Unpaid bills, infrastructure monitoring, insufficient staff, equipment… the Neuropsychiatric Center of Kamenge (CNPK) faces several challenges. The help of charitable souls is requested. Brother Hermenegilde Nduwimana, director of the center, takes stock. An opportunity to call for changes in perception regarding mental illness. Why does discrimination once morest the mentally ill persist?
Unpaid bills, infrastructure monitoring, insufficient staff, equipment… the Neuropsychiatric Center of Kamenge (CNPK) faces several challenges. The help of charitable souls is requested. Brother Hermenegilde Nduwimana, director of the center, takes stock. An opportunity to call for changes in perception regarding mental illness.
Why does discrimination once morest the mentally ill persist?
It is deplorable. For a very long time, mental illness has always been considered sometimes as an object of sorcery, sometimes of demonic possession, sometimes of mind wandering and so on. This causes the sick to be mistreated. There is a misunderstanding of Burundian society.
And yet, a mental patient can be treated and cured?
More than 90% of mental pathologies can be treated and cured if treated in time.
As head of the CNPK, what challenges do you face?
Let’s start with the staff upgrade. We do it but not as we would like. Training is always done on site, which displeases the staff. They would like to have qualifying training outside in order to obtain certificates. When you have already done 3, 4 or 5 training sessions, there is no longer any motivation. And it’s frustrating. And when the staff is frustrated, you understand very well that it does not give the desired effect of the training.
Do you have at least sufficient and qualified personnel?
(Laughter) Sufficient and qualified staff, it’s very difficult to say. In Burundi, until today, there is only one school of specialization in mental health which has opened with the authorities of the CNPK. It is the National Institute of Public Health (INSP).
Concretely ?
We have ten doctors, two of whom are administrative. Those who are in care are all general practitioners, except for one general practitioner trained in Senegal. To be able to pay for this one, we had the help of the Swiss cooperation with whom we have a 12-year project.
What are the needs ?
For it to really be a neuropsychiatric center, we need at least two psychiatrists, two neurologists. For other categories, we don’t have many, but it’s enough. The social agents are there, the psychologists at our disposal are quite competent. There aren’t many psychiatric nurses, but you can manage with them.
No other challenges?
The list is long. There is the feeding of the sick. Not having all the necessary budget, we are obliged to feed them somehow. Psychotropic drugs require a good diet. However, what we give is very little in quantity and quality.
What is the cost of food?
That’s over 12 million a month. It is enormous!
What regarding the quality of care?
Here too, the challenges are not lacking. We often need this or that other device that we cannot easily find for lack of sufficient means. Sometimes, we appeal to benefactors who grant us this or that, but that remains insufficient.
Some institutions have debts to Regideso. What regarding CNPK?
When I arrived, in 2018, there were already arrears of more than 400 million BIF. There were discussions and the government agreed to pay part of the amount. And we paid the other amount.
So no power outage like in other neighborhoods?
When we talk regarding Regideso, I get chills. The cuts are there. Often, mental patients in crisis assault caregivers in the dark. There, it is very serious.
What do you plan to do to deal with it?
I don’t know how yet, but I’m thinking of another solution. For example, using solar energy which can be permanent.
Families of the mentally ill say the drugs are expensive. Is it true ?
They are extremely expensive. When they come here, they are partly subsidized. All that remains is for the government to take other measures to subsidize the rest. Many of these drugs are not covered by the Mutuelle. There are only a few molecules that are supported. It’s a huge challenge.
What probably leads to unpaid bills?
It’s serious ! To date, the arrears, since 2021, stand at 1,232. BIF 822,875. We have the Ministry of Solidarity with 524 million BIF. There are also others, such as the military and the police. Without forgetting the agents of the Ministry of Health who are treated here.
Destitute and insolvent patients too…
It can never fail. Some arrive without having estimated the cost. They are not identified as destitute. They become so as they stay in hospital. And this causes a serious problem. And for others who are identified as destitute at the start, from the 72 hours on entry, it becomes easier because we begin contact with the Ministry of Solidarity. The latter will pay even if it may take a long time, many years. At least they will end up paying.
For others, when they become a big burden, they give up and leave without paying. And we can’t help it.
With so much debt, how does the center manage to continue its work?
We have some benefactors. It is among others our Congregation through FRACARITA, its international organization, Médecins sans vacances Belgique, and other occasional partners who support us from time to time.
The money used for training comes from these organizations. This allows us to direct the money that was intended for it in the payment of staff.
What regarding the state of infrastructure? Are they sufficient?
Far from there ! They are very old. Some date back to 1990, the year the center was created, while others already existed. They were dwelling houses of the Brothers.
That’s why we started building a new block. It was to try to unclog and at least have decent administrative offices. And everything else should go to hospital services.
But apparently the construction site has stopped. Why ?
There are two aspects. First the manufacturer who did not respect his commitments, but also there are internal causes. Then, there is the staff who revolted at a certain moment saying that this site consumes a lot of money. Thus, the board of directors entered the management and recommended the temporary stop of the works to evaluate if one can continue to build while paying the personnel.
How do you ensure that patients respect the barrier gestures once morest Covid-19?
There, I risk being like the others and talking regarding God in these affairs. (Laughs). It is so difficult to control the mentally ill. Barrier gestures in a psychiatric hospital… really impossible to control. We were lucky enough to see that we had no more than three positive cases. But, we try to sensitize the nurses.
Does the CNPK have antennas?
We decided to open a center in Gitega in 2010. And in 2014, in Ngozi, we opened another center in Ngozi.
Is this enough for Burundi?
We would need other centers: to the south and another to the northeast. We are in a phase of decentralization and integration into ordinary health centers. With this policy, the multiplicity of specialized centers is not recommended. That is the problem. The workload of the specialized centers will decrease to deal only with those who will not have been taken care of in the other structures. It is also a way to lighten the burden on families.
Comment ?
Taking someone from Cankuzo to Ngozi or Gitega is more difficult than taking the patient to a nearby Health Center (CDS). There, we try to treat it. When this is not possible, he is taken to a district hospital. If this does not work, the specialized centers will take over.
Are these structures equipped for such pathologies when you recognize that the CNPK does not have sufficient and qualified personnel?
This is the challenge facing the government. There are always discussions, debates going on with many stakeholders. I hope that over time they will come to understand that psychologists are essential. Otherwise, it won’t work.
There are also trainings. At the CNPK, two are in specialized studies. There are others from general hospitals in specialized training. I hope that in 8 years, 12 years, when we will have more than 12 people who will have been trained in specialized health care. Afterwards, there will be the training of psychiatric nurses and psychologists.
It is now up to the government to see how to hire more psychologists in these structures.
What are the infrastructure needs?
We need to rehabilitate the psychiatric emergency at the entrance, the kitchen to protect the domestic workers and the ceilings of the pavilions. We also need an administrative block, an addictology block and a mother-child building.
Your appeal to the families of the mentally ill?
To the families, we ask them to help us, to treat their mentally ill as whole persons. We must not resort to prayer rooms because that is what happens very often. When we don’t hide them, we start running to the prayer rooms even before consulting the specialists or ordinary hospitals.
We must try to collaborate with the structures. And those who bring the patient to the hospital, it’s like an evacuation, a waste that we get rid of. We leave it there and we leave. A mental patient has feelings, emotions. He needs to be supported by everyone and his family in particular.
Interview by Rénovat Ndabashinze
