As we commemorate the 1994 Genocide against the Tutsi, it’s a time to look back at the tragic events of 23 years ago which caused so much anguish. As reflected in the 2017 theme, “Remember the Genocide against the Tutsi, Fight Genocide Ideology, Build on our Progress,”it is a time for sober reflection to remember the victims, support the survivors, and stand in solidarity with the Government and people of Rwanda to say “Never Again”. It is also a time to ponder the psychological impact of the Genocide on the lives of the victims’ families and survivors and to address the residual consequences which still linger on till today.The theme of the 2017 World Health Day, DEPRESSION: LET’S TALK cannot be more apt in drawing attention to the need to address the psychological health of survivors.
Everyone is at risk of depression. Depression affects people of all ages, rich or poor, city or rural dwellers, males and females. The World Health Organisation (WHO) defines depression as an illness associated with a persistent feeling of sadness and loss of interest and inability to perform day-to-day activities for a period of more than two weeks. Its origin is linked to a complex interplay of societal and emotional factors. Symptoms include loss of energy, too much or too little sleep, disturbed appetite, inability to concentrate or take decisions and feeling of hopelessness, suicidal tendencies and suicide in severe cases. The illness may be precipitated by situations which trigger acute sadness – such as a sudden loss of livelihood, loss of loved ones or a relationship, illness, pain, or alcohol and drug abuse. Patients find it difficult to perform day-to-day activities and require increased care and supervision. This creates a huge burden on affected families.
More and more people are living with depression. Global cases rose by 18% between 2005 and 2015. Although Africa accounts for only 9% (29.9 million persons) of the global estimated 322 million cases of depression, this is certainly an underestimation. Stigma, social isolation and neglect are daily occurrences for people with mental illnesses, causing sufferers – and their families – to delay seeking help. The Regional Director for WHO in Africa, Dr Matshidiso Moeti, recently stated, and I quote:“In much of Africa, mental illness is a silent epidemic. The effect of the silence is further compounded by inadequate focus at policy level. We should promote and support our national authorities to develop policies and legislations that protect and promote social justice and welfare for people with mental disorders.”
In its characteristic manner of strong commitment to the health of its population, the Government of Rwanda has provided good opportunities for addressing the problem of mental health including depression in the country. A fully fledged mental health division has been established in the Rwanda Biomedical Centre, the Ministry of Health is charged with coordinating and providing leadership, and a national mental health policy has been developed. Several mental health workers, including psychiatrists, psychologists and mental health nurses, have been trained, and medicines for depression are included in the national essential medicines list. This puts the country in a unique position to attain the mental health targets of the sustainable development goals.
To realise this goal, we need to do more. Quantifying the national burden of mental illness, including depression, will help to design effective programmes to reduce the problem. Frontline health workers (including community health workers) require regular refresher trainings on early identification, treatment and to be alert for depression in society. Community-based mechanisms to reduce the stigma will encourage more patients to seek medical treatment. This could be achieved by openly talking about depression as we do with any other disease; including mental health in primary health care services, and supporting community-based organisations to expand services beyond the formal health sector. School-based programmes, providing counselling and support for those with depression and their families, and early detection and prevention, especially among children and youths, are further strategies to keep depression at bay.
As we say “Never Again” to genocide and its ideologies, let us think about everyone who may be affected by depression due to the Genocide, and all those suffering from other forms of mental illnesses in general. We would be doing a great and noble service by ensuring that we create a voice for them and that our actions contribute to dealing with their condition, providing the services which they need to heal. WHO and the One UN family will continue to support the Government and people of Rwanda in this regard.
Depression is preventable and treatable if diagnosed and treated early. Avoiding stress, having a proper diet and being active will improve wellbeing and can prevent depression.
Together, let’s talk about depression and ensure that we take everybody along!
The writer is WHO Representative to Rwanda