 So you don't use Zoom? We do sometimes, yeah. Some of our teaching, but most of our teaching is on Blackboard. So yeah, this is the kind of so-asked platform of choice. We end up doing some things in Zoom as well. So it sometimes gets a little bit confusing. Great. We might go ahead and start, I think. I can see that there are still some people coming in. Welcome, everybody. My name's Phil Clark. I'm a professor of international politics at SOAS, and I'm also the co-director of the Center on Conflict Rights and Justice. And that's the center that this evening is really honored to be co-hosting this particular event with the Aegis Trust in Rwanda. And this evening, it's really fantastic to have with us Dr. Gloria's Uwe Zehe, a really fantastic researcher who I'm so glad you're going to get to engage with this evening. Gloria is a research fellow in anthropology at Dartmouth College in the U.S. She recently won a very prestigious Dartmouth Society of Fellows Fellowship at Dartmouth, one of the university's top postdoctoral fellowships, incredibly competitive, and I think a real reflection of the importance of Gloria's research. Gloria has a professional background as a mental health nurse and then has very much moved into the academic space, researching in domains of health and public health and anthropology, as I'm sure you'll see in her presentation this evening. She's going to speak on this evening's topic, which is youth, physical and mental health after rape during the 1994 genocide against the Tutsi in Rwanda. The format of this evening is going to be that Gloria's will present for 30 to 40 minutes and then there'll be lots of time to discuss with all of you after that. When we get to the discussion time, you'll see down at the bottom of the screen that there's a hand function. You'll be able to put your hand up and ask whatever you would like of Gloria's. Just a small housekeeping thing. I think all of you are listed as presenters in Blackboard, which means that you've all got access to Gloria's slides. I would just ask you not to touch the slides during the presentation because it's a bit disconcerting for the presenter if suddenly the slides start moving in this ghost-like fashion. I'd really like it if only Gloria's can manipulate those slides. Also, this evening session is being recorded because we put these events out as podcasts in the next few days. So bear that in mind, especially when it comes to the question and answer time. I'm just going to, Gloria's, put your slides back up on the screen. Without any further ado, Gloria's, it's a real privilege for both CCRJ and Aegis to have you here this evening. Of course, we're conscious that this is still the period of the commemoration of the genocide against the Tutsi in Rwanda. This is a very timely presentation on a very important topic and no one knows this topic better than you, Gloria. So we're very much looking forward to hearing your presentation this evening. Over to you. Thanks very much. Thank you so much. Thank you for the introduction and thank you for the opportunity to present my work on physical and mental health after the genocide in Rwanda during the 1984 genocide against Tutsi. I would like to thank SOA Centre on Conflict Rights and Justice and the Research Policy and the Higher Education Program at AGC Trust for this opportunity to share my work. It's always a pleasure to be able to share the work and also hoping that we generate new ideas but also action to take care of the people that I focus on in my study. I will start my presentation. This study was conducted in Rwanda just a little bit of geography. Rwanda is in East Africa. It lies 75 miles south of Equator. It bordered Uganda, Rwanda bordered Uganda, Tanzania, Burundi, and the DRC, Democratic Republic of the Congo. And also Burundi, I think I forgot to say. So the genocide against Tutsi, in 1994, Rwandan endured one of the most cataclysmic genocides in history in a period of 100 days where the genocide happened. Maybe a little bit more background on this. The genocide against Tutsi was a result of decades of tensions and conflict between Hutu majority and the Tutsi minority and these are the 18 groups constructed by European colonialists. In a period of 100 days, over 1 million people were killed and rape was used as a weapon of genocide. Approximately 350 women were raped but only one in six of them survived. It is estimated that between 2,000 and 10,000 children were born of genocidal rape. That's 26, 25, 26 years of age and now younger adults. I want to talk about what does it mean to be conceived during the genocide against Tutsi? What are the consequences? There is a comparing evidence that maternal environmental experience influences offspring health outcomes. Prior studies, including the Dutch Panga study, those studies on prenatal adverse childhood experience they suggest that exposure in the first trimester of genocide. Please keep the slide in the same place. Thank you. Prior studies on prenatal adverse experience, including the Dutch famine study, suggests that exposure in the first trimester of registration leads to the lasting poor mental and health outcome compared to being exposed later in the pregnancy. Individuals who were conceived during the genocide against Tutsi who were conceived by Tutsi women during that time were exposed to maternal stress related to genocidal or genocidal rape during the very beginning of their development in the first trimester of gestation which is marked by rapid formation, differentiation and growth of embryos. So this is the time when the body is starting to form and most of the organs and the system are formed during this, the initial formation is during this period. So given the influence of early life adverse experience on subsequent health outcome, these offspring were conceived during the genocide against Tutsi by Tutsi women who were targeted by the genocide. I like to highlight the high risk of stress-related chronic odysses. Most of chronic odysses that we do of self, they are related with stress. For example, cardiovascular disease can be associated by exposure to prenatal exposure. But individuals who were conceived by Tutsi women who were raped, the genocide, for those women who survived the genocidal rape, stigma, shame, and stress-related rape continued beyond the end of genocide. And the children who were born as a result reported extreme lifelong emotion and mental health challenges due to the stigma of their birth origins. So in addition to the mother's stress, they also have, they do enjoy a lot of experience which put even them at higher risk of stress related chronic odysses. These relationships are supported by development origins of health and disease, Dohert, and all aesthetic load models. Dohert suggests development origins of health and disease. Suggest that psychological, nutritional, and other stress experience in the utero through ultra-good could alter our growth and the development in ways that lead to diminished health adult. Arostatic load model posits that way and the tier due to sustained stress and the discrimination take a toll on health. So for these individuals conceived by genocidal rape, they do have those two exposure, prenatal exposure and postnatal exposure. So as a conception model, we do apply this model suggesting that the combination of extreme stressful conception by rape and life-long identity of having been conceived by the enemy in the commission of rape combined