They say making healthier choices in our daily lives will not only reduce the risk of facing chronic diseases, but it will also keep us away from hospitals and improve our overall quality of life.

During the 18th National Dialogue Council (Umushyikirano) 2023, one of the topics tackled is the increase in non-communicable diseases and obesity, which the Minister of Health, Dr Sabin Nsanzimana, said has doubled over the last 10 years.

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Ensuring that Rwandans lead healthy lifestyles is a mission Gabriella Nandi, a Rwandan physiotherapist and founder of The Health Hub, located in Gikondo Merez, is dedicated to.

Nandi is a very calm and free-spirited person and you can tell that she doesn’t just trade her expertise, she literally practices what she preaches—wellness.

When you walk into The Health Hub, you immediately get a sense of wellness from the therapeutic scents that hit you from the onset.

Starting out

Nandi says she was always interested in health, the body and human anatomy generally, even as a child.

"I thought I was going to be a doctor but I ended up loving physiotherapy. I also saw that there was a bit of a gap here in Rwanda when it came to after care, that is secondary and tertiary care,” Nandi says.

Secondary or tertiary care is the care someone receives for example after a surgery or when they are healing from a certain condition.

The 28-year-old, who pursued a Bachelor’s of Science (BSc, Hons) in physiotherapy from Sheffield Hallam University from 2012 to 2015, stayed in the UK to study a Master of Science in Public Health at King’s College London, which she completed in 2020.

Nandi decided to stay in the UK to work after her postgraduate degree. She had a permanent job working with the National Health Service (NHS) as a physiotherapist in Rotherham.

In 2018, she made the decision to come back home and practice what she learned in her home country.

"When I came here the work was a lot more than we anticipated. It took three to four years to actually start.”

Initially, it was just meant to be a physiotherapy space, but then she realised there was more because Rwanda is an economy that’s growing very quickly.

"In every country, as the economy grows, health tends to decline or slow down, and we see an increase in non-communicable diseases. You might see a reduction in infectious diseases, but an increase in non-communicable diseases, like strokes, heart disease and diabetes,” she says.

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Nandi says this is largely because of sedentary lifestyles, especially among the middle class, where people spend more time in cars or seated all day in offices and do less walking.

She also says that the same people have money to buy whatever food they want, and can afford eating out in restaurants, or unhealthy snacks, all of which create a dangerous combination that is detrimental to our health.

Nandi believed that her contribution would come in handy in terms of reducing Rwanda’s disease burden. When she decided to establish The Health Hub, it was not going to be just a place where people go to get physiotherapy, but rather an all-round space focussing on disease prevention while promoting a healthy lifestyle.

"When you come to The Health Hub, we don’t see you as someone who just has a problem. Let’s say you have a back issue, we don’t just see your back pain, we look at different things. Are you overweight? What’s your activity level like? What’s your work situation? What kind of couch do you sit on at home? Are you stressed? All these factors can lead to these diseases,” Nandi says.

Nandi states that the reason they want to prevent these diseases is because they have become a huge burden for the country, and they are expensive to treat. Many people have to live with them for the rest of their lives, relying on medication. Some people live with them for a long time, while others die early.

Nandi says that her mission is to ensure that people don’t get to that point where they have to see a doctor or rely on pills to survive. She set up the hub to ensure that people get all the services they need in one place, without having to go to different locations.

You can go to the sauna, use the gym, get a massage, enjoy a fresh smoothie and also be advised on your nutritional needs.

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One of the main things Nandi does is to advise people to dump their sedentary lifestyles and become active, avoid smoking and alcohol if they are to live longer, because these are the leading causes of NCDs.

To make it affordable, Nandi categorises her clients in two different groups; the seniors, from mid-50’s to 90’s, who are people mainly dealing with aches and pains in different parts of the body, as well as young people dealing with certain conditions.

Upon assessment of each case, each person is put in their respective class where their issues are specifically addressed.

For example, they have a category of young people, 30 upwards, who suffer from the same conditions, working long hours, sitting 90 per cent of the time, and also have a poor diet.

"Those people also tend to come in with similar problems. It can be back pain, it can be that they went to the gym to lift and they had an injury but that injury came from weakness that was already existing,” Nandi says.

"Our main clients are the elderly but we also have that young group of people and it’s becoming more common now because of the kind of jobs that we have,” she says.

As a physiotherapist, she carries out subjective and objective assessment on clients, where she chats them up and assesses their medical records and vital signs to get a good picture and come up with a solution.

A delicate balance

Physiotherapy goes with discipline and consistency. Sometimes patients will fall off track either because they expected quick results or simply got tired.

Nandi and her team aim at encouraging their patients to carry on and continue the treatment because the kind of care they give is not passive.

As such, they take their patients one-step at a time, beginning with education, where they make a patient understand their problem and the journey they will go through to deal with it.

Communication plays a major role in physiotherapy because without the patient understanding the process, it might be pretty difficult to achieve the goal.

Nandi currently works with a team of 11 people at the hub, where they offer different therapies to clients, including massage, gym and other forms of physical and physiotherapy.

They use different essential oils such as lavender, tea tree oil, coconut which they add to massage oils to create a sense of relaxation and eliminates aches, cramps and other forms of pain.

They also use different organic oils to make treatment even more efficient. The products are coupled with other forms of therapy, including electrotherapy modalities to reduce pain and inflammation.

Trials

It wasn’t an easy journey for Nandi because as she was establishing the hub, the Covid-19 pandemic hit, setting her back and up until last year, she was still setting up.

Another big challenge that nearly set her back was the investment needed because she had not anticipated how much it would cost to set up an ideal health hub.

"The challenges that I’ve encountered are many. The first was that I wasn’t prepared for, that actually almost made me not do this, was investment,” she said, citing equipment as an example.

"Investment in any health-related business is high and the return is going to take a long time.”

One of their biggest challenges was importing equipment, which turned out to be costly, paying nearly 80 per cent in taxes on all equipment.

Her other challenge was introducing a new concept to people, some of whom didn’t fully understand. Today, it is something she continues to do—educate.

However, having all the specialists needed in one place, physiotherapists, personal trainers, nutritionists and masseuses and the fact that she herself is a physiotherapist, sets her apart.

Change of mind-set

Like it is in many countries, people have learned to prioritise everything else but their health, Nandi says.

"You find someone can easily go to a restaurant and pay Rwf30,000 for a meal, but won’t go to a physical therapist or gym and pay Rwf50,000 a month or Rwf20,000 for a massage that can obviously be life-changing. They will say it is too expensive, we don’t have the money,” she says.

Nandi calls on Rwandans to wake up and start thinking about their health, right from the food they eat, the oil they use, amount of sugar or salt consumed, as well as fat.

"Most of the time, we don’t even look at what’s going on in the kitchen because we have cooks and all that. So that’s why it starts with nutrition,” she says, adding that it will take Rwandans a change in mind-set and priorities.

If you are working hard today, at the expense of your own life, time will come when your health will give in and you won’t work as hard anymore.

Striking a balance between work and self-care is very important if people have to live longer and enjoy the benefits of their efforts, and, Nandi says, the only way is to be intentional and consistent about it.

"Don't wait until the issues hit you for you to wake up because at the moment that’s all that happens. Set yourself up better for the future,” she says.

Nandi says the government has played its part, setting up the car free day, night runs and other awareness campaigns to make us mindful of the dangers of unhealthy lifestyles. The remaining part is ours.