Saturday, March 29, 2014

The Aftermath of Horrific Realities

"You cannot measure the consequences of war and conflict by counting the number killed. You have to count the survivors and what happened to them."
"The health outcomes aren't good."
Duncan Pederson, World Health Organization Collaborating Centre for Research and Training in Mental Health, Montreal

"We're not just starting to see PTSD, we are in the thick of it. It's an extremely big problem and we're not keeping up with the suffering."
"Will we come out of it quickly. I don't think anyone knows, but we need to work or study or do something that allows us to think of something other than death."
Naasso Munyandamutsa, Rwandan psychiatrist

"The whole thing is just so pervasive, you probably need 10,000 counsellors to even begin to make a difference. For most of us in other countries, the problem is anxiety, and this is ten times deeper than that. It's a huge challenge."
Delanyo Dovlo, World Health Organization Rwandan representative

Young people gather in Amahoro Stadium in Kigali for the 18th commemoration of Rwanda’s genocide, in 2012. Photo by Sue Montgomery/The Gazette

The question is: How do vulnerable young children survive the horror of witnessing atrocities so brutal that their minds would be forever in a state of confused derangement over the loss of parents, siblings, extended family, leaving them as children to cope on their own and attempt to surmount that horror? Over a quarter of the Rwandan population now suffer post-traumatic stress disorder.

Each of the country's 43 district hospitals sees between 15 and 25 patients a day for psychiatric problems. Its first addiction facility, recently opened, treats 300 to 400 people a month, from age 16 and up. There are six psychiatrists serving 11.4 million Rwandans. A UNICEF national trauma survey that took place a year after the genocide took place warned of problems to come.

Of the estimated 99.9 percent of Rwandan children who witnessed violence during the genocide, 79.6 percent had at least one death in their family; 69.5 percent witnessed someone being killed or injured, and 31.4 percent witnessed rape of sexual assault. Those children in the UNICEF study are now young adults, and the trauma of their experiences has left them still struggling to understand what they experienced.

In 1994, at the Munigi refugee camp near Goma, a Rwandan child cries at his dying mother's side. Associated Press file photo

On April 7, Rwanda mourns the 20th anniversary of the genocide that befell it. And every April 7 there is a national recognition of the genocide, with a national week of mourning. The very churches and schools where hundreds of thousands of desperate Tutsis sought refuge, but found death instead, stand as memorials, testament, if any were required, of their torment. An estimated 300 people butchered each hour of one hundred days of slaughter.

Those young adults still struggling to understand what their young eyes were assaulted by in one hundred days of butchery where neighbours, former friends and even relatives by marriage viciously used machetes, nail-studded clubs and spears engaged on mass slaughter. Their minds cannot help but wander helplessly in the direction of the same question repeated without answer; what would make Hutus turn on that segment of the citizenry known as Tutsis?

This is an entirely different country now than it was twenty years ago. It present as clean, safe, and swiftly developing to embrace and meet all of the advanced indices the United Nations' eight Millennium Development Goals by next year. The very picture of success in living standards for Africa, achieving a list of targets agreed to by all countries in 2000; inclusive of pledges of poverty reduction and universal primary education provision by 2015.

And while the country becomes an information-technology hub, installing over 1,600 kilometres of fibre-optic cables and a 4G network covering 95 percent of the country, many among its population are barely managing to function. An estimated 600,000 people who lost both parents and have little to no access to psychological support, plagued by stress, epilepsy, unable to sleep, resorting to alcohol and drugs for relief.

Jonathan Nettal, a psychotherapist working for a Canadian NGO called Hopethiopia/Rwanda, counsels 19- to 23-year-olds how to help one another, even while traumatized. A native of Montreal whose grandparents are Holocaust survivors, Mr. Nettal teaches small groups of ten to 15 people coping skills. "So you have more calm, people are more supportive, more socially connected, and that's a huge resource in terms of post-traumatic resilience."

Think about it: how do you cope as a teen when you've just been informed you were conceived through mass rape. That venomous, self-destructive mind-flood of shame, confusion and anger must be confronted and dealt with. Mental illness in Rwanda is a dire issue, where thousands of "genocidaires" (perpetrators) live among their victims.