CASE NOTES from the 2009 Rwanda Trauma Relief Mission

By Suzanne Connolly

LCSW, LMFT, TFT-Adv

 During these two days we treated over 60 people from the district of Byumba, the young and old, all of them poor people of the countryside who live by sustenance farming.  These were persons who wanted to participate in the study but due to the fact we had prepared materials for 200 only, they had to be excluded.  Father Jean Marie Vianney reported that there was some upset because they couldn't participate and so we decided to treat them ourselves over a period of two days.

 Suzanne Connolly says, "My first client on the 16th lost her only parent and her beloved fiancée in the genocide of 1994. She was given shelter in a refugee camp in the Congo , and while there married and had children. When she was able to return to Rwanda she and her husband had to be tested for the HIV virus. Unfortunately her husband tested positive. She lost several children, likely to AIDS, and she now practices safe sex. Her husband is very sick and cannot work. Her life is very sad because of these losses and because she alone must work very hard to support the family.  She wants to have more peace about her losses and difficult circumstances.  In a very short time, by using TFT, this woman was able to feel peace around her present circumstances.  Her SUD level went from a ten to a one and the change in her facial expression was remarkable.

  Another young woman, only twenty-two years old with a young baby has a husband who drinks too much, and insults her. He sometimes tells her to sleep outside with the chickens. She reported that she gets so angry she cries. She loses her voice and cannot even speak. We talked about not arguing with him or defending herself verbally when he's drinking as it does no good, but at the same time, not agreeing with him. She could say things like, "That's your opinion, I don't think this, but we can agree to disagree", and she can still keep her dignity.  But more importantly, she cannot be assertive in this way if she is so anxious and upset that she cannot even find her voice and literally cannot speak. Using TFT we worked on her sadness and her fear and anger around her husbands "bad behavior" and she could no longer work up the upset she previously experienced.  She could now picture herself being positive in the face of her husband's bad behavior. Her throat was not constricted and she felt like she had a voice even under these circumstances.

 The last person I treated on August 16th lost her husband and all seven of her children in the genocide of 1994. She understandably reported much sadness. She couldn't even imagine feeling peace after this tragedy in her life. She reported that she has flashbacks during the day and flashbacks that wake her up at night. She has had very bad dreams consistently and was afraid at night. She suffered from painful feelings of loneliness. We used TFT to address her symptoms of trauma.  Her face, which was very sad when she arrived, began to brighten and eventually her frown grew into a huge smile. Her worn but beautiful face glowed and she was full of hugs and gratitude. She now could not bring up any sadness. Her only concern was that these good feelings might not last. I assured her, as I had assured the others, that likely the good feelings would last, the bad feelings they worked on almost never return. I told her that the Rwandan therapists will now be working at the Izere Center and would be able to help her should any of these fears and other negative feelings return.

 One man reported only physical symptoms. He suffered from headaches, back-aches stomach-aches and chest pains. He often couldn't work and felt very sad and reported feeling like 'half a man'.

 He had been to several clinics and nothing seemed physically wrong with him. He said that he is not bothered by the trauma of the past.  He ran from the perpetrators who were chasing him with guns and escaped by hiding. However, most of his family was killed. At the same time, he reported no anger, fear, feelings of guilt or sadness. However as we conversed he mentioned flashbacks and bad dreams. His flashbacks were so severe that when he experienced them his neighbors accused him of being crazy. When he thought about the events that came back to him as flashbacks and bad dreams he reported a SUD of 8.  We worked with the memories that come up during his bad dreams and flashbacks and he soon felt only feelings of peace. He was not experiencing pain at the time of his treatment because he was ta king pain medication for his symptoms. We are hoping that by addressing his symptoms of trauma his physical symptoms of pain will also be reduced as these symptoms appeared for the first time soon after the genocide.

 One woman whose husband was killed during the genocide spoke of the double pain she experienced because he was a person of a certain ethnic group and was mistaken for a person of another ethnic group and killed. Because of their relationship to him, she and her children were pursued but she was able to hide herself and her children. One of the children was killed a week later by a bomb and another has been missing and presumed dead since 1994. She has one child in secondary school that did very well but she could not afford school fees so the girl now lives at home and cannot go on with her studies. She is not entitled to genocide survivor benefits because of her ethnic identity. Her daughter's having to drop out of school was the woman's greatest concern and greatest cause of anxiety. TFT successfully addressed her feelings of despair and after about an hour and forty five minutes of treatment to address her past trauma and her current anxieties she reported a feeling of peace in her heart when remembering her losses and in thinking about her current unfortunate circumstances.

 Another woman was eleven years old in April of 1994. Whenever she sees soldiers she has intense fear although Rwanda is not at war and the soldiers now work as peace keepers.  It is unclear what she witnessed or experienced concerning soldiers in 1994, however her fear of soldiers seemed crippling, as soldiers are everywhere in Rwanda. At one point, while she was concentrating on her fear she opened her eyes and looked at our interpreter and said, 'You are a soldier'. This young woman's fears were successfully alleviated to the point where she could think about seeing them along the road and be able to pass by them and even greet them.

 During these two days I treated fourteen persons all with similar problems to the ones above. Others included alcoholism, loneliness and three women who had intense fears of the loved ones they lost coming back as ghosts during the night.

 Between us we successfully treated 58 of the sixty persons who had not been admitted into the study due to the 200 study slots allotted already having been filled.