The wake: Health issues in post-Genocide Rwanda

TWO decades have passed since Rwanda witnessed the worst ever man-made catastrophe in 1994. In the aftermath when peace was restored, survivors were left with many issues to deal with including those of health. There were many survivors of the 1994 Genocide against the Tutsi left with injuries. For some, injuries were temporary and healed with time, but a large number of individuals suffered permanent disability in the form of loss of one or more limbs or loss of eyesight or hearing due to trauma suffered during those terrible days. These have been the direct physical sequel of genocide. But several other health related problems emerged after the massacre, HIV/Aids among survivors is one of such problem. Many women (about a quarter a million as per a UN study) were raped during that time and many of them acquired HIV infection as a result. Unknowingly, this infection was passed on to their partners and children conceived, thus increase in prevalence of HIV after the Genocide. This has lead to affected individuals becoming sick in the prime of their lives due to opportunistic infections and many dying while young. It has also created social as well as economic problems for the survivors and their living family members. To cope with a child borne out of ethnic hatred and rape, to cope with a chronic infection occurring for no fault of the individual is not easy. These women have also suffered from chronic pelvic infections as a sequel to sexually transmitted diseases acquired when raped. Carcinoma of cervix has also emerged in women survivors at a later age due to chronic pelvic infections. Issues of mental health are equally large in magnitude, most important being post-traumatic stress syndrome. It is said to be a set of symptoms and signs which individual experiences after witnessing or experiencing something beyond human imagination. Many survivors of the brutal killings have been experiencing unexplained palpitations, sense of fear, insomnia, night mares breathlessness, chest pain, among other symptoms since that time. They visit hospitals seeking consultation for their problems; many tests are done and repeated several times with no conclusive results because there is no existing physical problem. The symptoms remain persistent or repetitive. Social problems created due to the genocide like single mothers who bring up children alone, separated families where some member is missing, orphaned children, all these add on the mental stress and anxiety an individual suffers. The apparent outcome of these physical and mental problems is rise in prevalence of non-communicable diseases like hypertension and or diabetes. The risk factors for rise in the number of these diseases is not obesity and lack of exercise as in other places. An average Rwandan man living in a village or small place walks considerable distance in his daily routine, is not obese, does not consume lots of saturated fat like cheese, butter, etc, yet he suffers from high blood pressure or diabetes. The government has taken good measures for physical and mental rehabilitation of the survivors of the Genocide, including care of the health problems. Successful efforts have been made to rehabilitate them and take the country and people forward. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital