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date: 04 December 2020

Ihahamuka: An Indigenous Medical Condition among Rwandan Genocide Survivors

Abstract and Keywords

One of the core metaphors in Rwandan traditional medicine concerns the flow of bodily fluids. This metaphor is a recursive one, extending into other domains of Rwandan symbolic thought, including notions of the person, ritual, and myth. Stated briefly, this metaphor opposes states of orderly flows to disorderly ones, including blocked flows and excessive flows. The healthy body is characterized by sufficient but not excessive or inadequate bodily flows. Unhealthy or afflicted bodies are often characterized by disorders in “flow” states. After the genocide, many Tutsi victims experienced post-traumatic stress in the form of a specifically Rwandan symptom that they termed ihahamuka. This symptom, as described by Rwandans, involves the blockage of breath in the lungs. Many Rwandans who had suffered extreme trauma during the genocide, but had managed to survive, complained of ihahamuka. Many were highly “Westernized” in terms of their education and religion but were experiencing a disorder that can only be fully understood via traditional Rwandan medicine, a medicine in which they expressed very little credence.

Keywords: Rwanda, medicine, traditional medicine, genocide, survivor, ihahamuka, blocked flow, disorder, gacaca

By now it is generally accepted that there are many different and culturally specific ways of thinking about the human body and its processes, pathologies, and cures. Yet despite this diversity, some core metaphors are found again and again, although the cultures in question are often distant from one another in time or space. One such root metaphor focuses on the idea of flows of substances or energies along bodily pathways. In Chinese traditional medicine, for example, there is qi, whose orderly or disorderly movement is thought to underlie health and sickness. In Indian Tantric medicine kundalini serves a similar role. In Rwanda, where I have done several stints of fieldwork, there is no specifically named energy, but perturbations in the flows of bodily substances—such as blood, semen, menstrual blood, and breast milk—are a central preoccupation. These liquids, acting as icons, come very close to what Roy Wagner calls “symbols that stand for themselves,” in that their cognitive and pragmatic functionality cannot be separated from one another (Wagner, 1986). In this essay I will concentrate on Rwandan traditional medicine and attempt to show that it is only by understanding this medicine that we can understand the techniques of cruelty employed during the 1994 genocide and the disorder known as ihahamuka, a symptom that only became common after the genocide.

My first fieldwork in Rwanda began in 1983. More recently, in the spring of 2009, I was there to study the post-genocide localized justice system called gacaca. Although in recent years I have concentrated on issues related to the 1994 genocide, much of my earlier work concerned local notions of the body and of healing. When I returned to the United States in 1985 after my first period of fieldwork in Rwanda, I noticed that many of the case histories of patients and healers were characterized by what I came to call “flow/blockage disorders.” For example, there are conditions known as kumanikira amaraso and umukobwa utajya mu mihango, caused by sorcery, which negatively affect female fertility (see the discussion later in the essay).

Medicine in Rwanda during the 1980s was pluralistic. There was a medical school, and its graduates were trained in scientific biomedicine. This was the most prestigious type of medicine, and for most disorders that could not be treated at home, it was probably the most frequently employed. Consulting a physician at one of Rwanda’s hospitals did not require that the patient pay. In sharp contrast, filling a prescription at one of Rwanda’s pharmacies did require payment. Since most medicines sold for prices comparable to those in Western countries, it was often difficult for Rwandans to obtain modern pharmaceuticals. This acted as something of an impetus to push Rwandans in the direction of other medical systems, such as Chinese, Indian, or Rwandan traditional medicine.

Rwandan traditional medicine, or ubuvuzi bwa Gihanga, employed both empirical and nonempirical treatments. Medicinal herbs were the remedies of choice in the empirical treatments, while ritual procedures in addition to the use of plant or animal substances were employed in the latter case. Pluralism also characterized traditional medicine. Some healers concentrated on diagnosis through divination. Others were herbalists. Yet others employed ritual. Some used a mixture of these techniques. In addition to differences in healing techniques, healers differed over the theoretical bases to their therapies. Some healers, for example, believed that many disorders were the result of sorcery; others denied the existence of sorcery and witchcraft, maintaining that such disorders were caused by fear or by sin (Taylor, 1992).

Both Rwandan and Chinese medicine possesses notions concerning flows and blockages. In the Chinese case there is qi. It is difficult to define exactly what qi is. At times it appears to be simply a bodily fluid. At other times qi is more like an energy flowing along circuits in the body and influencing the flows of other bodily fluids such as blood and bile. There is disagreement among practitioners about qi and its action, but some schools within the tradition see the liver as the locus where qi coalesces then is dispersed into other parts of the body. Problems arise when the flow of qi stagnates in the liver. This causes perturbations in the flows of other bodily fluids and substances and can also cause emotional disorders (Farquhar, 1994; Zhang, 2007).

Similar to the notion of qi, although it is more unambiguously an energy rather than a substance, is the Indian Tantric idea of kundalini (Kakar, 1982). Kundalini is thought to flow along the spinal axis from a place at the base of the sacrum halfway between the genitalia and the anus to the top of the skull. This energy passes near six centers or chakras and can deviate either through the male ida or the female pingala. The object of therapy is to rechannel energy that normally might flow through the ida or the pingala to the central conduit, or sushumna. As the rechanneled kundalini passes upward in this way it enters each of the six chakras. The “lotuses” associated with each of the chakras can then open. This signifies the opening of the spirit to “knowledge” and transformation (Kakar, 1982, 187).

Early European and near Eastern humoral medicine (Yunani) are different from traditional Chinese and Indian medicine in that it is not simply the flow, obstruction, or stagnation of substances that is of concern, but rather the balance among four humors: yellow bile, black bile, blood, and phlegm. Four reservoirs of these substances reside within the body and can affect one another; when one humor is deficient, another is in excess. The object of therapy is to regulate the flows of these humors among one another so as to achieve balance.

Even biomedicine has its flows and blockages. Atherosclerosis and all the maladies that follow in its wake—ranging from heart attacks and strokes to peripheral artery disease, deep vein thrombosis, pulmonary emboli, and even erectile dysfunction—are said to be the result of obstructed blood flow due to plaque buildup in veins and arteries. Using empirical evidence, biomedicine can easily demonstrate the physical existence of blockages and obstructions in blood flows. However, would experimental inquiry have been oriented in this direction had a model taken from humoral medicine not already existed? It is reasonable to ask if William Harvey’s 1616 depiction of the circulatory system would have been created if it had not been for traditional medicine’s preexistent conceptual imaging of flows.

In addition to Rwanda other sub-Saharan African examples of flow/blockage symbolism exist. Similar to Rwanda, these are encountered in the domains of health, fertility, and ritual. One of the most striking examples concerns a group called the Komo, which resides in northeastern Congo (Democratic Republic of Congo [DRC]). Because the Komo live not far from Rwanda, it is perhaps not surprising that their symbolism would show some similarities. In sharp contrast to Rwanda, however, their symbolism is explicit and conscious, whereas in the case of Rwanda the symbolism is covert and implicit. During the Komo male initiation ritual, a small reed is inserted into the urethra of the penis (de Mahieu, 1985). Elders then remove the reeds from the neophytes while they sing, “Who obstructed the waterfall?” This ritual action signifies the transformation of infertile boys into fertile men. Another Congolese example concerns the Sakata, who reside in north central Congo (DRC). Among the Sakata life is thought of as a “flow of life force” (Bekaert, 1997). When this flow of life force is interrupted or obstructed, illness results: “Illness is like a ‘bubble of blood’ (kembomene ke makela), a constipated clot of blood, blocking the healthy redistribution inside the body” (Bekaert, 1997, 351).

It is not my intention in this essay to explore all the avenues of inquiry to which these speculations give rise. Instead, I will concentrate on indigenous Rwandan notions of the body and of pathology. I begin by discussing bodily humors that are of particular concern in Rwandan medicine. I will also examine material from case histories that I collected from patients and healers during the 1980s. I will then show how certain specifically Rwandan notions of the body recurred in the “techniques of cruelty” employed during the 1994 genocide. Finally, I will discuss one of the sequelae to the genocide, ihahamuka.

Bodily Fluids in Health and Illness

The first fluid that one observes playing an important role in Rwandan popular medicine is saliva (amacaandwe). In most divinatory practices the client spits upon some object used in the procedure before the procedure begins. Saliva is used in divination, for it is thought to embody the person’s nature or essence (kamere muntu). When Rwanda was ruled by the mwami (king), court diviners employed the king’s saliva (de Heusch, 1982, 118); a special ritualist was charged with the function of obtaining this saliva and keeping it in a special container. The saliva of imaana (supreme being, fertility principle) was also imbued with special properties; imaana was said to have given life to the first man by using his spittle to moisten a clay simulacrum. Healers sometimes use their saliva in therapeutic practices, especially when the disease they are treating is a skin disease. In this instance it is not unusual to see healers expectorate directly on the skin lesion. Some healers say that saliva is a by-product of the brain resulting from its normal action. People that are mad, for example, are said to have mouths that are dry. In other words, they are lacking in an essential fluid, one thought to contain the “nature” of the person, his kamere muntu.

Probably the most important humor in cases of spells or poisonings (uburozi), however, is amaraso (blood). Poisons attack the blood first, except those that cause madness. In such cases the poison attacks the heart (umutima) and the brain (ubwonko), for the heart and brain are thought to work together in producing and maintaining consciousness. When Rwandans speak of “losing heart,” they mean loss of consciousness or fainting. The heart is the seat of reason, volition, and desire; the brain aids the heart in these functions. The organ of tactile sensibility is the blood. Blood coursing through the veins allows the heart and the brain to sense whether something that one touches is hot or cold, soft or hard.

Healers state that amarozi (spells, poisons) diminish the total volume of blood in the body; poisons dehydrate the body. A poisoning can decrease the volume of blood in the body by as much as one-half without yet killing the victim. When someone dies from an uburozi, it is because he or she has lost most or all of his or her blood. Male semen (amasohoro) is also thought to be blood, but in a purified form. Some healers state that semen production begins within the brain and then passes through the spinal cord into the scrotum. The production of semen is promoted by a healthy diet and beverages such as igikoma (a thick liquid made from sorghum), ikigage (sorghum beer), and amata (milk). Beverages that have a higher alcoholic content than ikigage, such as urwarwa (banana beer), Primus (a brand of Rwandan bottled beer), and whiskey, are detrimental to the production of semen when drunk to excess. Such beverages dehydrate the body and delay or impede ejaculation.

Contained within semen (amasohoro) is its active principle, intanga (“gift of self,” from the verb gutanga, “to give”), which gives semen its power to impregnate. Unhealthy intanga lack the power to fertilize, while yet others are like gasoline and can either burn the woman’s uterus or dehydrate the child in her womb if she is already pregnant. Women also possess intanga. This intanga resides in the woman’s blood, but it is not as strong as that of the male. As a result, some healers say that the sentient and moral qualities of the person, the heart (umutima) and the brain (ubwonko), are inherited from the father. Some healers, more often female than male, state that the contributions of mother and father to the child’s makeup are equal. Healers say that male intanga and female intanga join together to produce new life after both the man and the woman have had orgasm during coitus. The most likely time for conception to occur is within the first week after the woman has had her period.

