The following post by Dr. Agnes Binagwaho, Permanent Secretary of the Ministry of Health of Rwanda, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Dr. Binagwaho is a pediatrician specializing in emergency pediatrics, neonatology, and the treatment of HIV/AIDS in children and adults. She has served 4 years as Chair of the Rwandan Steering Committee for the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and was responsible for the management of the World Bank MAP Project in Rwanda, while also serving on the country’s High Commission on Aid Policy.

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A few days ago the world celebrated Mental Health Day, and more recently it was the Human Rights Day, as such I have decided to post a reflection on the rights of all people to access mental health care as a part of the access to health care as a basic Human Right. I especially dedicate this reflection to the issues surrounding access to quality mental health care services for women.

Unfortunately, in the majority of the developing world, mental health is not an issue that is given adequate attention. However, if we take the definition of WHO, mental health plays as important part in overall health as the physical aspects do. To improve mental health, governments have to create a well-trained and well-equipped workforce to care for mental health and ensure that the funding and human and physical infrastructures are available. This will help to increase access to mental health care, but should be completed by making drugs available, like psychotropic drugs. Many of these medications are not so expensive and can be part of public essential drugs available at public health facilities. It is a matter of paying attention to the problem.

Also, the general population should be educated via mass media campaigns so that they will have less fear and a better understanding of mental health diseases and those who suffer from them, causing mental health patients to suffer from less isolation, stigma and discrimination. This can be done by partnering the government with civil society organizations to improve the public education on this issue through TV, radio, speeches, billboards and community events.

Both of these points are vital and necessary if we wish to improve the care of people who suffer from mental illness, because they will encourage the community to send people for care when mentally ill, and when the patient arrives, the health care providers will be ready to give proper care.

This is the system that the Government of Rwanda is creating by having one psychiatric nurse in each district hospital working in an integrated manner with hospital personnel, and by training general practitioners in the diagnosis and treatment of simple mental diseases and in the identification of severe ones so that such patients can be transferred to the national referral hospital for mental health. We also have some psychotropic drugs available as essential drugs, but we still have a long way to go to ensure that every Rwandan in need of mental health receives it.

An extremely important area of mental health care for women is trauma due to conflict situations, where many women are devastated because of rape and other sexual violence, as these health issues are often neglected. Mass rape has been used as a tool for war for centuries, and can be found in modern history as well: from the rape by German and Japanese armies during World War II, to the use of systematic rape and deliberately infect women with HIV during the Rwandan 94 genocide against Tutsis; this: from the rape of women during the Kosovo conflict, to the current use of rape to intimidate and humiliate women in the eastern regions of the Democratic Republic of Congo and through the devastation of their genital organs. For these women, international organizations should play a bigger role, since most of the conflicts are predictable and usual time for rape, sexual abuse and violence and psychological traumas.

In post conflict situations such psychological destruction needs specific attention to rebuild mental health and care for psychological reconstruction as a priority. Instead, the thousands of individual women suffering from this type of trauma are totally neglected and suffer in silence. Furthermore, in some countries these women additionally face stigma because of forced sex and pregnancy out of marriage, and are sometimes even forced to leave their households and villages because of that – doubling their trauma. In this manner, the communities who should be helping these women instead end up being on the same side of the perpetrators of this violence. For the prevention of mental health illness in women post wartime sexual violence, we must do massive behavior change campaigns for tolerance in countries recovering from wars.  That was we did and still do in Rwanda. If not, these women will be denied their basic human rights to gender non-discrimination, to live without violence, and to access care for mental illness and other health issues like STIs, HIV, and genital organ damage.

This entry was posted on Sunday, December 13th, 2009 at 4:20 pm and is filed under Access, Global Health, Mental Health, Patients, Women's Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.