After years of listening to stories of gender-based violence, depression and psychological trauma, Belise Iradukunda began noticing changes in herself.

The former psychiatric nurse, who worked in Burundi before relocating to Rwanda in 2015, says the emotional weight of caring for patients gradually became impossible to ignore.

"In my line of work, I encountered many difficult cases, from gender-based violence to depression and severe stress,” she says. "The more I understood the mental challenges people were dealing with, the more my own mental health was affected.”

For years, Iradukunda, who now lives with her elder sister in Kicukiro district, continued working despite emotional exhaustion, believing it was simply part of the profession.

The hidden cost of caring for others

Like many healthcare workers, she focused on helping patients while quietly suppressing the psychological toll of repeated exposure to trauma.

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Her experience reflects a broader but often overlooked reality within Rwanda’s healthcare system: while conversations around mental health are becoming more visible, the emotional wellbeing of healthcare workers themselves is rarely discussed.

Across hospitals and clinics, doctors, nurses, psychologists, and mental health specialists operate under constant pressure. Hospital corridors fill early each morning with patients waiting for consultations, diagnoses, and treatment.

Inside consultation rooms, healthcare workers move rapidly between files, emergencies, and emotionally demanding cases, often with little time to recover before the next patient arrives.

This year’s Mental Health Awareness Month theme, "More Good Days, Together,” emphasises emotional wellbeing and support systems. But for many healthcare workers, it also raises a difficult question: who supports those providing care?

When stress becomes burnout

Clinical psychologist Justine Mukamwezi, Director of Clinical Services at Solid Minds Counselling Clinic, says burnout among healthcare professionals often develops gradually and is frequently normalised until it begins affecting behaviour, emotions, and workplace relationships.

"There is this expectation that because you help others, you should not struggle yourself,” she says. "But that is not true.”

Mukamwezi distinguishes ordinary stress from burnout. While stress may be temporary, burnout develops when pressure becomes prolonged and recovery time is limited or nonexistent.

Warning signs, she says, include irritability, emotional exhaustion, reduced empathy, and a growing dread of returning to work.

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"You can start feeling frustrated with patients or colleagues. You lose patience more easily,” she says. "Some people become emotionally detached from work they once loved.”

Despite these warning signs, many healthcare workers continue working through exhaustion because emotional strain has become widely accepted within the profession.

"You should not only seek help when you are already in crisis,” Mukamwezi says. "People need to manage stress before it reaches that point.”

She also stresses the responsibility of employers to create supportive work environments, allow recovery time, and ensure healthcare workers have access to mental health services.

Carrying patients’ pain home

For doctors like Marie Solange Mukanumviye, a consultant internist, gastroenterologist, and hepatologist at CHUK, the emotional impact of difficult cases often extends beyond hospital walls.

Some involve critically ill patients. Others involve conversations with families receiving devastating news despite every effort made by medical teams.

"When we have done everything possible for a patient, discussing it together helps,” she says. "It reminds us that we gave the best care we could.”

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Outside work, many healthcare workers rely on family time, rest, travel, or short breaks to recover mentally. However, structured psychological support for medical staff remains limited and not always easily accessible.

Some hospitals have introduced wellness initiatives such as sports activities and group programmes, but heavy workloads often prevent staff from participating.

The pressure behind the profession

Jean-Damascene Hanyurwimfura, Director General of Masaka Hospital, says healthcare workers face unique psychological pressure because they are constantly exposed to illness, suffering, and emergencies.

"There are situations where a patient does not improve despite treatment, and that naturally affects healthcare workers psychologically,” he says.

Masaka Hospital has introduced internal support systems, including staff discussions, days off for affected workers, sports activities, and access to in-house psychologists and mental health nurses.

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"If you do not take care of workers, it eventually affects service delivery,” he says.

Still, he acknowledges that heavy workloads remain a persistent challenge across the healthcare system.

Secondary trauma among caregivers

Mental health nurse Olive Mukase of Nyamata Hospital says healthcare workers are particularly vulnerable to secondary trauma because many of the cases they handle reflect realities within their own communities.

"They are hearing difficult stories every day, and they are also members of the same society,” she says. "What happens to patients could also happen to them or their families.”

Repeated exposure to trauma, violence, and emotional distress, she says, can gradually affect healthcare workers if there is no structured support or space to decompress.

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Over time, this may lead to emotional fatigue, withdrawal, irritability, and strain within family life.

Mukase believes support systems for healthcare workers should become institutionalised rather than occasional.

"There should be systems where staff can regularly speak to a psychologist or counsellor before burnout happens,” she says.

Rwanda’s healthcare system has made significant progress in expanding access to care and improving health outcomes. But healthcare workers say sustaining those gains will also depend on protecting the wellbeing of those delivering care.

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For Iradukunda, the experience left a lasting lesson: healthcare workers are not immune to the emotional weight of the suffering they encounter every day.

As Mental Health Awareness Month continues, many caregivers are urging greater recognition that caring for healthcare workers is not optional, but essential to the survival of the system itself.