very well and has been committed to the project for the past 10 years. We will commit more resources to it in the near future as well as establish similar homes in other areas of the country", he observed.

On the challenges his organization faces, he stated that their major challenge is the financial resources to implement the identified projects. Ezengwa's tour of sub Saharan Africa is funded solely by Kiara College. It has come with a lot of sacrifice to himself and his team in the UK, who have been very encouraging and supportive.

He however observed that Africa has the resources to address her challenges and they will work with regional and continental funding bodies to ensure that these projects are implemented.