Emmanuel Hakizimana (not real name), a 28-year-old resident of Ntarama sector in Bugesera District, recalls suffering from depression which drove him into excessive alcohol drinking.
His mental health issue is a result of the psychosocial impact of the 1994 Genocide against the Tutsi. His mother is a genocide survivor while his father is in jail for genocide crimes.
However, through socio-therapy — a community-based health intervention — he is being rehabilitated.
The programme, championed by Interpeace in partnership with Prison Fellowship (PFR), has proven to be an effective tool for personal well-being, family unity and social cohesion in this part of Rwanda.
Interpeace is an international organization that prevents violence and builds lasting peace.
The programme is designed under a project known as "Reinforcing community capacity for social cohesion through societal trauma healing in Bugesera District”, funded by the EU through its instrument contributing to Stability & Peace (IcSP).
Niyonkuru is being healed through group-therapy—"Mvura Nkuvure”, which can be loosely translated as ‘Healing Each Other”.
"I have realised that my mother hadn’t recovered from the fact that her family members were killed during the genocide. She was traumatised and always bullied me that I am from genocide perpetrator’s family.”
This always put Niyonkuru at a collision course with his mother, and affected his mental health.
"Before joining ‘the healing group’, I was not open to anyone about my depression. Rather I would prefer consuming alcohol thinking that I can get sleepiness,” he said.
The group helped him to open up about his mental challenges and paved way for the restoration of his relationship with his mother.
When we visited him, it was his sixth week on the programme.
"I realised that I was not the only one dealing with these issues,” he explained, "After revealing my struggles, I got counselling,”.
Niyonkuru’s situation has since improved.
The programme, championed by Interpeace in partnership with Prison Fellowship (PFR), has proven to be an effective tool for personal well-being, family unity and social cohesion in this part of Rwanda.
And the relationship between mother and son have improved significantly so much that his mother donated a plot of land to him.
According to Niyonkuru, a combination of stigma and the patient’s reluctance to open up are still major challenges to addressing mental health issues.
"When the community stigmatises you, you feel lonely and not open to anyone,” he said, disclosing that his elder brother also battled mental health problems before he was taken to Caraes Ndera Neuropsychiatric Hospital for treatment.
Liliane Uwamahoro, 22, has suffered from mental health issues since she dropped out of school and gave birth at a teenage age.
"My mother used to mistreat me. I could not get basic school needs. That mentally affected me and I was always lonely. After joining the Mvura Nkuvure therapy group, I was consoled and advised on how to deal with the issue,” Uwamahoro said.
I would not sit with my mother and talk but the situation is changing now thanks to the support, she added.
"I have hope it will become better because adults are also engaged in the healing approach.”
Currently, he major challenge how to get herself out of poverty, and support her sick mother.
According to a survey conducted by Interpeace and Prison Fellowship (PFR) in collaboration with the National Unity and Reconciliation Commission (NURC) and Rwanda Biomedical Centre (RBC), 44 per cent of the genocide survivors aged over 45 years’ experience recurrent depression while 22 per cent of the perpetrators who have served their sentence and been released for these crimes battle the same in Bugesera district.
The survey found that most mental health challenges among the Bugesera District population have symptoms of trauma at their core.
Specifically, anxiety, depression, identity disturbance, suicide thoughts, substance abuse, and aggression were all found to be correlated to Post Traumatic Stress Disorder.
Socio-therapy — a community-based health intervention is tackling mental illness in Bugesera district
The intervention
Interpeace’s Great Lakes Regional Representative, Mr. Frank Kayitare, said that the societal trauma healing programme in Bugesera District is aimed at contributing to the strengthening of mental health service provision; promote social cohesion and support collaborative livelihood initiatives.
"We aim to build sustainable peace through unity and reconciliation.We are working with the government and other partners to promote social cohesion. And this requires that we contribute to healing societal trauma and livelihood improvement for the community,” he said.
Benjamin Ndizeye, the coordinator of Reinforcing community capacity for social cohesion through societal trauma healing in Bugesera District project, said that the program has three components mainly mental health, social cohesion and livelihoods as a holistic approach to heal wounds.
