Photo: Hugh Kinsella Cunningham
Mental health services are on a shoestring budget at this Rwandan health centre. One psychiatric nurse supporting 311 patients with chronic conditions, and medics talk of life-saving potential of therapeutic services that must continue.
At three-years-old, Bridget* woke up in a field, alone and with blood on the ground around her.
She found her brothers dead next to her after a violent attack in her village in Burundi. Her parents had been away at a farm producing banana wine and came back to find all but two of their children had been killed.
For the rest of her childhood she moved around, and when further violence erupted in Kirundo province in 2015, she fled to Rwanda with her husband and was housed at Mahama Refugee Camp. Like many who have experienced conflict first hand, the 35-year-old is left with mental scars and difficult memories from her childhood.
Episodes of what she describes as “crisis” every five months mean she has come under the care of Grace, a psychiatric nurse with Save the Children in Mahama refugee camp, at the Mahama II Medicalised Health Centre run by the organisation.
As a mother-of-six, Bridget* says she needs to have a clear mind to provide for her family and look after her children, and the weaving skills she learnt at the health centre have become her therapy.
“Without this,” *Bridget said, pointing at a black and white table runner she is making, “how shall I live?
“That is always on my mind. I don’t like leaving my house and having to go out. This helps me a lot.”
She now takes the weaving home and her older daughter *Yvonne helps with the cooking so she can keep working, making the family around £6 per week.
It’s been an incredible recovery, she said, noting Grace’s support during a particularly difficult period when her husband left during one of her bouts of illness, before he later returned to the family.
Across the world foreign aid cuts have had a devastating impact. Though the budget from the US for Mahama II Medicalised Health Centre, has remained steady, there has been a re-prioritisation of where that money is spent and mental health services are often vulnerable.
Sitting opposite *Bridget as they weave brightly coloured plastic strips into baskets is Cherissa*. The 58-year-old is also from Burundi, and was displaced for years by fighting, until it became so severe in 2015 she fled across the border to Rwanda. Her entire extended family, as well as the adopted children of her friends who stayed behind, all became her responsibility.
When her business in the local market started failing, she became unwell and began to hear voices. Neighbours shunned her. Eventually the police helped her by referring her to the hospital. While medication has helped, she worries that if activities like basket weaving aren’t available for her and other patients she will struggle again.
“It gives a feeling of having a duty, and we don't overthink. Once people see you as being sick, they always think of you as being sick, even when you are able to do something,” she said.
“This helps me and prevents me from falling back into mental health issues. I am no longer getting sick like before, and when it happens, it's for a short time.”
The basket weaving was the idea of Grace Musabyimana, Psychiatric Nurse, Save the Children Rwanda and Burundi and her patients. She started the novel project four years ago, after noticing far too many women she was working with were relapsing once back in the camp with little to do or support network.
As the sole psychiatric nurse the health centre, after the psychiatric doctor left she now has an enormous case load of 311 women with chronic conditions.
The overall budget for mental health services for Mahama has remained constant in recent years but is only $32k per year compared to the $180k needed to provide a more comprehensive service that could help so many more mothers.
“Already we are not able to provide the materials anymore,” Grace said, worried about the future of therapeutic activities at the health centre. “When they are doing activities, the women don’t over-think. They are busy, they laugh, they have stories among them,” she said.
Budget cuts to aid from foreign donors has also meant food provided at the camp by another NGO has been reduced, which is leading to more anxiety among patients.
“The fact that they are no longer getting enough money is very disturbing for them and they are very worried about their future,” Grace said.
Grace’s colleague, Dr Yassin Uwimana, Save the Children's Head of Comprehensive Obstetrical and Neonatal Care, works on a ward nearby and delivers babies, often via C-section. Many of the women who attend the weaving sessions will have had their babies delivered by him and his team.
He sees the mental health services at Mahama as intrinsic to the success of the entire health service they provide.
Pointing to the women chattering and singing while they weave, he said: "It's a very important service and it can be life-saving. The mothers are weaving here and at their homes. By supporting people with mental health, you can prevent suicide.”
*Cherissa said her own children and those she adopted now spend much more time with her because her health has improved.
She said: “They come to me whenever they have issues and we spend most of our time together even though they live in their own house.
[“The weaving] helps me and prevents me from falling back into mental health issues.”
Jo Musonda, Country Director of Save the Children Rwanda and Burundi, said the aid cuts earlier in the year meant she and her team were forced to make decisions about aid that fit definitions around which is “life-saving” or not.
She said: “Mental health services are not always considered life-saving and we see their support withdrawn first. Yet they are life-saving services. I’ve seen this first hand at Mahama refugee camp, and any humanitarian doctor or nurse will tell you that.
"World Mental Health Day serves as an important reminder to those making these cuts to budgets that only a mother with good mental health can feed her children and be self-reliant. Mental health is never an added extra – it’s fundamental,” she said.
“Mothers and their children living at Mahama have already been traumatised by violence and insecurity over a long time and their journeys here were dangerous.
"Let’s not let mental health provision become an easy target for budget cuts, whether that’s in Rwanda or elsewhere in the world.”
Until the beginning of this year, Save the Children had been operating in all five refugee camps and transit centres across Rwanda, managing six health centres across the camps, including the Mahama II Medicalised Health Centre.
However, due to reductions in funding, the organisation has scaled down its operations to only two refugee camps, one transit centre, and support for urban refugees.
*Names changed to protect their identity
