During this coronavirus disease (COVID-19) pandemic, it became apparent the different approaches lowand middle-income countries have taken to engage in both preventative and responsive measures. Rwanda engaged preemptively in these measures starting in late January 2020 and continues to provide regular communication to Rwandans in order to limit the spread of COVID-19. This pandemic has disrupted livelihoods and tested the current mechanisms and resources that Rwanda has to offer. Observations from mental health professionals in Rwanda and community challenges have illustrated the mental health needs that exist. Rwanda's preexisting decentralized health care and mental health care system and its concerted efforts to address people's needs have highlighted the impact of COVID-19 within the country's unique context. Nonetheless, hope is alive and evident in Rwanda through snapshots of ongoing education, community support, collective messages of mental health, and solidarity. The world can gain knowledge from Rwanda's stance in times of uncertainty such as COVID-19 and strive to overcome through national cohesion.
The coronavirus disease (COVID-19) pandemic has illustrated the wide range of preventative measures and responsive strategies of low- and middle-income countries (LMICs). LMICs have implemented lessons learned from previous periods of epidemics and uncertainties. Rwanda's pre-existing decentralized healthcare and mental health system which are in response to the mental health distress from the 1994 genocide, continues to be a formidable system that collaborate and combine efforts to address people's mental health needs. COVID-19 has heightened or exacerbated people's mental health within the country. Rwandans have been exposed to and endured adversities, yet their cultural forms of resilience serve as a mental health protective factor to also overcome COVID-19. Nonetheless, Rwanda has engaged in interventions targeting public safety, social and economic protection that specifically address vulnerable communitie's mental health needs. Lessons from preparedness for the Ebola virus disease (EVD) epidemic has contributed to Rwanda's organization and approach to combating COVID-19. Policies and best practices that were enacted during the EVD outbreak have guided Rwanda's response within the healthcare and mental health system. Coincidentally, this outbreak emerged during the 26th commemoration of the 1994 genocide against the Tutsi. Although for the first-time post genocide, Rwanda was not able to engage in public traditional forms of collective mourning and community healing, evidence of Rwandan's resilient spirit is demonstrated. Community resilience has been defined by Magis [401] as the “existence, development and engagement of community resources by community members to thrive in an environment characterized by change, uncertainty, unpredictability and surprise.”. Referring to this definition, community resilience has been an interwoven into the cultural framework that guided Rwandans in past challenges and continues to be evident now. Rwanda's resilience throughout this pandemic remains through ongoing psychoeducation, community awareness of mental health concerns, collective messages of highlighting mental health support, and solidarity. The global community can gain knowledge from Rwanda's learned lessons of their past which has positioned itself to stand on its resilient values in times of uncertainty such as COVID-19 and endeavor to overcome through national cohesion.
Background: This study sought to assess the knowledge, attitude about menstruation among high school teachers, boys and girls in Butaro, a rural area in northern Rwanda. In addition, the menstrual hygiene practices of the high school girls were also assessed; to inform the design of intervention.Methods: A school-based cross-sectional questionnaire was administered to 339 people in three high schools in a rural region in Rwanda.Results: Thirty-two teachers and 307 secondary school boys and girls were surveyed. Only 9.8% of students had good knowledge related to menstrual health, with slightly more schoolgirls (13.9%) than schoolboys (5%). Feeling insecure, scared, and worried that others could smell them, were the common menstrual-related concerns cited by girls. About 20% of girls used cloth to manage their menstrual flow and 22.3% reported menstrual-related school absenteeism; lack of sanitary protection products and fear of being teased were among the most prominent reasons.Conclusions: Providing accessible facilities for girls to change, pain medication, and sufficient sanitary pads are necessary. Reusable sanitary pads and menstrual cups could be cheaper and more sustainable alternatives to commercial menstrual products. Cultivating a psychologically safe school environment is necessary.
