Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.

Abstract

In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory.