Keywords

Challenges of refugees; Healthcare; Refugee support groups

Introduction

The UN Refugee Agency [1] reported that in 2015 a record number of people, 65.3 million, were forcibly displaced from their homes as a result of persecution, conflict, violence, and human rights violations. The report also pointed to a record high number of 2 million asylum or refugee status applications. The United States was the second largest recipient of these applications numbering 172,700 [2]. In the fiscal year ending in September 2016, the United States accepted 84,995 refugees. These refugees came from the Democratic Republic of Congo (16,370), Syria (12,587), Burma (aka Myanmar, 12,347), Iraq (9,880) and Somalia (9,020). Over the past decade, the largest numbers of refugees have come from Burma (159,692) and Iraq (135,643) [3].

The challenges these individuals face in navigating their way to resettle in a foreign land are formidable, finding housing and employment, navigating transportation options, learning a new language, understanding new customs and cultural imperatives, to name a few [4]. Also, many lived in refugee camps, many times not in their home countries, for several years before being granted asylum in the United States. The burden that people who are considered to be refugees bear is enormous. They have endured very extreme conditions in poverty, lack of food, money, and often basic human rights [5]. They also lost a large portion of their culture and cultural practices, which they believed they could not practice even in the refugee camps. These individuals epitomize the concept of resilience and strength of spirit [6,7]. Understanding their experience is vital for those assisting them to become successful as new Americans. This article is a review of an initiative conducted in a medium sized city designed to help and support the efforts of these individuals and hopes to shed some light on the experiences of this population and insights gained from this work.

There are many misconceptions about the nature, intent, and goals of individuals who come to the US as refugees. Having gotten to know many of these individuals and families over the years, it is continually impressive to see how these individuals find the courage, strength, and determination to find and maintain employment. They face overwhelming odds and barriers, but, one by one, they overcome challenges, and continue to learn and grow, and take on new challenges. They are also happy to work as long and as hard as they have to in order to provide for their families. They are also very thankful and gracious to have this opportunity to become citizens of the United States, and, although they are free to practice other cultural customs here in the US, they are also making a concerted effort to learn about US culture and to learn and practice new customs [8-13].

Refugee Support Groups

I was given a very unique and in some ways very challenging opportunity to work with, observe, and support individuals who were resettled through a program that provides support for various groups of refugees to form and grow support groups in various neighborhoods in Pittsburgh, Pennsylvania. The support group program is sponsored by Jewish Family and Children’s Services (JFCS) in Pittsburgh, PA. The agency is a leader in terms of providing financial resources, housing, social, emotional, legal, and casework support to immigrant and refugee families. The effort this agency makes in providing this assistance is a beacon of light to families who are so badly in need of this type of help. My role with the refugee support groups is to provide some technical expertise in running the support groups in terms of structure and perhaps some suggestions about curriculum, but often this was left to the support group leaders who would be able to receive feedback from the group members about what their needs and concerns would be.

I would visit the groups approximately every 8 weeks to monitor progress, changes in functioning, provide helpful feedback, help with acculturation efforts, and provide information about American cultural imperatives, including increasing knowledge about holidays, customs, educational systems, business systems, etc. The groups would sometimes ask me to provide some information on a variety of topics. At other times I would participate in the group cultural practices, such as yoga or other types of frozen language participation. Often they would share native cultural foods or dance or greetings and other salutations.

The support groups represent individuals from the cultural groups of Korea, Bhutan, Nepal, Karen, Syria, Iraq, Burma (Myanmar), Syria, China, and Congo. They meet in various locations throughout the city of Pittsburgh, some in churches, others in conference rooms of community libraries, and sometimes in community centers. Some groups have 25 to 30 members, others have 10-15. The groups very widely in terms of content, customs and practices. They are as diverse as the racial and ethnic backgrounds of the group members themselves.

