Middle of Everywhere - Mary Bray Pipher [46]
Some refugees come from places where to admit you had a physical or mental problem was to be killed. They are ashamed of these experiences and do not share them with others. But they have physical and psychological scars. Some withdraw from their families. Others are violent or suicidal. Given their histories, it's hard to talk such people into hospitals, which cost a lot of money and involve paperwork and dealing with strangers and unfamiliar treatments. One woman from Mali had chest pains for a week before a public health nurse stopped by for a routine visit. The nurse told me, "She could easily have died of a heart attack."
Mental Health
Every culture has its own ways of expressing and repressing emotional pain. Many complaints that we would consider mental health problems are expressed somatically. Often refugees say they are sick when they really mean "I am incapacitated by stress." People don't sleep well, are always tired, or their back hurts. Middle Eastern people frequendy express emotional pain by talking about pain in their arms or legs. A woman from Liberia complained about blurred vision and eye pain. The doctors could find nothing. Finally I said to her, "I imagine you must have seen terrible things." She answered, "They shot my husband in front of me."
It's more acceptable to speak of physical pain than mental pain. A doctor with training and experience working with refugees will understand that some of their physical problems are stress related. A less-experienced doctor may order expensive and scary tests.
Psychology is irrelevant to most newcomers. This doesn't mean refugees don't have mental health problems. They have high rates of depression and anxiety. But in their hierarchy of needs, these are not their most pressing problems. It's hard to do therapy with someone who is hungry. In fact, it is silly to sit and talk to someone about their need for a ride to the grocery store. It's better to just take them.
Every culture has its own system of healing. All over the world, healing involves calmness, beautiful places, kind people, simple routines, rituals, and temporary protection from everyday problems. Laughter is a part of many healing systems. There is really no period in history when humans didn't laugh. Even during war there is laughter. Music, touch, dancing, food, and prayer are part of healing all over the world. But psychotherapy is a hard sell.
BUREAUCRACIES AND QUESTIONNAIRES
Even before refugees arrive in the United States they must go through interviews to determine their refugee status. Many say this interview, conducted in a foreign language and consisting of odd questions that must be answered precisely, is more stressful than being tortured. Even the smallest mistake can condemn their families to permanendy live in a refugee camp or return to a situation that will get them killed.
Assuming the family establishes refugee status, they begin a lifetime of dealing with bureaucracies. America is awash in paperwork. There is a form for everything from going to the dentist to signing up for a field trip to checking out a library book. These forms are an annoyance if one knows the language, but they can be an insurmountable barrier to adults who cannot read or write in English. There are other barriers as well. Many refugees don't know their age or birthdays. They may not have other vital information about health history and vaccinations, about school and employment, or about dates and places of residence.
Often our categories don't even fit native-born Americans, but they really collide with the cultural traditions of refugees. For example, the Kurdish sisters tried to fill out a scholarship application