to disproportionately affect health beyond the early life exposure to genocides alone. In particular, for those conceived via genocidal rape. So in this study, we have two aims. Of course, as a tragic, the genocidal guest duty provides a unique ability to test this hypothesis or explore this relationship among humans. And the aim of this study, we had two aims. The first aim was to evaluate the relationship between a range of adult, mental and physical health outcomes and exposure to extreme maternal stress related to genocides and genocidal rape. And to determine how exposure to cumulative stress throughout the young adult would, adult, childhood may exacerbate vulnerability to poor mental and health outcomes. The second aim we evaluated whether the duration of gestation exposure to maternal stress related to genocidal genocidal rape is associated with variation in health outcome. Does the length of exposure predict any variation in health outcomes? So for the aim one, the design of study, we used a comparative and association cross-section design, the first one, 24-year-old one has participated in this study, including 30 conceived by genocidal rape. We are using some double exposure to genocidal rape. And the 31 age and sex, age and sex matched two young adults conceived by survivors who were not raped or single exposed, exposed to genocidal only. And age and sex matched 30 older born of women who were not exposed to genocidal rape. These are the women who were outside the country. They were enrolled in the study. So the total was 91 participants. All participants were estimated to have been conceived during the genocidal by about 80% of the genocidal sex. The genocidal sex is to happen from April 7 to July 4, 1994. A convenient sampling method was used to recruit initial participants in the two exposed group. The double exposed group was recruited through Sevota. Solidarity for development of widows and orphans to promote self-sustained and livelihood, which the name is in French, it's known as Sevota. And those who were exposed to genocidal only were recruited through Avigar Agahoso. And each participant was invited to recommend age and sex matched random who fall in any of these three categories of the studies. For the M1, the independent variables were the level of exposure, double exposed single exposed and exposed and adverse childhood experience. So in addition to these levels of prenatal exposure as postnatal exposure, we used adverse childhood experience to be able to capture the exposure after birth. For the M2, which look at the duration of impact of exposure, we did only did analysis that included the two exposed group. And we tested the hypothesis that the duration of exposure to maternal stress related to genocidal or genocidal rape is associated with the short duration of exposure predicting the health outcome. I want to note here that we did not hypothesize that this relationship will be observed among those born of genocidal rape because given that these individuals are exposed to stress related to the mother's rape experience that continued beyond the acute period of genocides. So for them, the end of the genocides didn't necessarily mean the end of exposure to maternal stress. So the independent variable for this M was the duration of exposure. It happened during a period of 12 weeks and 5 days. And those conceived during the genocides had a longer exposure, duration of exposure to maternal stress related to genocides or genocidal rape. And so that means for those participants conceived at the beginning of the genocides, the maximum of exposure for some of them were 12 weeks and 5 days. For the measures, we measured participant characteristics, status, race dates, family structure, who raised, the person who raised or those who raised the participant, the level of education, type of work, social and demographic and economic categories using of the categories. We also measured resilience using Conan Davidson Resilience Scale 25. As health outcome, we measured mental and physical health outcome. For mental health outcome, we measured mental function using the SF-36 depression and anxiety satisfaction with social role using Promise 29 version 2.0. I also measured PTSD post-traumatic stress disorder using checklist civilian version 5 or PCL5. For the physical health outcome, for the physical health outcome, I measured physical function using SF-36 and the pain intensity, pain interference with daily function, fatigue and sleep using Promise 29. We also measured anthropometrics, height, weight, heat circumstances and skin fold thicknesses. I also did the correct biosum by MACAS to test CRP which is a reactive protein which is a bio marker of inflammatory bio marker and also to do DNA methylation analysis. I used, I collected dry blood spots on these cards. As a result for the M1, the findings under the M1 were published in this paper that just went out. Maybe if you will help to share the link so that you can read in your own time. Briefly, as a result for this, we tested the difference between groups, the groups double-exposed, single-exposed and unexposed, the three groups. To determine the difference between groups, we used bivariate regression analysis to determine the difference between groups in the mental health and the consistent with our prediction, individuals exposed to maternal stress related to genocide only had the poorer mental function, highest of post-traumatic stress disorder anxiety and depression compared to young people who were not exposed to genocide or genocidal rape. Individual conceived by genocidal rape reported more depression and PTSD compared to those prenatally exposed to maternal genocide stress only. As a physical outcome, individuals exposed to maternal stress related to had poorer physical function, higher scores of pain intensity and pain interference with a daily function and the poor quality of sleep compared to young adults who were not exposed to genocide or rape. Individuals conceived by genocidal rape reported more pain interference with daily function compared to prenatally exposed to maternal genocide stress only. This is the first study of which I am aware of that looks at physical health outcomes among these questions. Given that this is a relatively young and lean and health population, it is meaningful that physical health is compromised, so though we didn't get much information on all the variables that we evaluated, but the fact that they have poor physical outcome, this is quite something to note. The results demonstrated that these results demonstrate compelling evidence exposed young adults consistently exhibited the poorest health outcome when even compared to those individuals conceived during the genocide who were also exposed to genocide only. This is a consistent and significant additional risk of those being conceived through genocidal rape. For example, as we saw, they have greater scores of PTSD, depression and the pain interference of their lives. Our findings are consistent with the previous study that reported the difference in health outcomes among the children of survivors in Rwanda, but also survivors of the old cost compared to the same age children of women who were not exposed. In contrast to our study, these other studies did not explore the impact of prenatal exposure to genocidal rape. They did not measure the physical health outcomes. That is a kind of added value with our study. Women who were raped