The unique aspect of this article is that the content of the article will be driven by the topics and practices of the groups themselves. For each group I was able to observe and join, I wrote a description of the activities and content of the group. It was a rewarding and challenging experience and I often thought about the fact that I was attempting to embrace Alfred Adler’s definition of a multi-cultural person, being able to be part of and apart from each cultural context. It was illuminating to see the differences in how members of the host culture experience customs from a completely different perspective than individuals who are attempting to experience culture and customs for the first time. Even in having to explain some of the more mundane and rote cultural experiences, such as saying please and thank you, I gain new knowledge and insight about my own culture, realizing how much of a cultural imperative manners are and how much it is expected. Other cultures didn’t have some or all of these imperatives. Sometimes assisting people to understand cultural practices was a challenge. One group had gotten into some trouble for being too forward or aggressive toward women. They believed that if a female addresses them a certain way and then smiles and makes eye contact, that surely is a signal that they are interested in pursuing a relationship

The needs of the groups varied as did the style and approach. The writing in the following vignettes will reflect those differences in style. The overriding theme of the groups that remains constant was the desire of each individual to learn as much as they could about American culture, to relish and bask in a country that respects freedom of expression, custom, and religious practice, to be able to reconnect with their own cultural practices by recognizing the gift of historical perspective that the older members of their communities could provide, and to fill a gap where their own culture was destroyed, or at least suspended.

It was uplifting to see that people from other parts of the world still see America as a place to be free to be who you are and to be respected. As it seems that, as Americans, we sometimes lose sight of who we are and what we should stand for.

The following observations of the support groups and their respective goals and purposes should serve as a lens to view other cultures, cultural practices, and ourselves, as well as to provide insights to those in the helping professions that will aid them in becoming more effective in their work and interactions with this population.

Bhutanese Support Group February 2016

Despite the weather, single digits and snow, there were 16 members present. It was also the last day of a month of fasting, which ended with a ritual that many community members were attending. This was a more unique group session than some of the others. The group started out as it usually does with meditation and breathing and some movement. Then, as planned, the group facilitator had several very informative community members, who share their cultural and ethnic background, make presentations about a variety of topical issues. The speaker talked to the group about resources available to help the community, including community gardening in a nearby neighborhood. They have small grants from the Office of the Refugee Settlement Foundation. Indoor gardening using coke bottles was discussed. The coke bottles containing soil and water are hung inside the homes by the windows. The plants are onion leaves, spinach, lettuce, cilantro, carrots, and sometimes tomatoes. This provides food, healthy air, and productive activities. They also believe it is very beneficial for children to see living things being grown.

A facilitator from another group, was at this meeting and he shared information about Immigrant Services and Connections (ISAC) and the help offered by Jewish Family & Children’s Services (JFCS) Resettlement Programs. He also was present to share ideas and concepts that have worked with his group and to receive ideas from this group about effective, proactive strategies. This is wonderful example of communication and freely and unselfishly sharing with each other without competition and self-interest.

A second presenter discussed mental health and wellness concepts. In his opening statement he posited that mental illness is not different from any other somatic disease. Very interesting! He discussed issues of depression and suicide. Seven suicides occurred in the Bhutanese community in 2013. Four occurred in Pittsburgh between October and February of 2013. He speculates isolation and inactivity as problems. He also discussed issues such as sleep apnea, heartburn, and numbness in limbs. He recommended 7 hours of sleep daily, eat 4 times daily including at least one fruit, socialize, and practice yoga and meditation. The group members were paying strict attention to the facilitator, listening to every word and, at times, responding spontaneously.

A facilitator was able to go onto google maps to show pictures of the village from which they came, a very mountainous country, beautiful with streams and rivers. It promoted nostalgia and introspective thinking with the group participants as to their journey from where they have been and where they are going. The group transitioned to a snack of fresh fruit, water, and some traditional foods, including samosas. The group then had some conversation, shared thanks, and then began the transition from the group activity [14].

