Coping with trauma in Rwanda

Extremely painful experiences may lead to long-term effects on an individual in form of psychological (mental/ “thoughts”) or physical (bodily) trauma. Trauma can be caused by exposure to extreme physical and psychological events in form of accidents, feelings of betrayal, abuse, threat or experience of violence and brutality, natural disasters and war. Trauma may be induced by recent experiences and events or by events that happened in the past but whose memory is imbedded in the subconscious mind of the victim, for example children who witnessed extreme violence. There are many traumatised Rwandans, but many cannot tell that they are victims and when they do many times, they blame themselves or argue that they are “ok”. Trauma is a general term used to refer to the effects of severe emotional shock, and or pain caused by an extremely upsetting experience in one’s life. The experience may be physical or mental, may involve a single event or series of events and may have happened once or repeatedly in a short period or extended period of time leading to a “shift” in the victim’s perception and views of his/her family, religion, surroundings, authority, spouse, friends and the environment. Trauma may lead victims to fail to coherently interpret and integrate ideas and motions. Symptoms of and reactions to trauma may vary widely and may differ from one person to another. There are many ways in which trauma affects the lives of victims depending on the events/feelings experienced, the person in question, support of relatives and friends, culture and socio-psycho and psychiatric (mental discipline in medicine) attention they receive and the ‘stage’ of trauma at which they receive it. Due to the 1994 genocide and the guerrilla war waged by ex-FAR and Interahamwe militia in west and in the northwest of country, many Rwandans suffer from trauma though with varying degrees. The commonest symptom of trauma in Rwanda is victims screaming and at times running or trying to hide themselves; because in their minds, the traumatic events of the past are happening in the present. Victims may see “real killers” entering ones house and another butchering the occupants. This results from a “trigger(s)” or cue that is related to events before, during or after the traumatic event(s) which cause anxiety to the victim and triggers flashbacks and nightmares. When this occurs repeatedly, victims may fail to readjust to intense feelings of anger frequently, sometimes in very inappropriate or unexpected situations, as danger may always seem to be present. Some victims of trauma suffer from panic attacks when surrounded by crowds of strangers such as in the market places, or at taxi parks, and may trigger off chains of emotional turmoil. Whereas this is a psychosomatic reaction (caused by anxiety and worry) and may not last long, it may lead to long periods of acute arousal in which the victim experiences physical and emotional exhaustion. The victim may experience heightened fear and insecurity making the victim hyper-vigilant day and night, with some spending the night awake due to the perceived threat leading to insomnia due to lack of sleep and interruption of his/her employment and daily chores, which may lead to poverty and social maladjustment. Many victims of the genocide blame themselves for the death of their loved ones. They believe that had they done something different their loved ones would be living. Many parents blame themselves for the death of the families. This phenomenon commonly referred to as survivor guilt is a symptom unusual among victims of Post-Traumatic Stress Disorder (PTSD). Others suffer from Survivor Syndrome characteristic of survivors of massive and traumatic events, and blame themselves for surviving, while others perished particularly widows and widowers. Such victims may suffer from anxiety and depression including physical complaints, nightmares, social withdrawal, recurring distressing dreams, lack of sleep, and loss of “interest in life”. Many survivors of the genocide, did not burry their departed loved ones and believe that somehow they are alive and living somewhere. They jump at the sound of an unfamiliar voice hoping that it is their loved ones and many keep memorabilia of the departed ones hoping for a reunion. This may precede the development of post-traumatic stress syndromes. Continued failure of the loved ones may lead to distractions, “disassociation” and emotional detachment. Dissociating from the painful emotion may include numbing all emotion, and the person may seem cold, preoccupied, or “distant”. The victim may become confused; have memory problems and hardly cope with situations normally. Some trauma victims are angry, reject help even from close friends and relatives, are aggressive melancholic, and exhibit symptoms such as lack of appetite, sleep disturbances, phobia especially in relation to people and the place of trauma, reduced personal drive, unspecified complaints of bodily pain and are treatment resistant arguing that they have no problem. This mainly applies to male survivors and orphans who believe they should or could have done something to save their loved ones or should do something for the dead, now. Post-traumatic embitterment disorder (PTED), as the phenomenon is referred to, affects victims’ ability to concentrate and may impair their ability to engage in economic activities. There are victims of trauma caused by a sense disempowerment, helplessness with no or loss of control, and in the context of either captivity or entrapment in caves, hiding places such as pit latrines, ceilings, pig sties or under beds for the duration of the genocide. Many victims who were raped or abused, physically and psychologically tortured during captivity or in hiding, fall into this category otherwise referred to as Complex post-traumatic stress disorder (C-PTSD). Victims of C-PTSD exhibit reduced self-worth, safety, trust, and coherent sense of self. Many demobilized soldiers and ex-combatants in the different Interahamwe militias in the jungles of Congo, may not have had enough debriefing sessions and counselling and may suffer from Combat Stress Reaction (CSR) otherwise referred to as shell shock. Soldiers are not supposed to be scared or show any fear in the midst of battle and risk disciplinary action if they do. In intense, at times prolonged battle, soldiers became “burned out” or fatigued as a part of their body’s natural shock reaction to intense and frequently repeated stress and yet they are not supposed to “show cowardice like civilians”. This may lead to “mental shutdown” due to overactive adrenaline response that creates deep neurological patterns in the brain and where it does not occur, the stress is “stored” in their minds only to reoccur in their lives later. This may explain many people in this category are wont to psychological disorders that lead to engagement in disruptive or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions such as violence, alcoholism, failed relations and crime. Many Rwandans watched or took part in the gruesome violent killing of someone they knew. Others saw, at least, a dead body or bodies of friends, schoolmates, parents or someone close to the family. They saw the total reversal of the “right” as adults were humiliated, mothers and girls raped and killed and babies and toddlers murdered. The images/flashback comes to them in the dead of the night. Many used to reason that it was the government of the dead to blame, and are now coming to terms with their past and acknowledging their individual roles and responsibilities. These people suffer from the effects of trauma, may affect the normal growth of their children and need assistance to overcome the effects of trauma. Some symptoms of trauma can be prevented or its incidence reduced through medication when given in close proximity to a traumatic event under supervision by qualified medical personnel to reduce traumatic stress symptoms, inhibit the formation of traumatic memories, in relieving or reducing nightmares, controlling moods and aggression. When poorly administered medication may lead to dependency and drug abuse. Experts in the field recommend management of trauma through prevention and psychotherapeutic intervention under the supervision of trained practitioners. Prevention is mainly through debriefing immediately after a traumatic experience. Therapy may be through Cognitive Behavioral Therapy (CBT) aimed at changing the victim’s patterns of thinking, negative emotions and behavior that are the sources of trauma and consequently their feelings and behavior. The victims may be assisted to discover another approach and outlook, different from the traumatic past. Another approach is the Exposure Theory (ET) which involves assisting the victim to confront the source of his/her trauma and “conquer” it. Eye Movement Desensitization and Reprocessing (EMDR) and other therapeutic methods have shown positive results. Whatever the method used in assisting trauma victims many, Rwandans are traumatized and will continue to be traumatised for a long time to come the degree of trauma notwithstanding. ekaba2002@yahoo.com