Bass Displacement and Mental Health Project Blog

 

This Bass Connections research working group under the Global Health theme is building on the existing archive of refugee narratives from urban, refugee camp, and resettlement contexts gathered through KIE’s DukeImmerse: Uprooted/Rerouted program. Using this prior research as a point of departure, the group is studying how the resettlement process, a global and transnational program where refugees are provided settlement in countries such as the United States, affects the mental health and well-being of refugees. Undergraduate research team members include: Grace Benson, Kiran Bhai, Kelly Howard, Esther Kim, Malena Price, Leena El-Sadek, Jennifer Sherman, and Julie Stefanich. Graduate student team members include Sonia Hatfield and Libby King MacFarlane.

Libby MacFarlane – a grad student journey


libby-colorLibby MacFarlane,
First-year MSc-GH student

(an interview with the Duke Global Health Institute)

In 2007, I vividly remember attending a land rights rally in a township outside of Cape Town protesting urban planning decisions prior to the 2010 World Cup games. Joining hands with the local protesters and hearing their distress about being relocated, I became deeply passionate about the psychosocial impacts of being displaced. The energy at this protest continues to live within me and inspires me today.

A journey to get to where I am today

One could argue that graduating from Wellesley College with a BA degree in Economics and a minor in Environmental Studies is far removed from the topic of mental health. But, I have realized that my interest in Economics stems from a curiosity about peoples’ behavior, psychology and decision-making. After college, I worked as a change management consultant. It was essential for me to understand peoples’ attitudes, emotions, environment and mental state to succeed on the job. Complementing this, I became a certified yoga teacher and explored traditional healing practices in Thailand, Nepal and China. Four months later, I knew it was time to shift my career trajectory. I left my consulting job and took a position with International Honors Program working as a global health trustees fellow.

When I returned to Cape Town in 2012 – this time to lead a study abroad program for undergraduates that compared health systems across four countries — I realized the lasting impact of the urban planning decisions I had seen five years earlier.   The landscape of Cape Town had changed drastically, as had the psychology of the community. I knew it was time for me to head back to the classroom to understand the academic research and practice that surrounds my interests and to learn from leaders in the field.

Global mental health at the Duke Global Health Institute

Now as a Master of Science in Global Health student at Duke, one of the things I love most is the program’s focus on collaborative and interdisciplinary learning. The Duke Global Health Institute (DGHI) is an outstanding example of bringing a diverse set of experts in the field together to work on substantive global health issues, while also having a richness and depth to each area of expertise. From experts in climate change to infectious disease to health economics – the institute has it all.

Setting it apart from other health programs, Duke is home to numerous global mental health practitioners and researchers; many of whom make up the Duke Global Mental Health Working Group.  With mental health research projects in 16+ countries, I knew I would be faced with the challenge of narrowing my fieldwork options (a good problem to have).

How DGHI has influenced my interest in mental health

There are many ways for me to be engaged in global health at Duke, from courses and research to lectures and special events. Collectively, these opportunities have deepened my understanding and appreciation of global mental health work. In addition to enrolling in the Global Mental Health course and attending events like World Mental Health Day earlier this month, I can tailor my work and activities to fit my interests.

I am a research assistant with Duke global mental health expert Dr. Brandon Kohrt, a well-respected psychiatrist and medical anthropologist who focuses on populations affected by war-related trauma in Nepal, Liberia and Uganda.   Working with him, I have been exposed to the complexities of cross-cultural classification, ethics and stigma related to mental health. With his mentorship, my thesis research will explore the psychosocial impacts of climate change in Nepal.

The Bass Connections program is another outstanding example of interdisciplinary work here at Duke. I am a member of a Bass Connections team focusing on “Displacement, Resettlement and Global Mental Health”. This team is vertically- integrated, consisting of undergraduates, graduates, post-docs and faculty, and we concentrate on the psychosocial effects of resettlement on Bhutanese, Iraqis and Syrian refugees in Durham and abroad.  As a global health student conditioned to focus on the big picture, I really enjoy having the opportunity to be so connected with the local community…. which in turn, helps inform the big picture.

The breadth and combination of distinguished faculty, coursework, events and research opportunities at Duke have provided a framework to see where my specific interests fit within the global mental health field and where I can make the most impact.  As I begin to apply my learning in the field, I look forward to see how my interests evolve and the new insights I will have as a result!

Kelly Howard – from DukeImmerse to Bass


kelly-howardKelly Howard,
Trinity senior (Evolutionary Anthropology major and Ethics Certificate)

“As a DukeImmerse alum, it’s been exciting to have the chance to use global health as a lens for examining Kenan’s prior research on displacement,” says Trinity senior Kelly Howard. This semester, Howard is part of the Bass Connections Displacement, Resettlement, and Global Mental Health research team, which has focused on developing research questions and building relationships with local resettled refugee communities.