Bhutanese Support Group May 2016

I arrived at the meeting place prior to the start and met a group facilitator in the parking lot dropping off group participants. At that time there were 16 participants. While he went to pick up additional members from the community who did not have transportation, many of the group members graciously greeted me and said hello and Namaste. I had short conversations with many of them and noticed that they tried to use the greetings that I use, such as hello, how are you, and it is a rainy day. You could see their attempts to reach out to be friendly and to attempt to acculturate. Soon there were 25 group participants. Many of the older women were dressed in traditional clothing, long skirts and flowing scarves, many covering their heads. Many younger women were dressed casually in jeans and shirts. The older man were dressed in business casual attire with topi head garments. The younger men dressed in jeans and shirts.

I was asked to address the group, which I did for several minutes, mainly stating that the community benefits from their living here and that they make this a better place. Also, I thanked them for accepting me into their group and encouraged them to continue to practice mindfulness and in their attempts to reach citizenship. The group wanted to address me using their facilitator as a translator. They thanked JFCS for their support. A couple of the group participants asked if we could arrange to have the group meet twice per week. They also discussed their hopes and fears about citizenship. One participant stated that if they couldn’t achieve citizenship their many years of turmoil and relocation could be rendered meaningless. Others expressed concern about citizenship and not being part of the political process. Others expressed concern that when they reach retirement age (some of them are there now) they will only be supported by social security benefits for seven years. They are concerned that as their children get swept up in earning a good living that they will no longer have time to take care of them. We discussed these issues for about 30 minutes. The facilitator also expressed concern that in 5-10 years there was going to be problems with families in the communities brought on by aging and relocation of family members.

The next portion of the meeting involved stretching, movement, and dancing. There were smiles on almost all of the participants’ faces. After that activity they had a guest speaker from Magee- Women’s Hospital of UPMC. She addressed the group about healthy living options. Her topics included a healthy diet, getting enough sleep, prevention of heart disease, reducing depression, communication with health providers, and biorhythms. In hearing the presentation on healthy living, I couldn’t help but see the contrast in how advanced the Nepal culture is in terms of personal health, and prevention of health problems, as the group gave feedback about sleeping 7-9 hours per night, eating whole foods, exercising, developing support systems, such as this group, paying attention to what their bodies are saying, and others. The presenter continued to ask group participants a series of healthrelated questions which were interpreted by the facilitator.

The next portion of the meeting consisted of music and therapeutic movement which lasted about 15-20 minutes. Then the group began to prepare for a snack which consisted of native foods and fruits, samosa snacks, oranges, and bananas. It was a community effort to prepare and serve the food to all participants and they then enjoyed a community meal together.

Bhutanese Support Group November 2016

This very effective group experience began the way it usually does with relaxation and the individuals getting centered to be present for the group experience. The group facilitator led a breathing exercise and group members talked about things they were grateful for. Several mentioned that they were grateful for having the opportunity to meet as a group, and for JFCS and their facilitators. The group then entered into a very interesting and thoughtful discussion about how people can and should become and remain tolerant of each other. They discussed the fact that the majority of individuals in their home communities were Buddhist in their religious philosophical approach. However, in America their group is now Buddhist, Hindu, and Christian, and others. They discussed the notion of tolerance that they see being embraced in America. In their home country, they saw their philosophy as being the one right approach and in America they are expanding their notions of what constitutes what is right and what is truth. Regardless of belief system they discussed that all individuals and their beliefs should be accepted for who they are and what they believe. It was apparent that they were wrestling with many of the issues and processes involved in understanding and accepting various cultural beliefs. For example, they were trying to find common ground on different religious philosophies. They agreed that, at their core, all religions are very similar in the belief, that we should take care of the poor and indigent, and that we should have respect for all individuals regardless of differences. They see a difference between the giant temples (churches) we have in America and their simple small alters they build. However, they see similarities in the fact that we should all live the good spirit and be the embodiment of the good (i.e. our bones are the pillars of the church that lead to our brains, which are the center of all divine thought).

Two additional cultural imperatives that were discussed were the role of gender in society and socio-economic status roles. In their country males and females had much more prescribed roles. The male was the provider and the female held the household together. In America, they are seeing the differences and how this could translate into possibilities for them. Similarly, with their home country, they would be born into a socio-economic status in which they would remain and be able to relate and understand all others from this lens. In America, they see that economic status or social status are, or can be, in flux. This creates both opportunity and anxiety for them.