Conception does not occur all at once. For this reason, many healers add that a couple must have frequent intercourse (gukurakuza) during pregnancy to permit the two types of intanga to continue to fuse. Gukurakuza is said to be especially important during the later stages of pregnancy. Other healers, more influenced by biomedical notions of health and hygiene, dispute the idea that semen has any long-term constitutive effect on the fetus. While these healers discount any direct effect of semen on the fetus’s growth, most say that semen fortifies the woman by adding to her blood. According to these healers and even many Rwandans influenced by biomedical ideas, women who have had frequent intercourse with their husbands during pregnancy are less likely to miscarry or suffer problems during childbirth, for they have blood in sufficient quantity. Moreover, after childbirth, the husband’s semen is said to aid in healing any lesions the woman may have sustained during parturition. Both “traditional” and “modern” Rwandans agree, therefore, that sustained sexual activity during pregnancy is desirable.

Some healers also told me that the vaginal intake of semen after childbirth aids directly in the production of breast milk (amashereka). Others, however, say that it is the action of intercourse that aids lactation, rather than any direct effect of semen per se. A woman’s breasts consist of fat that, according to these healers, must melt in order for amashereka to be produced. Frequent intercourse with her husband develops a feeling of congeniality and human warmth (ubushyushe) on the part of the woman. It is this warmth that promotes the melting of the breast fat and its transformation into maternal milk.

Their mother’s milk is the principal sustenance of Rwandan babies, and children may continue to nurse until they are three or four. Obtaining amashereka in sufficient quantity, therefore, is often a matter of life and death for Rwandan infants. Kwashiorkor, for example, is most frequently observed among children who are no longer being breast-fed. A woman who lacks amashereka is called igihama, a term that also applies to women who lack vaginal secretions (amanyare) during intercourse. The noun igihama comes from the verb guhaama: “to cultivate a field hardened by the sun; to have sexual relations with a woman who lacks vaginal secretions” (Jacob, 1985, 1:437). Although someone outside the context of Rwandan culture might not see any connection between a woman who lacks breast milk after childbirth and one who lacks vaginal secretions during intercourse, Rwandans not only see a connection, but they also equate the two women by using the same term to denote them. Both women lack an important bodily fluid. One that is important for a woman and her child, and another that is important for a woman and her husband. In both cases this lack of the requisite fluid compromises the woman’s and the household’s fertility.

A woman can become igihama in several ways. According to some healers, the condition can be congenital. In other instances, menopause, parasites, or the Rwandan disease called ifumbi can cause it. In yet other cases, uburozi (poisoning) can be the basis. Poisoning is thought to be common among co-wives in a polygynous household. If one wife succeeds in stealing some of the fluid (amanyare) or urine (inkali) that her rival produces during intercourse, she may poison it in order to make her rival become igihama. She might also use her victim’s menstrual blood. One possible treatment for a woman who has become igihama includes the following plants: umunkamba (Clematis var. sp.); umukuzanyana (Clerodendrum rotundifolium), a plant that is frequently given to calves because its name derives from the words gukuza (to make something grow) and inyana (calf); umusange (Entada abyssinica); and igihungeri (Philippia benguellensis). These medicines act by restoring “heat” (ubushyushe) to the woman’s blood. With sufficient “heat” the woman will be able either to lactate or to produce vaginal secretions in sufficient quantity.

The sickness known as ifumbi, which is probably the most common malady of women treated by Rwandan healers, can cause a woman to become igihama. It can provoke miscarriage as well. Though this sickness is perhaps the most exemplary Rwandan disorder, ifumbi is not caused by poisoning. Nor is it propagated by ordinary contact between people. Some healers say that ifumbi is caused by the eggs of parasitic worms such as Tenia. The illness attacks the lower part of the abdomen first, causing pain especially during pregnancy and preceding menstruation. It can cause a woman to bleed from the vagina during pregnancy or at times when she should not be menstruating.

Though more common in women, it can also afflict men. Nosebleeds are a frequent symptom among men who have ifumbi. Furthermore, when a man contracts ifumbi, he may have difficulty urinating, his testicles may swell, and he will usually lose the power to ejaculate, though not necessarily the capacity to have an erection. Without treatment, such a man can become permanently impotent, for ifumbi is said to be able to “buckle” its victims. In either men or women, ifumbi can cause vomiting, constipation, bladder problems, and sterility.

After attacking the lower abdomen, ifumbi enters the blood and begins to damage it. The sufferer experiences feelings of generalized pain, weakness, or dizziness. Though ifumbi can become localized in the lower abdomen or in the legs and cause swelling, ifumbi may move upward in the body, passing through the spinal column into the mouth and head. The teeth can be attacked by ifumbi—their color can change, or they can rot away completely if the disease is not checked. Once ifumbi has moved to the head area via the spinal column, it can propagate along tendons, veins, and nerves, causing dizziness, diminished eyesight, and even mental debility. Though some of these symptoms resemble syphilis, healers are quick to point out that ifumbi and syphilis differ. The latter is accompanied by sores, while the former is not.

The medicines already mentioned previously, which are used to treat women who have become igihama, can also be employed to treat ifumbi. Such medicines follow the course of the disease in the body. They begin their action in the lower abdomen and then move along the spinal column, nerves, tendons, and so on. Another Rwandan medicine that is often used to prevent and to cure ifumbi in girls and women consists of a somewhat complex mixture of several plants and clay dug from a swampy area near a lake or pond where cattle go to drink and to urinate. This medicine is called inkuri, and it is frequently administered to pregnant women as a prophylactic measure against ifumbi, as well as other sicknesses.

