Mozambique’s First Fellows in Psychiatric Research Training Come to Columbia University Medical Center
The New York State Psychiatric Institute at Columbia University Medical Center was one of five institutions recently awarded a $5.8 million grant from the NIH Fogarty International Center to promote international training in mental health implementation research in Mozambique. This grant is part of a larger effort by the National Institute of Mental Health, the Global Alliance for Chronic Disease, and other groups to reduce the significant burden that neuropsychiatric disorders place on health around the globe.
In September 2014, Columbia PIs Milton Wainberg, MD, and Maria Oquendo, MD, launched a fellowship program to train Mozambican scientists in research techniques that will help bring evidence-based care to mentally ill patients in that Southern African country. “This is a tremendous opportunity to provide much-needed training and assistance to our colleagues in Mozambique,” said Dr. Oquendo, adding that, “a surprising benefit of conducting this type of work is that some of the interventions that are implemented and disseminated in low and middle income countries (LMICs) may also be useful in underserved areas of New York or other parts of the United States.”
Together with partners from Mozambique’s Eduardo Mondlane University and the Ministry of Health’s Mental Health Department, and in collaboration with the Vanderbilt Global Health Center and the Sao Paulo Federal University in Brazil, Dr. Oquendo, Dr. Wainberg, and several faculty members from Columbia’s Department of Psychiatry welcomed the first group of fellows to participate in an intensive four-week training in the United States. An additional four-week course will take place in Mozambique.
Earning a place in the fellowship is a notable achievement, given that researchers inMozambique and other LMICs rarely, if ever, get the chance to apply for an NIH postgraduate training program.
For Palmira Fortunato Santos, PsyD, MMHPS, PhD, training director and coordinator of the research service in the Center for Applied Psychology and Psychometric Tests in the ministry’s Mental Health Department, this international collaboration is critical. While her role in the ministry is to help implement policy, “There is no evidence-based work to guide professionals in terms of service-delivery and medications,” she said.
Mohsin Sidat, PhD, is dean of the Faculty of Medicine at the University Eduardo Mondlane. “There are challenges in the health system,” he said. “The health system covers only 60 percent of the population, so 40 percent have no access to health facilities.”
One of the biggest challenges is a lack of human resources. In a country of roughly 24 million people, “we have only nine Mozambican psychiatrists and four from Cuba,” said Lydia Gouveia, a psychiatrist and head of mental health in Mozambique’s Ministry of Health. To meet that challenge and fill the treatment gap, the country grooms high school graduates to become mid-level professionals, psychiatric technicians, who receive three years of mental health training. But even that isn’t enough to get care to those who need it.
Psychiatrist Vasco Cumbe, a coordinator of mental health services in one of Mozambique’s provinces, knows firsthand how wide the treatment gap is. He balances a work load of inpatient and outpatient visits with support and oversight of psychiatric technicians in 10 districts comprising nearly 2 millionpeople. He would like more local partnerships with general practitioners: “We’re not succeeding in terms of engaging them deeply in mental health care, so this is a big issue for us.”
Integrating mental health training early on may be one way to do that, and Dr. Sidat wants to make that a reality. “As a medical school, we train only medical doctors,” he said. “But we want to introduce a clinical psychology course. We have a mental health master’s program, and we want to strengthen that program so we can increase the pool of people trained in research.”
The new research training fellowship program is one step toward strengthening the capacity and sustainability of mental health research in Mozambique and moving toward the ultimate goal of implementing relevant evidence-based treatment for citizens with neuropsychiatric illnesses.