After the discussion, they were led in a mindful meditation. They all were given a banana and directed to take their time to feel, see, smell, and taste the banana to use all of their senses to experience the banana. Questions were posed such as what part of the tongue actually tastes the banana. The group members gave their reactions to the exercise.

Chinese Support Group October 2016

I entered the support group location a little before the scheduled meeting at a Chinese Church located in the North Hills of Pittsburgh. We were able to begin to talk and get to know each other better. There were three Chinese group members and their American spouses in addition to the group support facilitator. There were several group members that were not present today as the school, located some distance away, started back today and several member took their children there. Also present today was the pastor of the Chinese Church and a representative from JFCS.

The group facilitator asked that all of those present introduce themselves. One Chinese woman indicated that she would like to have the opportunity to meet more people who understand their language and culture. Another Chinese individual wanted the opportunity to meet new friends and acquaintances. Another discussed the challenges of acculturation in so many areas, including attempting to obtain a driver’s license. You can take your driver’s test in Mandarin but the books to study for the test are not in Mandarin. Within this meeting there were needs expressed by the members that others had experienced and they were able to assist each other. One example was with cell phone app that explains and includes pictures of road signs. The JFCS representative did a presentation on cultural sensitivity and the community at large. She also discussed issues with the generations in terms of acculturation. She discussed at length ISAC and how it can help immigrants and the array of services that JFCS offers. She talked about the different initiatives for community support available for immigrants. One participant, a spouse of a Chinese member, talked about a company he works for that often hires people. He brought up the issues of hiring more immigrants and people of color. Other topics were housing patterns and where people live, and the cost and lack of transportation in Pittsburgh. WeChat was described, which they explained is the Chinese version of Facebook. Other issues discussed were language access, noting that there must be 10% of a particular population representing a language or culture before translation becomes mandatory. Other ideas for help were discussed. Friendly Pittsburgh, which is designed to introduce education, tourism, business/investment, and real estate opportunities in Pittsburgh to a Chinese audience, and others were discussed such as the “idea factory”.

The group facilitator summarized the initiatives discussed throughout the meeting including starting their own webpage, and several others. We then began to dismiss the very energetic and idea filled meeting. At the end of the group, the facilitator had several questions about the group rules, dynamic, and procedures. I sat with her for a while and answered questions for her. In response to her need for additional support we arranged for my return in a couple of weeks to further support her efforts [15].

Congolese Community Support Group June 2016

Upon my arrival the group facilitators were unloading their cars with water, mixed fruits, crackers, and napkins for the group participants. We finished unloading paper products from the cars and discussed other logistics related to the group meeting. They began to compile and agenda of important items that the group could discuss.

The group of 8 participants, the two group facilitators, and I gave introductions about ourselves and our hopes for the group. One young man has only been here in the U.S. for 7 weeks. He was admitted to a local high school where he spent the past two weeks in the ninth grade. There was a participant present with his wife who stated they had two young children. Another woman was a parent of 4 children from 10-18 years of age. Another gentleman had two children in school. Another young man had 5 children. Each and every person expressed their gratitude for the support of Jewish Family & Children’s Services (JFCS), for this group, and any and all manner of support that has been shown to them. The genuineness of their gratitude was readily apparent even with the language barrier. Their nonverbal communications told a story of their feelings, happiness, and a sense of relief at being where they are now and having the support of others. A couple of members of the group were also members of another group that was run by the same facilitators. They thanked me for the information I had presented in the prior group about the schools and how they can get help for bullying, attendance, differentiated instruction, and others.

One group participant wanted to know about shopping because they had not had the orientation to shopping and did not even know where to purchase food. They were also shown only one store and they need to know more about options and types of stores and products, such as generic vs brand name, etc. They had many questions about where and how to buy certain products at the stores, and how to draw comparisons of stores. In discussing the need for additional information about food, shopping, and bus transportation, one group member retold a story of his being sent on a wrong bus to the grocery store. He wound up at the airport with his three young children and wife in a winter blizzard. They had no money at the time. They finally got assistance from a helpful stranger who drove them home.