One of the recipes for inkuri includes the following plants: igihoondohoondo, umusene, inyabarasanya, ukurimwonga, igicuncu, umushishiro, umuravumba, umunkamba, kazigashya, akanyamapfundo, umuzigangole, umushaariita, igifumbafumba, and umwanzuranya (I.N.R.S. dictionary, n.d.). Igihoondohoondo (Dracaena steudneri) is a tree that has yellow wood and white flowers; the word for yellow, umuhoondo, resembles this tree’s name and also designates the first milk a cow gives after calving. Umusene (Ficus asperifolia) is a plant that has yellow fruit. Inyabarasanya (Bidens pilosa) is a plant that has white and yellow flowers. Ukurimwonga (Thunbergia alata) has whitish-yellow flowers. Umushishiro (Zehnaria scabre) is a plant whose flowers are whitish-yellow. Umuravumba (Tetradenia riparia) has whitish flowers. Umunkamba (Clematis hirsuta) has white flowers. Kazigashya (Ranunculus multifidus) has yellow flowers. Akanyamapfundo (Leucas martinicensis) has white flowers. Umuzigangole (Pauridiantha paucinervis) is a plant with white flowers. Igifumbafumba (Rumex abyssinicus) is a plant with greenish, yellowish, white flowers. The plant is used in preparing a yellow dye. Umwanzuranya (Dicoma anomala) has white flowers.

Notice that most of these plants are associated with the colors white and/or yellow. Yellow, one of the colors, until 1994, of the Rwandan flag, is often used to symbolize peace. White is the color of milk and semen. It is used to symbolize purity, fertility, and the termination of mourning (kwera: to whiten). It is not fortuitous to find these plants, whose flowers evoke the two important fertility fluids, milk and semen, used against a sickness whose symptoms involve primarily the perturbed flow of bodily humors.

The clay used to prepare inkuri reinforces the symbolic powers associated with the colors white and yellow. As mentioned earlier, this clay is found in wet areas where cattle drink and urinate. Once again, the drinking and urinating evokes a flowing process, for the waters that the cattle drink enter, then exit, then reenter their bodies. According to legend, cattle were supposed to have originated from the terrestrial waters of a lake (Taylor, 1988). When cattle return to drink at a pond or lake, they are in a sense returning to their place of origin. Such places can be thought to be particularly auspicious repositories of imaana. Furthermore, when cattle ingest these waters, excrete, then re-ingest them, imaana becomes concentrated, just as the drying out of the mud and adding herbs to it potentiates its medicinal efficacy.

Rwandan Sorcery

Although not all Rwandans during the 1980s believed in sorcery, those who did frequently consulted traditional healers. We see that sorcery spells or poisonings also conform to the flow/blockage logic I have previously discussed. The spell termed kumanikira amaraso—literally: to suspend blood—is a good example. This spell prevents a woman from being able to deliver her baby. Sometimes it prevents her from conceiving. One traditional healer explained to me that the spell causes the baby to rise toward the heart instead of descending toward the birth canal. Another healer, a woman named Antoinette, told me that many pregnant women are victims of kumanikira amaraso, which causes the baby to become turned transversally in the womb.

One method of afflicting a woman with this spell is to take some of the blood and other fluid, called igisanza, that exuded from her womb during a previous childbirth, place it in a packet along with other medicines, and suspend it from the rafters of a house. This form of the spell prevents the woman from being able to deliver again.

Another version of this spell involves taking the woman’s menstrual blood (irungu), vaginal secretions (amanyare), urine (inkali), or, if none of these things is available, a piece of her clothing, putting it in a packet with medicines, and (1) placing it in a cave, (2) suspending it from the rafters of a house, or (3) laying it among rocks, where rain cannot touch it, on the summit of a high hill. In this instance, the woman’s menstruation is stopped, and she becomes sterile. An interesting variant of this poisoning entails putting the blood, secretions, or other bodily fluid into a stream of fast-moving water. In this case, the woman’s menstruation becomes hemorrhagic. It also causes sterility and can be life-threatening. Some healers refer to this last variant as umuvu, while others consider it a form of kumanikira.

In effect, by suspending a woman’s blood or other fluids involved in sexuality or reproduction, the woman’s reproductive functions are also “suspended.” Either she becomes unable to deliver the baby already in her womb, or menstruation stops and she becomes sterile. By suspending the woman’s bodily fluids in a position between sky and earth, or in a place where rain cannot touch them, the woman’s body becomes “blocked.” When her fluids are put into a body of fast-moving water, her menses become dangerously abundant.

Healers vary in their treatment of this poisoning, but treatments nevertheless possess features in common. One healer has the woman lie on her back while naked. He sprinkles medicines in a line from the woman’s forehead, over the middle of her face, over her chest and abdomen, down to her genitals. The logic behind this treatment appears to be that movement must be encouraged from the top of the body to the bottom.

Antoinette, mentioned earlier, uses another method. Her treatment of kumanikira follows a similar line of symbolic reasoning to the previous treatment, but it engages more elements from the macrocosmic sphere in which the female body as microcosm is embedded: house, earth, sky, and rain. Antoinette has the woman lie naked on her back inside her house. Someone climbs on the roof of the house, parts the thatch, and then pours an aqueous mixture of medicines through the opening onto the woman’s abdomen. Another person inside the house then rubs the woman’s stomach with the medicinal mixture. In this treatment the blockage within the woman’s body is seen as a blockage between sky and earth, for it is countered by someone actually moving to the sky position (ascending to the roof of the house) and pouring fluids earthward. This time, however, the downward movement of fluids includes the woman’s body in the circuit of flow from sky to earth. The cure is virtually a one-to-one homeopathic reversal of the symbolic operations accomplished in the poisoning, which removed the woman’s body from the circuit of moving fluids by suspending her blood. In this cure, an analogy is established between the female body and the elemental forces of nature.