as part of the genocidal strategies to kill Tutsi have reported experiencing intense shame or guilty as a result of the rape. And subsequent conception which also is reflected in health outcomes of their offspring. We also, in addition to bivariate analysis, we did multiple linear regression analysis for each outcome was performed with interaction term of adverse childhood experience as post-natal exposure. So the interaction we created an interaction term of prenatal exposure in each of the three groups and adverse childhood experience. And these interaction multivariate regression analysis did control for six multi-status level of education type of work and resilience. For the past and present family structure we looked at was also included this is like who you have in the family who you grew up with who raised you up but also the member of the family that are available. So the demographic characteristics were controlled as we test the interaction term of prenatal exposure and adverse childhood experience. First I want to highlight that among these groups in terms of adverse childhood experience which is this figure here as you can see those exposed to genocides only had higher levels of higher scores of adverse childhood experience compared to those unexposed and those exposed to genocides also higher adverse childhood experience compared to those exposed to genocides only. So in terms of interaction between the prenatal exposure and the health outcome in a predicting health outcome among the group conceived via genocidal web the effect of prenatal exposure on depression and physical function pain intensity and the pain interference with day life were exacerbated by adverse childhood experience which was of course which was higher in this group compared to those exposed to maternal stress related to genocides only and those were unexposed. This finding that double exposed group have a higher adverse childhood experience and that this adverse childhood experience exacerbated the effect of prenatal exposure to rape to exposure to rape on health outcomes also suggest four types of postnatal and childhood if the vulnerability induced by prenatal exposure to genocidal genocidal rape were magnified by adverse childhood experience so prenatal postnatal experience providing a less favorable environment for growth and development and thus elevated the risk for larger for large range of negative mental and physical health outcomes in adult world. However it is worthy noting from this moderation models that for those for some in adverse childhood in the group of those who were conceived via genocidal rape health outcomes were comparable or even better than those of other groups exposed to genocidal only unexposed if adverse childhood experience were low this makes clear the importance of postnatal environment where the low adverse childhood experiences suggest a positive family supportive family, peer and community environment where this process where the process of building individual sufficient level of resilience can take place it is possible that those double exposed individuals with low adverse childhood experience were able to achieve a level of resilience that improve their well-being and kind of like mitigate the effects of prenatal exposure. These findings added to the debate that suggests that early life adversity is not over-determinant of long-term health outcome but point towards the potential mitigation the potential of mitigating the effects of these stress if this based intervention are implemented adverse childhood experience maybe they are preventable and modifiable and the resilience can be improved through a stress-based intervention that enable individuals to harness the resources needed to mitigate this effect of adverse experience so for the M2 as the M2 was about looking at the duration of exposure, we find out that the shorter the duration of exposure, the better the health outcome with low scores of anxiety and depression among those exposed to maternal stress related to genocide only the association remain significant between the duration of exposure and anxiety even after controlling for sex and adverse childhood experience this highlights the effects of prenatal exposure because the prenatal as I said, the first remaces the most sensitive period of life if they happen during that time there is a risk, increased risk of poor mental health outcome in postnatal so this our study does expand our knowledge of vulnerability in the first trimester as reported in the Dutch hunger study and others which have highlighted that the first trimester is the most sensitive but they didn't look at if the duration in that same trimester has the variation of duration of exposure in the first trimester does predict the health outcome but what is known is that the first trimester is always the most sensitive compared to other trimester of gestation so our study does expand on that knowledge by looking at the variation within this most sensitive trimester exploring this phenomenon in the context of psychological distress and including different levels of exposure the exposure to genocides or genocides of the web the duration of exposure did not predict variation in any measured outcome among individuals conceived by genocides of the web this could be explained by the fact that stigma, shame and stress related to web experience by pregnant survivor women by the end of the genocides as I said earlier it is possible that the fetus was exposed beyond the stress beyond the genocides they were exposed beyond the duration of exposure to genocides because of the stress and the stigma that continues in fact survivors of the genocidal web consider this experience as the worst than the genocidal experience itself as we noted under the analysis of M1 we demonstrated that these young people conceived via genocidal web reported more adverse childhood experience compared to the other group those exposed to age and sex much younger that conceived by women survivors were not ripped or those were not ripped surprisingly we find association between the duration of exposure and the physical health outcome and this could be because we have a variety of young and lean population and that follow up study are needed to observe impact of early adverse diversity on physical health as these participants continue to age the ratio between the shorter exposure to genocidal stress related and the better health outcome can also be explained by the fact that probably the maternal buffering system that is usually in place to protect the fetus are capable to work if the duration of exposure is shorter to kind of like a buffer those effects summary this study demonstrated that the young adult conceived during the genocidal have poor mental and physical health outcome compared to sex and age much younger were not exposed to genocidal web during the genocidal but not exposed to genocidal web and those conceived by genocidal web that additional burden of poor mental and physical health outcome compared to those exposed to genocidal only this study also demonstrated the variation in duration of exposure with the shorter exposure to prenatal maternal stress related to genocidal only being associated with better health outcome we also demonstrated the effect of birth or gym on the experience of trauma may have a larger impact on other health than prenatal exposure only I would say that the primary prevention of genocidal and the genocidal