Refugee Life After Trauma

Photo: Sam Ouandja The Humanitarian and Development Partnership Team in the Central African Republic 

Hassina Adams, 19, and Jamilah Adams, 22, live in the North Side of Syracuse – an area thriving with the newly arrived refugee population. Born in Uganda and later went to spend their life in South Africa, Hassina and Anwar moved to Syracuse in March of 2015 with other siblings.

Just right across the street lives a 33-year-old Baraka Nyiramugisha who just came to the U.S five months ago with her 7 children without her husband who is still waiting for his case to be processed in Congo his country of birth. Nyiramugisha loves in a small dilapidated house – almost devoid of any furniture and exhaling rotten smell. She is still happy with it because it is better than the refugee camp in Uganda where she spent 15 years of her life.

Her travel to America was a journey of hope, but also a stark contrast from the dangerous journey her family had from Congo to Uganda 17 years ago during which she lost four of her siblings.

According to United Nations there are 16,000,000 refugees and asylum seekers in the world and 3% to 35% have experienced violence and trauma first hand – making the refugee population vulnerable to some deeply rooted psychological issues. According to U.S. Bureau of Population, Refugees and Migration last year almost 70,000 refugees were resettled in U.S out. New York is the third biggest resettlement state for the refugees.

After arrival in U.S., according to standard procedures and practices, resettlement agencies help refugees meet their primary needs like renting a house, finding job, applying for proper documentation, setting up a primary care doctor within the first 90 days of a refugee’s arrival.

Pamela Kefi is the Director of Program Development and Integration at Jewish Family Service in Buffalo, New York – which is the one of the few refugee agencies offering services to survivors of torture. She said that there are no national standardized procedures for screening and treating refugee mental health in U.S., however all refugees who come through formal resettlement channels receive required refugee health screening (physical health), usually it is managed by the State Department of Health.

Hasina’s younger brother has epilepsy, which is a neurological disorder. Sometimes he also have to be hospitalized. She said that they are getting very good medical care for their brother, which was not available back in South-Africa.

“Doctors know what they are doing, they have proper medication, equipment and facilities,” she said. “We have Medicaid, so it covers his medical bills,” she added.

Hassina and Jamilah are the only ones who can communicate with their neighbor Baraka in their broken Swahili. Baraka follows Jamila everywhere because she doesn’t have many people around who can speak her language. Baraka is happy to be in U.S. but at times she feel lonely and sad because she has no one to talk to. She can’t speak any English at all. Not even enough to go to the grocery store, even though she has been going to the language school for months.

Language is the biggest barrier which stops many refugees from accessing the services that is available to them. This becomes also a challenge for the refugee agencies, hospitals and doctors to provide health care to people who don’t understand English.

Kefi said that they get all sorts of client; some who are highly educated and can speak English but there are others who can’t even speak a single word of English and they have to use interpreters for this reason.

“One of the problems that we have is that Buffalo being a medium city, we don’t have lots of different speakers of many languages. So we might have only one or two interpreters of a certain language. So the clients feel that they don’t have that kind of confidentiality. They don’t want a certain person to hear their story because it’s also someone who goes to their church,” She said.

Dr. Yakov Rubinchik who is a Psychiatrist at Upstate Medical University in Syracuse, said that during his practice, he has never seen an interpreter who already knew his patient, but some interpreters from Buffalo agree that they have had assignments where they had to interpret for people they already knew.

Dr. Rubinchik, “the interpreters are legally bound such as us doctors that it’s confidential and you are not allowed to talk about what you hear. The interpreters usually do a good job of trying to be objective and to translate the best they can,” he said.

Dr. Rubinchik feels that while using an interpreter, it becomes hard to understand the culture his patient is coming from. In an ideal situation a doctor needs to form a bond with their patients to treat them, which becomes extremely difficult in the presence of an interpreter.

“That sort of middle person sometimes also makes it less intimate, the connection that you have with the person you are treating,” he said. Dr. Rubinchik added that while most of the times interpreters are available in person for patients who have their appointments set up, however in emergency cases hospital have to use interpreting services over the phone.

“It is also pretty expensive for the hospital to get an interpreter, so in one way it puts a strain in a financial aspect. And oftentimes some of the refugees don’t have insurance, so our social worker helps set them up with an insurance so that they can get more resources,” he said.