Another spell that is characterized by flow/blockage symbolism is the one known as urukarango or umukobwa utajya mu mihango (girl who cannot menstruate; whose menstruation has been stopped). This spell is similar to the kumanikira amaraso spell, and some healers consider it to be a variant of it, but, according to one healer named Baudouin, the procedure used to cast the spell is different.

Baudouin told me that a poisoner can inflict this spell by taking some of the girl’s urine, or her menstrual blood, adding medicines (he did not know which ones) and water to it, and then cooking the mixture on a piece of broken pottery taken from a vessel that has never been used (urujo). The mixture is cooked until the liquid evaporates. The girl stops menstruating and becomes sterile.

Baudouin usually treats this spell with the powder of a dried insect called impanguzi, which lives among plants called imvura idahita. The powder is added to other plants, including umurasanka and amarebe (a plant that grows in, or near, lakes). The plant amarebe (sing. irebe) is probably used because its name is similar to the words mu irebe, which means “in front of the door to a house.” The idea here is that the girl should find herself, after the cure, before the door to a house, that is, ready to enter it as a fertile woman with a husband.

The impanguzi is used because its name derives from the verb guhaanguura, one of whose meanings is “to impregnate a woman, or a female, previously thought sterile” (Jacob, 1985, 1:456). Furthermore, this insect lives among plants called imvura idahita, which means “rain which does not cease falling.” In this instance the reasoning is that after treatment the girl’s menstruation should never fail again. In summary, a girl treated for umukobwa utajya mu mihango should recover her capacity to menstruate and consequently her fertility. Then she will find herself before the door to a house (that is, be marriageable).

Techniques of Cruelty Employed during the Genocide

State-promoted violence persistently defies the state’s attempts to rationalize and routinize it. Issues of personhood and the body, all of which are generally implicated in nationalistic expressions of violence, do not follow a universal logic. Likewise, this logic is not limited to the common exigency to eliminate as many of the regime’s adversaries as possible. State-promoted violence persistently defies the state’s attempts to rationalize and routinize it. The psychologically detached, dispassionate torturer does not exist; the a cultural torturer who acts independently of the habitus that he or she embodies does not exist. Nor can the interposition of killing machines or technology efface what Kafka so perceptively recognized in The Penal Colony, which is that societies “write” their signatures onto the bodies of their sacrificial victims (Kafka, 1987). As Foucault shows, power constructs human subjects and a certain homology obtains between the quotidian disciplinary practices employed by social institutions like the army or the school to produce “docile bodies,” and the more coercive measures employed against criminals and enemies of the state (Foucault, 1977). Taking this observation further, one might justifiably ask: Why do the French guillotine, the Spanish garrote, the English hang, and the Americans electrocute, gas, or lethally inject those in their midst whom they wish to obliterate from the moral community? Among the numerous forms of state cruelty that Edward Peters examines in Torture, he notes that “there seem to be culturally-favoured forms of torture in different societies” (1996, 171). Not all methods are used everywhere. In Greece, for example, there appears to be a preference for falanga (the beating of the soles of the feet), a torture that is not as common in Latin America where electrical shock predominates. In 1994 in Rwanda torturers manifested a certain proclivity to employ violent methods with specific forms. These forms betrayed a preoccupation with the movement of persons and substances and with the canals, arteries, and conduits along which persons and substances flow: rivers, roadways, pathways, and even the conduits of the human body such as the reproductive and digestive systems.

Among the accounts of Rwandan refugees that I interviewed in Kenya during the late spring and early summer of 1994, there was persistent mention of barriers and roadblocks. Like Nazi shower rooms in the concentration camps, these were the most frequent loci of execution for Rwanda’s Tutsi and Hutu opponents of the regime. Barriers were erected almost ubiquitously and by many different groups. There were roadblocks manned by Rwandan government forces, roadblocks of the dreaded Interahamwe militia, Rwandan communal police checkpoints, barriers set up by neighborhood protection groups, opportunistic roadblocks erected by gangs of criminals, and even occasional checkpoints manned by the Rwandan Patriotic Front (RPF) in areas under their control. For people attempting to flee Rwanda, evading these blockades was virtually impossible. Moreover, participating on a team of people manning a barrier was a duty frequently imposed upon citizens by Rwandan government or military officials.

Several Hutu informants who escaped Rwanda via an overland route explained to me that they had had to traverse hundreds of roadblocks. One informant estimated that he had encountered one barrier per hundred meters in a certain area. Another counted forty-three blockades in a ten-kilometer stretch on the paved road between Kigali and Gitarama. Leaving major highways was no solution, for one would encounter barriers erected across dirt roads and footpaths manned by local peasants. At every barrier fleeing people were forced to show their national identity card. Since the ID card bore mention of one’s ethnicity, distinguishing Tutsi from Hutu was no problem and, almost always, fleeing Tutsi, said to be ibyitso or “traitors,” were robbed and killed. When a refugee claimed to have lost his or her ID card, physical features were relied upon as ethnic identification. It was to one’s advantage to look Hutu (to be of moderate height and to have a wide nose). One refugee that I interviewed, classified as Tutsi because his father was Tutsi and his mother was Hutu, escaped without showing his identity card because his features were typically Hutu. Another, classified as Hutu because his father was Hutu but his mother was Tutsi, narrowly missed being executed in Gitarama because of his Tutsi-like physiognomy.