Another group member discussed the misunderstandings the community has about African refugees. They sometimes ask questions and/or make assertions that are not really grounded in the truth. Even in the housing complex where many of the families reside, a suggestion was made to consider meeting with administrators and managers to discuss the refugee experience and promote better understanding. They are hopeful that greater understanding will result in greater tolerance, less fear, and more harmony. There was an incident in the housing complex where a family, who was relocated here, was assaulted by their neighbors. The incident is being looked into by the housing managers and others. Although the families have some challenges in acculturation and with activities of daily living, they still communicate joy about their living conditions and the opportunity to live here in the United States.

The discussion moved to self-help and self-efficacy, that they have the power to support each other in many important ways. The group facilitators were very kind to continue to translate the group conversation, which is not always easy to do. The group discussed having a men’s group, a women’s group, and childcare. The group facilitators were attempting to educate the families about child welfare responsibilities, and at the same time empower them to be able to support each other with childcare and supervision.

One group member asked me why refugee families were resettled often together in the same community. I explained that one reason was that leases needed to be obtained for large groups of people and sometimes they are difficult to find, also that having groups together could be a support to each other. When asked him what he thought, he said an advantage is the support for each other and a consequence was that the communities get very suspicious and threatened when groups of them congregate. Another man said when he was resettled two years ago there were few families in the neighborhood and they experienced some harassment (i.e. ringing their doorbell and running) but with more families the harassment has diminished. Another said he is a Christian and was living next door to a family of Muslims. He had some beliefs about them that were negative, but after getting to know them he sees that they are very good people. He noted, maybe even better than some Congolese Christians he knows.

Throughout the time of the group meeting I was struck by the fact that each and every group member was so focused on the here and now. Not one acted like they would rather be somewhere else or that they had somewhere else to go. They listened respectfully to each other, from a 15 year old to middle aged participants [16].

Congolese Community Support Group October 2016

The Congolese group met at an apartment community meeting center. There were 12 adults who were present for the meeting, and at one point there were 6 children as well, mostly under the age of 5, and one very pleasant young man who stated that he was in grade 5. There were two new families who had been in the country for only two weeks.

I had prepared a presentation on differences in cultures and specifically cultural imperatives in America with regard to several important interactional areas. We discussed social space and appropriate space to allow for social conversation, business conversation, space in public, etc. One of the group facilitators was able to add to the explanation as this was a shock to her. For example, on a bus, if there are several open rows of seats you don’t sit next to a stranger, which would be the opposite in her native country; it would be rude not to sit next to someone.

We also discussed non-verbal communications such as smiling, that Americans smile often and have come to expect a smile in return. We discussed greetings such as “Hi. How are you?” That this was just a pleasantry that only calls for a short reply, not a detailed answer, which is what they thought. We discussed the use of time, that American’s believe that if people show up late it is a show of disrespect, and that being on time for an appointment at school or a job interview means being 5 minutes early; and cancelling appointments can have negative ramifications. Other non-verbal communications we discussed were waving the middle finger in anger (they had seen this and didn’t know what it meant), also that crossing the legs and placing the foot on a knee is a common practice in America, but is seen as rude in their native country. Throughout the presentation, the group members asked very appropriate and thoughtful questions about culture, and shared their observations and their desire to acculturate. In delivering the presentation and discussion, I wanted to be careful not to be condescending, acknowledging that they may already know some of these things and also that it was okay to make mistakes and take risks for learning cultural practices. The feedback was very gratifying and humbling. Many of the group members were thankful and acknowledged that talking about these cultural imperatives was extremely helpful for them.

We also discussed the meaning and practices relating to Halloween, which had scared several of them. Some thought it was akin to Mexico’s Day of the Dead and others thought it was something negative and sinister. We discussed the fun and frivolity of the holiday for children and showed pictures of potential costumes for children, also for adults. I gave the example of people dressing up, such as the man who asked a question on the presidential debate wearing a red sweater and black rimmed glasses. It was noted there is an upcoming trick or treat event in their community. The group participants expressed they also wanted to learn more about the Thanksgiving and Christmas holidays in a later session.

