Handling trauma and other psychiatric disorders

In traditional Rwanda, when somebody had mental disorders, the family addressed it to the traditional healers. This testifies to the general beliefs concerning the mental disorders which are compared to “external ill will” often “of occult origin. There was also in the families a kind of support for people with psychological problems.This situation is changing with all the investments made in the development of mental health care in Rwanda. In 1974, “charity brothers” opened a neuropsychiatric hospital.The care was exclusively psychopharmacologic.From April to July 1994, a Genocide was perpetrated in Rwanda during which more than one million Tutsi were killed. In comparison to other genocides committed in modern history, the Genocide perpetrated against the Tutsi is unique in the sense that it was planned and executed by Rwandans themselves supervised by their leaders. The consequences of such a slaughter are multiple and multi-sectoral. Within the area of Mental Health, the 1994 Genocide had severe after effects as daily observations showed a significant number of Rwandans developing trauma cases because of the devastating experience they had gone through. Studies in this regard have confirmed high risk of psychopathology in Rwandan population (Dyregrov, A. & al. 2000; Hagengimana A., & al.2003).Because of these after effects, it became a matter of urgency to create policies, innovative frameworks and institutions that address this special situation. Several initiatives were taken to address cases related to trauma. However, despite the importance of these actions and the invaluable interventions, the Ministry of Health quickly realised that the issue of trauma management for post-Genocide victims should be integrated within the general framework of a mental health programme. This required multidisciplinary management. Therefore, in 1995, MoH undertook general and coordinated activities aimed at designing a health care and prevention system in mental health through the set up of a national policy on mental health and a mental health program, responsible for the implementation and the execution of this policy. Today, mental health forms one of the key priorities for Health care in our country because the fight against trauma requires the establishment of a system of mental health care at all levels and closer to the victims. As a sector, we are designing plans of decentralising this service in accordance with the structure of our health system. Presently, mental health care is provided in two referral institutions, Ndera Neuropsychiatric Hospital and Psychosocial Centre (SCPS), which became the Mental Health Department of CHUK in 2012. Our programmes have also been integrated in the primary health care system and decentralised at district hospital level and some local associations working in this field. The sector has also set up 6 specialized services in psychiatry in 6 district hospitals and together with these other units, they cases ensure that drugs are made available, engage in counselling and draw concrete plans and interventions for handling trauma cases for survivors of Genocide. Recall that in 1994, Rwanda had 0 psychiatrist, 0 clinical psychologist, 0 psychiatric nurse. We only had 1 psychiatric hospital at Ndera. Gradually, things have improved and, as of today, we have 80 mental health nurses working in the 40 district hospitals and at least one doctor trained on mental health issues in each district hospital. We also have close to 270 mental health nurses and more than 500 psychologists that have graduated. Six psychiatrist doctors are practicing and 4 are in training abroad and more than 12,000 community health workers have been trained. 118 health centers out of 433 are employing 2 or 3 nurses trained in mental health. Indeed, 18 years after the Genocide, trauma is still there and becomes complicated in particular by poverty and social networks of the survivors. Munyandamutsa & Mahoro (2009) did a countrywide research to evaluate the depth of Post Traumatic Stress Disorder (PTSD) and other co-morbid disorders. The 2 Authors discovered that: 28.54 per cent of people in general population have PTSD; usually co morbid with depression.Based on the results of such studies, we must recognise that there’s still a lot to do with regards to this area. We will continue to offer support to victims who need mental health services and we will always seek to improve quality and quantity of our services. The author is Head of Mental Health division, RBC/IHDPC

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Handling trauma and other psychiatric disorders