Building on her experience with DukeImmerse, Howard says Bass Connections “provided the chance to apply my background in the study of ethics and also learn more about other fields from faculty members on the team.” The vertically integrated team structure of Bass Connections, linking undergraduate students, graduate students, and faculty, has been an asset to Howard as she works on her senior honors thesis. “I’ve had the incredible opportunities to gain exposure to global health and build a research question based on my personal interests,” she explains. “I can’t wait to continue our work next semester!”

This Bass Connections working group is building on the existing archive of refugee narratives from urban, refugee camp, and resettlement contexts gathered through KIE’s DukeImmerse: Uprooted/Rerouted program. Using this prior research as a point of departure, the group is studying how the resettlement process, a global and transnational program where refugees are provided settlement in countries such as the United States, affects the mental health and well-being of refugees.

While there are growing bodies of research on pre- and post-displacement, this project is innovative in that it considers resettlement as a global process which has implications for refugee health at different points, from the country of first asylum to the resettlement country. Prior research will be augmented by additional fieldwork in Jordan and Lebanon. Primary focus will be on the effects of displacement/resettlement on three communities: Bhutanese, Iraqis and Syrians.


Grace Benson & Jennifer Sherman – research ethics

Grace Benson, Trinity senior (Public Policy major and Ethics Certificate) and
Jennifer Sherman, Trinity senior (Cultural Anthropology major with a Theater Studies minor)

Grace-300Our Bass Connections research concentrates on interviews with Bhutanese and Iraqi refugees, both abroad and domestically. Interviews are semi-structured; conducted with two interviewers and a translator, they encompass participants’ most important events and the meaning they give to their experiences of displacement and resettlement. Extending previous research by the Kenan Institute, our team hopes to interview resettled Iraqi and Bhutanese refugees in Durham in order to analyze refugee experiences and the mental health effects of refugee populations both in a country of first asylum (namely, Nepal, Egypt, and Jordan) and upon resettlement.

As we begin the interview process with Bhutanese and Iraqi refugees who have resettled in Durham, we have paid special attention to the ethics of community based research. We are co-founders and directors of the Mastery tutoring and mentorship program for refugee youth, a program that has been ongoing since 2011. Over the past three years, we have formed personal relationships and friendships with the families who participate in the program. Each week, we transport the students to Duke in order to provide one-on-one tutoring sessions with Duke students that emphasize community building, self-esteem, and academic skills.

We’ve spent many afternoons drinking tea over brightly colored rugs, chatting with parents or dancing with the kids. Jenny and I both feel that the most fulfilling aspect of the past three years has been our time spent with these spunky, energetic, and brilliant kids. Last semester, we had our students draw timelines of the 7-10 most important events in their lives. Unprompted, every single child wrote “Joined Mastery” or “Met Grace and Jenny” on their drawings. We feel the same way – these families are our extended families, and they compose the most important part of our community at Duke.
Group-400Our current challenge is how to navigate the different roles we play in the community in the context of research. Mastery and our Bass research are entirely separate and we want to be clear about this separation in our representation to the local community. At the same time, we don’t want to deny anyone who has enrolled their children in Mastery the opportunity to document and express a life story with our project. We want this project to be an enthusiastic expression of agency and for participants to feel they are part of an effort that they believe in. The diversity of our Bass Connections team is one of the best parts of this project. The participants in the project are a part of this collaborative effort as well, shaping and directing the research. Following this ethic, we want to neither push nor deny the opportunity to participate in the life story project to the people we are connected with through Mastery.

In order to ensure that parents feel comfortable and that shared information will remain confidential, we have decided to provide the initial point of contact for our research group to speak with refugee families involved with Mastery. Beyond this connection, we will not be the ones to share further information or conduct interviews with the parents of children with whom we have had an extended relationship. It is a delicate position from which we approach these families and we are dedicated to continuing our personal relationships while providing an opportunity for adults to express their stories.

Leena El-Sadek – living in refuge

Leena El-Sadek, Trinity junior (Cultural Anthropology and Global Health)

(This article originally appeared in The Chronicle, Duke’s undergraduate newspaper)

Imagine yourself on a flight’s standby list. You’re stuck in a liminal period that is predetermined by some higher power—“some” being the key word, because you really have no idea who this higher power may be. This feeling of betwixt and between leaves you plunging for any opportunity that will lead you to the front of the line. And even then, it’s not guaranteed that you’ll get a seat.

Now imagine instead of a seat, you’re plunging for food, water, medications—you’re fighting for the basic items of survival. And these items are not only for you. They’re for those who have managed to escape the turbulent lands with you.