Barriers were ritual and liminal spaces where “obstructing beings” were to be obstructed in their turn and cast out of the nation. The roadblocks were the space both of ritual and of transgression, following an ambivalent logic that Bourdieu underlines: “The most fundamental ritual actions are in fact denied transgression” (1990, 212). There were scenes of inordinate cruelty. Often the condemned had to pay for the quick death of a bullet, while the less fortunate were slashed with machetes or bludgeoned to death with nail-studded clubs. In many cases victims were intentionally maimed but not fully dispatched. Beside the line of motionless corpses awaiting pickup and disposal lay the mortally injured, exposed to the sun and still writhing, as their persecutors sat by calmly, drinking beer.

If the movement of people could be obstructed with barriers, it could also be hindered by directly attacking the body. The parts of the body most frequently targeted to induce immobility were the legs, feet, and Achilles tendons. Thousands of corpses discovered after the violence showed evidence of one or both tendons sectioned by machete blows. Other victims later found alive in parts of Rwanda where humanitarian organizations were able to intervene had also sustained this injury. When it entered eastern Rwanda in late June 1994, Doctors without Borders declared in presentations to televised media that this injury was the one most frequently encountered in the area. While the organization managed to save many lives among those so injured, it warned that in practically every case, costly surgery would be needed to restore some capability of movement to the foot. This injury, known in medieval France as the “coup de Jarnac,” has sometimes been attributed to the influence of French troops and their alleged training of Interahamwe militia members (Braeckman, 1994). While I have no evidence to refute this claim in this specific instance, Braeckman’s assertion does not explain why the technique was used in Rwanda during the violence of 1959–1964 and in 1973. Moreover, in previous episodes of violence as well as in 1994, assailants also mutilated cattle belonging to Tutsi by cutting the leg tendons. Although many cattle in 1994 were killed outright and eaten, and others were stolen, a large number were immobilized and left to die slowly in the field.

This technique of cruelty has a certain logic to it where human beings are concerned. In the presence of a large number of potential victims, too many to kill at once, Interahamwe might immobilize fleeing victims by a quick blow to one or both of the Achilles tendons. Then the killers could return at their leisure and complete their work. This makes sense, yet it does not explain why many who sustained this injury were children too young to walk, elderly people, people who were crippled or infirm, and people in hospital beds incapable of running away. It is here that the pragmatic logic of immobilizing one’s enemies and the symbolic logic of “blocking the path,” which are not contradictory in many cases, are in conflict. Why obstruct the already immobile? As with barriers on paths and roadways, there is a deeper generative scheme that subtends both the killers’ intentionality and the message inscribed on the bodies of their victims, even though these techniques of cruelty also involve a degree of improvisation. Power in this instance, in symbolic terms, derives from the capacity to obstruct. The persecutor “blocks the path” of human beings and impedes the movement of the material/symbolic capital necessary to the social reproduction of human beings—cattle. Even when it is apparently unnecessary to arrest the movement of the immobile, the assertion of the capacity to obstruct is nonetheless the claim and assertion of power.

If the movement of bodies could be obstructed by roadblocks and the severing of Achilles tendons, then the body as conduit could be completely blocked by impalement. Liisa Malkki (1995) notes that, during the 1972 violence against Hutu in Burundi, many victims were impaled from anus to mouth for men, or from vagina to mouth for women. Rwandan Tutsi victims during 1994 also suffered this fate. Although none of the refugees that I interviewed in Nairobi spoke of having witnessed impalement, it was reported in Kenyan newspapers that I read during the summer of 1994. More recently it has been cited in an African rights report entitled “Rwanda: Killing the Evidence” as a means by which perpetrators of the genocide still living on Rwandan soil terrorize surviving witnesses (Omaar & de Waal, 1994). For example, the report cites the case of a certain Makasi, a resident of the Kicukiro suburb of Kigali, who, several months after the genocide, found a leaflet shoved under his door threatening his life and that of several others:

You, Makasi are going to die no matter what. And it will not only be you. It will be Bylingiro as well. Let your wife know that she will be killed with a pole which will run from her legs right up to her mouth. As for Charles’ wife, her legs and arms will be cut off.

(Omaar & de Waal, 15)

Even before the genocide, impalement was occasionally depicted in the popular Rwandan literature of Hutu extremism as one of the preferred means of torture used by the RPF and other Tutsi to dispatch their Hutu victims.

In pre- and early colonial times Rwandans impaled cattle thieves. The executioners inserted a wooden stake into the thief’s anus and then pushed it through the body, causing it to exit at the neck or the mouth. The pole, with its agonizing charge, was then erected, stuck into the earth, and left standing for several days. Dramatically gruesome and public, this punishment carried a clear and obvious normative message intended to deter cattle thievery. In a more subtle way, the message can be interpreted symbolically. Because cattle exchanges accompany, legitimize, and commemorate the most significant social transitions and relationships, most notably, patron-client relations, blood brotherhood, and marriage, obviating the possibility of such exchanges or subverting those that have already occurred by stealing cattle removes all tangible mnemonic evidence of the attendant social relationships. Diverting socially appropriate flows of cattle by means of thievery is a way of “blocking the path” (gusiba inzira) between individuals and groups united through matrimonial alliance, blood brotherhood, or patron-client ties. It is symbolically appropriate, therefore, that people who obstruct the conduits of social exchange have the conduit that is the body, obstructed with a pole or spear.

