10 August 2018

Rwanda: Schizophrenia - Experts Urge Rwandans to De-Stigmatise Patients With Mental Illness

Nyiramana from Muhanga was living a calm normal life until she suddenly started behaving in an alarming manner.

Five years ago, 63-year old Nyiramana started to change her attitude and behaviour such as sitting alone and biting her tongue, said Jaqueline Umuhoza, her grandchild who takes care of her.

"When we spoke, she would respond with unrelated answers and she was no longer doing what she used to do and taking care of herself," Umuhoza said.

First they thought it was witchcraft and they tried to get medical treatment from traditional healers, but nothing was changed, she said.

The community and family members abandoned her, some thinking her illness was due to demons, others thought she couldn't socialize anymore.

They decided to take her to Kabgayi District Hospital, which referred them to Ndera Neuro-psychiatric hospital for further treatment and she was diagnosed with schizophrenia.

"When she got there, she received treatment and somehow recovered. For now she sleeps well at night, she can take care of herself, going to the church and she can even work," Umuhoza said.

Umuhoza's grandmother has to take drugs every day in the morning and evening in order to avoid a relapse.

"I come every month with drugs for my grandmother," she said.

Many Rwandans take schizophrenia disease as a malediction from demons and witchcraft and patients are taken to traditional healers and religious men for prayers, experts say.

Schizophrenia is a mental health disorder characterised by the abnormal social behaviours which result into failure to understand the reality.

Dr Rutakayire Bizoza, a psychiatric at Ndera Neuro Psychiatric Hospital, said most of the times the disease is inherited, however, some social and environmental factors may increase the risks.

Prof. Vincent Sezibera, a psychologist, said the way people live, especially in the family, circumstances and situations people pass through, may all increase the risk or lead to schizophrenia.

Symptoms

Mostly, people seen on the streets picking up pieces of paper or just behaving in an abnormal manner, suffer from Schizophrenia and need to get proper treatment, Bizoza said.

Individuals with schizophrenia may experience hallucinations, most claim to hear voices. They may have delusions often bizarre or persecutory in nature, and disorganised thinking and speech.

The last may range from loss of train of thought, to sentences only loosely connected in meaning, to speech that is not understandable.

Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment are all common in schizophrenia.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always remain present.

Bizoza said patients may also be very aggressive to the point of beating anyone without reason they may also lack for sleep.

Treatment

Dr Chrisostome Habimana, a psychiatrist at Ndera, said Schizophrenia can be treated and the patients return to their normal lives, but the treatment lasts forever.

However, due to misconceptions in Rwandan society, most of the times patients stop treatment and they are taken into churches and traditional medicine, which causes the disease's relapse, he said.

The mindset and way of thinking of the Rwandan society has a big impact on how schizophrenia patients receive treatment, he said.

"They should ask themselves why people who showed symptoms of schizophrenia for a long time and have been receiving prayers all along and nothing changes. But when they come here we treat them and they become normal.

It's not a matter of demons and faith, it's a mental illness which can be treated like any other chronic disease like diabetes, high blood pressure and others," he said.

Sezibera added that apart from receiving drugs, additional treatment such as psychotherapy is needed.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behaviour and overcome problems in desired ways.

Besides, basing on the causes of the disease, most of the times it's needed to help the family members to accept their patient's status.

"When a family has a mental health patient, they take it like a curse or a shame in the society which sometimes causes them to stigmatize their own patients. Some decide to hide and not to take care of them, which result into relapsing," he said.

However, if these people are helped as it should, they return into the society and continue with their lives without any sign of the disease, he said.

Where to get help

Damascene Iyamuremye, Director of Psychiatric Care at Rwanda Biomedical Centre (RBC), said mental health services are available from basic health centres up to referral hospitals.

"At every health centre, we have nurses who have been trained to offer first aid services to patients showing mental health symptoms, and transfer them to hospitals when necessary," he said.

Statistics from RBC shows that 1 to 2% of Rwandans suffer from Schizophrenia.

The treatment is being improved and drugs are being made available and affordable to everyone, in order to help more patients, Iyamuremye said.

Sezibera said people should be aware of the symptoms and seek help on the nearest health facilities.

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