Mentalisation based therapy training in the ED…. the story so far

What are we doing?

 Since September Dr Jon Patrick and and Art Psychotherapist Kate Pestell have been training the ED staff in mentalisation. 

Why are we doing it?

So as a team I think we are pretty empathetic, this slips the busier and more stressed we get. When it slips we have negative team and patient interactions. The question is can mentalisation help us improve the care we give to our patients and strengthen our team relationships?


What is mentalisation?

The term mentalisation refers to the ability to reflect upon, and to understand one’s state of mind. 

In addition mentalisation also helps us to understand the state of mind of other people. The benefits of mentalisation are: 

1)  Mentalisation enables us to understand our own contributions to problems and conflicts with others; 

2)  Mentalisation helps us to change our behaviours and calm down when we are upset; 

3)  Mentalisation allows us to relate to ourselves and other people with empathy and compassion; and 

4)  Mentalisation promotes our ability to effectively cope with conflict. 

How are we doing this?

The one-day training sessions are continuing in to the New Year so if you haven’t had the chance to attend one yet please chat to your line manager.

Jon and Kate are running twice weekly sessions in the ED teaching room from 09:00-10:00 on Tuesday and Thursday mornings. These are open to everyone (whether you have been on the one day training or not). They are happy to discuss difficult cases or teach new techniques for mentalisation.

Please join us!

We are very grateful to the Edinburgh and Lothians Health Foundation for funding this project.

Heading home from Bangladesh.....

To DAT or not to DAT, that is the question!

You can see from the pictures that some diphtheria pseudo membranes are fairly obvious. Nobody would miss that. Many however are far trickier and as doctors we all have different thresholds for what we would treat with DAT - diphtheria anti toxin. We’ve had a couple more significant reactions to the treatment and of course there isn’t an endless supply. Also it’s incredibly time consuming and as a team we can only DAT 3 at once maximum. Interestingly we are seeing less children these days and more adults, particularly working men. This is a worry as this population isn’t vaccinated as the WHO vaccination campaign has so far focussed on the under 15s. Less paediatric patients reassure us that the vaccination programme is working at least and there’s talk of extending it to adults soon. 

This last few days of the trip has been focused on our exit strategy. Our wards are closing and we will no longer give DAT in our centres. The local staff will provide a triage service only and refer potential diphtheria patients on to MSF for treatment. Training them in referral, transfer and triage is the most important aspect of what we are doing now. Both the medical and nursing teams we leave behind are motivated but very junior. My training was fairly straight forward - ABC’s and resuscitation of the sick child. It was well attended. 

We visited an MSF camp today as well as the Malaysian field hospital. Very impressive set ups. We all know that cholera is coming next and facilities are being prepared for this. The mud huts and roads of the refugee camp will become a wash in the monsoon and the threat of typhoons snd hurricanes are always present... the next outbreak is on its way. Interestingly there are still new people arriving. We see them leaving the holding centre with their initial ration pack donated to them to make some sort of life here.

There is a sadness at leaving this place. It’s been an amazing experience. Our team has gelled really well and in these circumstances that doesn’t always happen. We feel to have been part of the local Bangladeshi team too and some of them move on now as we do. And of course we leave the Rohingya. A population of people who wish to live in safety and peace. It is very humbling when you pass a family the apple from your packed lunch and a boy splits it into 9 pieces to share with the entire family. It makes you realise how lucky you are. And yet on the other hand as I leave the dusty streets with children waving goodbye to us I am reminded that whilst they have little of material value, they have family and community and hopefully some healthcare that we have been part of providing. 

From ED research nurse to volunteer in Laos, an inspiring story.

We often say that our skills in Emergency Medicine are transferrable across a number of vocations and different environments. Mia Paderanga, one of our ED research nurses, has certainly put that to the test!

Here's her account of working as a volunteer nurse in Laos.

