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a strategy for refugee health
by Ammala Douangsavanh
The wars in Southeast Asia may seem miles and decades far removed, but their effects remain profound, enduring, and borderless. That is because millions of Cambodians, Hmong, Lao, and Vietnamese perished amidst the atrocities of the Vietnam War, the U.S.’s bombings or “Secret War” in Laos, and the genocidal “Killing Fields” in Cambodia under “Pol Pot’s” Khmer Rouge. Millions more suffered tremendous trauma loss and isolation in “re-education” and refugee camps or migration to the West.
“The wars and refugee experience have everything to do with the severity of the health issues affecting the Southeast Asian community.”
- Margret Chang, medical student, Alpert Medical School of Brown University
talking points
- As of 2000, according to data compiled by the Southeast Asia Resource Action Center
(SEARAC), there were 1,814,301 individuals in the U.S. who reported one or more of the following ethnic/racial designations: Cambodian, Hmong, Lao, and Vietnamese. Of that number 11,043 were in Rhode Island.
- The United Nations’ World Refugee Day is observed on June 20 and honors refugees’ courage, strength and determination. For local information or event information, visit International Institute
Rhode Island, www.iiri.org.
- According to an Issue Brief on Domestic Violence in Southeast Asian American Communities published by the Southeast Asia Resource Action Center, domestic violence victimizing women and children in Southeast Asian American communities is a large problem that is frequently not discussed. Their paper also focused on women affected by mental and emotional abuse by abusers who themselves are often suffering from the stress and depression “of surviving the Khmer Rouge back in Cambodia.”
- Local resources for issues around domestic violence include Destiny House (www.destinyhouseri.com) and Sojourner House (www.sojournerri.org).
What does this have to do with health in Rhode Island?
Thousands of Southeast Asian widows or widowers, orphans, and
families resettled in Rhode Island beginning in the 1970’s, with over
ten thousand Cambodian, Hmong, Lao, and Vietnamese reported in the 2000
census. And according to Margret Chang, a third year medical student
at Brown University’s Alpert Medical School, “The wars and refugee
experience have everything to do with the severity of the health issues
affecting the Southeast Asian community.”
In a community where there are very few words, if any, to
adequately describe conditions like Post Traumatic Stress Disorder and
depression, and where illness is just as easily attributed to spiritual
or karmic reasons, as biological ones, mental health issues and chronic
diseases in the Southeast Asian community are compounded by many
factors that impact access to healthcare.
“Many Southeast Asians continue to be haunted by memories from
their past. What they endured is unimaginable to me. Many were
tortured, starved, and made to witness violence directed at themselves
or their loved ones.” To this day,” says Chang, “these experiences have
stayed with the community and have formed the basis for mental health
problems such as Anxiety, Depression, and Post Traumatic Stress
Disorder.”
Prior to moving to Rhode Island, Chang was a Research Fellow at the
Centers for Disease Control and Prevention, where she studied the
growing epidemic of Type 2 diabetes in the Southeast Asian population.
It was there that she discovered an alarming connection. “What struck
me most,” she reflects, “was how closely cultural and historical
factors were connected with the high rates of disease in that
population.”
In Chang’s view, it seemed that “very little was being done to
educate the Southeast Asian community and their healthcare providers
about the burden of diabetes and other chronic diseases” or their
possible connection to past trauma. She noticed trouble in some
providers’ abilities to properly diagnose and treat this population and
key factors from the community’s side: poor acculturation, poverty,
limited English proficiency, and other cultural barriers.
What can be done, and why does it matter?
The ongoing story and struggle of Southeast Asians is broadly
pertinent in Rhode Island given the continued resettlement of refugees
from other distressed countries like Somalia, Burma and Iraq. Says
Chang, “One of the most important lessons for the medical profession is
that we need to think more carefully about the long term health of
refugees.”
She stresses the importance of providing health education and
resources to incoming refugees, and believes community organizations
and social service agencies can help immensely by providing support to
help bridge the gap between provider and patient
For Chang personally? She says she was drawn to Brown because of
its reputation for being community-focused. She is studying to become a
primary care physician and is interested in continuing to serve
immigrant and refugee populations. “Maybe it is my own background as a
child born to immigrant parents that makes me attracted to this type of
work, but I know I will always try my best to help medical providers
understand the populations they serve, regardless of differences in
background or culture.”
 Ammala Douangsavanh is a Lao-American student, majoring in
Communication Studies and Sociology at URI.
Photos by Agapao
Productions.
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