Introduction

It has long been accepted that consultants are appointed to posts in the National Health Service (NHS) with an expectation that they will immediately take the lead in teaching medical students, general practitioner trainees and specialists in training. It is often the case, however, that they will have had little formal supervision or training in teaching and assessment methods. This chapter describes the Scotland–Malawi Mental Health Education Project, an innovative project that provides higher trainees in Scotland with the opportunity to prepare, deliver and examine an undergraduate psychiatry course, while supporting the development of psychiatric capacity in a low-income country.

Background to the project

Ever since the travels of the Scottish Presbyterian pioneer and medical missionary Dr David Livingstone (1813–73), Scotland and Malawi have had strong cultural and educational links. Malawi is a sub-Saharan African country with a population of around 14 million and a per capita gross domestic product of US$312. The health of the Malawian people has suffered under the burdens of poverty, a devastating HIV/AIDS epidemic (the adult prevalence was 14.4% in 2003), a lack of health workers owing to attrition and emigration, and a lack of training resources. This has given rise to a human resource emergency in the health sector (Kauye & Mafuta 2006; Kauye, 2008).

In 2005, the Scottish and Malawian governments established the Scotland–Malawi Partnership (see http://www.scotland-malawipartnership. org), the purpose of which was to support Malawi in areas of medical and social development. The International Development Unit of the then Scottish executive (now the Scottish government) and the Ministry of Health in Malawi identified appropriate areas of focus for the initiative. These included teaching and training for all cadres of health workers, clinical support (after discussion with Malawian counterparts to ensure appropriateness and cultural sensitivity) and provision of clinical supplies and equipment. A specific priority area identified was support for teaching at undergraduate and postgraduate levels at the College of Medicine, Malawi's only medical school.

Mental health services in Malawi are provided mainly at three psychiatric hospitals – Zomba Mental Hospital (333 beds) in Zomba in the south, a small mental health unit in Lilongwe in the central region (30 beds) and the charity-funded St John of God Hospital in the north (50 beds) – amounting to a total of just over 400 in-patient psychiatric beds for the entire population.