South Dakota Summer

pr1.jpgAfter a week of training in Minneapolis, I am finally in Pine Ridge, South Dakota. My job with Youthworks is Kid’s Club Coordinator. Every week we will have youth from around the country to learn about Lakota history and culture and serve in the community. I will be facilitating a day camp for community kids where we read stories, sing songs, play games, make crafts.

pr2.jpgOne of the best part of my first few weeks as a Youthworks employee is getting to know my fellow staff. Liz is our Site Director; she oversees our ministry and community interactions. She is a middle school Spanish teacher and going to graduate school for history. John, our Ministry Support Coordinator, is an AmeriCorp member currently working as an outdoor therapist. Nathan is our Works Project Coordinator and worship leader. He studies Music Education at Northwestern.

pr3d.jpgDespite being a born-and-bred East Coaster, I am falling in love with the Great Plains. My first night in South Dakota consisted of visiting the Badlands, complete with buffalo and prairie dogs. Yesterday when I woke up, a herd of horses were grazing by our church. Unlike in my home of suburban New Jersey, dogs and horses here roam free. Every time I see a horse galloping sans fence under the open sky, I am reminded that I am in the most beautiful place in America.

To learn about the community I am getting to know this summer, check out this TED Talk by Aaron Huey. He brings a lot of the issues Pine Ridge is facing into the light.

Where in the world is Kelly?

As of last week, I am halfway complete with my undergraduate degree in English with a teaching certificate in grades 7-12. This year was transformational for me in many ways. I spent fall semester studying abroad in Rwanda, where I took courses on the 1994 Genocide, African Religions, Economic Development, and Cultural Arts. I taught English as a second language with JAM International at Fred Nkunda Secondary Vocational/Technical School.

In addition to studying and teaching, I got to go on all sorts of African adventures, such as camping in Nyungwe rainforest, hiking volcanoes in Virunga, and going on safari. I saw gorillas, monkeys, giraffes, zebras, buffalo, elephants, and a leopard. I spent a weekend at the gorgeous Lake Kivu, where I also had the opportunity to visit Kiziba Refugee Camp and audit a beginner English class.

I returned to Messiah College for spring semester. During January, I went on a service trip to Baltimore, MD. I know I travel a lot, but I also spend a little time at college occasionally (I promise!). In my postcolonial literature class, I wrote a play based on my experience in Rwanda. You can read it here.

I was also accepted to Messiah’s Teacher Education Program. This semester, I observed classroom environments at the SciTech campus of Harrisburg High and Cedar Cliff High School. At Cedar Cliff, I loved being in the English as a Second Language classroom, which brought back some wonderful (or should I say…Rwanda-full?) memories of Africa. As a result of my ESL experiences, I declared a minor in TESOL (teaching English to Speakers of Other Languages). I love studying literature, but I am so excited by the possibility of teaching English to immigrants or refugees, or even teaching abroad!

This summer, be sure to check my blog for updates on my adventures in South Dakota, where I’ll be Kid’s Club Coordinator for YouthWorks and living in a Lakota Oglala community.

Post-Traumatic Stress Disorder in Post-Genocide Rwanda: Part II

Continued from a previous article.

Every year on the anniversary of the genocide, the Trauma Clinic in Butare sees a significant increase in patients with symptoms of PTSD. The fact that trauma increases during the anniversary periods of the genocide proves that the post-traumatic stress in Rwanda is not healing with time, but leaving deep scars on the mental health of survivors. “Mental illness in Rwanda remains largely unknown and untreated. The culture and its language, Kinyarwanda, still lack words for common depressive and anxiety syndromes. Only since the 1994 civil war has a word emerged for PTSD: ihahamuka, which means ‘breathless with frequent fear.’” Rwanda is known around the world as a nation of remarkable recovery, reconciliation, and development, but if survivors cannot find peace within themselves, then peace does not exist in the full sense of the word.

infographic 1The National Institute of Mental Health analyzes two methods of treating PTSD: medication and psychotherapy. The most common medication prescribed to those with PTSD are antidepressants which regulate sadness, worry, anger, and feelings of numbness. There is no medication used specifically for PTSD, but various medications can alleviate associated symptoms, such as Prazosin for insomnia. The second form of treatment is psychotherapy, one-on-one or in groups. Effective psychotherapy does not “cure” PTSD, but it does equip patients to manage symptoms and live a more normal, happier lifestyle. These are not the only treatments, but they are the most common and have proven to be successful many instances of PTSD.

