A Place Called Home
A family designated as refugees arrives at Burlington International Airport with just a few bags of belongings. They speak little or no English. They have no idea where they will live other than among strangers. They must find places to buy food, navigate the school system and learn to drive. At some point, sooner or later, they'll need to see a doctor. Many arrive traumatized and grief-stricken. They've left behind loved ones in war-torn areas or witnessed them murdered, raped or tortured. Some suffered such violence themselves in their homes or in refugee camps.
In Vermont, they will join some 7,000 people with refugee status, many living in neighborhoods of Burlington and Winooski within the shadow of the University of Vermont. Their connection to the University has grown beyond physical proximity. Some of the institution's most esteemed faculty have devoted time, attention, scholarship and research to better understand and ease the transition for those forced to leave their home countries and resettle in the United States.
The relationship between UVM and the refugee community stems from a fundamental responsibility to the greater public good as part of the university's land-grant mission, says Pablo Bose, Ph.D., associate professor of geography and an expert in refugee migration.
"This is one of the big issues facing the country as a whole the demographic shift, the changing nature of our different cities and towns, what the influx of new people brings in terms of both possibilities and challenges," he says. "An institution like UVM is well-poised to take on a lot of these interdisciplinary and multifaceted challenges."
UVM scholars learn much from the refugee community, which forces them to approach their work from a different point of view, says Andrea Green, M.D., associate professor of pediatrics and director of the New American Clinic, part of the University of Vermont Children's Hospital.
"We forget that the way we understand medicine is through our own personal cultural lens," she says. "So one of the great things with working with refugees is they teach you new ways of thinking, new ways of problem-solving, new ways of managing health problems that we may not have thought of before."
SOCIAL WORK FROM "A DIFFERENT SET OF LENSES"
Susan Comerford, Ph.D., associate professor of social work, wants to prepare her students to better understand the people with refugee status whom they might meet in the field when they practice in Vermont.
"They will not go to that meeting blind. They will go to that meeting with a depth of understanding," says Comerford, who teaches both an undergraduate course and a master's seminar on working with refugees, as well as an undergraduate course on diversity.
Such empathy for those coming from vastly different backgrounds helps future social workers, even if they don't see refugee clients, learn to recognize their preconceptions and personal biases and step outside of their own experience. Working with refugees teaches them to consider the larger systemic and contextual circumstances that lead to individual struggles.
"Try to think about it with a different set of lenses," Comerford says to the 13 students in her master's seminar. Comerford often shares her own experience with her students, going back to her days right out of college, when she was in her early 20s and worked for nonprofit groups on the Thai-Cambodian border and other conflict-riddled parts of Southeast Asia. The human resilience she saw in the face of horrific acts still resonates with her today.
Since that initial exposure, Comerford has kept one foot in refugee work. She is a consultant for the Vermont Refugee Resettlement Program, as well as programs in other states. She provides many of her services pro bono, quietly and behind the scenes.
During a gathering of her master's class this past spring, part of the discussion focused on the appropriate level of personal involvement that a social worker should have with clients. The students questioned whether typical professional boundaries should shift when new American clients follow their own customs by offering a gift or a dinner invitation to their homes.
"It's a very Western notion," Comerford explained of the inherent "power imbalance" and line drawn between a professional and the person served. "The amount of clear distinction we have in the U.S. is a culturally bound notion."
TECHNOLOGY TO TACKLE TRAUMATIC STRESS
Soon after she began working with refugee families in Vermont, Clinical Professor of Psychology Karen Fondacaro, Ph.D., broke her own rules about keeping a personal distance from clients, attending their weddings and funerals and a Bhutanese religious ceremony called a puja.
She spent time in the Somali Bantu and Bhutanese communities, trying to overcome their skepticism about therapy. Fondacaro, who is the director of UVM's Connecting Cultures clinical science program that provides mental health services for resettled refugees, has since helped hundreds of refugees address the extreme trauma they faced before, during and after their arrival in the United States.
The unique experiences of those with refugee status goes beyond the typical diagnosis of post-traumatic stress disorder, or PTSD, and the traditional methods to treat it, Fondacaro says. She recently coined a new designation: Chronic Traumatic Stress. It recognizes that these torture survivors struggle with ongoing anguish.
"We're not just dealing with post-traumatic events," Fondacaro says. "We're still dealing with it." The new designation includes a package of 10 "modules" for treatment, including coping techniques for debilitating episodes of disassociation or depression. With language barriers and gaps in understanding, however, clients who are refugees may have trouble recalling those steps at home between sessions.
