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Mental Health Assessment ―Umutwe ni wo w’ibanze!‖ or ―The head is on the top!‖ A health worker says that in Bisate neighbors help neighbors, but when he tries to talk to a friend with an alcohol abuse problem, he doesn’t know what to say. If the friend becomes violent while drinking, the police are called and he is given a fine, but there is nothing done to address the underlying problems. All the health workers agree that they are interested and willing to take on the task of counseling in the community. However, they find it hard to go to a family and counsel them because they don’t have the skills.

The Government of Rwanda in its February 2005 “Health Sector Policy” included mental health as one of its seven “priority interventions.” The government plans to develop standards and guidelines for the “integration of mental health into primary health care….” In the government’s Health Sector Strategic Plan 2005-2009, the government emphasizes Rwanda’s history of trauma with respect to the 1994 genocide and how the genocide has “greatly magnified the problem of mental trauma and places a huge burden on health services in the country.” They emphasize the impact on children by citing a UNICEF study that reveals: 80% lost at least one family member 90% felt in danger of dying 95% had witnessed scenes of violence “Anecdotal evidence from health facilities suggests that psy-

In June 2007, Dr. Kathleen Allden conducted a chological distress is widespread and accounts for a signifinumber of consultations, particularly during the months mental health needs assessment of the Bisate Clinic cant of April and May (the anniversary of the genocide).” region. Through a key informant survey of all the stakeholders she identified numerous mental health and psychosocial problems in the region. The focus of concerns and priorities, however, varied from informant to informant, depending on their work context and/or social environment. Nevertheless, there was a great deal of overlap among those interviewed and a general consensus on three key issues: 1. There are significant consequences of post genocide violence in the region. As a result, there are numerous child headed households, teenage pregnancies (among orphan teens), widows and female headed households, polygamous marriages with problems related to polygamy, and many people suffering from psychological trauma. 2. Alcohol abuse is common among men in the community. Alcohol abuse contributes to poverty when earnings are diverted from family needs to alcohol. Domestic violence is common when men abuse alcohol. There is no intervention or precedent for intervention for maintaining sobriety, alcohol “rehabilitation,” or self-help groups for those trying to remain sober. 3. As in much of Rwanda, poverty affects the health and mental well-being of many, if not a majority of families and individuals in the region. The combination of poverty and the consequences of post-genocide violence have for some, created a deep and overwhelming sense of hopelessness. Hopelessness affects motivation for education, enterprise, and social development in general. During Dr. Allden’s visit, she and Claudine Mukamana conducted two training sessions, one for the Bisate Clinic Health Animators and one for Bisate Clinic Staff. The themes of the training sessions were how to identify mental health problems in the community and basic components of counseling. The content of the Health Workers, Dr. Kathleen Allden and Claudine training sessions was devised after meeting with Bisate Mukamana discuss mental health issues faced by the community. health animators. The content was based on problems the animators identified and information they requested. The training sessions demonstrated the hunger for information on mental health among clinic staff and among health animators. Both groups stated that in their opinion, the top priority for training and staff development is mental health. They highlighted their priority by teaching Dr. Allden a Rwandan saying that, while obvious, has multiple levels of meaning: “Umutwe ni wo w’ibanze!” or “The head is at the top.” [Dr. Allden’s Mental Health Assessment / Trip Report-Attachment 5] [Project Proposal: Integrating Mental Health at Bisate Clinic-Attachment 6]

Bisate Health Clinic: 12 Month Progress Report  

Working in partnership with the Rwandan Ministry of Health, the CCHIPS project was created to pilot a cost efficient and sustainable solutio...

Bisate Health Clinic: 12 Month Progress Report  

Working in partnership with the Rwandan Ministry of Health, the CCHIPS project was created to pilot a cost efficient and sustainable solutio...