I heard this analogy on my research trip during Spring Break. I traveled with my Displacement and Mental Health Bass Connections team to Amman, Jordan to dig deeper into some key refugee issues that are often overlooked. This afforded me the opportunity to meet key stakeholders and organizations that shape refugees’ trajectories. This also afforded me the opportunity to realize that the way we’re talking about refugees is hurting our research and, more importantly, hurting the millions of people who have been involuntarily displaced.

We numb our conversations, drowning our words in a pool of political correctness and prestigious rhetoric. (Although, let’s be real, we shouldn’t turn to politics for correctness.) We place a shield around our conversations so that only those with similar backgrounds can participate. Our bodies have become desensitized as we have trained our mouths to sing the songs our media exudes on repeat.

While these discussions place us one step ahead of those who remain oblivious (read: ignorant), we miss an important part of the conversation: humanness. Refugees are people who have histories, memories, families, love, relationships, heartbreaks, careers and dreams. And just like, us, students, they want futures. By privileging the voices of refugees, we learn so much more than any textbook or article can tell us.

I grew as a student of mental health, displacement and behavioral issues during one of the conversations I had with refugees in Amman. Refugees can recall the exact corner near their home where a best friend was killed or the market where a brother was kidnapped or the street where an explosion killed hundreds of community members. A lot of refugees have no desire of returning to their motherlands, even though those are often the only lands they’ve ever known.

These memories don’t dissolve, and it takes more than politicians to pose solutions. Refugee issues transcend all disciplines. Leaving them out of our discussions is leaving out an important part of the story.

Let’s put the obvious disciplines aside and look at some less discernible fields that are influenced by, and influence, refugee studies. Economics is one. At millions of dollars a year, refugee camps are financial burdens to host countries. But there are more to refugees than refugee camps. The United Nations High Commissioner for Refugees estimates that over half of all refugees are urban refugees. While in Amman, I learned that two of the city’s largest hotels are owned by Iraqi refugees. These hotels are focal points of the city and welcome tourists, and their money, from all over. While many camps still exist, Palestinians now make up about half of the Jordanian population. During my visits to various organizations, I met lawyers, professors, doctors and directors of nongovernmental organizations who are of Palestinian descent. And let’s not forget about the refugees’ influence on us here in Durham, N.C. Sondos Taxis was started by an Iraqi refugee and now employs over 15 refugees from Iraq and Sudan. Discounting these stories from our discussions and studies is not accurately representing Jordan, Palestine, Iraq, refugees, the hotel industry, the taxi industry, the Duke experience or the financial successes of economic systems.

Anthropology is another discipline that grows with refugee studies. Ethnographic research is an essential tool because it allows us to understand how others constitute themselves in society. It’s only then that policy reform can capture the nuances of different refugee populations and develop effective programs. We see this through mental health services, which call for a solid understanding of interpretations and current resources before proposing any intervention for refugees.

Medicine, global health and bioscience are other avenues that push researchers to the next level when studying refugee issues. It allows students and researchers to combine their backgrounds with effective, innovative solutions that place them outside of the box that a textbook prescribes.

These last two years, Duke has given me the opportunity to interact with and understand refugee issues in Egypt, Jordan and North Carolina. But it takes more than a handful of students and professors (many thanks to the Kenan Institute for Ethics) to change political discourse. It’s not always about repatriation or caveats in the system—it’s about the mothers, the children, the doctors, the fighters. It’s about the students who, too, want a college education. It’s about the pregnant mothers who are dodging the damaging effects of a failing healthcare system. It’s about the men and women whose economic successes go unheard. It’s about the stories. And it’s about how we develop and integrate them into our lives.

My ode to all students: listen, learn, and grow. Because our educational trajectory is for more than us. Our educational trajectory is shaped by and is for so, so many more than us.

Julie Stefanich – presenting at the Refugee Studies Centre

Julie Stefanich, Trinity Senior (Public Policy and Ethics Certificate)Julie Article Photo

Upon returning home from Oxford this past week, my friends and classmates asked how my travels and presentation at the Refugee Studies Centre conference went. At first I just wanted to respond with the easy, yet delightful, “Everything was great, except of course for the rain! And the conference was so enlightening!” While such a response would have been rather truthful, it certainly wouldn’t have captured the complex set of emotions and thoughts that enraptured me throughout my time in Oxford and upon my return to Durham.

The truth is, while the trip and conference were nothing but delightful, it felt bittersweet. The conference marks the end of the four incredible years at Duke, more specifically at the Kenan Institute, that I was lucky enough to have spent working with my professor Suzanne Shanahan and classmates Kiran, Kelly, and Esther.

