Hildegarde Mukasakindi, a clinical psychologist and dedicated mental health advocate is a proud alumna of UGHE’s inaugural cohort of the Master of Science in Global Health Delivery. 

For Hildegarde, UGHE is more than just a campus; it holds personal significance. The skills and inspiration she gained from her alma mater have molded her into the change agent and health equity champion she is today. 

In our conversation, Hildegarde shared insights into her journey of improving mental health care in Rwanda. She highlighted her contributions to equitable access to mental health services through her work at Partners In Health Rwanda, also known locally as Inshuti Mu Buzima (IMB). 

From Caregiver to Mental Health Champion 

Hildegarde’s path to becoming a stalwart in mental health care began with a deeply personal experience – supporting a loved one through a battle with cancer as a care giver. The journey took her across countries, exposing her to diverse healthcare systems and igniting a passion for global health delivery.  

“As a caregiver to my loved one battling with cancer, traveling to different countries seeking care ignited in me a desire to learn more about global health delivery. I came to realize that comprehensive care is essential for all human beings.” 

Recognizing the significant impact of illness on the mental health of patients, caregivers, and family members, Hildegarde felt compelled to contribute to bridging the gap between physical and mental healthcare. 

Responding to Mental Health Needs 

At PIH, Hildegarde found a home for her aspirations – an organization dedicated to providing quality healthcare to those most in need.  

“When I saw PIH mission and its practical implementation science, I felt this is the right place to give my contribution. Since then, I have been working with a team that implements a community-based mental health care model.” 

Inshuti Mu Buzima/PIH Rwanda supports community-based mental health care in rural public primary care systems in Rwanda’s Kirehe, Kayonza, and Burera Districts using task-sharing models for psychotherapy, psychosocial rehabilitation, mentorship, training, and supervision. Hildegarde’s team works with District hospitals, health centers and community health workers in PIH supported facilities in Rwanda. 

Collaborating with her team at IMB, she worked on the integration of mental health services into existing healthcare frameworks, recognizing that true mental healing encompasses not only medical treatment but also social support and community engagement. 

“The implementation of this community based mental health care model has contributed a lot to patients’ access to mental health care.” 

Beyond Treatment: Lessons From UGHE MGHD Program 

“We cannot achieve better health outcomes in our patients without addressing social determinants of health,” a lesson Hildegarde learned in the UGHE MGHD program. 

 Learning about biosocial framework taught her to look beyond patients’ health issues as there are various factors that have an implication on the patient’s health. Factors like health diagnosis, social conditions, poverty, occupational, and all of those that affect people’s mental health every day. 

The program equipped her with strategic planning, problem solving, critical thinking, quality improvement, monitoring, and evaluation and research skills which she fondly admits support her daily activities.  

“It’s helping me to come up with solutions to the challenges I face at work,” she says. “The research skills from the MGHD helped me to focus on research even after graduation.” 

Hildegarde has been doing research to assess health and functioning outcome among patients with severe disorders and epilepsy receiving treatment in Kirehe and in Kayonza. She hopes that the findings from those manuscripts will inform policies and programmatic decisions about the national scale up of this community-based mental health model. 

“You can’t separate social determinants of health with mental health” 

“To enhance patient outcome, you can’t separate social determinants of health with mental health.” 

Hildegarde explains that the PIH’s Community-based mental health care was designed to treat mental health issues and tackle underlying social determinants of health through robust social support systems. 

“PIH provides tailored social support at the individual patient level, catering to diverse needs such as food, clothing, hygiene supplies, medical and health insurance coverage, transportation, and shelter, among others.” 

In a bid for sustained support, Hildegarde’s team implemented the PIH’s Psychosocial Rehabilitation Program at the community level, aiming to enhance patients’ social skills, functionality, and livelihood capabilities. 

“The existence of mental health conditions often exposes patients to stigma,” she says. “To combat this, we use peer support groups, fostering camaraderie among patients and caregivers, where they share experiences, learn essential social, communication, and relational skills.” 

These initiatives aren’t confined to theory; they manifest in tangible support groups operational in Burera, Kirehe, and Kayonza, benefiting over five thousand patients. These groups engage in diverse projects like agriculture, livestock farming, tailoring, and handicrafts, aiming to improve living standards and address economic determinants of health. 

 A Vision for the Future 

Looking ahead, Hildegarde remains steadfast in her commitment to reducing disparities in healthcare and advocating for mental health equity.  

Drawing on her education at UGHE, she is dedicated to continuing pushing boundaries, leveraging research, technology, and community engagement to drive systemic change especially in mental health field. 

“Paul Farmer left a homework to us – to reduce disparity in health care. I’m committed to use the knowledge I have acquired at UGHE to advocate for health equity in mental health care.”  

Over the past decade, PIH has developed a comprehensive and effective global mental healthcare delivery model. This model has been proven to work and can be expanded nationally by collaborating with local communities, governments, and Ministries of Health. 

As Rwanda advances in its mental health services, Hildegarde stresses the significance of adopting the established community-based mental health approach across the country. 

“I endorse the broader implementation of PIH’s impactful Community-Based mental health model into primary care throughout Rwanda and propose new innovations to enhance accessibility.” 

UGHE is training the next generation of practitioners on how to provide holistic, human-centered health care including mental health care. UGHE alums such as Hildegarde are pioneering efforts to demonstrate to upcoming physicians that they too can contribute to her team’s mission of ensuring equitable and high-quality mental healthcare, not only in Rwanda but also globally.