Published January 2018 by the Harvard Program on Refugee Trauma Newsletter
Utilization of Mind Body Practices for Survivors of Natural and Human Made Traumatic Events and Their Caregivers
Uganda, still recovering from the trauma of war, the AIDS epidemic and deeply rife with poverty as well as continued violence has shown itself to truly be the pearl of Africa in that it has opened up its land and heart to over a million refugees.
The Imvepi Refugee Camp hosts over 100,000 South Sudanese. 85% are under the age of 18. Their fathers have been brutally murdered. Mothers raped. They have walked miles upon dangerous miles to safety. Many of the 300 Red Cross volunteers - all of whom work for a few dollars a day, lunch and a place to sleep - have begun to experience the effects of vicarious trauma and empathy fatigue while offering aid to thousands of traumatized children and their families.
Kilifi County, Kenya is rampant with the defilement and sex trafficking of children. In a 2015 report published by the Standard Digital, 367 children were raped by relatives, 207 of whom gave birth at local hospitals. Many of these children, supported by Friends 4 Justice, find refuge at the Kikambala Rescue Center which provides food, shelter, clothing and emotional support until they are either returned to their families, if appropriate, or sent to one of the many local orphanages where they receive much needed education and continued care. The social workers and caregivers are emotionally and physically exhausted.
Neuroscience shows us what yogis, monks, priests, nuns, and shamans have known for millennia - contemplative practices create inner change, specifically by affecting the brain’s neural integration as well as the body’s response to stress. For those of us in refugee or IDP camps, prisons, and rescue centers, even for those in offices, medical buildings, or safe at home - what we always have is the Body. When we consciously connect to the body we can begin to heal, to restore resiliency, to reintegrate ourselves.
“The Embodied Mind: A Review on Functional Genomic and Neurological Correlates of Mind Body Therapies” and Harvard University’s “8 Weeks to a Better Brain” are excellent resources as is the work of Dr. Herbert Benson of The Relaxation Response, Dr. Bessel Van Der Kolk of The Body Keeps The Score and Dr. Stephen Porges of The PolyVagal Theory.
In August 2016, Gaea Logan (HPRT ‘17) Director and Founder of The International Center for Mental Health and Human Rights - and I co-facilitated a week long Contemplative Based Trauma and Resiliency Training at Makerere University, Kampala, Uganda for 79 trauma therapists, social workers, aid workers, street counselors and caregivers. The fundamental concept behind this was that calm creates calm and that - “Mental health professionals and humanitarian aid workers must start with themselves if they are to create a calm environment. Refugees cannot find their calm in the midst of the storm if the staff cannot.”
A 2013 research study at Columbia’s Mailman School of Public Health found that amongst 376 Ugandan workers at 21 humanitarian aid agencies “a significant number of the staff at these organizations experienced high levels of symptoms for depression (68%), anxiety disorders (53%), and post-traumatic stress disorder (PTSD) (26%), respectively.” Vicarious trauma and empathy fatigue easily lead to burn-out. Burn-out is responsible for a decline in productivity as well as the longevity of one’s ability to give aid.
In a 2013 NY Times article, Rosalie Hughes, a former UN refugee agency worker describes her own sleeplessness and anxiety and cites a 2013 study commissioned by the United Nations High Commissioner for Refugees - “47 percent of its staff members who were surveyed indicated having had sleep problems in the previous month. And 57 percent had recently experienced symptoms consistent with depression. Rates of clinical depression among aid workers are double those of American adults. One cites “adult trauma exposure” as a main cause.”
Utilizing mind/body practices such as LovingKindness and Compassion meditation, mindfulness, breath work, mindful movement (such as yoga, Qi Gong and martial arts) rest and restoration as well as play and peer support help to prevent burn-out and PTSD amongst caregivers and the people they aid.
In April of 2017, as a faculty member of ICMHHR I was invited to speak and share these practices at the 3rd Annual Ugandan Clinical Psychology Association / Ugandan Behavioral Health Alliance Conference at the University of Kisubi, Entebbe, Uganda which Sebastian Ssempijja, (HPRT ’17) founded. Over 150 mental health care professionals and students attended and participated in Care for the Caregiver workshops. The idea being that health care professionals use the practices for themselves and share them with their patients or clients. We train the trainers.
Funded by Second Response, an organization dedicated to the well-being of wounded and traumatized children as well as their caregivers, I was able to offer skills to over 60 children and 20 caregivers in Kenya as well as hundreds more children and 130 caregivers in Uganda. On my final day in Kilifi one of the lead social workers at the rescue center facilitated every aspect of the practices with the children - many of whom were pregnant, had just given birth, or were young mothers, including a 16-year-old mother of a 17-day-old infant girl and a 15-year-old mother with her 3.5 year-old son.
Accompanied by Turhan Canli (HPRT ’17) of The Mind Brain Center for War and Humanity at Stony Brook University and Sebastian Ssempijja, I returned to Uganda and shared these practices again. It is important to remember that these are embodied practices. The devastating effects of gender based violence, mass trauma, forced evacuation and/or the witnessing of such disconnect us not only from our communities but ourselves - not only is the body beaten and abused but the mind is broken and fragmented. We heal the one with the other to become whole again. The body itself is the healing environment.
At Imvepi, a two hour Strategies for Self-Care workshop was held with the Red Cross volunteers who claimed feeling more calm, refreshed and peaceful and continue to not only do the practices but share them with their co-workers, families as well as the refugees. A one hour “play” workshop was conducted with over a hundred refugee children in the “safe space” - a fenced off and razor wired area solely for children in the camp.
The African Youth Initiative, directed by Victor Ochen, a 2015 Nobel Peace Prize Nominee, in Lira, central Uganda, has a staff of 35 dedicated to helping reintegrate survivors of war into their communities. With the help of WhatsApp and video footage shot during our half day workshop, I am able to continue sharing the work as well as advising the staff on best practices to share with the different communities they serve.
Additional workshops were held at the James Kaleesi Memorial School in Mityana which houses more than 80 orphaned youth and at the Butabika Mental Health Care Hospital in Kampala.
Mind body practices can be used anywhere, at any time and by any body - as we share the practices they become tools, a skill set for resiliency passed down from one to another and for one another.