Field Placement:  International Medical Corps
Location: Jordan-Amman
Preceptor:
Student Name: Sherin Mermash
Year: 2008

I conducted my internship with the International Medical Corps in Jordan-Amman from July 17th until September 30th, 2008.  The main objective of this internship was to improve the quality and access to community basic mental health services for vulnerable Iraqi and Jordanian children through school outreach services. Children spend more time in schools than they do anywhere else outside their homes. As such, schools are not only educational settings, but also an access point to parents and communities.

During Phase 1of the project we devised and implemented a training program for local physicians (general practitioners) to enhance the capacity of primary health care providers involved in the Primary health care outreach project to better understand mental health problems, provide frontline management of mental health disorders, support paraprofessionals, address curative and preventative components of the school outreach program and conduct appropriate psychiatric referrals when necessary.  This training was done through our collaboration with an Iraqi child psychiatrist who was trained in Britain and who was the only child psychiatrist in Jordan. Child Psychiatry services are very primitive in Jordan and this branch of study is overlooked in the medical school curriculum. The general practitioners were recruited through collaborating with a local NGO called the Jordan health Aid society, Ministry of Health and Jordan Red Crescent.  During this phase we developed a relationship with the Ministry of Education, Save the Children, Ministry of health and Jordan Red Crescent.  To access our target populations (Iraqi refugees and vulnerable Jordanians), we took advantage of overlooked, underused opportunities for mental health and psychosocial activities: the school environment provides a secure, sustainable and stable base for the provision of psychosocial activities that address the healthy psychological development of small children. We identified nine save the children supported schools that host programs for Iraqi refugees and vulnerable Jordanian children. We obtained consents from our target populations through our culturally competent, program relevant designed consent forms. We also installed necessary screening equipments in each of these schools.

During phase 2 of the project we launched primary health care outreach visits to the pre-identified schools to provide basic child health services. The outreach team consisted of one physician, one nurse, and myself.  The medical team conducted general physical screening following a screening checklist outlined in a student card adapted by us and filled out by the medical team for each child. They also kept record of each case by filling out a log book. In addition to the physical screening, a psychosocial/ mental health screening was conducted by myself and the medical team using an SDQ (strength and difficulty questionnaire) adapted by the IMC.  The parents/ guardians of these children were invited to the screening and they were involved mainly in the psychosocial screening to provide history of the cases. In the meantime we have devised a referral system including all of the available international and national NGO clinics and resources. Children requiring further health services were referred to those facilities for primary health care and other specialized services. We also followed up with the cases that we identifies to have psychosocial / mental health concerns by arranging sessions for them with the child psychiatrist and with other NGO’s that offer psychosocial support.

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