In late 2015 Fondacaro received a Small Business Innovation Research Grant through the National Institute on Minority Health and Health Disparities to create an interactive smartphone application that guides participants through the exercises they would do with their therapists. Under development by Gametheory, a Burlington-based tech company, the mobile app uses only images no words and personalization options to encourage at-home practice by patients.
Fondacaro is currently testing a prototype with a group of clients. She and the developer are collecting usage data and to see how the app works in actual practice. Then, Fondacaro will apply for a second SBIR grant to roll out the product and run a full-scale trial.
"The research is so challenging in that it's really different from using a Western measure with Western folks to understand a concept," she says. "The challenges are: are we asking the right questions? Are we using the right measurements? Do we have the right constructs? Are we respecting the cultures, and are we distributing it in a way that makes sense?"
A DATA-DRIVEN DEPICTION
Pablo Bose quietly has studied refugee resettlement patterns for more than a decade, but his work recently was thrust into the political spotlight with the Syrian refugee crisis and presidential campaign debates over national security.
The heightened interest including some backlash against refugees only reinforces Bose's drive to tell the real story, correct misinformation and guide better policy decisions, he says. "A lot of the work that I was doing all of a sudden became much more relevant for moving away from the kind of myths that we tend to have about who's coming, where they're going, and what they're doing."
Over the past few decades, the influx of new Americans has shifted from the traditional big cities with infrastructure and resources New York, Los Angeles and Chicago to places such as Burlington and Rutland. Bose is now in the final phase of a three-year project studying resettlement in small- and medium-sized communities.
The project includes interactive maps and an annual survey to gauge Vermonters attitudes about resettlement. This summer, he and his team interviewed refugees who resettled in the previous 30 days about their expectations for housing, employment, and income. They'll revisit the same group for two succeeding years afterward.
This summer Bose began what he calls a "PhotoVoice" project, in which ten new Americans and ten longtime nonrefugee residents will each get a camera and follow prompts to take certain pictures: something they want to change; something they want to stay the same; something that represents America; something that represents community. They will write explanations for their choices, then Bose and his students will gather the participants into separate groups to discuss their photos and impressions.
"One of the hopes out of this overall three-year study is to create a model for understanding how resettlement is going," he says. "If we want to make policy that is evidence-based, what is the evidence we want to base that on? And right now, when we look at refugee resettlement in the U.S., we have very incomplete data."
Bose intends to replicate his work in four similar-sized U.S. resettlement locations outside the Northeast. Om a planned sabbatical next year he will expand and apply his research to small towns in Canada, Sweden, Denmark and Norway.
CLINICAL CARE CONNECTED TO THE COMMUNITY
When Andrea Green took over the New American Clinic in 2004, it already had a goal to serve as a "one-stop shop" for refugee children's primary care. Her patients come to see the doctor, but they get much more.
Green has moved beyond the individualized, single office visit and into a "community pediatric practice." She networks with other service providers, schools and government agencies. She builds relationships with elders in the refugee communities. She brought in funding for an in-house social worker to help families deal with household complications, such as trouble paying bills.
"The immigrant community can be used as a lesson in understanding barriers to care," Green says. "The barriers are really obvious: You have the barriers of lower socioeconomic status. You have the barriers of communication and understanding. And I think if you can work in this group and overcome those barriers, then you can take that model and extend it everywhere, because the barriers are with every patient population."
Green is part of a cross-disciplinary Hatch Grant from the U.S. Department of Agriculture along with Bose and colleagues from the College of Agriculture & Life Sciences and the Department of Nutrition & Food Sciences, for a project related to food insecurity. With her own interest in obesity and the social determinants of healthy eating, Green and the team will study refugee families' food choices and "what's in their cupboards," to understand their views of food in the United States and whether those change over time.
Through her creative funding efforts, Green has launched several refugee-related programs: an annual bike helmet/car seat awareness day; smoke detectors for refugee families provided by the city fire department; swim and water safety lessons, including 80 slots from the city Parks & Recreation department and "modest Muslim swimwear" that Green found so refugee women would feel covered and comfortable.
"You need to change the way you're practicing to match the cultural values of the people you're working with," she says. Green goes to new Americans' homes to check out their décor, so she can address any child-safety concerns. When asked about taking these extra steps on her own time, without compensation, she gets choked up.
"You go into pediatrics because you believe in the value of creating healthy children, supporting children so they can become healthy adults."
Work with refugee patients takes problem-solving skills, open-mindedness and flexibility sometimes just to deal with the logistics, Green says.
"You have to have some patience," she says. "People are not always on time. But you have to remember what they've been through just to get here."