Medication and psychotherapy are extremely effective, but are most often practiced in high-income countries. African PTSD Relief suggests using transcendental meditation as an alternative treatment in the majority world. Transcendental meditation uses meditation, yoga, and repetitive mantras to help PTSD patients separate themselves from their anxiety. While psychotherapy consists of two or more people processing and discussing the illness and its symptoms, transcendental meditation promotes introspection and the discipline of hope. Ninety percent of Congolese refugees find the Transcendental Meditation Program effective in regulating symptoms. (See infographics). In Walking With The Poor, Myers claims that the nature of poverty is spiritual. Transcendental meditation digs to the root of spiritual poverty by prompting patients to combat their illness through the spiritual therapy of meditation.

Of all nations affected by political unrest, Rwanda has one of the highest PTSD rates in the world. There is only one study on the recent prevalence of psychiatric disorders in Rwanda, conducted by Athanase Hagengimana in 1997. According to Hagengimana’s survey:

“Fifty percent (79 out of 157) met DSM-IV criteria for a psychiatric disorder. The most common diagnosis was acute grief reaction (25%), but depression (22%) and PTSD (20%) were also common. The average number of traumatic events during the 1994 war reported by each subject was 15. Four of these events were significantly related to the diagnosis of PTSD: forced isolation, the helpless witnessing of atrocities, rape and loss of parents. Treatment for any of these disorders was rare.”

Forty percent of those living with mental illnesses live in low- and middle-income countries. According to the Journal of Public Mental Health, “Between 75% and 85% of people with severe mental disorders are unable to access the treatment they need for their mental health problem in LMICs, compared with 35% and 50% of people in high-income countries.” This problem is not independent from poverty; those suffering from homelessness are three times less likely to recover from mental illness.

Based on the lack of awareness of and available treatment for PTSD in Rwanda, education is the first step in alleviating the impediments that PTSD imposes on community development. Mental illnesses constitute 14% of all global health conditions and receive less than 1% of most countries’ healthcare budget. Mental health education must be implemented in Rwanda on two levels: first among the public to negate the negative stigma, and second specifically for public health professionals to ensure that PTSD is properly diagnosed and treated.infographic 2.png

Many of those suffering from PTSD do not seek help at all, and if they do, they turn to traditional healers rather than psychiatric treatment. Having no exposure to the science of mental health, they interpret their illness as a curse or possession. Perhaps if Rwandans were more educated about the significance, causes, and treatments, of mental health, more people would turn to reliable treatment rather than traditional healers. PTSD can no longer be an illness suffered in secret; it should be taught in schools and medical clinics, and discussed as typically as any physical illness would be. Portraying PTSD with the same level of severity as physical illness and treating it with the same level of care exposes the crisis in all its austerity. For this result to be effective, the medical system must be sufficiently educated to provide treatment for those suffering from PTSD.

Post-Traumatic Stess Disorder in Post-Genocide Rwanda: Part I

Three years after the 1994 Genocide in Rwanda, a young girl was admitted to a medical clinic in Kigali. However, she displayed no physical symptoms. She reported feeling nausea, the sensation of insects crawling on her face, a strong smell of feces, increased agitation/fear, and vivid flashbacks of being attacked by men. “For months she had vomited at the sight of avocados, and for three years she had been unable to tolerate the sight of rice.” Her family was murdered in the genocide and the girl was severely wounded. The perpetrators thought she was dead and “had thrown her into an open public toilet, where she lay for one week among feces and maggots – white maggots resembling bloated grains of rice-feeding on the avocados that fell on her from a tree above the toilet.”

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Rwandan flag at Nyamata Memorial

This is one of the too many stories depicting post-traumatic stress disorder (PTSD) caused by the 1994 Rwandan Genocide. PTSD is a mental illness common to victims or witnesses of abuse, violence, sexual assault/rape, or war. According to the medical diagnosis, “After a trauma or life-threatening event, it is common to have reactions such as upsetting memories of the event, increased jumpiness, or trouble sleeping. If these reactions do not go away or if they get worse, you may have PTSD.” Although Rwanda has come a long way since the end of the genocide in 1994, individuals continue to suffer due to the repercussions of the genocide. One cannot deny the astounding development and peacebuilding that has been occurring in Rwanda, but there is still an immense amount of work to be done in order for Rwanda to reach a state of harmony. The process of holistic development in Rwanda begins at the individual level and ends with the stabilization of the mental health of the nation.

