Leila Umubyeyi was 8 years old in 1994 when the Genocide against the Tutsi began. At that time, she was living with her grandmother in Bugesera, the current Nyamata District. One morning they woke up to news that their village was the next target by the interahamwe militia. As they tried to flee, they were intercepted at a roadblock that was being manned by the militia. Instinct immediately told the old woman to let go of her beloved grandchild and ask her to run for safety.

But the blood-thirsty militias had spotted her and ordered one of their men (who had until a few days before worked as a herdsman at Umubyeyi’s home) to go after her but he was soon out of breath and gave up the chase. Umubyeyi eventually blacked out in the middle of a thick bush. And yet the worst was yet to come.

As the tormented girl tried to find her way out of the bushes, she found what would come to traumatize her for the rest of her life: her grandmother had been chopped to pieces by the militias and her clothes soaked in blood. But despite that horrific scene, Umubyeyi soldiered on in search of a safe place. That journey, however, was characterized by many other near-death encounters that she fortunately survived. She was later re-united with her parents who were in Burundi at the time. Umubyeyi now lives in Kigali and currently works at Mount Kenya University.

However, much as Umubyeyi survived to tell her story, she says every genocide commemoration period brings back traumatic flashbacks.

In fact the Ministry of Health says over 3,000 cases of trauma were recorded during last year’s commemoration events.

Trauma is defined by the American Psychological Association (APA) as the emotional response someone has to an extremely negative event. While trauma is a normal reaction to a horrible event, the effects can be so severe that they interfere with an individual’s ability to live a normal life. In a case such as this, help may be needed to treat the stress and dysfunction caused by the traumatic event and to restore the individual to a state of emotional well-being.

Government efforts

With activities to mark the 21st commemoration of the Genocide against the Tutsi slated to begin tomorrow, the Ministry of Health has announced that its staff and volunteers will be at hand to offer psychological support to all trauma victims.

Addressing journalists last week, Dr Yvonne Kayitenshonga, the head of mental health division at Rwanda Biomedical Centre, said they have trained different agents in communities and set up a committee that will coordinate the support.

Kayiteshonga said 28 per cent of Rwandans have mental disorders, according to statistics, and cited Genocide among the major causes.

She said 68 per cent of those who suffered trauma last year had short emotional reactions which were treated instantly, while 32 per cent had severe stress reactions that required medical attention.

"Among the 3,094 trauma victims last year, 81 per cent were female and this is largely attributed to rape that was rampant during the Genocide,” she said.

Nancy Claire Misago, a worker from the mental health division at RBC, said they have trained 50 mental health nurses, 150 Rwanda Red Cross agents and 200 members of the association of students who survived the Genocide ahead of this year’s commemoration period.

Increase of cases in past years

The number of people receiving treatment and counseling for trauma following last year’s commemoration of the 1994 Genocide against the Tutsi rose compared to those treated for the same problem in 2013.

Rwanda Red Cross Society says 231 cases were registered at Kigali Genocide Memorial Centre in Gisozi and Amahoro stadium on the first day of the commemoration alone last year. Yet only 180 cases were registered from the two places on the first day of the commemoration in 2013.

Aid workers said districts reported 20-30 cases on April 7 last year.

"We noticed that over the years, parents have learnt to open up to their children, causing increase in trauma cases among the youth,” said Samson Nkiko, the head of community first-aid in a previous interview.

He added that Kigali registered the highest number of cases last year because a lot of people travelled from up-country to participate in the commemoration.

"People between the age of 15 and 30 were the most affected. People who were born after the genocide find it hard to come to terms with what happened, this is why they get overwhelmed,” he said.

"We also decided to change the colour of our uniform from red to white, as some people associate the former with blood, hence triggering trauma levels.”

Claver Irakoze, the archives and documentation manager at AEGIS Trust, an organisation that works to prevent crimes against humanity, however noted that over the years, the degree of trauma had moved from acute to mild.

"Most of these survivors have now experienced progress socially and economically, and this in a way has helped erase some memories of the tragic past,” she explained.

Irakoze however, said that challenges remained, especially concerning victims who refuse to open up, making it difficult to help them.

Alphonse Mutware, a psychologist living in Kimiroko, says there is need to intensify training of community health workers and other care givers as far as handling advanced trauma cases is concerned.

"We noticed that there are particular people who have repeatedly suffered from trauma over the years, so there is need to avail more specialised care”.

Trauma therapy

Karera says it is important for people who are traumatic to have plenty of sleep, exercise, have a balanced diet, desist from stressful work, alcohol and drugs as this helps them recover faster.

