In the recent years, Rwanda government, through its Ministry of Health, has made significant strides in extending health services to the people, investing heavily in improving the quality of health care provided.
As such, the battle against infectious diseases has so far yielded positive results and the commitment in dealing with non-communicable diseases is steadily gaining ground. Among the non-communicable diseases being dealt with is Mental Health.
According to Dr. Yvonne Kayiteshonga, the Division Manager of Mental Health at Rwanda Biomedical Center (RBC),”Mental health is a component of health. It is not only absence of disease, but a concept of well-being. It affects the way you interact with people in society, the way you handle your career and the way you cope with stress.”
The 1994 genocide not only claimed lives but also left large segments of the population suffering from mental disorders. Statistics show that close to 99% witnessed violence and 31% were either raped or sexually assaulted.
The outcome of this was a massive burden of Post-Traumatic Stress Disorder (PTSD) that the country hoped to address. Other mental disorders included depression and drug-related diseases. In comparison with neighbouring countries, Rwanda’s trauma prevalence is high.
Other than the genocide, there are other causes of mental health disorders like genetics (biological reasons), psychological reasons and the society.
“After the genocide, the government decided to design a mental health policy in order to address the mental health issues. It is among the major priorities of the health sector. In that framework, a mental program was added which eventually became the Mental Health Division, “says Dr. Kayiteshonga.
She adds that, “This division ensures accessibility of mental health services, the hiring and training of human resource, purchase of drugs and advocacy about mental health. It has trained communities on how to deal with mental disorders. This helps early detection and treatment. Only severe cases are treated in specialized settings.”
Medical, Psycho-Social interventions in alleviating mental health problems
There are different types of medical care that can be given to patients to cure their mental disorders. In case of mild mental disorders like depression, there are anti-depressants given to patients whereas in the case of acute psychotic disorder (patient are unaware of their condition), they are given anti-psychotic medicines.
For the psychological reasons, psycho-therapy-professionals offer a setting where patients can feel free to share their experiences, express their feelings and generally have someone to lend an ear of understanding and sympathy. The psycho-therapists give them counsel and re-assurance of a better life ahead. These professionals are highly-trained to deal with any behavioral changes that emanate from mental disorders.
Many mental disorders and illnesses are caused by societal issues. Situations like growing up in dysfunctional families, poverty, death or divorce could greatly influence the state of mental health. The availability of drugs in the area could pose a threat on the state of mental health in that society. In this case, societies have been empowered with knowledge about the causes of mental illness, some of which are mainly societal. With that education, communities can be able to play a role in fighting mental illness. They can address the causes or identify cases of mental health early. They are also educated on how to deal with these cases.
State of capacities of mental health workers
“At all levels of the health system, we have integrated mental health care. This is right from community level to the district level. We work with psychiatrists, psychologists, psychiatric nurses, general medical doctors and nurses with mental health training, trauma counselors, community working with victim associations and community health workers, “says Dr. Kayiteshonga.
The Ministry of Health through Rwanda Biomedical Centre has trained more than 15,000 community health workers who are attached to health centres.These health workers are not professionals but they are people selected from different communities with basic formal education who are trained on how to identify and deal with symptoms of mental illness in their areas. In addition, the ministry has 7 psychiatrists in the country that operate in different referral hospitals like Centre Hospitalier Universitaire de Butare (CHUB), Centre Hospitalier Universitaire de Kigali (CHUK), Ruhengeri and Ndera Hospitals. However, the psychiatrists are rotated in different hospitals.
More psychiatrists are being trained at the University of Rwanda to be deployed to district referral hospitals. Furthermore, RBC currently employs 100 psychologists and 100 psychiatric nurses. Despite not having specialized mental health hospitals at district level, various district hospitals have mental divisions integrated in their health services.
According to Dr. Kayiteshonga, the Ministry of Health partners with various organisations that support genocide survivors like IBUKA, AVG, AERG (students association of genocide survivors), Nsenga Ni Manzi. These partners help a lot in advocacy and empowering communities to learn more about mental health and fight the stigma that arises from mental illness. The Ministry of Health also works with funding partners like the Belgian Corporation that facilitate some of the activities in the communities. The Ministry, through RBC, coordinates all these organisations working on mental health.
“The enemy of mental health is ignorance. Ignorance leads to lack of service, human resource, funds, and respect. We have been emphasizing the sensitization of people about mental health through all possible channels. We have created mental health services from community level to district level. We have been able to integrate psychotic drugs into the national list of essential drugs, meaning people can access the drugs at an affordable price, “states Dr. Kayiteshonga. She adds that, “mental health services have also been integrated into Mutuelles de Sante. This is a great achievement.”
The Ministry has built strong partnership with other stakeholders in that mental health services so that they are not only found in medical centers but also in the communities. These organisations have assisted in addressing mental health issues. This has improved the accessibility of treatment or medicine by the victims.
The Ministry of Health has worked with the Ministry of Education to incorporate a Post Graduate Diploma in the curriculum. “Today, Rwanda is invited to share their success story in dealing with mental health.”
For Kwibuka 23, The Ministry of Health with partners, will deploy 130 ordinary cars, 30 buses, 30 ambulances stocked with medicines will help Trauma Victims during this difficult season of remembering.
For the 23rd commemoration, the Ministry of Health has put strategies and measures in place to provide psychological support have been taken to help the victims in need. Thousands of health and non-health professionals are skilled to deal with emotional and trauma crises and large outreach programs are put in place to raise awareness against trauma and promote mutual support.
A toll-free hotline 6200 was put in place to provide quick support to people in need, psychological first aid, advice and orientation will also be provided by specialists 24/7 from 7 April to 4 July 2017.
Despite the great work, the Ministry of Health through RBC, has mass education about mental health, the issue of stigma is still prevalent in society. The Ministry is committed to sensitizing people about mental health, training more people to work in mental health, psychiatry specialiasation and to focus on child psychiatry as well.