web should be the ultimate goal but we know that we continue to hear about genocidal around the world so this study does benefit the community that already affected or who are being affected and our work suggests that there is a potential to mitigate the effect of prenatal or early life exposure to genocidal or worse or any psychological stress related to genocidal or worse if early intervention are implemented as early as possible any fact any intervention at any point during the life of those who were exposed we always have effect as the next step for me now I'm working on DNA methylation as I mentioned above I collected drive blood spots so I'm working on DNA methylation analysis from the drive that I collected to examine the epigenetic pathways potential linking prenatal exposure to health outcome measured in this other world I also plan to initiate a prospective study to better grasp health change as this population age and study their pregnancies the pregnancies of this population and spring so I mean whether and how genocidal trauma passes to the next generation and the course study will enable us to observe some of the physical health outcome that we are not able to observe at this time because this generation is still young I also hope to be able to design some evidence based intervention for this population and similar population I acknowledge the institution and people who helped me during this study but also want to thank you all for your presence and listening and also special thanks to SOAS and AGC trust and also feel thank you for inviting me and giving me this opportunity to share your question and comment I very welcome thank you so much for your attention fantastic thanks so much Gloria such a rich presentation in terms of the findings but also I think the methodology might be quite interesting for many of the participants that I can see on the list here let me just take the slides off one might turn their cameras on as well because that makes it a much more personal experience if we can have the discussion time now by actually seeing people's faces I want to throw it open for people to make their comments and ask their questions, the way you can do this is at the bottom of your screen you'll see a little icon that has a hand in the air, if you just click that then I'll know that you have a question that you'd like to ask use yourself, I think that would help Gloria's a lot just to know exactly who you are so who would like to get us started? Jaanan, thanks fantastic thank you so much Phil and Gloria I listened to your presentation when I was in Wanda also organised by AGC trust and Phil Clark, so it's definitely my honour to listen to your more updated research this time so as Phil put on I was like, yes, this is happening again so where I called Jaanan so I'm doing my PhD as this is my last year but my research is slightly different from yours it's more focusing on women's political empowerment and representation in the Wanda context so just by comparative lens as Phil pointed out, I find your research methodology very interesting and intriguing because it's slightly, sorry about my phone, it's slightly diverging from a lot of SOA's methodologies, as in like I think a lot of us at SOA's would employ including myself would employ ethnography as the methodology to do our research and I found your research is incredibly especially the result is incredibly rich I don't know how to describe it, it's in a way that I always find quantitative research or approach is overwhelming considering the results as well and how you would frame your results but what really pumped to my head is it's also a question that I had last time for you but I didn't get the chance to ask you is that how do you actually view your relationships with your research subjects with your audience who are like me sitting at the end of the computer you have quite of a distance from your research subjects and I'm wondering how you view your relationship with your research subjects or do you even have research interlocutors that you also investigate and examine their life stories thinking about mental health from the genocide against TUCI and further on I would also like to know your opinion on the research ethics on gal metrics if that's even related to your research that's from me, thank you very much again some great questions there about methodology about the epistemology about ethics yeah glorious thank you as you mentioned this research does build on the work that I conducted prior to my doctorate research that was funded by AGC trust and so much input from Phil and Nikki who provided mentorship and the group from AGC trust we choose qualitative methods so I did correct the stories I did interviews with the young people who conceived via genocidal rape but I decided with my doctorate research of course part of it I wanted to do the qualitative but the time was not I didn't have enough time to do both to do a mixed method I use this qualitative method because most of the work that has been done was qualitative and we miss kind of like a systematic or quantifying the effect of genocide so I believe both methods has a place or mixed method quantitative, qualitative or each of these two approaches they have a place and they have a role to play and it's always good to be able to in a given population targeted to do a contribution from those uncles so I do want also to comment about those two methods in terms of relationship with the study participants these people I relate to them because I'm Rwandan because I understand their experience and some of their experience is related to my own experience so I don't know if I would say that is personal so it is my population that I'm studying so I'm connected with them and I do emotionally correct with them the analysis and conducting this study was not easy for me especially when I start making a sense the result to be honest with you I did cry a couple of times I continue to cry which is not bad it's a process of healing it's a process of relating to these people and also building more commitment to my population of study and of course moving away from the idea that they are subject they are human being there are people that we know we know their name we are our neighbors or there are people that you've traveled to one and see them which I think your approach of ethnographic approach is really very good part of it is also building that relationship and it's not just understanding the experience or being personal it's also being able to understand the context of these people that is beyond what can be captured by a standardized scale or even an interview guide that you can develop because you understand the context of these people you can be able to make sense of these people of course there is something that there is at some point that way you need to distance yourself a little bit with data to be able to see objectively which I do appreciate by working with a group of people who some of them are not wanted and asked can you ask me some question that I wouldn't ask myself or can you help me to see when I'm going beyond or becoming more emotional and not objective so I'm going to ask you a question in terms of ethics I think using markers taking the different like the way that I did blood sports I did I went through the UIC University of Chicago IRB to get this approved and I did put in my constant form implication and what I'm going to use with this blood sample so