The APS Grant for Intercultural and/or International Projects of up to $10,000 supports innovative projects that have an intercultural and/or international focus, particularly in countries where psychology is an emerging discipline. Dr Angela Ebert MAPS, Murdoch University clinical psychologist and trauma specialist working with survivors of genocide, was awarded an APS Grant in 2011-12 for master class training for psychologists and trauma counsellors in Rwanda. Rwandan society suffered genocide in 1994, leaving 13 per cent of households in Rwanda headed by children looking after younger siblings, and widows who were often raped and intentionally infected with HIV/AIDS. Not surprisingly, this has led to high levels of mental health problems, including a high prevalence of depression, anxiety and PTSD, with high proportions of orphans classified as suicidal. Angela shared her experiences and insights about the APS Grant project in Rwanda with InPsych.
What did the project in Rwanda involve?
Rwanda faces the pressing task of training well prepared psychologists who can deliver professional services not only to the survivors of genocide but also to those experiencing the range of mental health issues found in any nation. Training in psychology was only introduced in 1997, and a Masters level program in clinical psychology commenced in 2005.
The project aimed to support practising and trainee psychologists by offering specialist trauma training in the form of trauma work master classes. A further aim emerged during the visit, namely to support a profession that faces considerable challenges not only in terms of the mental health problems prevalent in Rwanda, but also in terms of the poor recognition of the profession and need for developing frameworks such as forming a cohesive professional body, a psychologist registry and quality training assurance structures.
How did you come to be involved with the project?
My involvement in Rwanda reaches back to 2007 when a delegate from the Kigali Memorial Centre (KMC) visited Murdoch University and attended a ‘Trauma in the Media’ conference. His role at the KMC is to record testimonies of survivors of the 1994 genocide. He shared information about the high levels of trauma in the population, and the personal as well as vicarious trauma experienced by those working with survivors in various capacities. His account indicated a need for supporting psychologists and counsellors working with trauma survivors.
Following his visit, a small group of Murdoch academics representing media studies and psychology visited Rwanda in 2009. I was fortunate to be part of this team and had the opportunity to meet representatives of the KMC, survivor organisations, the Ministers of Health and Culture and the Commission for the Fight against Genocide, and to visit the National University of Rwanda. Having taken some presentation materials with me, I delivered impromptu workshops for psychology students and professionals working with trauma survivors. A captive audience absorbed what was shared in the two hours of training and I was urged to come back and deliver more in-depth training.
The APS Grant has enabled me to do exactly that, yet also to learn so much more about the people of Rwanda, the culture, the inspiring resilience that coexists alongside trauma, and the ingenious ways in which this nation is seeking to rebuild a future.
How did the APS Grant assist you in your work in Rwanda?
The Grant enabled me to run a master class for psychology students at the National University of Rwanda and at INATEK, the only other university teaching psychology in Rwanda. In addition, I spent time with research students giving them input to their projects and in discussion with academic colleagues regarding current and future research projects. The standard of the research projects is high and it is disappointing that so little material is published in international journals.
I was also invited to present to practising psychologists, counsellors and agency staff at the Commission for the Fight against Genocide, a key government body that offers trauma counselling and supports the work of survivor organisations. The master classes were well received and we are now thinking about teleconferencing options for further training. Unexpectedly, the APS Grant also gave me the opportunity to meet and exchange with other influential people in the context of care for survivors, and I was invited to deliver a keynote address at a symposium held just before the commemorations of the genocide. A highlight was an invitation to attend the commemoration ceremony at the stadium where thousands of people had been killed – a sombre yet important experience.
What are some immediate and/or longer term mental health and wellbeing issues confronting the people of Rwanda?
The prevalence of PTSD (29%), anxiety disorders (39%) and depression (34%), often with suicidal ideation, is still very high in orphan and widow survivors of the genocide, with rates sitting well above the levels reported in other trauma contexts. Widows often have been infected with the HIV virus (as intentional genocide activity) and many have been raped and had children born from rape. These physical and social challenges interact with mental health problems, making treatment and recovery more difficult. The mental health needs of children born from rape have thus far not been investigated.