The pilot project started in October last year and will end next year in April.
"We came up with this project to facilitate the healing of the community because people were no longer connected to each other and that since a wounded heart causes problems in a community,” he said.
He said the project is using different approaches to healing, including community-based socio-therapy, multi-family therapy that focuses on people in conflicts related to genocide effects, resilience and intergenerational trauma therapy approaches.
"After interpersonal healing, it goes to reconciliation and unity of the community which also becomes a pillar of building socio-economic livelihoods,” he said.
He said the project is reinforcing a mental health program to improve mental health service delivery by reaching out to the community.
"Mental health in Rwanda is still in critical condition because someone with a mental health issue is always stigmatized in the community and doesn't know processes to get treatment and how to get support,” he said.
Ndizeye said there are currently 32 groups under protocols of socio-therapy to get healed.
"The program is built on groups’ capacity where people come together for 15 sessions-one session per week. Each group therapy is composed of 15 people. Socio-therapy has six phases namely safety where people look back to what they have been going through, what has destroyed their safety and how they can build their safety,” he explained.
He said the following phases include building trust destroyed by lack of safety through faced circumstances.
The next phase is looking at care explaining that someone is not trusted and safe, no one cares about them and themselves do not care about others.
"People discuss in groups, discuss with each other and look for solutions to help members of the group. From the care phase, there is the phase of respect followed by the phase of new orientation which means another way to follow and to behave. The last phase is memory of what they have gone through during socio-therapy.”, he said.
He said at least 2, 775 people will pass through such a process of healing.
"There are groups bringing together adults and youth to help them solve their conflicts and also tackle intergenerational transmission of trauma and other genocide legacies,” he said.
In groups of youths, they discuss and heal intergenerational trauma transmission.
"We will also help youth from 8 sectors from families of genocide survivors and perpetrators to create employment for better livelihoods through TVET skills, financial literacy.” he said.
Improving mental health service delivery
According to Interpeace’s Great Lakes Regional Representative, the project recently donated 17 motorcycles to improve mental health service delivery at the community level in Bugesera District.
He said providing care to everyone who requires psychiatric aid is still a challenge due to capacity constraints and the reluctance of the population to take up mental health services.
He noted that the project is helping to decentralize mental health care.
The availed transport means is expected to enable mental health professionals conduct more regular randomized clinical trial processes, scale up home-based care to mental health patients, and conduct regular community screening and awareness campaigns on mental health in a sustainable way.
"By November this year, we will have also availed a mobile clinic to help enhance mental health service delivery. It will be carrying out screening, assessing mental health issues for support and treatment,” he said.
Sœur Perpetue Mukamabano, the Head of Ruhuha health centre said they have over 180 patients with mental health issues they have been treating but added that despite transport support to reach the community, there are still few mental health specialists.
"It requires reaching out to the community because many do not come for support,” she said.
Gad Mbarusharugira, a resident from Nyamata sector in Bugesera district suffering from mental health disorder said that the main challenges affecting such people is stigma in the society and lack of parents’ commitment.
"The stigma in the community and at school is a big challenge. My father didn’t care about me and refused to pay school fees for me because of mental health issues. Only my mother helped me. I also used to change schools due to stigma as they told me I was not able to follow some courses,” he said.
He added that some service providers stigmatize people with mental health issues thinking they have no capacity to perform.
Mbarusharugira added some parents prefer to take the patients for traditional healing saying this is also one of challenges that impede taking up mental health services.
"There is a need for mental health specialists at the health centre level so that people can easily access mental health services,’ he said.
Dr. Yvonne Kayiteshonga, the Manager of the Mental Health Division at Rwanda Biomedical Centre (RBC), said that mental health issues are still an issue that requires more efforts for improvement.
"Three per cent of Rwandans have depression and 28 percent of genocide survivors have depression. Research has revealed that only five percent of people go for consultation to get support. This has to change under joint efforts,” she said.
This article was commissioned by Interpeace in the framework of its pilot programme "Reinforcing community capacity for social cohesion through societal trauma healing in Bugesera District”, funded by the EU through its instrument contributing to Stability & Peace (ICSP).