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Fluorescent sandals litter the entrance to a church on the outskirts of Rwanda's undulating capital Kigali. A coffee-coloured river slithers by in the valley below.
On the floor, a dozen middle-aged women sit contorted in knots, wearing puckered expressions which explode into wide smiles, accompanied by a chorus of giggles - a rare spectacle in a culture known for its quiet reservation.
In the dappled gloom Seraphine recounts how, while seeking refuge in a similar church 16 years ago, soldiers beat her with a boy's severed arm - just one of many events which has caused over a decade of paralysing trauma and depression.
1 in 3 Rwandans suffer PTSD
She says yoga helped her deal with the shock of witnessing and surviving genocide.
"When you do yoga, you start believing that it's going to relieve your soul," she says.
The horrifying chronicle of Seraphine's survival and subsequent emotional funk is far from unique.
Almost one in three Rwandans suffer post-traumatic stress disorder (PTSD) resulting from the 1994 genocide in which 800,000 ethnic Tutsis and politically moderate Hutus were slaughtered, according to a 2009 study by the Ministry of Health.
People with PTSD often relive the traumatic event through nightmares and flashbacks and have problems concentrating, sleeping, and feel isolated and detached, according to the British National Health Service website.
Yoga's effects anecdotal
Yoga's effectiveness in treating PTSD remains anecdotal but Deidre Summerbell, founder of the yoga organisation Project Air, says it appears to help sufferers calm themselves down, process the trauma and regain confidence.
"In the cases of clinical trauma the brain is overwhelmed by experience and is unable to process it and turn it into memory," Summerbell said.
The autonomic system continues to handle the information without it being processed. Physical or emotional stimuli can return people physiologically to the trauma, she added.
Breathing has calming effect
"Breath is the most readily available portal we have to the autonomic system and yoga, by virtue of the fact that it marries breathing and movement, teaches somebody how to calm themselves down," she said.
The women lie sprawled on a spectrum of pastel mats. Wood-smoke and birdsong drift in through the church windows as Seraphine explains that mainstream treatment didn't work for her.
"I took medicine, but it did not work out for me. It didn't stop the flashbacks and I could not sleep. But since I started practising yoga, I sleep effortlessly," Seraphine said.
Like so many across Rwanda, Seraphine had to cope with a catalogue of catastrophes during 1994. Hate radio stations made her boyfriend turn against her because she was a Tutsi. Her brothers were beheaded in prison and several close family members were buried alive in a drop-toilet, she says.
Following the events of 1994, Seraphine says she found it impossible to connect with her children, experienced difficulty concentrating and finally lost her job as a secretary in the local "Gacaca" genocide courts. People believed she was mad, she says.
Depression stifles development
Yvonne Kayiteshonga from the government's psycho-social centre says the scale of trauma and depression across society may even be retarding the country's development.
"We have a dramatic problem in Rwanda," Kayiteshonga told Reuters.
"Imagine a country where 30% of people suffer psycho-social trauma and that this is linked with depression. This impacts their capacity to work and our economy is affected. If the government doesn't take care of that, there will be severe consequences."
Project Air
Project Air, which is endorsed by US pop star Madonna, has helped over a thousand people in its first year, according to Summerbell. However, it has encountered hostility from local evangelical Christian groups who brand yoga as Satanism and devil worship, Summerbell said.
"We've encountered resistance so project Air has a policy that we are strictly a physical philosophy," she said. "We're not promoting any form of spirituality at all."
Research into yoga as a trauma therapy is still in its infancy, but in the meantime Seraphine and her fellow practitioners will remain its secular disciples. - (Hereward Holland/Reuters Health, January 2010)
