Tuesday 2nd September – A Visit to Nemba District Hospital

This morning Stefan, Rebecca and Vedast (a colleague of Stefan’s) visited Nemba district hospital that sits 1.5hrs drive North-West of Kigali. At the hospital we met with the Jean-Baptiste (Hospital Director), and the mental health team: Joselyn (Clinical Psychologist) and Claire (Psychiatric Nurse). There is an additional Psychiatric Nurse (Chantelle) but she was not in attendance.

The district hospital was founded in 1974. It was started initially by the Catholic Church in conjunction with a Spanish NGO called ‘Doctors of the world’, but the hospital is now financially supported by government. The hospital has a range of different departments including internal medicine, surgery, pediatrics, maternity, laboratory, ophthalmology and a pharmacy. There are currently 158 people now serving a total population of 250,000 people. The hospital serves 13 health centers. The biggest problems presenting at the hospital include dentistry problems and respiratory conditions. There are also a range of non-communicable diseases including cardiac problems and mental health services. There are currently 169 beds and 12 medical doctors at the hospital. There are a number of beds available for psychiatric admissions at Nemba Hospital; the admissions tend to be referred instead to Ndera. There is also a ‘One Stop Centre’ that supports women experiencing distress as a result of gender-based violence.

The mental health staff at Nemba perform a variety of roles. Psychotropic medications can be prescribed by the psychiatric nurses and occasionally by medical doctors prescribing. The Clinical Psychologist, psychiatric nurses and social workers conduct outreach to see if there are mental health problems. In addition, students of nursing and clinical psychology students can be based at the hospital during term. The mental health staff at Nemba educate staff at the community health workers on mental health. In addition, the staff also conduct house visits to people at their homes. Liaising with family and communities to work on stigma and economic issues.

Joselyn explained that the first aim of the mental health team at Nemba district hospital is to stabilise the individual. She highlighted that neurological issues such as epilepsy can constitute of 400 patients to the hospital every month. There are also numerous cases of psychosis with high rates of relapse. On many occasions these patients have to be referred on to Ndera Hospital near Kigali. There is also a high prevalence of somatoform disorders. The communities that the hospital serves are subject to high levels of social problems including familial conflicts, financial problems, and poor knowledge and understanding about mental health. The staff also reported that people disengage rather than come back to the hospital for medication. The staff again emphasized that the cost of travelling to the hospital to collect the medication can be prohibitive for people.

Stigma can be a big barrier for people seeking help. It is as by hiding the person in the house, the problem in the house is hidden. It seems that the people attending the hospital often have difficulties accepting psychotherapy, and they tend to prefer to be offered medication first. However, once they have been introduced to it they tend to engage well with it. There is a general sense that psychotherapy can be effective.

Jean-Baptiste provided us with a tour of the hospital site. We were impressed by how organized and well run the hospital was. A big thanks to Stefan who did a sterling job of translating the French spoken by the hospital staff into English for Rebecca and myself.

The drive back to Kigali provided a great opportunity to enjoy the beautiful Rwandan countryside; undulating sloping landscapes covered with lush green foliage. After a tasty lunch at a restaurant called Urban, it was time for me to make my way to the airport and the flight home (via stops in Nairobi and Amsterdam). It has been a great trip. A massive thank you must go to Phil for being such a great host, and to Stefan for organizing such a great schedule. I am already looking forward to my return!

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