By: Darlene Lynch, CVT
The Center for Victims of Torture, the largest treatment program of its kind for survivors of torture and war worldwide and a leader in global mental health, operates a small clinic in Clarkston, Georgia. Often called the “most diverse square mile in America,” Clarkston is the center of the state’s refugee community and home to people who hail from more than 50 nations and speak more than 60 languages and dialects. In any given day, the work of CVT’s clinicians traverses the world, as clients representing many different cultural and linguistic backgrounds come to the clinic for hope and healing.
CVT’s clinicians, whether in Georgia or in programs in Minnesota or countries across Africa and the Middle East, understand well the critical role that culture and language play in building trust with clients and guiding them along the path toward healing. Culturally competent care is at the heart of CVT’s work. It is also central to its popular toolkit for U.S. health care providers, Improving Well-Being for Refugees in Primary Care, which features the story of a women named “Paw.”
Paw’s husband and child were killed in bomb attack in Burma. After many years in a Thai refugee camp, she finally comes to the U.S. and seeks medical care for her headaches, nightmares, and physical pain. With the help of an interpreter, she tells her primary care doctor that she has a “heavy heart and a headache.” The doctor prescribes ibuprofen and something for heartburn, and when they don’t work, offers increasingly powerful pain killers. But what Paw is experiencing, and is trying to describe, is post-traumatic stress disorder, with symptoms that pain medications cannot resolve.
Paw is a fictional character whose experiences mirror those of CVT’s Karen refugee clients, an ethnic minority from the eastern region of Burma with a distinct linguistic and cultural heritage. These clients often describe their distress with heart-based metaphors, such as expressing that their heart feels heavy or tired. Clients from other cultures use other “idioms of distress” influenced by their unique cultural beliefs, social and historical factors, experiences of war and trauma, and daily life and social stressors related to their migration and resettlement. For example, distress may be described as “wind attacks” or “being hit by the wind” in Cambodian culture, “nerve attacks” in Latino/a cultures, “air in the brain” in Somali culture, or “burning from the inside” in Oromo culture.
Today, there are as many as 1.3 million survivors of torture in the U.S. from almost every continent on the planet. To help survivors like Paw heal and rebuild their lives here, CVT clinicians constantly hone their skills in culturally competent health care. They inform their therapy with research into the culture, history and politics of each clients’ home country, use culturally-validated screening tools, and hire specially-trained interpreters to become part of its therapeutic team.
In CVT counseling rooms, there are always three chairs. The client and clinician sit across from each other while the interpreter sits to the side. The interpreter is key to building a trusting relationship, ensuring that every word, including every side conversation or phone call, is interpreted in a language the client understands and prefers. In this way, interpreters empower clients to be full participants in the healing process and enable clinicians to provide the quality care clients need.
Unfortunately, access to culturally and linguistically appropriate care like this is rare. Consider the state of Georgia.
Today, one in ten Georgians is foreign-born. By some estimates, more than 60,000 have come to the state as refugees and thousands more have sought refuge through the asylum process. The U.S. Government reports that nearly 44% of U.S. refugees and asylum seekers are torture survivors.
Yet, CVT Georgia is the only treatment program in the state dedicated to caring for torture and trauma survivors, and one of the very few that offer culturally competent mental health services. In the past five years, its small team has served clients from more than two dozen different countries, including the Democratic Republic of Congo, Cameroon, Guatemala, Burma, Afghanistan, Ukraine and more. It has employed interpreters who speak more than a dozen different languages and dialects. And it has only scratched the surface.
Georgia’s behavioral health department recently recognized the rapidly increasing diversity of the state and identified the lack of culturally appropriate care as an unmet need. Last month, Georgia mental health leaders came together to provide a “Unified Vision” for improving mental health care in the state, and chief among their recommendations was the expansion of culturally competent care, including by creating a state Division of Cultural and Linguistic Competency, implementing national cultural competence standards, and committing resources to build a more culturally competent workforce.
CVT will continue to work in Georgia and around the world to provide healing care across cultures and languages and to expand access to culturally competent care for all those in need.