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  mental health career in Rwanda. She highlighted her contributions to improve equitable access to community–based 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 caregiver. 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 adversity and illnesses on the mental health of people -patients, caregivers, and family members, Hildegarde felt compelled to contribute to bridging the gap between physical and mental healthcare.

Responding to Mental Health Needs

In 2014 at PIH, Hildegarde found a home for her aspirations – an organization dedicated to providing quality healthcare to those most in need.

“When I learned about PIH’s 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 to improve access to equitable, affordable quality mental health care.”

Partners In Health 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 pharmacology, psychotherapy, psychosocial rehabilitation through training, mentorship, and supervision implementation strategy.

A 2018 survey conducted by Rwanda Mental Health unveiled that depression, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, alcohol and substance use disorders, psychotic disorders, and suicidal behavior disorders are the most prevalent mental health issues in Rwanda.

Several factors hinder people from accessing mental health services, such as a lack of awareness about where to find them, stigma surrounding mental illness, and adherence to traditional, cultural, and religious beliefs.

Hildegarde and team works with district hospitals, health centers and community health workers in PIH supported facilities in Rwanda to address those challenges and improve access to quality mental health care.

Collaborating with the team at IMB and cross-site team, she contributed  on the integration of community based mental health services into existing primary healthcare frameworks, recognizing that true mental healing encompasses not only medical treatment but also psychological,  social support and community engagement.

“The implementation of this community-based mental health care program has contributed to access to quality mental health services in my country Rwanda where high burden of mental health problems is associated with the 1994 genocide against Tutsi,” she says,

Beyond Treatment: Lessons From UGHE MGHD Program

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

Learning about biosocial framework at UGHE taught her to look beyond patients presented clinical symptoms as there are various factors that have an implication on the patient’s health. Factors like family support, distance to the health facility, socio-economic conditions, and all of those that affect patients’ treatment plan and recovery process.

The program equipped her with various theory used in multiple cases studies in global health delivery and how to apply them in overcoming the health problems of our society today. 

“The research skills from the MGHD helped me to focus on patients’ outcome, evaluation research, and quality improvement projects even after graduation.”

Hildegarde has been doing research on various topics including evaluating clinical outcomes of a primary care mental health implementation program scale-up in the Eastern Province of Rwanda, estimated costs of integrating mental health services into primary care: the case of two rural districts in Rwanda among others.

She hopes that the findings from those manuscripts will inform mental health practitioners, policies and decisions makers about the value  of national scale up of this community-based mental health programs.

“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 clinical issues and tackle underlying social determinants of health through robust psychosocial rehabilitation services.

“PIH provides tailored social support to the most vulnerable patients, catering to diverse basic needs such as food, clothing, hygiene supplies, medical insurance coverage, transportation, and shelter, among others.”

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

“The existence of mental health conditions often exposes patients to various social difficulties and stigma,” she says. To combat this, Hildegarde and team use peer support groups, fostering camaraderie among patients and caregivers, where they share experiences, learn essential mental health information and treatment available, interpersonal skills and vocational skills.

These initiatives aren’t confined to theory; they manifest in tangible support groups operational in Burera, Kirehe, and Kayonza, benefiting around 3,819 thousand patients. These groups engage in diverse vocational training and projects like agriculture, livestock farming, tailoring, and handicrafts, aiming to improve living standards and address economic determinants of health.

Beyond economic empowerment, the Psychosocial Rehabilitation Program addresses stigma and educates participants about mental health and their rights such as right to identification, treatment, have and maintain family relationship, own a property alone, and others.

Looking Ahead

Drawing on her education at UGHE, Hildegarde 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.”

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 trains 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 can contribute to PIH mental health program ‘s mission of ensuring equitable and high-quality mental healthcare, not only in Rwanda but also globally.