Refugee Women and Their Mental Health

Shattered Societies, Shattered Lives

Ellen Cole, Esther D Rothblum, Oliva M Espin

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135837679
• Topic: Política y relaciones internacionales
• Subtopic: Política

Currently, there are over 15 million legally designated refugees all over the world and it is documented that 75 percent of those refugees are women, yet most of the existent literature does not focus on this group as women. Most of the literature focuses on political, economic, and social issues with very little reference to the mental health implications of the refugees'experiences as women. Refugee Women and Their Mental Health begins to fill this paucity of information on female refugees'experiences. A book of immediate interest, Refugee Women and Their Mental Health focuses on understanding the plight of women refugees around the world, with an emphasis on mental health. The book adds successful and innovative treatment and recovery models for these women survivors.Some of the chapters are written by women who are therapists/psychologists now and who have been refugees themselves. This adds additional insight into the plight and resulting mental health problems of refugee women. The chapters cover a vast range of topics:

• torture and sexual abuse as refugees/victims of state violence
• elderly women refugees
• immigration law and women refugees
• first-person narratives
• the transformation of identity
• successful creative treatment programsIt becomes clear that women refugees from all over the world under different political events and circumstances share common values and have similar mental health needs. Refugee Women and Their Mental Health explores processes of recovery from the traumas experienced by these women and offers a variety of models for the application of feminist theory to the plight of women refugees. Experienced therapists of women and those in training to be therapists will want to read this book. The topics of refugee women rarely comes up in training programs, so the information in this book is vital for therapists, policy makers, and other service providers and professors of psychology of women, immigration and social work issues, and women and mental health issues.

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SECTION II: UNDERSTANDING REFUGEES: FROM THE INSIDE OUT

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Coping with Stress: A Refugee's Story

Delia H. Saldaña

SUMMARY. Le is a married 35 year old South Vietnamese refugee who works two jobs to support her three children and elderly relatives. The family of eight was one of many boat people whose journey to freedom involved prolonged stress as they left their home secretly and withstood the deprivation of a refugee camp for more than a year before being chosen by a sponsor to relocate in the U.S. Ten years later, Le proudly recites the new responsibilities she has acquired through this transition which have profoundly affected her roles as an employee, mother, and wife. Her story reveals several key elements which hold theoretical significance for the study of successful coping. She refers often to the salience of family values learned early in her life, and the importance of adhering to these during the most stressful periods. She lists several attitudes that helped her maintain hope and focus on her goals during the most difficult times. And, she describes a variety of supportive networks that were developed at different stages of the refugee experience that contributed to a successful transition. These elements clarify the interwoven effects of predisposing factors, coping, and social support on psychological functioning, and imply parameters that clinicians may find helpful in working with a refugee population.

When you cross a river, you use a piece of wood. Upon reaching the other side, don't forget that wood.

–Old Chinese Proverb

CASE STUDY

Le is a 35 year old refugee from South Vietnam who has been in the United States for ten years. Together with her husband, Minh, she works two jobs to support their three children, as well as Minh's grandmother, mother, and aunt in a modest three bedroom home with one bath.

Le is one of the many thousands of Vietnamese “boat people” who found their way to the United States and other countries in the early 1980's. Sponsored by a Presbyterian church, she and her family fled an oppressive Communist government who usurped private property and threatened citizens in its struggle to garner supplies for the war effort with Cambodia. Her voice still filled with outrage, she describes midnight raids in which neighbors' personal possessions, money, even food supplies were confiscated and they were thrown into the street to find another place to live. Although the marauders provided vouchers for “purchase” of the materials obtained, actual payment was never made and people lost savings accumulated over several generations without warning. Fabricated stories of consorting with the enemy or other wrongdoing were often offered as justifications for the government's actions, and the peaceful life that had characterized Le's village prior to the war was shattered.

However, leaving this chaos wasn't easy. Le remembers that at first many left. Those working with the U.S. government, or who had money or connections abroad, left by plane. But for Le's family, who like others feared for their lives and resented the daily indoctrination of their children into Communist ideology, leaving meant arranging secret liaisons with boats for hire who offered a gamble for safety. This required amassing a hefty price for every person who was to board the boat, and not letting word leak that an escape was being planned. It meant resolving to leave behind family and friends, home, and any possessions that could not be carried on board in a small parcel. It meant realizing that once out the door, there was no turning back; for once payment was offered for flight, more than just the money spent for travel was gone. Homes evacuated were immediately fair game for government occupation, and spoiled attempts at escape meant danger for those who risked returning to the neighborhood.

In part, this may be why the entire family made plans for their flight. In fact, Minh refused the offer of a friend to leave separately, with plans to later send for the others. Aside from an elderly uncle, Minh was the only male in the family. His protection was needed at home, and he had inherited a strong commitment to take care of older family members.

