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.

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