Iraqi Community Support Group May 2016

The group facilitator very warmly welcomed me to meet with the group this Sunday evening at their regular meeting location. I arrived early to meet the co-leaders and see how I could help to support them in their goals and mission. They were very friendly and engaging. They wanted to know a little about me and we spoke about some of my professional responsibilities and we found common ground on several of our mutual interests and activities.

One of the facilitators described how she has seen this group help people in the two years it has been running. She sees new people in the community be embraced by older community members and be supported by them. She is very enthusiastic about the power and efficacy of the group to bring about positive change in the Iraqi community and beyond. She is also very energized by her work at JFCS as a case worker and interpreter and community helper. She referred to the other facilitator as Doctor. I asked him if he was a doctor and he explained that in Iraq he was a cardiologist for 23 years. However, the credentials to practice medicine did not translate to the American credentials and he could not practice here in the states. He went on to explain that many of the Iraqis who sought asylum in the United States are very highly educated, many in medicine, sciences, and engineering, but that their credentials were not accepted in many instances. That is an issue for their community, one that they are still working on. Both of them like to refer to themselves as group helpers, not leaders. They provide various topics of interest to the group which leads to much discussion among the members.

As we continued our discussion, the group members continue to file in for the group. As it turns out, there was quite a large group of about 25 to 30 people who came to attend the meeting. The group assembled with the men in one room and the women in another room, and children in still another room. There were various conversations going on and new members were introduced and warmly embraced by all members. This group seemed exceptionally warm and engaging. I was greeted by all members of the group by nearly all of them saying what a pleasure it was to have me join their group for the evening. They also had many kind words for the people from Jewish Family and Children’s Services who had helped them with their journey and what exceptionally kind people they were.

The group shared many fruits, such as bananas, grapes, pears, strawberries, and apples. They also had freshly brewed tea. I was immediately offered food and they prepared a dish of fruit for me and a cup of tea. As all of us shared food together, the group facilitators handed out questionnaires that were written in Arabic about what types of programming the group would want in the future and suggestions for how the group could continue to meet the needs of the membership. Afterward, the group asked questions about the nature of my professional work. They asked me if I would do a presentation about public school policies including bullying, attendance, testing accommodations, and other issues including college admissions. I told them I would be happy to do this. This being the last meeting of this session, they stated the group would start up again later in the summer.

I then joined the table with the male members of the group. We discussed many issues including climate change and fracking, education, politics, and gardening. Many of the group members told me about their experiences in having to leave Iraq and some of the atrocities that occurred. The stories left me with a lump in my throat and a renewed sense that helping people who go through these experiences is the only right thing to do. One group member stated that he was given a choice to stay in Damascus where they had no rights, to go to Turkey, or to the United States. He chose the U.S. and has been very glad he did. We did discuss the amount of crime in their neighborhoods. They referred to gun crimes as accidents. It was unclear why they labeled them that way. After much discussion the group invited me back and dismissed for the evening [17].

Iraqi Community Support Group October 2016

The support group members met in the evening and, as is the custom of the group, the females met in one room and the males met in another room. The rooms were directly across from each other. There was a food table set up with many types of fruits, cakes, donuts, and drinks. They had hot tea, which I was told they drink in Baghdad even in 130 degree weather. I spoke with the new leader of the female group. She was very gracious and welcomed me to the group. The females in the group were dressed in a variety of styles. Some were in traditional Burkas, others in jeans and shirts, and still others were in business attire. There were about 15 members of the female group present. After speaking with the female group, I went to have a seat with the male group. I noticed that all of the 7 males present were wearing a suit coat, even if it was worn over a polo shirt. I felt underdressed in just a button-down shirt and khakis. I believe that next time I visit I will were a suit coat, knowing how traditional clothing is important to them.