Four years into the war, a contact was made: “My uncle-in-law has a friend who owns a fishing boat.” Payment had to be secured: in gold bullion, since currency was not accepted. And the price was steep, for it was necessary to help encourage shore patrols to “cover their eyes” and allow passengers to board the vessel. Upon arriving at the dock, however, Le's family was surprised to find that the greedy boat owner had arranged for far too many others, desperate like themselves, to leave. As family upon family got on board, the boat began to capsize. Finally, the owner's family agreed to stay, leaving 198 people to begin their uncertain journey toward freedom.

The first of many setbacks began as soon as they left the dock. Barely out of the harbor, mechanical problems forced the old wooden boat to stop and send back to shore for repairs. Meanwhile, everyone waited, fearful of imminent discovery. The next four days and three nights at sea were long but mostly uneventful. Luckily, Le says that the waters were calm and storms minimal, and at night everyone would be very quiet to keep from tantalizing the sharks swimming all around.

As the boat approached Bidong Island, a small patch of land near Malaysia that served as a refugee camp, several fishing boats were spotted nearby. The large wooden boat once again developed problems, and one of the boats offered to help guide it to the island. A line was cast between the boats, and the smaller one began tugging the large boat along. However, as the island grew closer, it appeared that the little fishing boat was in fact leading the larger boat away from the land, and the passengers became frightened. Stories had circulated about pirates at sea who raped and pillaged unsuspecting victims. Quickly the line was cut and the larger boat was left stranded in the water, hundreds of yards from the shore.

As dark fell, a large storm approached and the fragile boat began to creak apart in the strong winds. Surely the old wood could not withstand this menace. The passengers began to scream, and then to jump, reasoning that an attempt to swim to shore was better odds than staying in the old boat. Le could not swim, but Minh placed her along with her 9 month and 3 year old daughters on his back and carried them to land. He then went back to bring his grandmother, mother and aunt Minh's uncle, a strong swimmer, also jumped in but suffered a stroke while in the water and became completely paralyzed. Others helped drag him to shore.

The next morning, only the skeleton of the boat's hull and mast remained. The exhausted group of passengers was left on the island, alive but without food, water, or shelter. “For ten days we lived like that,” says Le, “until the Red Cross arrived.”

But even the Red Cross could not compensate for the miserable conditions in which the refugee camp itself was maintained. Le's family found out that they were Boat #190 to arrive at the camp, and already more than 40,000 people were in the camp when they got there. Health care was the worst aspect of camp living: much of Bidong Island was nothing but jungle. There were no shelters: people pieced together what they could from the nearby woods, using rice bags to cover the sparse frames and hang in the doorways. Illness from drinking the water thrived despite attempts to boil everything, and many died, including Minh's grandmother. Children faced daily hunger, existing on meager rations that consisted mostly of rice and water, and many suffered with ongoing skin diseases that reflected their poor nutrition and sanitation.

Few formal supports were available. Toward the end of the year and a half that Le's family was on Bidong, a clinic was established and staffed by one of the refugees who was a physician. A Red Cross nurse provided acupuncture for Minh's uncle, who slowly recovered from his stroke. But most social support was obtained through the chance encounter of old friends and relatives from Vietnam. The poverty, crowding, and disease led to irritability and suspiciousness among camp residents: food supplies were guarded zealously. But violent crime was virtually nil. Despite the fights that broke out periodically, robbery and assaults were not generally a problem, and people slept with only rice bags separating them from their neighbors.

When asked what the biggest source of stress during this period was, Le states that it was the fear that she and her family might stay at the refugee camp interminably. People could leave the camp only if they were selected by “sponsors” elsewhere, who would pay for their passage to another country. Of course, those who were young, educated, or had transferable work skills were the most desirable candidates. Working against Le's family was its size: once again, neither Le nor Minh would consider leaving if their elderly relatives could not also come along. The resolve to keep the family together was strong despite fears of sickness and death, especially of the small children. An offer from Australia was spumed since it included only Le, Minh, and their children. It was not until more than a year later that they received an invitation from a sponsor church in the U.S. to move the entire family of eight.