About eighty popular journals, each with a different point of view, arose between 1990 and 1994, quite extraordinary for a country with a population of about seven million. Some of these journals employed symbols of kingship in their depictions of Habyarimana (Rwandan President Juvenal Habyarimana), but it was more often the case that Hutu extremist journalists explicitly accused the RPF of wanting to restore the monarchy, its trappings, and its rituals. Routinely, Hutu extremist journalists referred to RPF members as “feudo-monarchists.” Several of their cartoons recall the former custom of emasculating slain enemies and then using these body parts to adorn the royal drum. See, for example, Figure 1 [cartoons from Chretien, 1995, 364–365].

IhahamukaAn Indigenous Medical Condition among Rwandan Genocide Survivors

Figure 1 The assassination of Ndadaye, reinterpreted according to the fantasies of extremist anti-Tutsi propaganda (La Medaille-Nyiramacibiri, November 1993, no. 17, p. 10).

Cartoon from: “La Medaille-Nyiramacibiri,” November 1993 (one of the many inexpensive political magazines, published in Rwanda during the years leading up to the genocide).

In Figure 1, a cartoon from an extremist Hutu magazine, La Medaille-Nyiramacibiri, RPF soldiers are depicted crucifying, impaling, and castrating Melchior Ndadaye, neighboring Burundi’s first democratically elected Hutu president. Elected in October 1993, he was subsequently killed by Burundian army officers (all of whom were Tutsi) in an abortive coup attempt


A civilian RPF supporter: “this stupid Hutu and after you cut off his genitals, hang them on our drum.”

Ndadaye: “Kill me, but you won’t exterminate all the Ndadayes in Burundi.”

Kagame (formerly RPF general, now president of Rwanda) [right side of cartoon]: “Kill him quickly. Don’t you know that in Byumba and Ruhengeri we did a lot of work. With women, we pulled the babies out of their wombs; with men, we dashed out their eyes.”

The drum: “Karinga of Burundi.”

This image condenses a great deal of violence at both the discursive level and at a level that I would call prediscursive or imaginary. At the discursive level we see a clear iteration of the oft-repeated charge by Hutu extremists that the RPF were “feudo- monarchists” intent upon restoring kingship, the royal rituals, and the monarchy’s principal emblem—the drum named Karinga. Another ideological claim is advanced by depicting Hutu victims of the RPF as Christlike martyrs, for Ndadaye is being crucified. Beneath these claims, however, a subtler message is being conveyed, one that takes root in the prediscursive, a level not easily susceptible to local exegesis. By impaling Ndadaye the RPF torturers are turning his body into an obstructed conduit, and as such they are transforming his person into an inadequate, unworthy embodiment of imaana (principle of life and fertility; see Taylor, 1992). In fact, at one of Rwanda’s genocide memorials, Nyamata, one can view the coffin of a Tutsi woman who was killed in this way. In the cartoon in Figure 1, the use of this technique of cruelty is foreshadowed. Moreover, specifically Rwandan symbols with deep historical roots have merged with those that are the more recent product of Christian evangelization.

Quite obviously between the pre- and early colonial times, when Rwandan executioners impaled cattle thieves, and 1994, when genocidal murderers depicted impalement in their magazines or actually impaled Tutsi men and women, many things have changed. Clearly the more recent victims of the practice were not literally cattle thieves, but in the minds of those committing the atrocities they were very much like them. Tutsi were obstructors of the cosmic unity of the nation as this unity was imagined by the Hutu extremist elite: a purified nation with a purified, reified “Hutu culture” expunged of all elements of “Tutsi culture” and rid of all who would resist the encompassing powers of the state. The torturers not only killed their victims, but they also transformed their bodies into powerful signs that resonated with a Rwandan habitus even as they improvised upon it and enlarged the original semantic domain of associated meanings to depict an entire ethnic group as enemies of the Hutu state.

Among other violence reported during the Rwandan genocide, there were frequent instances of emasculation of Tutsi males, even those too young to reproduce. Attackers also slashed off the breasts of Tutsi women. These techniques of cruelty were also employed during earlier periods of Rwandan history. Both emasculation and breast oblation manifest a preoccupation with the reproductive system and specifically with parts of the body that produce fertility fluids. In both cases, the symbolic function reinforces the pragmatic function, but the symbolic function cannot simply be reduced to the pragmatic one of destroying the future capacity of a group to reproduce. The torturers were assaulting specific and diverse human subjects as well as attacking a group’s capacity to reproduce. But in order to convince themselves that they were ridding the polity of a categorical enemy and not just assaulting specific individuals, they had to first transform their victims’ bodies into the equivalent of “blocked beings.” A logic, a posteriori, was operative—reclassify through violence bodies that do not, a priori, manifest the imagined inadequacy. Reconfigure specific bodies through torture so that they become the categorical abomination.

There were also cases of forcing adult Tutsi to commit incest with one of their children before killing them (Omaar and de Waal, 1994). Here the image of misdirected flows is quite clear, for incest causes blood and semen to flow backward upon one another in a closed circuit within the family rather than in an open circuit between families. Not only were the victims brutalized and dehumanized by this treatment, but their bodies were also transformed into icons of a sociality, for incest constitutes the preemption of any possible alliance or exchange relation that might have resulted from the union of one’s son or daughter with the son or daughter of another family.

