Helping Patients With PTSD Heal

In Rwanda, one in five people live with a mental health condition

Posted on Jun 27, 2022

An aerial view of Kirehe, where Partners In Health supports Kirehe District Hospital.
An aerial view of Kirehe, where Partners In Health supports Kirehe District Hospital. Photo by Pacifique Mugemana / Partners In Health.

Content warning: brief mention of violence, including rape

During the 1994 genocide in Rwanda, Mutima* watched helplessly while Interahamwe militia brutally murdered her husband. She also witnessed the massacre of her family and friends.

Mutima, now 56, survived. But she relived that trauma every day.

In April, the month when the genocide began, that trauma was magnified.

“I started to feel sick and really scared,” said Mutima.

During a vigil in 2019 in honor of survivors of the genocide, she had a severe panic attack that led her to be hospitalized for days.

In the hospital, Mutima was diagnosed with post-traumatic stress disorder, commonly known as PTSD—a mental health condition characterized by a failure to recover after experiencing or witnessing a terrifying event.

The Genocide

The genocide against the Tutsi claimed over one million lives in 100 days and left the whole country in ruins. Decades later, its effects can still be felt among the survivors and generations born after.

A study by the Ministry of Health found that at least one of five Rwandans has a mental health condition. Depression affects 11.9% of the general population.

As the country continues to rebuild, mental health is at the center of the Rwandan government’s recovery plan. Since 2005, Inshuti Mu Buzima, as Partners in Health is known in Rwanda, has been a crucial partner in that journey, supporting the Ministry of Health in building a world-class health care system that is accessible.

Symptoms of PTSD are wide-ranging and can include alertness or feeling on edge, anxiety, and flashbacks, among others.

For Mutima, those flashbacks came in vivid details that made her feel like she was reliving the past. Her husband was killed in front of her eyes; she was raped and contracted HIV; she survived a blow with a traditional mace; she walked through piles of dead bodies as she crossed the country to neighboring Democratic Republic of the Congo and later Tanzania, seeking refuge.

When the war was over, there were no family or friends to return to; the village she had lived in all her life had been destroyed. She decided to move far away and start a new life in Rwantonde village, approximately 137 miles from her birth village.

Even in her new home, the past followed her. She lived in constant fear, struggled to meet and talk with her neighbors, and cut herself off from the world. This came in addition to the strain of shouldering her day-to-day responsibilities as a single mother.

“I am getting old and I can feel my health declining,” she said. “But I still have to look after my daughter because I am the only person she has.”

Her daughter, born as a result of her rape, was married but evicted by her husband, with their eight-year-old, when she got sick with ascites, a disease that leads to abnormal swelling of the abdomen. She moved into Mutima's house.

The trauma, compounded with tough living conditions, led Mutima to feel depressed and alone.

One evening in April 2019, during a night of remembrance for the victims of the genocide, Mutima decided to face her fears and join others in honoring the victims. However, the pain was too much. She started trembling and screaming, as she experienced a panic attack.

That night, she was rushed to Partners In Health supported-Rwantonde Health Center, where she was diagnosed with PTSD.

Bringing Care Closer

Despite the high prevalence of mental health conditions in Rwantonde and across Rwanda, there is still a lot of misconception about such conditions. As result, many patients show up at the health center or hospital at a severe stage.

“Knowledge about mental health is still low,” said Augustin Mulindabigwi, Inshuti Mu Buzima’s mental health associate director. “Often mental health illness is associated with demon possession or being too fragile and not being tough enough to deal with difficult situations…The culture also stigmatizes mental health illness and discourages conversations around the topic.”

When mental health conditions are attributed to demon possession or witchcraft, he says, the person is often brought by friends or family to churches or traditional healers. But these efforts at intervention often lead to complications, delaying or preventing the patient from receiving medical care.

These are some of the challenges Inshuti Mu Buzima is trying to address.

Inshuti Mu Buzima has worked in Rwanda for over a decade, strengthening the health system in partnership with the Ministry of Health. Its mental health care program focuses on four core elements: education and awareness; pharmacology, or treatments with drugs; psychotherapy⁠, or treatments with verbal and psychological techniques; and rehabilitation of patients.

Kirehe, where Mutima lives, is one of the three districts supported by Inshuti Mu Buzima. Through Inshuti Mu Buzima’s support, in collaboration with the government, the number of people receiving mental health treatment and care has drastically increased, in large part thanks to community outreach and awareness campaigns.

But treatment alone isn’t enough. Patients need more than medical care—they must have their essential needs met.

“Mental health problems affect the socio-economic status of the patients and their families,” said Mulindabigwi. “Once they are recovered, we can’t send our patients home if their living conditions do not allow them to fit in the society. We continue following up on them to avoid any relapse and support them to reintegrate into the community.”

Much of that reintegration is carried out through support groups for patients and their families or caretakers—spaces where they can meet and share their experiences with the support of a trained psychologist.

“When I first joined the group I was lonely,” said Mutima. “But I have made friends who are supportive and understanding.”

In addition to these groups, Inshuti Mu Buzima supports patients through pscyho-rehabilitation activities such as farming and crafts, helping them develop skills that can help them earn an income—crucial for staying well in the long run.

Mutima and some 100 other members of her group recently received land for cultivation, crops, and training to start farming. Soon, they will start a beekeeping business. 

“Many of us struggled to do any activities when we started our group therapy,” she said. “But now we are expecting a big profit from our farming activities.”

Additionally, in collaboration with the Ministry of Health, Inshuti Mu Buzima has trained nurses to provide mental health treatment and care at the community level, as part of a larger effort to integrate the service into primary care. That approach emerged after a PIH-led study showed that decentralizing mental health to the community level led to significant improvements for patients.

"Our goal is to get mental health care closer to everyone who needs it," said Mulindabigwi.

A lot has changed since Mutima started treatment. She goes to therapy once a week. She was recently elected by her fellow members to lead her group’s activities. At the end of the day, one thing is clear: she feels less alone.

“I have people I can call when I am not feeling well,” she said.

*Name has been changed to protect privacy

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