Development is impossible without the maintenance of public health, and health must be viewed from a holistic point of view. World Health Organization (WHO) defines health 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.” Mental illness “affects people’s ability to work, creates a potential career burden on their families and generally leads to greater poverty. Therefore, it has a significant economic impact upon developing countries.” Clearly, the treatment of PTSD in Rwanda is crucial to development from a holistic standpoint. Rwanda is striving toward a state of peace and economic stability, but this goal is unreasonable if the livelihoods of so many people are hindered by PTSD. Unfortunately, Rwanda’s awareness and treatment of PTSD remain insufficient.

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Walking With the Poor by Bryant L. Myer

In his book Walking With The Poor, Bryant L. Myers maps the path toward holistic poverty alleviation from a Christian perspective. Myers denies the modern worldview that the physical and the spiritual are totally separate from one another. In his argument for a holistic understanding of poverty, he states that the nature of poverty is fundamentally relational and the cause of poverty is fundamentally spiritual: “A lifetime of suffering, deception, and exclusion is internalized by the poor in a way that results in the poor no longer knowing who they truly are or the purpose for which they were created. This is the deepest and most profound expression of poverty” (127). This is the opposite of the modernistic assumption that poverty is material and development should be economy-centric. Rather than merely providing economic relief, Myers calls Christians to strive for transformational development. “No transformation can be sustainable unless this distorted, disempowering sense of identity is replaced by the truth. Healing the marred identity of the poor is the beginning of transformation” (178). Although Myers does not specifically mention PTSD treatment, it is a part of development that is holistic and transformational from a Biblical perspective. PTSD contributes to a distorted, disempowering sense of identity, and must be replaced by the truth: mental illness impacts people in a very real way, and must be treated. Healing the marred identity of the poor begins with mental health; transformation begins with healing.

Transformation begins with healing.

The article “Mental Illness in the Developing World” by Andrew Chambers provides a broader perspective on the role mental health plays in economic and community development. People in first-world countries are more likely to donate to causes that they can more easily empathize with. This makes it difficult for NGOs to dedicate their time or resources to issues concerning PTSD. According to the article, “There are no externally apparent symptoms to create a good snapshot image, and indeed it is very difficult to understand what living with schizophrenia or bipolar disorder would actually be like. As a result, mental health charities struggle to raise funds.” In order for transformation to occur in Rwanda, mental health awareness must also be prioritized worldwide.

“Home,” Scene Four

The stage is divided into two parts. The first is Lisa’s room. It very simple, only a bed and a dresser. She is sitting on the bed, and her phone is on the dresser. On the other side, KAYLEE is sitting at a table holding a phone and dialing a number. Lisa’s phone rings.

LISA: (Picks up phone) Hello?

KAYLEE: Lisa! It’s Kaylee.

LISA: Kaylee! How are you? How is Muhanga?

KAYLEE: Oh, I love it so much! Teaching preschool is amazing; the kids are so so sweet. What about you? How’s teaching English?

LISA: It’s a little difficult. I’m realizing how irregular and confusing English can be. I had to explain gerunds to my intermediate class today. I bet half of the people I graduated with don’t even know what a gerund is.

KAYLEE: (Laughs) You should have taught everyone in American proper grammar before going abroad.

LISA: But that wouldn’t be nearly as much fun.

KAYLEE: Is Kibuye beautiful? Everyone here says the lake is gorgeous.

LISA: I’ve seen it, but I haven’t had the time to go up close yet.

KAYLEE: It sounds like your job is taking a lot out of you.

LISA: It’s a challenge. I don’t know how to relate to the refugees. They feel so displaced because they’re Congolese but don’t have a home in Congo anymore. They live in Rwanda but they don’t identify as Rwandan.

KAYLEE: You can relate to that. You’re an American living in Rwanda.

LISA: Yes, but I still have a home in America. I have roots that I can go back to, and the opportunity to plant new roots all around the world. I have an abundance of homes. These people, they have homes, but they’re homeless.

KAYLEE: I never thought of it that way.

LISA: I’m learning so much, it’s a little overwhelming.

KAYLEE: If you ever need to clear your mind, come join me in Muhanga sometime. I bet playing with the preschoolers would be really refreshing.