Upon arriving in the U.S., Le was overcome with the relative sumptuousness of the home they encountered. The sponsor church had paid rent on a small house for two months, and provided modest furnishings, linens, and a stocked refrigerator to greet the family. Within five weeks, the pastor's wife helped Le find a job as a short-order cook in a restaurant, where she helped prepare food she had never before tasted and learned English by constantly referring to her pocket dictionary. Established Vietnamese friends who lived nearby were helpful in getting a job for Minh. Reinvigorated with the promise of a new life, Le worked hard, putting in 60 to 70 hours at her job despite being paid for only 40. She viewed the arrangement as fair: “They liked me, they taught me English, and sometimes gave me fruit to take home to my family. I always did my best.” Unfortunately, she left after a year, distraught over a stolen wallet that her manager refused to help her report to the police. “It had my social security card, my green card. I had only been here a little while: I didn't know what might happen without my papers. He said that only rich people came to this restaurant. Nobody would have stolen my wallet. But it was gone.” A second job working in the kitchen of a nursing home was soon replaced by her current employment as a computer repair technician. She was hired without particular skills in this area, but luckily entered the market at a time when training was provided and staffing needs were high. Within three years she was promoted over others with more seniority to serve as a line leader, a position she still holds today. Did she encounter discrimination or resentment? “A little. But here, there is so much equal opportunity. I saw it, and took it, and with time those people came to accept me.

When asked what she lost by leaving her native country, Le looks slightly puzzled. “Of course, my family,” she says, “but no real property. We had just married and had very little.” She emphasizes, “I didn't really lose. I gained. Most of what I gained is that I feel really good about myself. There, I didn't know what I could do. The woman is brainwashed: you are told that you are stupid and so you feel stupid. There is not so much respect over there: I was just a daughter-in-law. That's nothing. I would never go back: my house is no longer there, and there is no future for my daughters. I want them to have opportunities. Like my oldest oneshe likes music and that costs money. But I try my best to make them enjoy what they think they can do.”

The change still presents a challenge. Le is concerned about the U.S. custom that insists that parents listen to their children. “Not like home,” she says, “where children did the listening.” And she fears that her daughters may not retain the same commitment to family that helped guide her through the roughest times. She works so hard in part because she sees her role as being a provider for three generations. She must provide for her children, provide for the elderly women still living with her, and provide for her own future in case her children should not feel willing to do so. But there is no resentment in this woman's perspective as she talks about current responsibilities. “I have more freedoms, and more responsibilities,” she states with pride. “Here, much more than in my old country.” And what are her dreams for the future? “I want to work in an office,” she says. “I want to dress nice. I worry about my job now. My age is growing, and parts of my body may not work so good any more. Maybe I will get a little more education, and then I can get in an office. So that way I can work longer.”

Le continues to maintain an optimistic assessment of her life. She is able to contrast the opportunities and responsibilities she currently faces with a much harsher existence, which helps reframe any current difficulties she may encounter. Her concerns about her children's greater voice in family matters are similarly mediated: “I try to learn from that. In one way, its good. The children can explore their talents, what they do and how they think about it.” She feels positive about her increased status within her marriage: “Now we're equal. I always go by what my husband says. But I talk to him. I tell him what I think.” And her willingness to work hard and maintain a perspective devoid of bitterness or resentment are important contributions to her psychological well-being. “I don't feel bad at all to work hard,” she states simply. “All I need is happiness.” Does she feel she has attained that? “Oh, yes,” she exclaims. “I feel good about myself.” Listening to this woman talk, it's hard to disagree.

ANALYSIS

This woman's indomitable spirit has seen her through all the change, and implied stress, of her life. And she seems to have weathered it with grace. She quotes the proverb at the beginning of this piece, using it to explain why she must continue to respect and care for her elderly family. But these words also refer to how she has used her longstanding traits of insight, determination, optimism and perseverance to adjust to what life has brought her. And the words refer as well to the values and goals that she wants to retain for her children, of holding onto their cultural roots.

Literature on individuals who cope successfully with stress implies that pre-existing factors such as personality traits and prior functioning must be linked to more current information about the types of stress encountered, supports used, and behavioral or attitudinal approaches adopted to deal with stresses (Burks & Martin, 1985; Gottlieb, 1981; Lazarus & Launier, 1978; Pearlin & Schooler, 1978; Riger, 1984).

Le's case certainly documents the importance of early correlates of later attitudes. Her resiliency toward the overwhelming stresses she has encountered appears related to values learned in her younger years. She recites examples of her life before marriage where she learned to value independence and self-reliance, as well as a strong commitment and loyalty to family. These attitudes served her well in her later experiences, and continue to be salient markers of her approach to life.

Equally important, however, are the types and qualities of supports that were available and utilized during times of highest stress. This woman's history alludes to overwhelming chronic stresses, many of which are similar to other immigrants' experiences. Anticipation of the war's devastation on one's way of life and threat to family's safety, the secrecy and tension ass...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Contents
• ABOUT THE EDITORS
• Foreword
• SECTION I: INTRODUCTION
• SECTION II: UNDERSTANDING REFUGEES: FROM THE INSIDE OUT
• SECTION III: WORKING WITH REFUGEES: THE CHALLENGES AND REWARDS
• SECTION IV: JOURNEYS TO RECOVERY: THE HEALING PROCESS
• SECTION V: DIAGNOSTIC STUDIES ACROSS CULTURES