for example what I said testing the seroactive protein and DNA methylation to see if the exposure to Genocide has changed the way that their gene function that was mentioned but also did mention that I'm not going to use these blood samples beyond those two things unless if I go back and ask them permission so for example those who want me to keep their blood sample and maybe go back and do other studies from the blood samples that I corrected they sent for me and they gave me details, contact details for me to go back and ask permission to do something else that was not mentioned in my research so one of the things that I'm kind of like reflecting on is when so vulnerable population sensitive topic like the Genocide these are the areas that need research but sometimes we are most scared of ethics and being over protected by the gatekeepers or maybe the IRB committees that protect these people and they prevent these people to be studied, to be researched which means that whatever intervention we should be designing for them is being either designed based on other population or we are missing out on their needs and not be able to design the interventions I don't know if I answered all your questions but you can always reach out to me if you have further questions Yeah that's great I'm glad we got the methodological issues out on the table because looking down the list those of you that I know and myself included are very much qualitative researchers and you have a very different methodology working on very sensitive topics with a tool that would be very foreign to most of us so I think it's useful to tease out some of these issues so I can see Ernest's hand up this is great too this is also a good way to catch up with a lot of people some of us all know but haven't seen in a long time so yeah Ernest over to you and then I'm going to come to Felix Hey thank you Phil, thank you Gloria Can you hear me? Yes you're very clear Ernest Hey Gloria Frajo Frajo Neza I know you know Gloria's but maybe if you could introduce yourself because I think others would like to know who you are and where you're based at the moment a colleague and friend to Gloria's growing kind of together I'm so much excited and I'm so glad that she's sharing with us this important piece of research I would like to I myself got PhD in the Peace and Development Research and I worked on this particular approach of intimate dimension of genocide it's something I kind of share with how it's something I've been going through and like my colleague who asked before it's sometimes not easy to take a distance away of the violence and I appreciate that Gloria's has been so courageous enough to have the take into the business so mine is a suggestion in the final conclusion of the findings somewhere you argue that some of the participants do somehow construct the experience of the genocide, the rape during the genocide the most atrocious as the most atrocious than the genocide itself I do quite understand and I agree with you but maybe I do have suggestion on how you can formulate it because otherwise you lose the historical and legal aspects of the violence what if you consider it as they just take that intimate dimension of the violence you know what remain attached to their own being the aftermath than other aspects or other acts of the genocide so that rape is not how can I say separated from the genocide but it's still parts of the genocide itself I don't formulate it in a very correct way but not in a clear way but it's something you can look at which is quite reflecting what you've been presenting which has no difference anyway thank you thank you so much and this was not what you were saying and I'm not saying that the genocide rape is worse than the genocide itself this is a quote from the participant in one of my other interviews this is kind of like a saying what participants say it you know when you say and you know that some of these women were raped sometimes they would say that I wish I would have died instead of being raped and survived this way to compare the genocide itself and the genocide rape so I do get your point this was just a quote though the presentation I didn't have enough time to say this is a quote but thank you so much for your and maybe coming back to the methodologies yeah I want to say something that I forgot to answer when I was answering the first question about the method of the qualitative and quantitative one of the things that expense that was really not not quite good expense for me it was by using structured interview skills I miss listening to participants somehow I felt like cheating to them they wanted to tell me more but I wanted to say yes or no or strongly agree or disagree so I did have a time after the interviews to let them express their emotion and share what they want to share but you understand when you have a questionnaire there are so many things that you are collecting as a data collector but you are not allowing the participants to share what they want to share so I had to cut them at some point because each interview did take maybe one hour one hour and a half but I provided time at the end just to add on what I said before Yes, can you hear me? Yes Felix, you are very clear, how are you doing? Yes, how do I do? Yes, Murao Murao Murao Neza Ego, Lurians, thank you so much for sharing with us this interesting study Of course, my name is Felix I am working for prison fellowship Rwanda I usually work with genocide perpetrators but also with genocide survivors I conducted a research on the identity of genocide perpetrators of course with the support of AGES trust and I am very inspired by hearing from this study and I was impressed I am impressed by the test used method both mental and physical and biological I think this method is really unique based on the way it has been conducted and the way you presented the result I have maybe two comments you said about the use of children born of genocide survivors who were raped and those genocide survivors who were not raped and of course you talked about that those born from those who were raped are presenting I mean severe mental health or trauma compared to those who are born from those who were not raped and that is one point and maybe I was clear to know maybe to hear from you to elaborate more about based on the research and to elaborate more about the way of transmission of that trauma of course and how was it transmitted given that of course you shared about your method talked about the biological and the physical and the mental health maybe to elaborate more about based on your findings the way of trauma and also it was interesting that you talk about childhood experience and also you mentioned about supportive families and also resilience I think that maybe maybe both use born from genocide survivors who were not raped and those who were rape of course depending on the experience maybe they grew up in different circumstances and also we usually meet with some challenges for example the issue of silence on sharing about the trauma to the descendants and also in some way it is also to do mental health of their parents if the parent have not yet been helped psychologically maybe they are not ready to provide such kind of enabling environment that could help their descendants to develop away so maybe from your experience and result if also you meet with the these challenges of not talking keeping silent and not sharing to the descendants