LISA: (Laughs) No, that’s okay. I think I like it here. This place is starting to feel like home.

KAYLEE: I’m happy for you. Listen, I have to go, my roommate and I are going to Kigali for the weekend. Call me if you need anything.

LISA: Have fun! Say hi to everyone for me.

KAYLEE: Will do. Get some rest this weekend.

LISA: Thanks, I will. Bye, Kaylee.

KAYLEE: Bye!

KAYLEE hangs up her phone and walks offstage. LISA is still sitting on her bed.

LISA: This place really is starting to feel like home.

“Home,” Scene Three

LISA, MARIE CHANTAL, and EMMANUEL walk onstage. There is a table with three chairs. They sit. WAITER approaches.

WAITER: Welcome to Cannabera. What would you like?

EMMANUEL: We would all like chipati.

WAITER: Would you like drinks?

LISA: I’ll have icyayi, please.

EMMANUEL: Tonic.

MARIE CHANTAL: Fanta.

WAITER: What kind of Fanta?

MARIE CHANTAL: Citron.

WAITER: I will be right back. (He walks away)

EMMANUEL: Risa, why did you choose to come to Rwanda?

LISA: I wanted to teach English.

EMMANUEL: Why Rwanda? Our country is developing country and has bad history.

LISA: Rwanda is a beautiful country. I love everyone I have met here.

MARIE CHANTAL: You did not have the fear?

LISA: I was afraid to be far from home, but now I am very happy here.

The WAITER returns to the table. He places a plate of chipati on the table, and gives a mug to LISA and Fanta bottles to MARIE CHANTAL and EMMANUEL.

EMMANUEL: The bread is called chipati. You can eat it alone or scoop up beans and cabbage.

LISA breaks off a piece of the bread and dips it in the beans. She takes a bite.

MARIE CHANTAL: Do you like it?

LISA: Yego, sawa cyane!

EMMANUEL: You like it! And your Kinyarwanda, it is very good.

LISA: Thank you.

EMMANUEL: How long are you staying in Rwanda?

LISA: Two years.

MARIE CHANTAL: Have you been to Congo?

LISA: No. I would like to visit Uganda soon.

EMMANUEL: Do you miss home?

LISA: I miss home very much, but I love being here.

MARIE CHANTAL: Earlier you said home is a place you should love and want to stay.

LISA: I love my home in America because my family is there. When I go home, I will be happy. But maybe soon Rwanda will be my other home.

WAITER: You are finished?

LISA: Yego, murakoze cyane.

WAITER: (laughs) The mzungu, she speak Kinyarwanda!

MARIE CHANTAL: She is living in Rwanda and speaking language of Rwanda.

EMMANUEL: Factile, please.

The WAITER gives them a receipt.

LISA: I will pay. (She places a few bills on the table.)

MARIE CHANTAL: Thank you, Lisa.

LISA: Thank you for showing me around Kibuye and chipati. It was such a good day.

MARIE CHANTAL: It is raining.

LISA: Oh, no. It’s such a long walk back to Kiziba.

MARIE CHANTAL: You live in Kibuye town.

LISA: What about you?

EMMANUEL: We will walk to Kiziba.

LISA: Let me pay for your motos.

MARIE CHANTAL: No motos will go so far in rain.

LISA: Would you like to stay at my house?

MARIE CHANTAL: I must be home for my children.

LISA: I understand. I will see you on Tuesday for class.

MARIE CHANTAL: Thank you, Miss Lisa.

EMMANUEL: Goodbye Risa!

They walk separate ways.

“Home,” Scene Two

The library is a house with a classroom and a small nook of textbooks and notebooks. The classroom has several desks, a chalkboard, and a map.

LISA: Welcome to Intermediate English Class. Good morning.

EMMANUEL and MARIE CHANTAL: Good morning!

LISA: How are you?

EMMANUEL and MARIE CHANTAL: We are fine. And you?

LISA: I am fine, thank you. Do you remember adjectives and adverbs?

MARIE CHANTAL: Yes.

EMMANUEL: No.

LISA: Let’s review. An adjective describes a noun and an adverb describes a verb.

LISA writes two sentences on the chalkboard: “The girl is loud” and “The girl sings loudly.” She points to the first sentence.

LISA: Is ‘loud’ an adjective or an adverb?

MARIE CHANTAL: Adjective!

LISA: Yes, because it describes the girl, which is a noun. Is ‘loudly’ an adjective or an adverb?

