A lot to Digest

I have seen refugees in Germany, the US and now here in India. Often people immigrate to other countries out of despair, survival, helplessness and for protection. But if we stop and think for a moment how often have we actually interacted with refugees. Not too much or never. The sad thing is that even though people might have never met refugees personally and learned the problems they go through, people tend to judge them for who they are and for what has brought them here. I have heard people say things like they come here and take away our jobs and resources that should be allocated to us, they should go back to their country and ask for help there. This type of attitude is further reflected by discrimination, racism and hostility in the country of refuge. On top of all the other problems refugees have, this becomes one more thing in a long list of things that is making life not easy for them.

During my internship I have visited Don Bosco, a non-profit organization supported by the United Nations High Commission for Refugees. Their main goal is to teach refugees’ self-reliance and sustainable livelihoods through the implementation of various training centers in which for example they are educated and taught useful skills in order to find jobs in factories and other places. When I talked to one of the social workers there, she told me that it is so important people like me get interested in projects like this to see and learn about the ways refugees are living, what brings them here and why they need support. By educating me, they hope I can then spread the word and maybe tell my experiences to third parties and subsequently get the ball rolling for more awareness. This is why I decided to share my experiences with you.

The mental hospital VIMHANS that I am interning at sends a psychiatrist to one of the centers of Don Bosco to treat people with psychological problems. Two doctors alternately visit Don Bosco every week. I have decided to come along with one of the doctors on one of those days. The center that we had to visit is only a couple of minutes walking distance from VIMHANS so we left the hospital after our daily case presentation at around 11am. When we arrived, there was already a full room of patients awaiting us. Another clinical psychologist and I were accompanying the doctor so we both positioned our chairs behind the doctor to observe her work.

The patients were coming in accompanied by an interpreter and a social worker. Most of the refugees did not know how to speak Hindi or English so the interpreter was absolutely crucial even though there is a reason why they are called interpreters. There is a lot of information that gets lost in translation. There was one patient whose diagnosis was completely changed because she was not understood in a way that she was supposed to be understood. Communication between patient and doctor depends on how the interpreter understands the questions of the doctor, how the question is translated to the patient and finally how the patient understands the question. The same problem is vice versa, which is when the patient answers the question. There is always a fine line between correctly understanding and misunderstanding the patient.

A lot of the patients who come to see a psychiatrist have undergone lots of trauma in their countries from which they have fled. The people we saw, suffered mainly from depression and anxiety disorders such as PTSD and panic attacks. For me, those illnesses make sense. I know that sometimes we should not conclude so fast but I felt like it is so clear. Somebody who has seen what they have seen will be scared regardless of their predisposition which is why I wonder if the condition should be called a disorder and can it be cured by medication. This is even what the doctor was asking. She told us about one of the patients and how the medication is not working for her but there is nothing she can do. The doctor was also questioning whether or not there can be anything done for people in such conditions. People who have undergone so much trauma can they even be helped? Maybe… but the additional resources that this person would need are not available therefore the people are stuck in a cycle from which they cannot escape and there is nobody who can help them get out. There was this other patient who said that she often feels like screaming. She was diagnosed with depression and obviously the desire to scream was not the only symptom she had but I thought that this statement was clearly showing that there is so much more which this woman needs to express and can’t. By giving her the medication might or might not help her suppress that symptom but in patients like that it is important to help them get to the root of the problem in order for them to get better. At the same time I understand that this is easier said than done. Who is going to pay for it and who is going to take care of the children while she will get additional treatment? There was this other woman who was depressed too and she also suffered from anxiety. She was still victim to the things that caused her to be scared. A lot of the women still live in abusive households so how can they be expected to get better when the abuse still continues. So many questions but no answers. In those situations people who try to help women like them feel helpless, there is really so little they can do.

 Nevertheless, Don Bosco is one of the organizations that provide refugees with as much help as they can. They have centers all over Delhi. Here in South Delhi the centers mostly serve Afghani and Somali refugees. The other centers are divided amongst mainly all Somali refugees and Burmese. I was told that the refugees divided them up like this themselves. Obviously, when people come to a country where everything is foreign to them they will try to find people who are familiar to them.

The centers I have visited are in South Delhi. Altogether there are three centers. One center, the one where patients are treated for psychological problems as described above, is focused on social, psychological and physical wellbeing of the refugees. The center helps them get medication for free and tries to arrange appointments with doctors or possibly getting doctors to the center itself. The social workers are usually the ones who do all this and in addition provide as much counseling as is required for the individual refugees. The social workers also assess the homes of the refugees to see what they need and how much more and in what ways they can help them.

Downstairs of the center, they have a child care center where little children can stay and play from morning till night so parents can go to work. Then, they have two classrooms in which the older children are taught. There is one class that is a “bridge class.” Those children are being prepared for regular schooling in India. Before they can go to a real school, they are taught Hindi, English and some basic math. The other class is for children who are already in school but need a bit more help with their school work. Don Bosco often employs refugees who have been going to school there themselves as teachers and/or as interpreters. The social workers told me that refugees themselves prefer working there than anywhere else because they feel most comfortable and welcome at this place.

The other center which is positioned right around the corner is mostly focused on teaching the older population English and Hindi. There are different levels of each language which they can attend. Beyond language classes, that particular center also offers computer skill training. This way, refugees are taught specific know-hows that can possibly help them find jobs more easily. In addition, the center helps them find work. Because of the refugee status which most of them have, they have difficulty finding a good job since the places they can be hired are limited. Nevertheless, the workers there do the best of their abilities to find what is best suitable for them.

The third center is providing mostly senior refugees with specific skill training such as sewing. Being taught that, they can find work which requires that one acquired skill. Or they can keep working at the center for a small amount of money, which sometimes is necessary when the refugees are too old and have only a small chance to be hired outside. The people working there make mostly kurtas, some bags and accessories which they later sell. The money inquired by the sells, the refugees can keep for them as additional money.

Going around the centers and watching peoples’ work I felt very inspired because I think it makes such a difference when refugees have a place to go to. Not only for specific help and questions but a place where they feel welcome and can spend their day, share their concerns, problems, difficulties and also achievements with other refugees who will understand them the best. They have all gone through similar things and having people who will surely understand them can have a better effect than any therapy. It’s kind of like an unofficial group therapy. This environment is telling them that they are not alone; there are other people who feel the same. Even though, there are often not enough resources to send refugees’ suffering from psychological problems for additional treatment such as psychotherapy but providing them with an unofficial group therapy setting might be the only alternative.