Substance use issues are becoming an increasing problem among young Rwandans and currently there are very few programs in place to address these issues. In Rwanda, substance use is conceptualised as a personal weakness, rather than a systemic problem related to the genocide and destruction of the social fabric and community structures.
Much work is yet to be done to further educate government stakeholders on the complex and long-term after-effects of the genocide. For example, mental health problems are also found in the children of perpetrators who have grown up (and still are growing up) carrying the blame for their parents’ actions even though they may have suffered losses themselves. While it is still a highly contentious issue, the Commission is starting to look at the mental health needs of all Rwandans including perpetrators and their families. One of the outcomes of my visit is that a PhD student has decided to investigate the mental health and social needs of Hutu children and young adults.
What kinds of personal qualities and professional skills were most valuable to you during that time?
Flexibility, curiosity and openness as well as a willingness to build friendly relationships with the people have helped with achieving the aims of the project. Working in Rwanda means time and travel plans will often need to be adjusted. Amazingly, remaining flexible meant not only that everything planned did eventually happen (sometimes surprisingly so), but also many unplanned meetings took place that enhanced my visit to Rwanda.
Being open-minded and curious allowed me to discover Rwandan ways of understanding trauma and hearing about fears of visitors pushing Western models without considering the cultural and value-based understanding of trauma recovery in Rwanda. I was thus keen to have opportunities for informal get-togethers after the training with the hope of engaging Rwandan colleagues and psychology students in an active debate concerning culturally valid practices of trauma psychology. These meetings engendered lively discussions. I learned much and realised the tremendous obstacles psychologists face, including the difficulties of working in a profession that does not enjoy the recognition granted to other professions such as nursing or teaching. Psychologists in Rwanda earn a third of the salaries of these other professionals and there are very few real jobs in psychology. Moreover, psychological interventions are not seen as effective treatment methods by other (mental) health professionals, especially medical doctors. Many of my colleagues sounded disheartened.
Fortunately, resilience prevails. A group of academic and practising psychologists is setting up a professional body and developing accredited training standards. Just before my return to Australia, I learned about the official recognition of a registered organisation of psychologists. The first step is achieved, yet many more need to be taken. We continue our exchange of knowledge and ideas for further development of the profession.
What has the experience meant for you as a person and as a psychologist?
On a personal note, it is impossible to visit Rwanda and not be inspired by the survivor spirit in this nation while also being deeply touched by the omnipresent reminders of unspeakable atrocities and suffering. Living in a peaceful nation and all this affords us is something I now value even more deeply. From a professional perspective, visiting Rwanda was a privilege that has given me an opportunity to learn more as well as teach about trauma in the context of genocides. Having to work on a community level versus individual work is a challenge that Rwandans have embraced and there are models for us to look at and consider.
Likewise, being able to teach the neuropsychology of trauma and discuss trauma treatment in the context of neurobiology and brain processes has enabled practitioners there to understand better the complex trauma presentations they encounter, such as, for example, the high prevalence of pseudo-seizures. A special moment occurred when the head of the student psychologist organisation told me that my training had rebuilt the students’ confidence that working as a psychologist has a future. After the training, which provided a considerable body of evidence for the efficacy of psychological interventions, he wanted to use his organisation to start an education campaign for other health professionals in order to change outdated views of the profession.
Is there a take-home message for us as psychologists here in Australia, and as global citizens?
By sharing and exchanging, we learn from each other and can extend knowledge and models of practice. Personally, I hope to learn more about the inspiring resilience of Rwandan people. My Rwandan colleagues (and now friends) are also keen to engage in continuous professional learning. In order to do this they need resources that will aid developing the profession, including books and access to databases (students can only access a few journals!) and support with publishing their research. We take so much for granted having easy access to electronic materials and big libraries. I was able to use a small part of the APS Grant to purchase resources for the university library and I continue to look at ways to build up psychology materials for Rwandan students and practitioners. Anyone with good ideas on how to help further is most welcome to make a contribution.
Angela can be contacted at A.Ebert@murdoch.edu.au
The call for applications for the 2013 APS Grant for Intercultural and/or International Projects can be found here.