by Chris Killian

Psychiatrist Kristen Underhill Welch, M.D., has counseled people who have endured extreme suffering and survived humiliating torture. But she hadn't experienced anything like what she saw in Rwanda. Welch attended Kalamazoo College in the late 1970s, during which she studied abroad in Sierra Leone. She completed her undergraduate study at University of Michigan.

More recently, in 2008, through contacts she had made with Heartland Alliance for Human Needs and Human Rights, a Chicago-based human rights organization, Welch traveled to Rwanda with another psychiatrist to consult with WE-ACTx, an HIV/AIDS treatment program for women and their families which provides medical services and trauma counseling, on the introduction of psychiatric treatment into their services. She worked to find out how primary care physicians were dealing with the psychological needs of the many persons who required help.

"Those physicians were incredibly busy," Welch said, adding that many of Rwanda's doctors died in the genocide. "It wasn't working for them to provide psychiatric care as well." With only three psychiatrists in the nation working to help a large population of survivors of incredible trauma, it's not hard to understand why.

During three months in 1994, one of the world's most vicious, swift and efficient genocides took place in the tiny African nation. Between 800,000 and 1 million persons are estimated to have lost their lives. The majority Hutus, who made up more than 80 percent of the population, killed Tutsis and moderate Hutus, often with machetes and other hand-held weapons. More than 2 million Rwandans fled the country to seek refuge in neighboring nations.

During the genocide, more than a quarter of a million women were raped, many by men who were purposely trying to infect them with the HIV virus. More than 70 percent of the women raped were infected with the disease and thousands were left pregnant with so-called "children of hate."

That's a lot of trauma to deal with for the scant corps of mental health professionals in Rwanda. Only one psychiatrist in the country is a native Rwandan, Welch said, and there is no faculty of psychiatry at the nation's only medical school.

Fifteen years on, the pain endured by so many - often at the hands of neighbors and even family members - still seeps deeply across generational and familial lines all over the small country, where victims often live in close proximity to their victimizers.

In the United States there is often a focus on the need for a victim to come to a place where he or she can forgive an assailant in order to fully heal, but that isn't always needed or necessary - especially in a situation as intense as was seen in Rwanda, Welch said.

"I'm less focused on forgiveness than understanding the resilience of people," she added. "It's just amazing
"Study abroad has been the backdrop shading and coloring to everything I've done."
to know someone who moved through that experience and into a new reality. People are getting on with their lives."

Of the experience, Welch said: "It deeply moved me, deeply. It still haunts me."

And even though there are no agreed upon best practices to deal with the trauma in Rwanda, there is hope and healing emerging from the pain and suffering.

"Research still needs to be done going forward," she said. "There are no great conclusions yet and many questions remain: which theories would best be used and what about the cultural components? There are more questions than answers."

Welch saw some of the many small support groups that have arisen across Rwanda as a way to provide victims with a place to speak openly about their experiences. Village tribunals called the gacaca system are taking the weight off the country's huge backlog of criminal cases dealing with the genocide and are providing a sense of justice. Children orphaned by the genocide are being adopted, sometimes even by poor families.

"There is a pull toward surviving and resiliency," she said. "People are carrying on."

Although she didn't graduate from "K," Welch credits her study abroad experience as one of the best things she has ever done.

"There is no question it was a formative experience," she said. "It has been the backdrop shading and coloring to everything I've done."

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