The lights from the buildings scattered up and down the street illuminated my path. Kigali is known to be a fairly safe city, with armed security and soldiers at various intersections. It can be a bit nerve racking seeing a shadow emerge with a gun, but at the same time it allows one to feel a bit more at ease when walking alone. Unlike most evenings, however, walking home this particular evening was different. I was almost home, when I heard footsteps approaching fast towards me. It seemed odd, but I kept on as people walked past me and continued on their merry way. It felt peculiar, being in a crowd, surrounded by people but still sensing that you are being followed. I slowed my pace hoping that the individual – whoever they may be- would walk ahead of me so that I wouldn’t unknowingly lead them to my home.

Just as I was about to shake off my paranoia, I felt a sharp thud on my back as a hand slapped me across my back. Startled, I looked to my left thinking it was a case of mistaken identity! Before I could react further, the individual yanked my earring from my left earlobe, looked at it, tossed it towards the plants lining the sidewalk and walked off. It took me a few minutes to let out a loud scream – it felt calming to let out the amalgamation of fear, shock and disbelief that had quickly formed within me. Blinded by shock, I only caught a glimpse of my attacker before she quickly walked away just as she had arrived.

Before long, a crowd formed around me speaking in Kinyarwanda. I made out the word “musaza” which means old. Shaking, I repeatedly muttered, in English, the words “what did I do to her?” As I scoured around for my earring in the poorly lit street, a lone moto-taxi driver tried to help, shining the faint light from his phone on to the ground. Soon, a man stepped forward and told me in English: “Don’t worry, she is a musaza an old woman. She is crazy. Don’t worry. She is crazy” I held on to my chest trying to calm my racing heart. The spot on my back was throbbing, I was scared and just wanted to get to the safety of my home.

When I eventually made it home, it took me a while to finally be at ease. As I replayed the incident in my head, I wondered about the woman’s story. Who was she? What triggered her to pick me out of the crowd walking ahead of her? Later on, a friend asked if my earrings had been offensive, my only thought was that they were a bit dangly. Perhaps she was curious, watching them swaying back and forth in the gentle wind. Perhaps she was saving me from something that only she could see. I would never know. But one thing is certain; no one tried to follow her to see if she needed help. Was she safe? No one wanted to know her story. They were fine accepting that the musaza was crazy and that was that.

It is estimated that 76% and 85% of people with severe mental disorders in low and middle income countries do not receive mental health care and treatment. According to Rwanda’s National Mental Health Policy there are only five psychiatrists countrywide and at least one mental health nurse at district hospitals throughout the country. In Rwanda, Partners in Health, is working with the Ministry of Health to train providers using safe, evidence-based and culturally appropriate strategies to address gaps in treating mental disorders. Mental health disorders do not only impact an individual’s health but, particularly in the context of low and middle income countries, their overall livelihood- including poverty alleviation, educational attainment and susceptibility to being victims and perpetrators of violence. There is a strong need to implement and safeguard policies that preserve the health and dignity of people with mental health disorders. By 2030, mental health disorders particularly depression is expected to be the leading cause of disability worldwide. As we look to the Sustainable Development Goals (SDGs) we must revisit and incorporate the WHOs definitions for both health and mental health:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

And

“Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

We must remember that our mental health is at the very core of our being. Without it, we are lost and unable to live to our full potential.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.” (Rethinking Mental Health in Africa)

It may take some time for me to feel safe again during my next few months in Kigali. I may not be able to walk home without constantly watching “my back” (pun intended) again. I may even be wary of every old woman I see, or fast approaching footsteps that I hear, but as the phantom ache in my back subsides, my only reminder of the incident will be my single earring missing its pair. My paranoia and shock will subside. For the old lady, however, she probably is battling more everyday than we could ever imagine. Perhaps, the only time a crowd will form around her or close to her would be to label her as a crazy musaza, but not to provide her with the support and care that she needs.

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