Marissa Vander Missen is a second-year medical student at Indiana University (IU) School of Medicine. She is one of three Slemenda Scholars who spent the summer in Eldoret, Kenya, with the AMPATH partnership.
This summer I was lucky to join AMPATH’s mental health research team –Scale and Improve Mental Health Services (SIMHS) – for my Slemenda Scholars scholarly project. My work focused on a new project called Husisha.
Husisha, the Swahili title of our team’s project which translates as “to be involved,” also nicely describes my experience becoming a team member on the SIMHS team at AMPATH. The atmosphere created by the SIMHS research team was welcoming, open, and engaging. I felt grateful to work alongside team members who so willingly got me involved in the Husisha project.
The Husisha project aims to implement and research outcomes of a community-based, peer-led intervention including mental health screening and treatment for adolescents in Eldoret, Kenya. Family Health Options Kenya (FHOK) runs a youth drop-in center in downtown Eldoret which will serve as the main intervention site for this project.
In Kenya, youth needing mental health treatment vastly outnumber licensed mental health professionals. Task-sharing mental health treatment to non-professionals (lay providers who are not psychologists or psychiatrists), has potential to reduce the treatment gap in areas with provider scarcity. For youth, non-professional peer counselors not only bridge this gap, but also have the benefit of increasing engagement and reducing stigma.
The Husisha team welcomed me onto the project at a critical stage of planning and implementing a two-week training for the soon-to-be peer counselors. The training curriculum included core counseling skills, an overview of mental health and disorders, introduction to problem-solving therapy, and demonstrations and peer role-play. Problem-solving therapy (PST) is one treatment that has been shown to alleviate mental health symptoms even when delivered by non-professionals such as the selected peer mentors.
What made my involvement with the Husisha project so special was working closely alongside two similarly aged Kenyan counterparts, Faith Njiriri and Gilliane Kusgei. Faith is a clinical officer (similar training to physician’s assistants in the U.S.) completing a research internship with AMPATH SIMHS and Gilliane is a counselling psychologist. Together, Faith, Gilliane and I recon ciled the schedules of over a dozen team members to coordinate the facilitation of all sessions in the two-week training. The three of us pored over the documents that comprised the PST intervention the peer mentors needed to learn. We edited, translated, and improved visual and verbal comprehension as a team. Some of our tasks were simple – printing endless materials, organizing the training room just-so and coordinating the delivery of meals and snacks for the peer mentors. However, working through the tasks as a team, and eventually getting to see our hard work come to fruition during training, made each checklist item worth it.
Faith, Gilliane, and I shared the responsibility of leading sessions with many other team members with diverse specializations. Gilliane’s background in psychology prepared her to be one of the two main role-play demonstrators throughout the training. Gilliane and another colleague, Wilter Rono, took turns acting as client or counselor, providing helpful examples of good counselling for the peer mentors to model. I shared the role of facilitator with Dr. Florence Jaguga, a psychiatrist at MTRH and researcher with AMPATH SIMHS, to lead the peer mentors through a manual that described using PST for counseling. We read and role-played through five structured sessions of counselling to prepare the peer mentors for the course of counselling with youth clients at FHOK. Throughout the two weeks, we were pleased to see the peer mentors engaging excitedly with the PST materials. We solicited feedback from them to improve their experience as counsellors and adapted our materials accordingly. By the last day of training, all the peer mentors demonstrated excellent understanding of PST application and much improved core counselling skills use in role play.
In my final week in Eldoret, we reflected on how training went. The Husisha team has a long new to-do list of adaptations to finalize in our intervention materials and next steps to start implementing the peer mentor counseling at FHOK. The Husisha team has graciously welcomed me onboard to remain involved as a team member remotely, and I cannot wait to see how the peer mentors will impact the lives of their peers through the counselling intervention.
On our last day in Eldoret, I wanted to celebrate the relationships we have made this summer as Slemenda Scholars and AMPATH research team members. Faith, Gilliane, and I were joined by the other two Slemenda Scholars, Micaela Gaviola and Destiny Resner, as well as our mutual friend and AMPATH researcher on the neurodevelopmental team, Mercie Yugo. The six of us headed to FHOK, the same youth drop-in center where our peer counselling project will take place. FHOK hosts salsa dancing multiple times a week, and we were excited to brighten our last day with music and dance! Seeing FHOK bustling with young adults of all ages and backgrounds that Friday night felt like our work this summer had come full circle. I feel confident FHOK will be a location with abundant opportunity to engage with youth needing mental health treatment. We even were able to spend time with two of the peer mentors from training, also enjoying their Friday night at FHOK.
I feel incredibly lucky to have been a Slemenda Scholar this summer for multiple reasons, chief among them being my new friendships and professional relationships with my Kenyan colleagues on different AMPATH research teams, and with my two fellow Slemenda Scholars. Although our time in Kenya has come to an end, this feels like only the beginning of an exciting journey forward in global health.
