Healing in Rwanda, Understanding and Naming Mental Health Problems: Translating Kinyarwanda Into a Clinically Applicable Language

Before the 1994 Genocide against Tutsi, reported rates of mental health disorders in Rwanda were low; Rwandan society and traditional healers had their own strategies to diagnose and address different mental health issues. Following the genocide against Tutsi in 1994, reports of psychological and mental health issues―including post traumatic stress disorders (PTSD), substance abuse and depression―increased significantly. To tackle these challenges, mental health specialists were trained―mainly in English and French―with key mental health concepts and disorders defined and elaborated in these languages. Consequently, specialists adopted Western ways of defining mental disorders and primarily referenced DSM-IV and V criteria for diagnosis. For example, most research names mental health problems that people experience as related to genocide and other events as “trauma” and “associated co morbidities”. From the research conducted by the Rwandan Biomedical Centre (RBC) on situational analysis for development of a model for management of trauma cases during the commemoration period of the genocide against Tutsi in Rwanda through Ubuzima Burambye project named problems that people suffered from as trauma, some concepts (such as “Ihungabana”, “Ihahamuka”, and “Ibikomere”) have been used to name trauma. But mental health professionals still prefer to name them as emotional, traumatic, collective, and/or collective traumatic crises. However, this use of primarily Western terms is a challenge for many Rwandan psychologists, as counselling sessions and other therapeutic interventions are conducted in Kinyarwanda. Such names might simplify concepts, as they are unable to fully translate the nuances within Kinyarwanda. To further study this linguistic issue, this current study investigated how people in Rwanda contextualise, name and give representations to the mental health problems they suffer from. It combined clinical and participatory action research, which started in February 2019. Participants were young survivors of genocide, people addicted to drugs from WAWA Rehabilitation Centre, as well as people who were received in the clinic/Uyisenga Ni Imanzi. Responses from the participants were classified according to their life experience on mental health pains. Twenty-nine percent of names of mental health problems from the participants were reflected on darkness, 25% of them have named as emptiness, 11% of participants have named their problems as heaviness, while rejection, bondage, physical pain each represent 8%, addictiveness or deviance is at 5% whereas dirtiness and judgement each has 3%. Different mental health symptoms―such as guilt, pessimism, anxiety, loneliness, depression and panic attacks―were identified to assess the respondents’ mental health. The data collected from this group showed that guilt among respondents takes a higher number of 22% of names for mental health related to pains, compared to the other symptoms. On other side, pessimism is ranked at 19%, anxiety at 18%, loneliness at 17% expressivity at 16% and panic attacks is ranked at 8%. Looking at the effect of mental health pains on different aspect of life, data represented that the most affected aspect of life is the human mind at 52%, social problems and emotions at 18% each, human body at 9% and relations among people are affected at 4%. Human senses (e.g., touch, taste, smell, hearing, sight) were used to identify and describe mental health pains. Results show that 62% of the identified unique names of the problems were found to belong to what people can feel, followed by sight (37%), touch (15%), hearing (13%), and smell (1%). However, there was no name for mental health pains related to taste. Clearly identifying and describing mental health issues in participants’ local language is an essential step towards finding effective solutions. Naming a problem helps practitioners and patients develop a shared understanding of the issue at hand and what can be jointly done to address it. Conversely, the inability to name the actual disorder leaves patients in a state of confusion, unable to progress with their treatment despite the availability of professional assistance.