In the discussion the group identified some of the ongoing challenges for their community in terms of acculturation. They stated that they needed more information about housing opportunities, other benefits, and entitlements, and health care, including information on vaccinations, on aging and elder care, and disease prevention. They also wanted additional information on cultural imperatives to reduce cultural confusion, including how society is structured. They detailed several cultural practices that have caused misunderstanding on the part of both Iraqi and American cultures. One was that, in Iraqi culture, they tend to point at people, even right at the person’s face. They have received feedback that in America this is seen as being aggressive and/or confrontational. Another cultural trait is that they see people with their feet up on the furniture, such as chairs, tables, etc. They even made reference to watching congressmen in session who had their feet up on chairs. In their culture that is a major insult. They described other practices that were germane to their culture such as never crossing your legs when you are in the presence of your parents.

One of the members had a new grandson last week. They named him Muhammed. His family was not able to visit the United States so his wife flew to Baghdad to visit them. His son was a medical doctor and daughter-in-law was a pharmacist. He also told a sad story that his son’s hospital was targeted by ISIS terrorists leaving 9 babies badly burned or killed.

We also discussed the challenges faced by many of the Iraqis who had been professionally trained but their credentials do not transfer into American professional accreditations. This gave me the idea that some American colleges and universities should be specifically gearing their approach to include the needs of immigrants and refugees entering into country to gain a better understanding of the differences and similarities in training and be able to fill these gaps for them, which would benefit society as a whole.

The group has decided to meet every other week instead of each week to accommodate busy schedules. They believe this will work well for them but they are experimenting with that approach in this group cycle.

Sudanese Support Group January 2016

The group facilitator is a very experienced and talented group leader and mentor for the participants. She has great insight and sensitivity to the needs and concerns of this culture, having been through the process herself. We spoke for a while about the frustration of attempting to get group participants to be committed and responsible to attend the groups on a regular basis, as she received a phone call that three members of the group could not attend.

There were four members of the group present today, three male and one female. The group spoke northern Arabic and the majority of the group was conducted in their native language with various English terms and words used and repeated for emphasis and help group participants, and to promote familiarity and understanding of the American cultural meanings. The facilitator translated the discussion for me during the session.

Group participants remained very engaged with the group and they listened and responded to the facilitator throughout the group experience. The facilitator addressed each and every group member and they responded in a very free and open manner. It was clear they wanted to tell their story and they knew that she would respond with sensitivity and understanding.

The discussion centered on child discipline policies and how they differ from country to country and how effective they are. One group participant spent time in Australia and observed that the children were spanked on Friday so that on Monday, when they returned to school, there would be no visible marks. Another participant was originally from Chad and discussed how children were sent to camps outside the home if they misbehaved. They were made to do hard labor in these camps and they looked forward to returning home. They asked me to explain how residential treatment facilities (RTF) worked in this country. They were surprised to hear that children in RTF did not earn any wage but would try to earn privileges like time on the computer, or visits with their family, or less restrictions and more freedom within the facility.

The discussion continued on to challenges of raising children in America with somewhat different cultural values and imperatives. A very important discussion was experienced by the group. They came to a consensus that the longer you are in the country the less anxiety you have. In the discussion they also stated that each group participant relocated to a different country the first time (Egypt, Australia, and Germany). They discussed how they felt the same way initially, fearful and unconfident. But they all discovered that, as you miss your old friends and habits less, you begin to expand your social circle again and gain confidence. This was an alluring message to one participant who has been here less than six months.

At a break point in the discussion, group members shared donuts and coffee together. The discussion was lighter and more social, and included a conversation of how sugar cane is a major product for Sudan and that the Sudanese love sugar, and it is even sweeter there as the processing of the plant is different.

After the break, the group facilitator initiated a discussion of our criminal justice system. She stated that, as opposed to their native country’s justice system, whose people are treated differently based on social status or ethnicity, our system was based on treating all people the same. I find myself feeling proud of that cultural imperative, but somewhat skeptical of that at the same time. At any rate, it seemed to be far superior to their native country’s justice system. Other topics included how you would address an employer when calling off sick or for other emergencies that may arise. It was readily apparent that having a mentor like the group leader was an invaluable resource for individuals in the acculturation process.

