Social Inequalities among People with Psychosocial Disability due to COVID-19 Pandemic in Rwanda

By Kalisa Joseph, Coordinator, HEIDI-Rwanda; Haragirimana Claver, Executive Director,
OPROMAMER and Umulisa Rurangwa Nelly, Student University of Rwanda. Joseph can be contacted by email at josephka300@gmail.com

Introduction & Background

Psychosocial disability just like in other countries across the globe is a big challenge in Rwanda, and as a result of its history of 1994 Genocide against the Tutsi in which over 1 million people were killed in a period of 100 days [1] , issues pertaining to psychosocial disability have exacerbated and have affected different categories of people from different sorts of background.

People with psychosocial disabilities over the years have been struggling with both family and community stigma and the constant suffering has led to people with psychosocial disability to join hands in trying to change stereotypes, prejudices and stigma [2] faced. This gave rise to associations like OPROMAMER (Organization pour la Promotion et la solidarité des Malades et Handicapés Mentaux au Rwanda) that loosely translates “Organization for the Promotion and Solidarity of people with mental illness in Rwanda” [3] .

A story I [John, pseudonym] share with a lot of others is the stigma that we have endured and since my year 4 in high school when I was diagnosed with Bipolar at a Neuropsychiatric Hospital and undergoing treatment and recovering, and despite the fact that doctors had declared my mental health to be stable, my family deliberately refused to take me back to school and refused to pay my school fees. I got a job in a salon where I used the money to go back to school. Wherever I worked and they found out about my mental health history, somehow, I would lose my job in unexplained manners. I decided to investigate if other people with psychosocial disability or who had undergone through treatment at Neuropsychiatric Hospitals were experiencing similar challenges and to my surprise we were all suffering from a similar fate that is full of stigma and discrimination. It was a time that something be done.

OPROMAMER has grown into an association of over 3900 members across the country and these are just a pool of others struggling with psychosocial disability and mental health
difficulties that have increased the inequalities that are not registered members and whose way-about might not be well known to the associations.

COVID-19 context

With the preventive measures introduced to contain the spread of the virus in Rwanda and across the region, the government of Rwanda has introduced different programs i.e. Solidarity fund to support those struggling from different sectors by providing food to them. However, given the fact that people with psychosocial disability already face stigma and discrimination and their underlying mental health difficulties affect their voice in benefiting these initiatives, many have been left on their own. Families have had to make a choice between spending the scarce resources on their family members with psychosocial disability or use them in supporting those who are considered “Normal”. Nonetheless, the requirements like wearing masks, washing hands requires ability and means to buy those products, which is something that cannot be accessed by a lot of people with psychosocial disability which makes it near impossible to prevent themselves from contacting the virus should it be in proximity.

Additionally, people with psychosocial disability have had to deal with obtaining their
medications and given that there is a single neuropsychiatric hospital in the Country, it has meant that they have to find means to travel to obtain their medications. Although the government has tried to decentralize mental health care and easing the accessibility of some of the medications, it remains hard for people with psychosocial disabilities to raise money to pay for this transport as well as paying their medical insurance during this pandemic.

Organizations like OPROMAMER have over the past years been trying to initiate new ways in which their members can have economic development hence empowerment as this is considered vital to overcome stigma and help in people’s recovery process. However, COVID-19 has forced members to sell of their small agricultural products and disrupted their savings that were otherwise meant to support them in buying food, paying their medical insurances and other basic needs.

Most common problem during lockdowns has been obtaining food, and early this year OPROMAMER in partnership with its good friends was able to feed a number of families and launched a “saving and loan project” in which some support groups have been awarded a small grant to support them in bridging the gap in social inequalities faced.

A story of Immaculate (a peer, pseudonym) who has been living with about 14 people with psychosocial disabilities with whom two of the people she is supporting gave birth to
children while struggling with psychosocial disability and with most of her members being taken out of street, she explains how it has been difficult to feed her family while she is also struggling. Immaculate vowed to take care of her peers suffering from mental illness and has been taking care of all these people without any
support. She narrates her feeling after receiving some support from well-wishers:

“I am married to my peers and they’ll be my
husband till death does us apart. I am having
difficult in feeding them and I was lucky that some people have supported me with some food that would take a week or two. I always pray to God who has provided for all this long. The government supports me with only Medical insurance for these people so far. ”

A peer support group gathered for discussions She has been volunteering to distribute medications to other hundreds of people that can’t afford to travel to Kigali to obtain them by themselves. To them, Immaculate is a living “Hero” during these uncertainties and continue to be an icon of hope.

The lack of prior aggressive community initiatives that targeted building economic empowerment and fight social Stigma means that people with psychosocial disability will continue to suffer from these social inequalities unless something is done urgently.

Recommendations

• Food relief programs and other essential service provisions should be encouraged to prioritize people with psychosocial disability during these difficult times and proper follow up made to ensure the support services reach those in urgent need.
• Putting in place mental health support system at community level as well as engaging local leaders in supporting individuals with psychosocial disability in accessing basic needs and looking after those who are marginalized. Laws should be set up that protect from discrimination, abuse and maltreatment of people with psychosocial disability in both public and private sector services.
• Involvement of people with psychosocial disability in the decision making and governance processes is fundamental in reducing the social stigma and listening to their social needs. Empowerment initiatives specific for people with psychosocial disability should be prioritized to allow economic emancipation and stop dependence.
• Ensuring families of individuals with psychosocial disability easily access support services such as education/training, social/recreational and employment programs.
• Establishing of an antidiscrimination policy that ensures provision of equal opportunities to individuals with psychosocial disability in workplaces.
• Lastly social integration program for people after discharge from mental health hospitals should be set up to fight and alleviate the social stigma.

References

[1] S. I. P. K. M. L. S. V. Kalisa Joseph, “Fostering the training of professionals to treat trauma
and PTSD in,” Rwanda Public Health Bulletin, vol. 1, no. 2, pp. 21-23, 2019.
[2] A. Z. a. M. Madianos, “Stigma related to help-seeking from a mental health professional,”
Health Science Journal.
[3] Dulwich Centre Foundation, “Solidarity and friendship,” The International Journal of
Narrative Therapy and Community Work, no. 4, p. 80, 2019.