Referring to 11-year-old Somali refugee Sheikhnoor Adan whose younger brother was slaughtered in his face, Dr. Rubinchik said, most of his patients who are refugees have an awful trauma background ; they have been raped, they have witnessed their families being murdered or seen a genocide. He said that while most of his patients are brought in by their families, once or twice they had been brought in by the police, because they were wandering outside on the street, yelling or being loud. Normally, they are some of the severe psychiatric patients.

“Most of them were brought in as psychotic. I haven’t seen many coming in for depression or anxiety,” he said. “They come because there is no other choice. They are so sick that they have to come in, they won’t survive or they will get arrested,” he added.

He said that it is a strange idea for them to come and speak to a stranger about their depression, trauma and life.

Warfaalibax Mursal is a Somali refugee who owns a small Somali grocery store in Syracuse. He came to Syracuse in 2006 after remaining stateless in Kenya for almost all his life. A lot of Somali refugees have directly experienced violence during the war of 1990s including his parents – whose siblings were killed.

“They lost their belonging, family, property everything, whatever the owned, they just ran away,” he said.

Mursal said that his parents never discuss the past with him – the violence and the war and he is glad they didn’t because he thinks, there is no point in reliving the past. He said that he has seen many people in his community dwelling on the past – they might also be dealing with trauma and depression.

“In our people we don’t go to professionals. In the family is the only way we can solve our problems, no outsider can help us with our problems,” he said.

Kefi said that American mental health system does not meet the needs of the refugees.

“Our clients are coming from cultures where people normally turn towards faith healers or other strategies to help deal with emotional stress. In a lot of the cultures that our clients come from mental illness is stigmatized,” she said. “It’s not something that you want to talk about nor you would go outside of the family to talk about it,” she added.

She said that they have to work together with their clients and educate them about mental health.

Dr. Rubinchik said that in order to treat mental illness, it is very important for the families of the patients to be involved and understand the illness. Even after the patient is discharged from the hospital, they need to keep taking their medication, so that they don’t become sick again.

“Oftentimes families would believe in spirits and magic, so they would feel that their family member’s need is more spiritual care. They don’t believe in medication,” he said.

He said that if the family is supportive even if they don’t understand the illness – the hospital is more than willing to help and this really ensure fast recovery of the patient.

“We had a Somali lady brought to us through the emergency department, she tried to stab herself because she thought there was an alien inside her”

Her family was incredibly supportive. They didn’t know what her condition was, but they were willing to learn, so the hospital arranged a family therapy session where they asked their questions to help better understand the illness.

“They brought her Somali food every single day, they visited her. Very close and very caring family and with that much love and support she got better pretty quickly,” he said.

Kefi said that stress and trauma in the refugee population is caused by a number of factors which doesn’t really stops when they finally flee to another location. They are vulnerable and every step along their way becomes victim by strangers or by the people they know.

“Nobody is looking out for them and they don’t have a voice,” She said.

Kefi said that different do different things to come in terms with their grief – there are some people who turn to their faith and family while others unfortunately get into drugs and alcohol.

“There are some if we get them a gym membership, they will go there every day and get rid of a lot of that angst,” she said.  “Some people just need to be around people. So we try to get them busy. We try to get them into English classes. Some people are better off when they go to work so we help them get the jobs,” she added.

Hassina said that when they first came to Syracuse, they were alone and living in a neighborhood where no one seems to be interested in their life.

“For the first three weeks, we did the same thing every day, wake up, eat sleep, wake up eat sleep.”

Hassina said it is inspiring to see that other refugee groups take care of each other whenever someone new comes in. Close knit family and community bonds help people alleviate their pain and rebuilt their life in a new place.

“Everyone looks after each other, all the Somalis look after the Somalis, all the Ethiopians would look after the Ethiopians, I don’t even know what me and my siblings are, we are Ugandan, but not Ugandan, we are South-African but not South-African, it is hard to say – hey this is where you belong,” she said.

Hassina will start going to Onondaga Community College from next January. Currently she has made herself extremely busy helping the community – she is teaching English to the refugee kids at North Side Learning Center and volunteering her time at two other non-profits working with refugees. She has also moved to a new house.

“We are in area where there are a lot of refugees and people are willing to come out and help out their neighbors that makes it easier not to become depressed and thinking that we are alone,” she said.

She said that she and her siblings do not talk about the past and the death of their mother much, because it will open too many wounds.

“On a random occasion I will see Jamilah crying in a corner and then I will console her. Then we reminisce on the old memories of our mom and say things which makes the other person happy,” she said. “I don’t want pity from people. I want to work hard and make something out of me,” she added.

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