Our impact Our fellows Dr Dickens Akena (2015) Host organisation: University of Cape Town (UTC), South Africa Project title: Visual Instruments for Mental Health in Africa: The VIMESA project Dr Dickens Akena is a psychiatrist and lecturer at Makerere University in Kampala, Uganda. He graduated with a PhD in Psychiatry from the University of Cape Town, South Africa in 2013. During his PhD studies, he developed a visual scale comprised of pictures that can be used to detect depression in people with low literacy. AREF Fellowship research project: Depression is increasingly recognised as a significant and largely neglected condition in Africa. It is rarely identified and treated among patients in health facilities. The reasons often cited are huge patient numbers and medical staff shortages. Conventional tools for assessing depression involve a good level of patient literacy but this is challenging in Africa, where one-third of patients may be illiterate. Visual scales which are easy to implement may be one innovation that could help improve case detection of depression in low literacy settings. Compared to letter-based instruments, visual scales could be self-administered by patients or trained lay health care workers irrespective of their literacy, leading to improvement in case detection of depression. For his Fellowship project, Dr Akena learned new methods in the area of psychometrics, and applied this knowledge to develop multiple scales for detection of mental illnesses in persons with low literacy in Africa. Dr Akena was mentored and supervised by Prof Dan Stein and Prof John Joska, who are based at the University of Cape Town in South Africa, and Prof Eugene Kinyanda at the Medical Research Council / Uganda Virus Research Institute Research Unit on AIDS, in Entebbe, Uganda. Dr Akena selected advisors and mentors who are distinguished mental health researchers with established track records in the African continent. The host institutions provided the necessary research support structures that Dr Akena needs to achieve his goal of becoming an independent research scientist. While at the University of Cape Town, Dr Akena attended proposal writing workshops at the clinical research Centre, as well as seminars and lecture series at the Centre for Higher Education Development. The AREF fellowship also offered Dr Akena the opportunity to develop a proposal that would examine the accuracy of visual scales in diverse populations in Africa. In the long-term, the impact of using visual scales on clinical outcomes will be assessed, as well as means of effectively integrating visual scales for routine use in primary health care settings.