MARIE CHANTAL: Adverb!

LISA: Yes, because ‘loudly’ describes ‘sings,’ which is a verb.

EMMANUEL: What is noun and verb?

LISA: A noun is a person, place, or thing, and a verb is something to do.

EMMANUEL: Thank you.

LISA: Can you come up to the board and write a sentence that uses a verb and adverb?

EMMANUEL: (Writes a sentence on the board) The singing was loudly.

LISA: Actually, you should use the adjective ‘loud’ because it describes a noun.

EMMANUEL: But singing is something to do.

LISA: Well, you’re right. But sometimes in English, if it ends in ‘i-n-g,’ it becomes a noun. We call it a gerund.

EMMANUEL: Engrish is difficult language. But I will learn because I want to go to U.S.A. and get job.

LISA: You’re doing very well.

EMMANUEL: Thank you.

LISA: What kind of job do you want to do?

EMMANUEL: In Congo I was pastor but in U.S.A. I will take any job.

LISA: A pastor is a good job.

EMMANUEL: Now I cannot be pastor because I live in Kiziba camp.

MARIE CHANTAL: I sold fruit in market. Now I care for six children.

LISA: How old are your children?

MARIE CHANTAL: My youngest is baby and oldest is sixteen. I too want to go to U.S.A. but I do not have husband.

LISA: What do you want to do in the U.S.?

MARIE CHANTAL: U.S.A. has good education for children. I want my children to learn and get good job.

LISA: Can you not be a pastor in Rwanda?

EMMANUEL: Pastor is important job. Not a refugee job.

LISA: Marie-Chantal, can you sell fruit at the Kibuye market?

MARIE CHANTAL: The market is long walk away. And I have no means to purchase fruit to sell. All my money goes to school fees.

LISA: Do your children go to school here?

MARIE CHANTAL: They go to Kiziba school. They would get better education in Kibuye but we are not Rwandan.

LISA: How long have you lived in Rwanda?

MARIE CHANTAL: Twenty years.

LISA: Your children have lived in Rwanda their whole lives.

MARIE CHANTAL: But parents are Congolese. I know how to live in DRC. I do not know how to live in Rwanda.

LISA: So, DRC is home?

MARIE CHANTAL: For now, Kiziba is home.

LISA: But you do not want to stay in Kiziba.

MARIE CHANTAL: Kiziba is home because I live there.

LISA: Home should also be a place you love and want to stay.

MARIE CHANTAL: DRC was my home, but now I cannot go home.

EMMANUEL: I would like America to be home, but my Engrish is poor.

LISA: Your English is getting better every day.

EMMANUEL: Risa, what languages are spoken in U.S.A.?

LISA: English, but some people speak other languages, like Spanish.

EMMANUEL: Do they speak French?

LISA: Some do. I learned French in secondary school.

MARIE CHANTAL: Do you learn Kiswahili in secondary?

LISA: No, mostly Spanish and English. I also studied Chinese.

EMMANUEL: You have been to China?

LISA: No, I learned Chinese at University.

EMMANUEL: Why do you love languages?

LISA: The more languages you speak, the more people you can talk to.

MARIE CHANTAL: Most of the world speak English because of colonized by British.

EMMANUEL: But Rwanda was colonized by Belgium, so we were Francophone. Now we are Anglophone.

LISA: I love Kinyarwanda. It is a good language.

EMMANUEL: It is not useful in communicating with other countries because Kinyarwanda is mother tongue of Rwanda only. English is an international language.

LISA: Kiswahili is an international language.

EMMANUEL: Only Africans speak Kiswahili. It is better to speak English.

LISA: Just because more people speak English doesn’t mean it’s better.

EMMANUEL: I cannot get job in U.S. if I do not speak English.

LISA: Your English is getting better and better.

MARIE CHANTAL: Risa, how long have you been in Rwanda?

LISA: I was in Kigali for two months and I’ve been in Kibuye for a few weeks now.

MARIE CHANTAL: How do you see Rwanda?

LISA: I love Rwanda. It is so beautiful.

EMMANUEL: Have you tried food of Rwanda?

LISA: I’ve had ugali, matoke, and mendazi.

EMMANUEL: You have not had chipati?

LISA: No. Can I find chipati in Kibuye?

EMMANUEL: Yego. After class we will take you to Kibuye town and show you chipati.