A group member who has been here less than six months produced a couple of utility bills she was confused about. The group, with the facilitator’s guidance, discussed the process of how utilities worked and how the bills are paid. She actually demonstrated tearing off the perforated section and how to mail it back. It was notable that, after almost three hours, the group members would have been willing to continue the meeting [18].

Burmese Support Group April 2017

Prior to the start of the meeting, the Burmese group facilitator and I met and discussed the progress of and formation of the group. She noted that there were Nepalese groups running, but not Burmese or Karen groups. This was an opportunity for these individuals to be reached out to and supported. The goals and direction of the group will be, in part, driven by the needs of the group participants as the experience unfolds. However, to begin the new group session, the facilitator selected topics she thought to be helpful, including language skills and pragmatic use of language, cultural interpretation, and the ramifications of misinterpretation, help with child and family issues and supports. The time for the group meeting is between 10:00 am to 2:00 pm, which works for families as they have dropped their children of at school by 10:00 and at 2:00 they leave to pick them up.

For this meeting there were 8 adults present and two young children under the age of three. There was one male and seven females. The children were 1 male and 1 female. To begin the group meeting, a man and wife introduced themselves and told a little about their experience. It was interesting that they all, when introducing themselves, stated that they were refugees and named the refugee camp they had come from. Members of the group had been in the United States for a period of six years to under one year. One female stated that when she arrived a couple of years ago, she felt very alone and frightened, and isolated. She wished to be back in Burma. But over time, she was gradually able to figure things out, such as the buses, where for a while they would ride sometimes for a long time and not know how to get to their destination. They found help and support from many different places. Of course JFCS, but also random helpful people, such as bus drivers who would read their address and tell them where their stop was. Many reported feeling more secure as these obstacles were being overcome, albeit gradually. One older woman in the group was discussing how she is in the process of obtaining citizenship, and that a representative of JFCS was helping her through the legal department. She was feeling anxious about it as she would be able to apply for Medicare once citizenship has been gained. I introduced myself and stated my purpose for spending some time with them and that we at JFCS want to help and support them.

An idea generated by the group was they would like to be able to visit museums and other cultural sites that were available to the public. Many were unfamiliar with how to access them, where they were located, how to use them, cost, and transportation that would be needed, etc. They determined that this excursion could be a very viable and helpful activity for the group to take part in. They were also discussing ways to get more of their community members involved in the group. They had good turnout considering this was only the second meeting of the support group, which could speak to how closely knit this cultural group is. The group facilitator also distributed fliers describing the Immigrant Services and Connections (ISAC) and led a discussion on the purpose and uses of the ISAC program and how they have and could continue to benefit from this service. There was a great deal of discussion in the group.

After the discussion the group members took a break to enjoy bottled water, orange slices, and bags of potato chips and pretzels. After a period of time of socializing, one group member gave the facilitator a letter she received from the Dept. of Welfare about the need for more information before she could receive benefits. The letter was read and interpreted for the group participant. The bureau needed additional information and the group member was happy to learn what it was that she needed to do [19-21].

Conclusion

The sharing of the collective experiences and expressions of families and individuals who are refugees and are attempting to acculturate is valuable in many ways. It helps us understand the issues and challenges they face, as well as learn about the client’s culture. This population is very diverse and is comprised of people from different continents, countries, socio-economic levels, education levels, and religious and cultural practices. Since formal training for counselors, social workers, psychologists, doctors, nurses, and other helping professionals often does not address the unique experiences and needs of refugees entering a foreign country, this sharing of information aids those professionals to understand their struggles with greater clarity and therefore develop an increased ability to meet their needs. The feedback received from the group participants and facilitators indicated many of them desire and need more education about the finer points of American culture and customs and cultural imperatives, especially as it relates to education, employment, and social practice. Effectively learning how to navigate the system in affairs of everyday life here in the U.S. is important to their safety, autonomy, and success in their new communities. As the participants expressed so often, the supports they received as group members were invaluable to them as they work to become successful in their new country, culture, and community.

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