about the truth of the suffering they went through to the actual brain so that is what my show comments if you can elaborate more on those two points it would be helpful and also I thank you so much for this interesting study great thanks very much Felix yeah Gloria thank you so much Felix for the question so for the transmission that is the face on I as I say they're connected blood blood spots samples to be able to look at the epigenetic mechanism that link exposure to prenatal exposure or adverse childhood experience to the health outcome that was observed during the study but the prior research that have looked at those mechanisms they have suggested intergenerational transmission of trauma and this can be seen in two ways either transmission of prenatal exposure to the maternal stress because you know the body does sense our environment so when the environment that we are in we do sense it and it does affect or does influence our epigenome so it doesn't change the gene by itself but it can change the way that the gene function especially for the during the prenatal period where the mother is exposed and the stress is able to affect to reach out to the child because usually in a normal time the mother has the capacity to or the present or the whole protection around the embryo is capable to do protected the child against the stress when it is stress related to genocidal or genocidal when it is beyond the measures the buffering system of the mother then the stress can reach to the child this is a stressful environment and then the epigenome can adapt to can it change the way that the genes that function to adapt to that space so that affected their development of organs and systems and their function which later does affect the health outcomes during the childhood for example children born of women were exposed to stress most of the time that we find them with low birth weight which has been connected with most of chronic disease in other food so one of kind of agreement that is among the researchers who do biomedical research on this topic there is implication of stress regression system the stress system of the body the system that help us to deal with the system it gets affected if the stress is impeded is strong and get beyond the ability of the body to negatively affect the body the body is no longer just able to manage the stress but it gets I think that is where I mentioned the stress system of the body when the response to stress does affect or does damage the system that involved in that management so I'm still studying that but one of the suggestion is the implication of the system regression system in the body that can be affected and be affected by exposure to genus in terms of parents who are not sharing I think that is something that needs to be looked at a little bit more closely why they don't share and what can facilitate them to be able to share the transmission of stress also can be post-natal when the stress of the parent not the mother only the parents can influence the way that they parent their children that's also another way of affecting the health of the child of their offspring so post-natal is very important that's why look at the adverse childhood experience but also the thing that was saying when the children don't know what is going on but yet they can experience the environment of someone who is with whatever they are struggling with so I would say that this needs to be a little bit more closely but looking at why not sharing what is the what can be done so maybe we can discuss about it later and hear it a little bit more because that's maybe be able to see advice what to do thank you you want to come back on that yes yes thanks Felix Felix did you have a follow-up question I just saw your hand go up again maybe I'll abuse my position as chair because I have a question that I'd like to ask it's interesting that there are so many discussions at the moment about issues of inheritance and issues of transmission after the genocidal sensitivity and these are Felix I might just have to get other people to mute their microphone sorry there's a bit of background noise there yeah so there's a lot of discussion about inheritance and transmission in the post-genocide context and it's often about the transmission of trauma it's often about the transmission of guilt to younger rewondens and I think what's remarkable about your work is that you're showing that there's an important degree of transmission that's happening prenatally which I think is very different from what a lot of the literature talks about that strikes me as incredibly important for that reason so first thing I wanted to know can you give us a sense of how many children born of rape are likely to be in Rwanda so can you just give us a sense of the scale like what percentage of the population do you think is affected by the issues that you're presenting here but more importantly I'm interested in and this is maybe a bit more of a qualitative question what is your sense of the people that you're interviewing the people that you're surveying how much do they internalise this issue of genocidal rape as a part of their own identity how conscious are they of the issues that you're raising is it something that they talk about is it something that they deploy when they describe themselves in their own experience how conscious is this identity in that particular segment of the population because I think that would tell us a lot about how they manoeuvre through society how they understand their own agency how conscious they are of the challenges that they're dealing with so yeah just wondering if you could tell us a little bit about the profile but also the consciousness of these particular actors thanks thank you for the question it is hard to know how many children were born out of genocidal rape the range is very broad they estimate between 2,000 and some papers also goes up to 50,000 so the number is quite not known but from my data a big portion of it they're affected by by this experience for example for PTSD more than half of them they meet kind of so the scars that are used are just they are not they don't diagnosed but they can give a sense so there is a cutoff from PTSD scale that suggests that somebody need a medical attention so for example that scale more than 50% of what I interviewed they meet the criteria of needing some attention so I would say that they affected and the very reason that they participated in this study and other studies that I have conducted it is because they are conscious of their life experience and they want it to be known and they do carry that identity so from the time I started talking with these young people as soon as they start looking like identifying that they are something about their birth without knowing through the process of disclosure of birth origins and also learning and navigating what does it mean to be born of genocidal rape that's something they carry and I think it's part of their identity I met with them during this study of course they have a sense of resilience they have a sense of standing together and be able to not be so much affected by the identity which they claim that it's not their fault that they were born of genocidal rape most of them they don't know their fathers and they shouldn't be seen as children of enemies or they are associated anyhow by the sin of their fathers in order to be biological they are associated with the father but they do