When I came into Duke as a rather perky freshman, I figured that my Focus program would be nothing more than two and half credits and a semester of free dinners (and, unfortunately, it seems just that for a lot of students). As it turns out, my semester in Kenan’s Focus program marked the beginning of my love affair with all things Kenan, refugee studies, and all of the institute’s passionate, ambitious students. Throughout the semesters that followed, I continued to pursue the study of forced migration and committed to building my academic path around classes and research on the topic. The big milestone, of course, was participating in the inaugural DukeImmerse program and traveling to Cairo, Egypt to conduct research during my sophomore spring semester. I spent the next semester abroad in Istanbul, Turkey, and couldn’t help but feel that my research and work as part of the broader research team at Kenan was incomplete. Having felt such a void last year, the opportunity to participate in Bass Connections this year has been all the more rewarding.

After all of our hard work, Esther and I were ecstatic to have the opportunity to once again take our studies outside of the hallowed halls of the West Duke Building to travel to Oxford to present our research. While I was conducting interviews in Cairo and coordinating community engagement events for refugees in Durham, I would often get caught up in my own work and forget about the multitudes of projects going on with other refugee populations throughout the world. Sharing our work side by side with other researchers at the conference, I was reminded of just how large and dynamic a field of refugee studies is, while at the same time feeling like a significant part of it.

When I came home and began reflecting upon my time at the conference, I found myself reflecting on the past four years, with the conference marking the real capstone on my Duke career. While I’m certainly apprehensive about life after graduation and sad to see my time at Kenan end, I realize just how fortunate I have been to have had such a passionate and fulfilling Duke career and to have had the opportunity to share my work prior to graduation.

Nali Gillespie – returning to the camps

Blog-Nali-1-400It’s hard to believe I’ve been here two weeks. Amman has a different feel, as Ramadan enters its final days.  Last time I was here in Jordan it was as part of the Kenan Institute for Ethics’ DukeImmerse: Uprooted/Rerouted program, collecting life stories of Syrian and Iraqi refugees. This time I am here to research issues of health and wellbeing among Syrian, Iraqi and Palestinian refugees in Jordan, as part of my senior thesis.

The issues feel more pressing this time.  The war continues to ravage Syria, as it morphs into a three-way conflict between President Bashar’s forces, the Free Syrian army and ISIS. Intense violence has reared its ugly head in Iraq as extremist militants threaten to take over whole swaths of the country.  And the seeds of the Israeli/Palestinian conflict, having been sown over the past sixty-something years, have once again sprouted into a grotesque humanitarian crisis.

Jordan has a long history of hosting refugees; stories of flight and the mark it leaves are found even in the most banal of places here.  Several days ago, when I went to a pastry shop, I stumbled inadvertently upon one of these stories in a Palestinian area of town. The baker, a young, wiry man from Damascus, told me his story of how he paid smugglers $1,000 to get his wife and children into Turkey, a far less exorbitant price than the 6,000 euros to get them to Italy or Germany.

Blog-Nali-2-400

But perhaps beyond the stories themselves, one of the most striking things I have encountered is the pain of permanence. Once woman I recently met, Leila, has been very involved with humanitarian assistance in the Palestinian “camps,” which now resemble towns rather than camps. Palestinians from the 1948 war were granted Jordanian citizenship when they came to Jordan, so they are not technically refugees; however this does not lessen the challenges they face. Leila begins the conversation by telling me about her own family’s flight from Palestine during the ‘48 war, when she was only seven years old.  Her family left Palestine, briefly stayed in Jordan and Syria, before moving to Lebanon.  When she married, she returned to Jordan and has lived in Amman ever since, which is how she became involved with assistance in the camp areas (where she herself does not live).  When I ask her why some of the Palestinians chose to live in these areas, where issues of poverty, family violence and high school dropouts are commonplace, she gives an answer I never saw coming.  “Because of hope.  In these pre-fab houses, which are not permanent houses, there is hope of one day returning home to Palestine. But if they chose to leave the camps and move into a house outside of the camp, it’s like they’re giving up on that dream.”

I also visited Zaatari refugee camp, the sprawling refugee camp hosting over one hundred thousand Syrian refugees. The Syrians I spoke to in Zaatari explain that in some senses, conditions have improved: there are new medical clinics, improved security and a bustling market within the center, nicknamed “Champs Elysees.”  Perhaps one of the biggest improvements has been the replacement of tents with caravans, yet this very transition of tents to caravans is a subtle reminder to the Syrians that they are here to stay. The idea of returning home seems more and more…impossible.  “Maybe we can return in 5 or 10 years, just maybe,” one Syrian family tells me. The note is somber. Some aid workers I spoke to explained that this phenomenon is eerily similar to the arrival of Palestinians from the ‘48 war. In the original Palestinian camps, refugees’ houses transitioned from tents to caravans to pre-fab.  Is the Syrians’ transition from tents to caravans a sign of their reluctant, impending permanence in Jordan? It certainly seems so.