Words cannot describe the anticipation and the excitement that I felt the moment I landed in Laos. I was in awe seeing the landscape of Laos from my tiny little plane.  I looked down with such amazement at the vastness of the Mekong River carving its way through rich tropical mountains with no concrete buildings in sight.

I'm finally doing it, volunteering as a Nurse in a developing country - the thing I've always dreamed of but somehow never had the courage to do. Now I'm finally here.

I was very fortunate to be given the opportunity to work as a volunteer nurse for the charity, Friends Without a Border (https://fwab.org/). This is a non-governmental organisation dedicated to providing free high-quality health care to children. They run a small Paediatric hospital consisting of a 24 bedded In-patient ward, Outpatient Clinics, a Neonatal ICU, an Operating Theatre and a 24 hour Emergency Department. 

I arrived in the hospital early in the morning, and already a long queue of patients was waiting to be seen in the outpatient clinic. The inpatient ward had no empty beds and in the ED were a couple of critically ill children undergoing resuscitation. There was a feeling of chaos as if I had just entered a battle ground, but behind the entire buzz, there was a sense of calmness from the local team. I noticed a strong sense of teamwork and comradery. Perhaps it is in the culture of Laos to be soft and calm; an admirable trait which everyone seems to have. I was welcomed by everyone with such warmth and a welcoming smile. I automatically felt at ease with the team and it didn't take long for me to feel like I am a valued member.

As a volunteer nurse my main responsibilities are to provide clinical supervision as well as teaching and assisting with patient assessments, and overall patient care. On top of this, we also manage the patient flow of the whole hospital. I won't deny feeling absolutely overwhelmed on my first day. The challenges that this type of work presents are surely different from the ones we face back home however, the highlights are profoundly rewarding. 

As a charity run hospital, I was impressed by how well established the hospital was despite only running for two years.  They have set evidence based protocols and guidelines. They have equipment and supplies of medications that although basic and limited, can be considered quite advanced for the setting. 

The ethos of the hospital is to “treat every child as if they are your own", and this resonates in the attitude and work ethic of the local staff and the volunteers. 

Despite all our efforts to provide the best health care, we face many challenges due to our lack of resources. It is particularly difficult to see a child have a less of a positive outcome simply because we have no access to certain medications, or that we don't have equipment to do diagnostic tests or to provide life support in critical conditions. At times we have had to send patients home with nothing but our sincerest apologies to offer, as we have no other means to further provide treatment. This is heart-breaking especially knowing that in developed countries, these children will have had a completely different outcome. 

Despite this, I have witnessed many patients recover and defy poor prognosis which I can only describe as something short of a miracle.

There is no doubt that the hospital gives many of the Laos children the opportunity and chance in life that they would otherwise have not received. There is a real sense of sincere gratitude from the parents/families of the children we see. A refreshing change from what seems like a growing culture of entitlement often seen in more developed countries. 

One of the most challenging aspects of the job was communicating with both the staff and the families. I knew I needed to adapt my way of communicating in way that is respectful and sensitive to each individual's level of understanding of English. I quickly learned a few common Laos phrases and with some help from the Laos staff, was able to communicate effectively in the best way I could. The families and the children also got a laugh out of my accent and more often than not my mispronunciation of words! However, they are more than appreciative with my efforts to learn their language. And with my broken Lao and strange "phalang" (foreigner) accent the locals are quick to respond “boh pan yang" translating to "no worries"!

Coming here has opened my eyes to different forms of health care and the ability for people to make the most of what they have.

This has truly been a life changing experience for me and one that I will forever remember. I go home with the knowledge that this experience has helped me develop professionally and more importantly I feel I have grown as a person and gained lifelong friends along the way.

I feel grateful for the support and encouragement I received from families, friends and colleagues who made this journey possible.  I am humbled by this experience knowing that in some small way I have contributed in making a difference in this small corner of the world. I strongly encourage others to take the leap and volunteer.