Jean Gakwandi, the founder of Solace Ministries Rwanda, a Christian charity engaged in rehabilitating Genocide survivors, says they offer trauma healing sessions to these victims.

"Immediately after the genocide many people were left with a sense of loss, discouragement and hatred, so we came up to offer them a shoulder by offering counseling services.”

He adds that 7,200 goats and 325 cows were given out to survivors between 2004 and April 2015 as part of efforts to reintegrate them back into society. "We understood that it was difficult for victims to recover if they were still affected by certain problems like poverty. This is why we decided to devise sources of income for them,” Gakwandi says.

Besides counseling and other needs, the NGO also provides free anti-retroviral drugs as well as HIV counseling and care to survivors living with HIV/AIDS.

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CAUSES AND SYMPTOMS OF TRAUMA

Main causes of trauma

Trauma can be caused by an overwhelmingly negative event that causes a lasting impact on the victim’s mental and emotional stability. While many sources of trauma are physically violent in nature, others are psychological. Some common sources of trauma include:

• Rape
•  Domestic violence
• Natural disasters
• Severe illness or injury
• The death of a loved one
• Witnessing an act of violence

Trauma is often but not always associated with being present at the site of a trauma-inducing event. It is also possible to sustain trauma after witnessing something from a distance. Young children are especially vulnerable to trauma and should be psychologically examined after a traumatic event has occurred to ensure their emotional well-being.

Signs of trauma

While the causes and symptoms of trauma are various, there are some basic signs of trauma that you can look out for. People who have endured traumatic events will often appear shaken and disoriented. They may not respond to conversation as they normally would and will often appear withdrawn or not present even when speaking.

Another telltale sign of a trauma victim is anxiety. Anxiety due to trauma can manifest in problems such as night terrors, edginess, irritability, poor concentration and mood swings. While these symptoms of trauma are common, they are not exhaustive. Individuals respond to trauma in different ways. Sometimes trauma is virtually unnoticeable even to the victim’s closest friends and family. These cases illustrate the importance of talking to someone after a traumatic event has occurred, even if they show no initial signs of disturbance. Trauma can manifest days, months or even years after the actual event.

Emotional symptoms of trauma

Emotion is one of the most common ways in which trauma manifests. Some common emotional symptoms of trauma include denial, anger, sadness and emotional outbursts. Victim of trauma may redirect the overwhelming emotions they experience toward other sources, such as friends or family members. This is one of the reasons why trauma is difficult for loved ones as well. It is hard to help someone who pushes you away, but understanding the emotional symptoms that come after a traumatic event can help ease the process.

Physical symptoms of trauma

Trauma often manifests physically as well as emotionally. Some common physical signs of trauma include paleness, lethargy, fatigue, poor concentration and a racing heartbeat. The victim may have anxiety or panic attacks and be unable to cope in certain circumstances. The physical symptoms of trauma can be as real and alarming as those of physical injury or illness, and care should be taken to manage stress levels after a traumatic event.

Trauma medication: Drug options

While trauma, unlike some other mental disorders, is induced by an event or experience, it can be treated through the use of certain medications. Not all trauma requires medication, but it can be a useful tool in treating the symptoms of trauma, such as anxiety and depression. It is important to work with a healthcare professional to determine whether medication is necessary.

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Survivors explain how they managed to overcome trauma

Alphonsina Umushaka

Genocide left me sad, poor and full of hate. But through sharing experiences with fellow survivors, our hearts were mended and we found peace and love. Sharing restores hope in life.

Jean Damascene Kayumba 

I came to realize that being miserable wasn’t going to bring my family members back. I also realised it was not the best way to thank God for being alive so I started focusing on the positive things hence healing.

Eugenia Kampogo

After the Genocide against the Tutsi, I was totally traumatised and spent most of my days admitted at the hospital. Eventually, after attending some trainings on coping and seeing how other survivors had moved on, I followed suit.

William Mutsinzi

I suffered a lot of trauma until I forgave the person who killed my family. Hatred and sadness always made my heart heavy but after several talks about forgiveness and personal development, I recovered from the trauma.

Olivier Shyaka 

Initially my mind used to be consumed with tragic memories of the loss of my family members. With time, I realised I had to get over it if I was to achieve anything. So I decided to keep myself busy hence recovering.

Eugene Gasigwa

Those bad memories always haunted me until I got a counsellor from Avega Agahozo. He listened to me, counselled me and guided me through my entire recovery process. It was really helpful.

Compiled by DENNIS AGABA