After the Genocide

More recently, during the spring of 2009, I returned to Rwanda and was able to observe a few gacaca tribunals, although gacaca was winding down and there were fewer trials. One of the tribunals took place in the Kigali suburb of Gikongo. I attended this session with a Tutsi woman named Daphrose, who had come very close to being killed and sexually assaulted during the genocide when soldiers and Interahamwe came to her home on several occasions. Managing to escape when a close Hutu friend rescued her and other family members, she returned to Rwanda after the genocide had run its course. Unlike some Tutsi survivors, she made a point to attend as many gacaca sessions as she could. This was in sharp contrast to her sister, Anne-Marie, who possessed a cynical attitude toward gacaca and never attended any sessions. I found this attitude to be common among some Tutsi survivors. They reasoned that gacaca only exposes survivors to more humiliation and can even expose them to danger. If one speaks up at gacaca, one is identified as a potential witness who could bring about the imprisonment of a former Interahamwe member still at liberty. A friend, family member, or the implicated Interahamwe might then try to kill the witness. I heard stories from Rwandans of witness killings of this sort, and one day the murder of a witness was announced on Rwandan radio.

After attending a gacaca session with Daphrose, she told me about her ordeal during and after the genocide. On one occasion a Rwandan government soldier ordered her to remove her clothes, then told her to lie down on her bed. Sitting at the foot of the bed, he pointed the rifle barrel directly at her vagina and said that he was going to shoot through her body. In effect, this would have resulted in the equivalent of a vagina to mouth impalement, an atrocity that some women suffered during the genocide, but by spear (see the previous discussion in this essay). She pleaded with the soldier to kill her in some other fashion so as to leave her with at least a modicum of dignity. Unexpectedly, the soldier decided not to kill her, but before he left he said that others would come soon enough and that they would kill her. A day or so later other soldiers came, and one of them took her to her bedroom and ordered her to disrobe so that he could have sex with her. She concocted a story that she was HIV positive and that she did not wish to have his death on her soul when it came time for her to answer to God. The soldier thought about this for a moment and did not rape her.

Because of what she had endured during the genocide, Daphrose felt that attendance at gacaca was necessary for the improvement of her psychological equilibrium. She also believed that it was her civic duty to help bring the perpetrators to justice. As for her mental health, she described symptoms that she referred to as guhahamuka. Later I encountered this term in stories told to me by several other Rwandan survivors. Most of them described it as a constricted feeling in the chest, a feeling that one can’t breathe properly, that the heart is out of place, and that the air that one has inhaled remains trapped in the chest. Others described it as a feeling that prevents words from correctly exiting the mouth. Literally the term means “to speak while trembling,” “to be unable to speak because of fear,” or “to be in the grips of extreme fear.”

Related to guhahamuka is the Rwandan folk syndrome termed ihahamuka, whose chief symptom is shortness of breath. Rare before the genocide, ihahamuka has become quite common among genocide survivors (see Hasengimana and Hinton, 2009). Ihahamuka is the noun form of the verb guhahamuka. It names the state of being characterized by guhahamuka. For example, a Rwandan might say “nahahamutse” and that would mean: “I am paralyzed by fear, I can’t breathe properly, I can’t speak properly, my breath and my words are caught in my chest.” Ihahamuka is not simple fear. The word for fear in Kinyarwanda is ubwoba. Ihahamuka is an emotion that blocks your breath and your words.

Several survivors that I interviewed told me that attending gacaca helped to relieve them of the feeling of ihahamuka. Other researchers who have worked on gacaca have also noted the frequent use of the word guhahamuka (Burnet, 2008). The term connotes obstruction and in that respect comes quite close to one of the root metaphors that I have explicated earlier. Undoubtedly, Western medical nosology would group the various symptoms termed ihahamuka under the rubric of post-traumatic stress disorder (PTSD), but this would obscure what is Rwandan about it. In effect, the survivors were somaticizing the experience of having endured extreme terror, but they were doing so in a culturally specific way related to their notions about the body. Gacaca, then, despite its many failings, has brought psychological relief to some survivors of the genocide.

Another aspect of ihahamuka that caught my attention during the course of my 2009 fieldwork was sociological in nature. Many of those who were afflicted by it were educated, middle- or upper-class Rwandans. As for their ritual lives, all claimed to be practicing Catholics or Protestants rather than practitioners of any of Rwanda’s traditional religions. (Admittedly, this is difficult to determine with a high degree of certainty, because often people practice both.) They were city rather than rural dwellers, and fluent in French as well as in Kinyarwanda. In my discussions with them, none of them indicated that they were likely to consult Rwandan traditional healers in the future. None of them expressed confidence in Rwandan traditional medicine. Because of time constraints I was unable to interview any Rwandan traditional healers during 2009, but it is likely that healers have encountered people suffering from ihahamuka and designed treatments for it. In other words, the sociological profile of many people suffering from ihahamuka in 2009 was that of people who were relatively well-educated, had been evangelized, were involved in the market economy, and were acculturated to Western cultural norms and notions of biomedicine.

In addition to this sociological observation, a cultural one should be added. People who suffer from ihahamuka have very little consciousness of the fact that the primary symptom makes perfect sense in light of the symbology previously discussed. Sufferers have no idea that the blockage of the flow of breath is perfectly consistent with ailments like ifumbi and malevolent spells such as kumanikira amaraso and umukobwa utajya mu mihango. Nor did I encounter anyone suffering from ihahamuka who ventured to give me an explanation in terms of the symbolism that I have discussed. Had I explained to such people that their symptoms manifested close affinity to disorders that can only be fully understood in light of Rwandan traditional medicine, chances are good that they would have rejected it. Even Westernized Rwandans continue to embody forms, symbols, and meanings in their habitus that manifest close kinship to the forms of “traditional” Rwandan culture, even if they have strayed far in their ritual lives from the practices of “traditional” culture. Moreover, they are relatively unaware of this. In that sense they embody many of the contradictions that characterize people living in the developing world today.


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