Background Men who have sex with men (MSM) and transgender women (TGW) in Rwanda are at higher risk than the general population of being subject to sexual and reproductive health (SRH) disparities pertaining to discrimination and marginalization. There is a significant gap in the literature concerning the experiences of MSM and TGW seeking SRH care, and the challenges that ensue. This study uses an MSM and TGW community-informed survey to analyze the barriers and recommendations to accessing SRH care. Methods A quantitative survey was administered to 134 MSM and TGW members of Hope and Care Organization (local non-government organization) in Rwanda to ascertain the magnitude of barriers and assign weight to the recommendations. Results COVID-19 induced restrictions, societal stigma, perceptions of community/local leaders, fear of disclosure/outing, and violence were found as barriers for both MSM and TGW (p≤ 0.05). Unsupportive policy/legal environment and long waiting times/delays were barriers specifically for the MSM whereas healthcare provider lack of knowledge was specifically for TGW (p≤ 0.05). More than 90% of respondents across both groups recommended unrestricted operation and capacity building of LGBTQI+ organizations, strengthening legal support, peer education & mentorship, mental health support/counsellors, increased community outreach, expansion of care to rural areas, sensitization of local, religious leaders and employers. Further specialized training for healthcare providers and more inclusive and accepting insurance were specific to MSM whereas increased media awareness and sensitization of the general population were specific to TGW. Conclusion This study highlights the unmet SRH needs of TGW and MSM while eliciting community informed recommendations that must drive policy change in Rwanda. The most emphasized recommendations include capacity building, economic support, accessible insurance, sensitization of healthcare providers and increased community outreach. The populations reiterated the need for SRH care to be holistic, highlighting the integral role of mental health care inclusion. Overall, psychosocial safety has been a pervasive theme that needs to be addressed to ensure SRH care delivery.
Background Globally, men who have sex with men (MSM) and transgender women (TGW) encounter many challenging experiences when accessing health services compared to the general population. Stigma, discrimination, and punitive laws against same-sex relationships in some sub-Saharan African countries have made MSM and TGW more prone to depression, suicidal ideation, anxiety disorders, substance abuse, non-communicable diseases, and HIV. None of the prior studies in Rwanda on MSM and TGW had explored their lived experience in accessing health services. Accordingly, this study aimed at exploring the healthcare-seeking experiences of MSM and TGW in Rwanda. Methods This study utilized a qualitative research method employing a phenomenological design. Semi-structured in-depth interviews were conducted with 16 MSM and 12 TGW. Participants were recruited via purposive and snowball sampling approaches in five districts in Rwanda.” Results Data were analyzed using a thematic analysis approach. Three main themes emerged from the study: (1) The healthcare experiences of MSM and TGW were generally dissatisfactory, (2) MSM and TGW hesitated to seek care unless they were severely ill, (3) MSM and TGW’s perspectives on how to improve their health-seeking behavior. Conclusion MSM and TGW in Rwanda continue to face negative experiences within the healthcare delivery settings. These experiences include mistreatment, refusal of care, stigma, and discrimination. Provision of services for MSM and TGW and On-the-job cultural competence training in the care of MSM and TGW patients is needed. Including the same training in the medical and health sciences curriculum is recommended. Furthermore, awareness and sensitization campaigns to improve the understanding of the existence of MSM and TGW and to foster acceptance of gender and sexual diversity in society are necessary.
Background Globally men who have sex with men (MSM) and transgender women (TGW) encounter many negative experiences when accessing health services compared to the general population. Stigma, discrimination, and punitive laws against same-sex relationships in some sub-Saharan African countries have made MSM and TGW more prone to depression, suicidal ideation, anxiety disorders, substance abuse, non-communicable diseases, and HIV. None of the prior studies in Rwanda on MSM and TGW had explored their lived experience in accessing the health services. Accordingly, this study aimed at exploring the healthcare-seeking experiences of MSM and TGW in Rwanda. Methods Semi-structured interviews were conducted on 16 MSM and 12 TGW, using purposive and snowball sampling approach in 5 districts in Rwanda. Results were summarized using thematic analysis approach. Results Four main themes emerged from the study: 1) The healthcare experiences of MSM & TGW were generally dissatisfactory, 2) MSM & TGW generally hesitate to seek care unless they were severely ill, 3) More services specialized in addressing MSM & TGW’s needs are necessary, and 4) Advocacy and awareness for and among MSM & TGW communities are needed. Conclusion Rwandan MSM and TGW continue to face negative experiences within the healthcare delivery settings. These experiences include mistreatment, refusal of care, stigma, and discrimination. Provision of services for MSM and TGW, and on-the-job training cultural competence in the care of MSM and TGW patients is needed. Including the same training in the medical and health sciences curriculum was recommended. Furthermore, awareness and sensitization campaigns to improve the understanding of the existence of MSM and TGW and to foster acceptance of gender and sexual diversity in society are necessary.
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