know the mothers and they do claim that identity to be not associated with the crime of their fathers and in particular during this study they were very willing to look at how probably biologically and beyond just the experience of maybe the identity how does this affect their lives especially they were very interested when I was collecting the biomarkers because they wanted to know how does this kind of like environmental experience does penetrate my skin and change my biology in where that can affect my health so they know the experience and they are willing to learn more about their lives but again I sense a lot of effort to be resilient to live in a better society contribute to the one in society reconciliation but also for themselves to have a better life yeah thank you we've got time I think for a couple more questions let me go to Felix in the hinder hi Felix you might be on mute Felix I think there's a chance maybe while Felix in the hinder is getting his connection sorted out Felix Begabo do you have another question because I can see your hand up I'm not sure if it's a hand left over from before or if it's a new question okay it was an old one Phil can I ask again yeah please Ernest yeah yeah please do thank you I was thinking about the other observation I made I thought about something else that could be related to that well maybe how do you relate to the the issue of proximity of you know victims and perpetrators how do you relate it and how does it come in the analysis it's something that can help you cause the victims even if they were somehow in the other community but they knew most of their victims there is a way of knowing you can understand they might not know the names but they knew how they were they were their neighbors so that issue of proximity then can lead to the intimate dimension of the violence which then helps in analyzing the issue of raping more in the more general context done it's kind of appearing right now but it's a suggestion it's not a question thank you yeah thank you thank you that's a good suggestion it's not something that I looked at during this study but I think that also has a contribution as I say this young adult that can be affected prenatally but postnatal in terms of adverse childhood experience that also includes the community that also includes what is around them so postnatal environment is very key and as you say being close to the victim sometimes it can be something that can kind of like exist in better experience but also can be maybe something that also help them to build some resilience so that's something that needs really to be explored as I said these young people can be affected through the genocide but also I did present the demographic characteristics also they leave the experience after being born not only being raised by parents who experience the genocide or genocide of rape but also their lives they export to so many other things that follow their birth origin or follow the exposure of their mothers that also continue to exacerbate the effect on their lives if the better life the environment is better than the health impact can be reduced or mitigated or even have access on a treatment or support then they need to be able to continue to move forward despite their birth origins So Gloria is I think Felix and the Hinders having troubles with his microphone but he's just added a question in the chat and he said his questions about the nature of adverse childhood experiences he says were the experiences broken down in the study and did different adverse experiences lead to different outcomes Yeah that's a good question Felix Thank you so much that's something that having worked on as you can tell I corrected a lot of data the scale the way that is was developed by the WHO by the way it was suggested to be used as a score a total score not to break it down but that's something I want to look at because I believe each individual adverse experience can be linked to different maybe health outcomes that's something that I want to look at it and I also did add a question to open-ended question because the scale had never been used in Rwanda to be able to capture that what is not included into the international questionnaires especially because the experience is different so that's another type of data qualitative data that I need to analyze to understand a little bit more but the way that is used in this study it was the total score or out of like the sum of all the adverse childhood experience I could see a hand from Marianne and it was used as a continuous variable because in some studies they do break it down maybe to four adverse childhood experience and above and less or less than four but I used it as a continuous variable Thanks, Marianne Hi Glorious Thank you for a very interesting presentation I have done not direct research in Rwanda myself but I have worked with researchers in Rwanda and then have helped write up some of the research and frame it in theoretical frameworks so I have worked with the research population without actually having done direct research myself but my question is more about in the future because what I thought you mentioned at one point is that you also would like to do research on the after possible interventions that you would like to do interventions and then do follow-up research the kind of the project that I have been associated with in Rwanda is a community-based sociotherapy we have other people who are associated with this program in the audience as well many of them who have much more experience than I do but I am interested in what kind of interventions you're thinking about you might like to use to do post-intervention research so much for the question I haven't yet been thinking about various I'm thinking that I will have to collaborate with other people because my research program is kind of like a big something that I can't handle by myself but given that I know that the group therapy community psychological therapy has been explored in Rwanda those are very good and they have been helpful and I feel like kind of like an individual and probably using some of the technology to make it accessible to the young people especially because I'm focusing on this young generation and these younger people who may be able to do some individual online interventions that are accessible to them on a kind of like an easier way but I haven't been there I do not know exactly what health outcome I'm going to target because I'm looking at all physical and mental health outcomes but I'm thinking like looking at not only the community that have been explored in Rwanda be able to advise them be able to explore them among the younger people but also looking at individual and things that can be much easier much accessible to the Rwandan population in particular because we do not have health system that is that easy easily accessible as in many other countries and probably maybe in a remote area or you may not have the right person to provide that intervention those are the ideas I haven't yet get there but I'm thinking that something that can be accessible especially to these younger people and people who do not want to even be seen or be open to go to the regular social community or the regular health facilities. What else can we put in place for people to work on. I've tried with NLS we have worked on something called writing for healing that's another thing some people don't have necessarily a mental problem