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For Refugees Who Flee War-Torn Nations, Trauma Often Follows

A special series by the Reporting on Health Collaborative

About This Series

Many immigrants feel isolated in America – suffering that can turn toxic over time.

Six news outlets joined together as the Center for Health Journalism Collaborative to highlight the interplay between immigration status and health. The USC Annenberg project involves Mundo Hispánico (Atlanta), New America Media (California and New York), Radio Bilingüe (Fresno and Washington), WESA Pittsburgh, Univision Los Angeles and Univision Arizona.

For Refugees Who Flee War-Torn Nations, Trauma Often Follows

January 06, 2014


Over the next five years, 50,000 Congolese will be resettled in the United States by the State Department. A few thousand of them will be moving to Pittsburgh. Many of them will come without any English and with trauma, depression and other scars of war. They’ll be in need of mental health services – services that as 90.5 WESA’s Erika Beras reports, many providers and the Pittsburgh Congolese community fear aren’t going to be there.

Music and Singing, Hallelujah!

On a Sunday morning in December nearly a hundred people are in a West End church dedicating their prayers to Claudine Mukankindi. It’s been a year since she died of a heart attack. At the time of her death, she was 36 years old.

Bring music back up.

In a pew near the front is Adeline Kihonia, dancing and chanting in worship (bring up Adeline amen) tears in her eyes as they always are whenever she speaks of her deceased friend.

A14: She was like a part of my family, when she passed away, it was like I lost a sister.

When Claudine Mukankindi arrived in Pittsburgh in 2001, it was after surviving the Rwandan genocide, enduring countless acts of violence and loss of family. She had fled to the Congo and then to Kenya, then Cameroon before being resettled in Pittsburgh by Catholic Charities.

With the exception of the young daughter she brought with her, she didn’t have family – but she quickly became close to Adeline Kihonia. With Kihonia, with whom she shared Congolese roots, she also shared much of what she experienced before arriving in the U.S.

A3: Claudine saw a lot of stuff I don’t know if I can say some of them but they were raping women and Claudine saw all of that and they did that to her and they killed even her uncle in her eyes. She saw a lot. She saw.

In her time in the US, she was diagnosed and treated for a slew of mental illnesses, among them PTSD.

Trauma is pervasive in the Congo and other conflicted and post-conflict countries. Lynn Lawry from Harvard Medical School has studied mental health issues there. A 2010 study she conducted in the Congo found that half of all adults exhibited symptoms of Post-Traumatic Stress Disorder – in contrast, in the US that number is between 5 to 10 percent of the population. Despite those high numbers, Lawry says there are little to no mental health services in the Congo.

L5: In most of the countries that I go to that are countries of conflict or post-conflict there may be one psychiatrist or two psychiatrists, which was the case for Democratic Republic of Congo.

Lawry says different cultural norms in the Congo may not allow people to realize that what they are experiencing is a form of mental illness. When people emigrate, those attitudes are exported.

J23: Back home people don’t know all the diagnoses of mental health other than just being crazy in general.

That’s Jean Elomba, a Congolese man who was resettled in Pittsburgh around the same time as Claudine Mukankindi. He too, had experienced traumatic events. One has left an enduring physical scar – a gunshot wound followed by days of hiding in fear without medical attention resulted in him losing his right arm.

For the first eight months refugees are in the US they receive federally subsidized medical assistance that covers their medical needs.  When Elomba arrived, he was fitted for a prosthetic arm. But he says he was never offered mental health care, even though in retrospect, he might have benefitted from it.

J8: It was very difficult because you don’t go to sleep, because you keep dreaming about all the things and you feel like someone’s going to come to get you.  You have all those bad dreams; you keep dreaming the same thing over and over.  

Even though he struggled in the Congo and in the US, if mental health services had been offered to him, Elomba doesn’t know if he would have partaken.

J15: You don’t want to just talk about anything because what will they think about me when I say those things – so you try to withhold some information and think well, maybe I’ll overcome this and maybe someday I’ll feel better.

Not everyone who experiences trauma develop post traumatic stress disorder. Its not known why some people develop PTSD and others don’t.

Elomba ended up working as a caseworker for several years with Catholic Charities, the same group that resettled him.

He says he often thinks about his friend Claudine Mukankindi - if her life would have been different if she had received mental health services immediately upon her arrival to the US.

 J24: I think there was a big missed opportunity when she came to try to stabilize her when she came, She should have gotten mental health care and entered into a treatment program.

In Claudine Mukankindi’s first few years in the U.S. she learned English and made friends within the Congolese community. There were also hospital visits and loss of mental stability. Along the way, she lost custody of her daughter, which friends say devastated her.

In 2006, she ended up at Bethlehem Haven, a homeless shelter.

Lois and Darvella: This is a typical room, this was Claudine’s room….keys jingling, doors opening, etc

She spent the last few years of her life at Bethlehem Haven’s long-term, supported homeless shelter for women with severe mental illness.

In the years, Claudine Mukankindi was at Bethlehem Haven, her daughter was adopted by her friend Adeline Kihonia. Her mental health was stabilized; she got a job and in 2010, became a U.S. Citizen. But last December, at the age of 36, she died unexpectedly.

Lois Mufuka Martin is the shelter’s executive director.

She says in some cases, supports refugees get upon arrival – housing, food and health care for the first few months aren’t enough.

LMM16: Trauma doesn’t just affect the mind, it affects the body, in our world of homelessness, we’ve been known to say that for every year a person is homeless it ages them up to ten years

Although the World Health Organization and The State Department recognize that many refugees are coming with trauma upon arrival, and the Centers for Disease Control and Prevention has guidelines for mental health screenings, those that work in the resettlement agencies and those who have gone through the screen say the screen is weak. And the screenings done before refugees come to the US are for communicable diseases like tuberculosis.

Martin says many of the problems Mukankindi faced are pervasive within the refugee community. With a growing refugee population in Pittsburgh, she says there has been talk within the mental health community that while Pittsburgh may have housing and employment for them, there may not be supportive services in place.

LM17: Mental health is grossly underfunded as it is. So what I am hearing in a general conversation is how do we absorb additional populations – be it indigenous or not. How do we absorb them into systems?

One way may be grassroots.

Rebecca Cech spent her childhood in the Congo and frequently returns. (speaking Swahili and showing map of where she lived) She is on the Congolese resettlement committee Allegheny County has set up to address some of the issues they may face. She says many of the refugees they are expecting are single mothers, women who may have some of the same vulnerabilities as Claudine Mukankindi.

Cech is working with others in the established Congolese community to set up homegrown support systems and connect new refugees to mental health services. 

RC21: Yr talking about people who have been victimized so trust comes really slowly and its really difficult to talk about some of the things that have happened to them and there is not a culture in Congo of that kind of support outside of family and friends networks.

Similar efforts are also underway in the Bhutanese and Somalian refugee communities in Pittsburgh.

I’m Erika Beras, for 90.5 WESA News and the Reporting on Health Collaborative.


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