Therapists help Nepalese refugees in Bhutan break down layers of trauma

Uma Acharya knows the daily hardships that refugees must go through in order to survive.

Born in a refugee camp in Nepal after her family escaped government persecution in Bhutan, she witnessed poor living conditions and lack of resources during the 15 years she spent there before settling. in the USA.

There was never enough food for the family; Acharya’s parents had to leave their camp to work on the farm for days or months, just to feed her and her two siblings. Some of their neighbors who left the camp for heavy labor never came back alive.

Now a 27-year-old Columbus-based mental health counselor specializing in serving refugees, Acharya said her own traumatic experiences helped her build relationships with those she cared for.

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“I have so many questions for them because I know what they had to go through just to survive,” Acharya said. “I always ask my client, ‘How were you feeling back then?’ and ‘What did you have to go through to get food?’ “

Acharya is part of a team of seven at the Center for New Americans, a community-based program located on the East Side that addresses the specific mental health needs of Bhutanese-Nepalese residents of central Ohio.

Recruitment of Nepalese counselors essential to provide culturally appropriate care

Unlike traditional service providers who offer sessions only in English or have to rely on interpreters to communicate with Nepalese clients, most counselors at the Center for New Americans speak Nepali and are former refugees themselves.

Recruiting members of specific communities is essential to offer culturally and linguistically competent counseling, according to Surendra Bir Adhikari, senior researcher on health equity and disparities in the Department of Mental Health Services and drug addiction from Ohio.

“If the doctor is well trained and has a higher degree of cultural humility and sensitivity, he would have the motivation to really ask the right questions and notice the symptoms at the end of their conversation with the client,” he said. -he declares.

The model also circumvents the challenges of using medical interpreters, which in some cases have led to more problems than solutions, Adhikari said.

“Due to the very literal translation of the language, some patients misunderstood the information and would react violently to what the doctor said because they thought it was offensive,” he said.

In Franklin County, there are approximately 23,500 Bhutanese-Nepalese refugees, a group that suffers disproportionately from mental health issues. The suicide rate among Bhutanese-Nepalese refugees is twice that of the general American population, research by shows from the Centers for Disease Control and Prevention.

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But there are simply not enough Nepali-speaking advisers in the area, defenders said. As a result, Acharya and her colleagues must each take on a heavy workload. In addition to her operational work as a program manager, Acharya works with 36 clients, with high risk clients requiring up to three sessions per week.

There is also the challenge of working with a population that tends to resist treatment.

To overcome the cultural reluctance to discuss mental health, the Center for New Americans team reaches out to potential clients by first helping them with practical tasks, such as filling out government documents or translating their mail. Staff members also travel to residents’ apartment complexes or their children’s schools to meet clients wherever they are.

“They are not asking for help and they would tell us to leave them alone,” Acharya said. “In American culture, we could just leave them alone. But with refugees, there is so much underlying trauma, so we have to keep approaching them until they say, ‘OK, let’s try this. “

Three layers of trauma

The Bhutanese refugees were part of the Nepalese minority who had lived in Bhutan in South Asia for decades. In the 1980s, they became victims of the ethnic cleansing of the ruling majority. Starting in the 1990s, civil unrest in Bhutan prompted the state to arrest, torture and deport Nepalese-speaking residents.

Those who fled to Nepal were unable to obtain citizenship there, and most past 15 to 20 years living in refugee camps before the international community started resettling them in 2008.

“The first few years in the camps were as bad as you can imagine. No toilets. No drinking water. No nutrition, ”said Tej Mishra, a former refugee from Bhutan and now an independent mental health researcher. “People would be busy burying children. Trees would fall during windy seasons, and you might just die when you sleep.

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Most refugees in Bhutan have experienced trauma during all three stages of their resettlement process –– in their home country, in the refugee camp and in their new host country –– according to Adhikari.

“They already suffered the loss of their property and their homeland when they were displaced from Bhutan,” he said.

But relocating to a new country comes with additional challenges. In the United States, refugees face language and cultural barriers, health issues, housing insecurity and financial stress. Seemingly simple things, like missing a doctor’s appointment or not having a car to get to work, could trigger existing mental health issues, Adhikari said.

Rising anti-refugee and anti-immigrant sentiments during the administration of former President Donald Trump heightened the emotional strain that new Americans experienced, according to Rochelle Frounfelker, postdoctoral fellow in the Department of Psychiatry at McGill University at Montreal, Canada.

“Having someone at the grocery store come up to them and tell them they should go back to where they came from affects people on a daily basis,” Frounfelker said, adding that discriminatory rhetoric from politicians could be a factor. stress for refugees, especially given their experience with legal proceedings in their country of origin.

A community healing process

Even when presented with help, things don’t always turn out well – like when a Bhutanese-Nepalese man walked into the Center for New Americans earlier this year, unaware he was about to receive her first mental health screening.

The man came to the United States as a refugee and his family had noticed signs of mental illness – talking to himself and laughing aggressively. His brother scheduled a mental health assessment on his behalf with the Center for New Americans without telling him, and when staff began asking questions about mental health, the man walked out of the room.

In the Bhutanese-Nepalese community, people with mental illness are often referred to as insane and hide their conditions to avoid social humiliation, according to Acharya. But having the right cultural background has at times allowed her to approach therapy in a more creative way.

One of Acharya’s clients is a woman who suffers from depression and PTSD. The woman’s children had died on the way from Bhutan to the refugee camp, and during one of the counseling sessions, the woman felt particularly upset.

Acharya knew that many Bhutanese spent their days tending to livestock and sang in groups to bond. “Are you good at singing?” Acharya asked the woman. “Do you want to make a song and sing for me next time?” “

The following week, the woman showed Acharya a song she wrote. From that point on, whenever the woman saw Acharya, she would recall the moment she was singing during the session, beaming at the memory.

“It’s so much fun, and I’m so happy to see them feeling confident,” Acharya said. “They don’t feel that very often here in the United States”

Despite the benefits of having counselors who share the culture and past experience of clients, it is still difficult to integrate clients who are not ready to deal with their mental health issues, according to Yolanda Board. She is Director of Organizational Development at Northern Community Counseling Center, the mental health agency that created the Center of New Americans three years ago.

“A lot of older people aren’t as willing to discuss or dig into the intricacies of what they’re going through,” Board said. “It usually puts you in a bind.”

Very often, Board said, opening the door for community members to eventually come in for treatment was a tangible task they needed help with, whether it was a bill they didn’t know how to pay or a letter they couldn’t read.

“Once they’re in that space and they see that we don’t have a hidden agenda, then these therapeutic conversations start to take place,” Board said.

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The man who came with his brother finally had a mental health exam at the center on their second visit. After staff members diagnosed him and referred him to a mental health center, the man started taking medication and is now in compliance with his treatment plan.

“It’s really about pulling the layers around their trauma and just having these normalizing conversations about their mental health,” Board said. “Tell them that they don’t have to live with this terrible feeling. We can really do something about it.

Yilun Cheng is a member of the Report for America corps and covers immigration issues for The Dispatch. Your matching donation to our RFA grant helps keep writing stories like this one. Please consider making a tax deductible donation at https://bit.ly/3fNsGaZ.

ycheng@dispatch.com

@ChengYilun