that needs a psychiatrist but probably they need to process their experience through writing and be able to get somebody to reflect on the writing and both with this healing process. So I'm thinking when I get there I will explore those different things but thank you so much and maybe I will keep in touch and learn from what you are doing Thank you for your answer Thank you We've got time for one last question if anyone has a burning comment or question that they'd like to pose to Gloria's Yeah, Jeananne I mean if I don't have to go to somebody else who hasn't spoken yet want to raise a question to Gloria I think it's fine Your first question was fantastic so I think we would welcome another one Yeah sure I'd love to ask another question to Gloria It's actually about while I was listening to you responding to other people's questions I was thinking of your future plans about this research project that you've been conducting for a very long time I believe from the doctoral research to now most doctoral research I'm also just thinking I think a lot of us who do Rwandan studies let's say there's a thing there's such a thing we are very committed to knowledge production we think the Rwandan context but I'm also very concerned about how do we go beyond the Rwandan context in a way that how do we generate theories and concepts from the Rwandan studies and then we can apply the concepts from Rwandan studies to other contexts I believe there are a lot of other post-conflict societies in context could actually make a good use of your research results Gloria such as I don't know I can name a lot so I'm just thinking what is your next step basically are you going to broadening up your research scale to other genocide or post-conflict scenarios or are you going to be more focused on some other research projects going on for Rwandan still for Rwandan population yeah great thanks Shanaan thank you Shanaan that's a great question yes I'm interested to also go beyond the Rwandan community to other communities part of the project we are working with ADC Trust and field involved is looking it's first using the piece education to produce some lesson that can be applied to other places so I'm hoping also with my own program that I'll be able to build on those kind of relationship study other communities but I'm also interested to look at not only direct violence effect on health but also structural violence we do live in the world currently that people are on a daily basis experiencing structural violence and those also do put people under stress and there are so many things that can be done so I'm looking for any opportunity to also study other population of course Rwandan would be my primary target but also want to and also publication that's part of it and I'm grateful for this opportunity to present this is a way of sharing so I hope to be able to go beyond and be able to share my lesson learn from Rwanda to other population fantastic that strikes me as a pretty good place to wrap up this discussion a question about the applicability of Gloria's you're really fascinating study to context far beyond Rwanda I think the question time here is really useful at teasing out a little bit more about your methodology about the people that you've been surveying some of the concepts that you're working with how this connects to other studies and other literatures that people are engaging with and also how this relates perhaps to places far beyond Rwanda so I think all of those questions just show the richness of your work and how relevant it is including for many of us here who are thinking about these issues but coming at it from very different angles so this is really important research I think we're all fascinated to see where you take it from here because there's clearly a lot of different directions that this could go in both academically but also in a practitioner sense so Gloria's thank you so much a quick plug for one thing before yeah one thing that one since we are with different researchers above the Rwanda one other thing that I mentioned in my next step is to share the result with my presentation I think there is an ethical and moral responsibility to go back and share with them not in the way that is stigmatizing or the way that they will read through these English papers and don't understand what this means to them I want to go back and share with them so this is my next project actually my very next project as soon as we are able to travel with the university money because I can travel with the university money so when we go back and talk with this community explain what does this mean and also from there I feel the ethical responsibility to kind of like do participatory research with them and start asking them what are the questions that matters for them that future research should focus on so that we are serving human being as I said before we are collaborating with them but we are also going back to give back and share with them what we have and not just to publish and get other academic benefit sorry for not at all and I think Mary Ann wanted to just jump in on this yeah just a very quick comment on you going back to share the result of your research with your research population which I think is is a wonderful thing to do and I salute you for doing it but I was wondering wouldn't that in itself be an intervention you could study yes I will it is an intervention I will correct data on that and I will because there is no guidance there's no protocols on how you do share these findings that's so positive so motivating some research they even call them the news how do you there's no protocol so I'm going to use this opportunity to go and share because I think this is ethically the correct thing to do but also correct data and try to come up with a protocol that can be used by other researchers yes all right thank you thank you yeah that seems a really important point to emphasise is you know this work as I think is so important academically it's clearly so applicable in a practitioner in a policy sense that you're raising really important questions about a generation of young Rwandans dealing with particular legacies of the 1994 genocide and one would hope that that starts to filter into the policy and the practitioner space as well but this has always been one of the beauties of your work I think that it's so scholarly rich but also so important from a practical point of view as well that we're able to bring some of that out towards the end of the presentation just a very quick plug for the next and also the final webinar in the Centre on Conflict Rights and Justice series this term it just so happens that we've got another event on Rwanda it doesn't always happen like this but this term it has a final event on the 21st of June we've got Omar McDoon from the London School of Economics presenting his recent book called the path to a genocide so this is based on his sort of 15 or nearly 20 years of field work looking at the micro causes of the genocide in 1994 so Omar will be with us on Monday the 21st of June I do hope that people will be able to join us for that once again just a huge thank you to Gloria for sharing her fascinating and really important research with us this evening and also to all of you who I know have joined us from around the world as part of the audience it's been a real pleasure to have all of you thank you very much and look forward to seeing you again soon bye bye thank you bye