Developing a respectful partnership

For the Butabika Partnership, understanding each other’s strengths and weaknesses is built into the way in which they deliver their work,

from informal feedback to more formal debriefing sessions. Here they explain the partnership’s approach and how it has benefitted them

Butabika East London Link is a partnership between East London NHS Foundation Trust in England and Butabika Hospital in Kampala, Uganda. The partnership began in 2005, and focuses on improving mental health services in Uganda. Through training, mentoring, and exchange visits, the partnership has managed several successful projects, including introducing a peer support service,

better management of aggression in inpatient settings, and improving child and adolescent mental health services.

Harriet Birabwa-Oketcho and Olivia Carmichael are the project co-ordinators in Kampala and London respectively

The partnership has formal and informal ways of reviewing strengths and weaknesses in projects.

Exchange visits are key to mutual understanding, giving visitors an opportunity to learn and appreciate the context of their partner’s work, as well as providing immediate feedback on early-stage ideas. In this partnership, there are short-term, two-week volunteer placements, but also longer-term visits, including a three-month fellowship programme.

The partnership benefits from having had people in key leadership positions on both sides take part in exchange visits. At a managerial level, whenever a UK group visits Butabika Hospital, members of the team meet with the hospital management to provide feedback on current projects and discuss longer-term strategy and focus. This gives both sides of the partnership the opportunity to reflect on what’s needed and what’s possible within current capacity.

More than one approach may be necessary to understand strengths and weaknesses. When partners set out to understand and engage with an issue, looking at it from different angles can produce a fuller picture. For example, one focus area was the children’s ward at Butabika Hospital. A long-term volunteer from the UK worked with Ugandan ward staff on an audit of staff opinions of the service. Olivia explains, “We wanted to see where ward staff felt the ward did well, and where they could improve, and see whether it matched up with UK volunteer observations. The aim was to ensure we were led by Ugandan priorities and to reconcile differing cultural expectations of the service.” The volunteer talked to the staff about what improvements they would like to make on the ward, and what support they would need to achieve these.

Additionally, short-term volunteers returning to the UK, had debriefing sessions to report back on their experiences, and took part in a reflections day. This was designed to enable volunteers to process their experiences on the ward, and to explore UK volunteers’ and Ugandan colleagues’ cultural perspectives.

It was an opportunity to discuss some of the challenges faced during the volunteer placements and to encourage discussion about how the partnership can address these in the future.

As a result of the discussions, needs of the children and staff were identified and the value of different roles was explored. Olivia explains, “Short-term volunteers are less able to impact the daily routine of the children on the ward – long-term volunteers are better placed to support sustainable ward development.” Feedback from the ward staff resulted in the hospital catering team serving the children’s breakfast before the other wards to enable ward staff to better manage the children’s daily routine. Funds raised by UK volunteers were also used to establish a sensory room for the children and a playground in the ward grounds to offer the children more stimulation.

“I think it’s basically a strong partnership, because we’ve got to know each other”, explains Harriet. “People have personal relationships within the partnership.”

The partnership is complex, made up of varied workstreams, projects, and groups, but it is fundamentally made up of people. Harriet and Olivia both credit the personal relationships between colleagues – and the open and frank conversations that can take place as a result – with strengthening the partnership and its results. Mentoring, collaboration, and making time to have conversations one to one, outside of group meetings, gives people an opportunity to build up confidence in talking honestly about the partnership.

Olivia also credits the partnership’s diaspora group with helping open up communication. The group is made up of Ugandans living in London, many of them clinicians, who work to improve mental health for Ugandans in the UK and in Uganda.

She says the diaspora group has a good working relationship with the UK team and understands the UK context, but brings the perspective and understanding of the Ugandan context,

I think diaspora involvement is really helpful to learn where we’re falling down, because they bridge that gap.

A representative of the diaspora group sits on each of the partnership workstreams, and they are often involved in discussions with key stakeholders, such as the Ministry of Health.

Key to managing a difficult situation is having someone to discuss it with. The partnership has found that clear structures and named advisory groups can be very helpful, particularly when working with long-distance partners. Having a group of people who are fully briefed on a project, and who can offer support and oversight if problems arise has been invaluable to the smooth running of the partnership.

For some challenges, particularly when it comes to administrative issues like meeting a funding deadline, or planning travel, simply picking up the phone can make it easier to sort out a problem.

Harriet says that feeling comfortable contacting partners makes resolving problems easier, “We can do that, we can phone, we have communication by skype, by email.”

Olivia agrees, but also recognises that the appropriate response to difficulties or challenges in a partnership will vary. Sometimes it is important to recognise that a solution may be a slow process and not a quick fix.