Ndera Neuro-Psychiatric Hospital (Caraes Ndera) is Rwanda’s main hospital when it comes to providing specialised healthcare in psychiatry and neurology.
A large number of patients with mental health problems including serious ones like schizophrenia, epilepsy, psychotic disorders, bipolar disorders, among others, are referred to this place.
The hospital handles between 200 to 300 consultations a day, and when patients check in, they come with varying symptoms and levels of illness which the medics have to address.
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According to Dr. Rutakayire Bizoza, a Psychiatrist and Psychotherapist at the hospital, when a patient is brought to them, one of the first things they do is understand the cause of the problem.
For instance, in case a patient is violent, Bizoza says "it is important to know what provoked his violence.”
"Sometimes their violence could have been provoked by frustration in the family, by a partner, or any other kind of aggression. It can also be connected to a disease,” he explains.
So, the medics welcome the patient to a safe place where they try to bring reassurance to them, showing them that they are interested in helping them.
"We give them the opportunity to speak. Sometimes, they explain why they are violent. Someone can say, ‘I was being deprived of some rights by my family,’ or ‘I was being stigmatised,’” Bizoza notes.
When the medics give a listening ear, patients speak out their issues and this brings calmness sometimes. However, in some situations, some patients cannot explain understandable things because their minds are not working coherently.
In addition to this, there are some patients that are quite aggressive and violent because they are critically ill.
This requires the medics to call for support from people who can help to hold them so that treatment can be administered.
"When the crisis is very high and we are not able to speak to them because they are aggressive, we are obliged to call for people who can master them. We then prescribe some injections which have the specificity to bring calmness to them,” he says.
After that, the patient is admitted to the hospital, and medication is prescribed for them.
"Most of the time, we keep them in the ‘crisis ward’ for two weeks as we do clinical follow-up of their evolution,” he notes.
Often, at the end of two weeks, symptoms like hallucinations, insomnia, aggressiveness and so on disappear. The patients can sleep, are aware of their environment and situation, know that they are sick, and can cooperate with fellow patients.
At this point, they are getting closer to recovery and are transferred to the "recovery ward,” where they are taken through various social activities including music and dance (music therapy), lectures, sports and so on. If they continue progressing, they are discharged.
The discharged patients, according to Bizoza, are in good shape and can go back to communities and play their roles in families, as fathers and mothers, employees and so on.
Their families are urged to take good care of them, and the importance of following the medics’ instructions well is emphasised.
Some patients have to keep taking medication, while some don’t have to.
Conditions like schizophrenia and bipolar disorder require a person to take medication for their entire life, while others like brief psychotic disorder require a person to take medication for about 6 months to one year.