Walani, a student helpline in Malawi

We have noticed that many of our students are stressed, overwhelmed and mentally withdrawn. We are concerned for their mental well-being. Mental health problems are on the rise globally but are already significantly higher in Africa where there are fewer health services available.

Trainee health workers are exposed to physical and emotional trauma and deal with the impact of death and dying during their training, at a time when they do not yet have the skills to manage complex conditions and patient interactions. They are vulnerable to burnout, which exacerbates existing stressors related to tuition, housing, and food and may help explain why mental health issues are higher in this occupational group.

In 2019, a Cape Town study showed that nearly 25% of medical students reported levels of depression and anxiety, significantly above age-based expectations. It was recommended that there be multidisciplinary efforts targeting initiatives aimed at building the mental well-being and resilience of future healthcare professionals.

There is no existing research to show levels of depression among trainee health workers in Malawi. Anecdotally, in our interactions with students, we have expressed concern about the levels of stress experienced by student healthcare workers in our community. In March 2022, we conducted a survey and needs assessment of our student community by asking the validated Patient Health Questionnaire 9 (PHQ9) depression screening questionnaire along with other eligibility questions.

We had a 54% response rate from Medic to Medic students. 94% of respondents had been overwhelmed in their studies. 56% of students felt that the psychosocial supports available at their college were inadequate. Overall, 60% of the students had a mild to moderately severe level of depression. This was broken down into 27% of students suffering from mild depression, 19% from moderate depression and 14% from moderate to severe depression. If extrapolated, these rates are likely to be underestimated for the student community in Malawi given that scholarship students do not have the same degree of financial burden as other students who do not receive support. for tuition fees. Students who participated in this survey were offered a follow-up phone call with a Medic to Medic MBBS graduate with several years of clinical experience. 62% of students requested a follow-up phone call.

Our survey demonstrates a compelling need to provide additional psychosocial supports to students across Malawi. We would like to embark on a new initiative, the establishment of a confidential and free helpline allowing students to access psychosocial counseling services. The helpline will be staffed with psychosocial counselors and mental health workers. All advisors will have gone through a rigorous selection process and training program. The helpline will be an evening telephone line from 5pm to 10pm to ensure that students have access to psychosocial supports outside office hours when other services may not be available. This initiative will not replace existing psychosocial supports offered to students at the university, but will complement existing services.

Our survey results showed that 100% of students surveyed felt a helpline would be acceptable and all said they would recommend such a service to their friend. 100% of faculty members from 10 universities and colleges in Malawi felt that a student helpline was an acceptable initiative and 100% would recommend it to their students.

In 2023, we aim to launch this initiative. This time allows us to work towards protocols and training paths that are well organized and efficient.

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