Suffering in silence: How Metro Detroit supports the health of its youngest immigrants and refugees

Janet Donahue has heard countless stories of horror from refugees and their families. 

As a certified clinical trauma professional and Southeast Michigan head of Survivors of Torture Program for Samaritas, a Michigan-based nonprofit refugee resettlement organization, she has direct contact with every refugee her organization places in homes across Macomb, Oakland, and Wayne counties. Within the last year alone, she interviewed more than 200 cases, each consisting of one to 15 people, often parents and their children under age 21. 

Sixty percent of Donahue's cases are survivors of torture. They suffer from disrupted digestion, heart rate, respiration, and sleep patterns. They have chronic headaches and stomachaches. Children, in particular, have what Donahue calls "Teflon brain," the physical inability to function well in school because the learning center of the traumatized brain shuts down.

In most cases, refugees suffer in silence. "These are adults dealing with internal demons, and they are trying to parent children who are experiencing trauma, too," says Donahue. Refugees from Middle Eastern countries, in particular, attach cultural stigma to their trauma, or simply have no vocabulary for their experiences. 

Time alone can't heal this level of trauma. "It's a normal physical reaction, and humans were designed this way," Donahue says, "but when it's repeated and severe, it's normal to need help to reset, just like a shattered leg needs to be reset."

Immigrant kids who settle in Michigan overcome many challenges to adapt to a new home. They navigate a foreign culture, learn a new language, and attend unfamiliar schools. 

Furthermore, refugees undertake an exhaustive five- to seven-year process to settle in Michigan, and many arrive strained by trauma from displacement, torture, lack of food and water, and family separation. Sometimes trauma kicks in after arrival, when kids adapt to a new school or community. Repeated trauma, in some cases spread over several years, can severely affect the growing child, according to the National Child Traumatic Stress Network. 

Fortunately, several organizations across Metro Detroit are recognizing the needs of immigrant and refugee kids, and are working to give these children—and their families—a brighter future. 

Educating teachers

For children, mindfulness exercises that feel like play can be a useful tool in the healing process. At a refugee war trauma conference held in October, Oakland Schools trained select teachers and staff from its 28 districts on calming exercises to use in classrooms. The group acted out a storm, with arms flailing like wind, and hands drumming like rain, followed by several deep breaths. 

"This is something that students can take with them, including the skill of being able to center themselves," says Dr. Linda Saab, assistant professor of psychiatry at Wayne State University, who led the exercise. 

Participants also learned the value and limitation of mindfulness, a skill that helps children focus on the present moment, as a way of breaking the pattern of ruminating over traumatic acts they have witnessed. 

"The jury is still out, but there is generally a good feeling about mindfulness," says Dr. Anthony King, clinical psychologist and research assistant professor of psychiatry at University of Michigan. 

King encourages the use of mindfulness techniques from Michigan Collaborative for Mindfulness in Education and Transforming Research into Action to Improve the Lives of Students. 

Community jewel in Hamtramck

Kids waiting to see the doctor at the Hamtramck School Based Health Center - courtesy HSBHC

While some schools are only beginning to recognize the needs of refugees and immigrants, others built avenues of support long ago. 

Back in 2000, the Detroit Medical Center and Hamtramck Schools opened the Hamtramck School Based Health Center (HSBHC) to meet the needs of the expanding refugee populations from Bosnia and Kosovo. HSBHC is open to all in the district, and has served children and their families from 43 countries with immunizations, health care and education, insurance enrollment, and other services, including help translating their mail, navigating public transportation, and using the ATM.

"Many refugees have lived in camps, displaced for eight years before they were allowed to come to the U.S. They live in limbo, waiting to be matched," says HSBHC social worker Sarah Peslar. "They come here, and life is hard. They waited eight years and they get here and struggle. They are extraordinarily frustrated."

That frustration filters to the children, who may engage in risky behavior as a means to deal with trauma. The village isn't around to help raise them, nor is a city- or low-cost health center. In Michigan, legal immigrant children are eligible only for Medicaid emergency services for five years after receiving qualified immigration status. While states have the option to remove this waiting period, Michigan has declined, which makes the HSBHC all the more important to this community. 

Last year, the part-time center logged 1,800 visits and saw 568 new patients. Lacking full resources, HSBHC has referred students to community mental health services, but starting this month they will provide in-center care through a collaborative with the Wayne State University Psychology Clinic.

"Hamtramck is a good landing place for people, and the population continues to evolve. Families come with no U.S. health care, for the most part, and no immunizations. And they can't get enrolled in school," says Therese Quattrociocchi-Longe, director of corporate and foundation relations with Children's Hospital of Michigan Foundation (CHMF).
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In partnership with the Jewish Fund, CHMF now financially supports the clinic, providing services traditionally available to immigrants to build their new lives. "It's a jewel of a place that is known and trusted. Neighborhood elders seek out the newest families and bring them to the clinic." 

Discovering what really worksDr. Arash Javanbakht

Treatments that address trauma have never been studied in refugee populations, but that's about to change. Dr. Arash Javanbakht and his team at Wayne State University's Stress, Trauma, and Anxiety Research and Clinical Program screened nearly 500 Iraqi and Syrian refugees in Metro Detroit and found that 50 percent of children have anxiety disorder, and nearly 80 percent show symptoms of separation anxiety.

"For kids, anxiety is avoidance of new situations, social anxiety, shyness in school, and separation anxiety," Javanbakht says. "Which makes sense if you were raised in an environment of terror." 

Javanbakht collaborated with Lana Grasser, a translational neuroscience graduate student with a dance background, and Dr. Holly Feen, associate professor of Art Therapy, to develop a pilot study involving 24 mother-and-child refugee groups. "In kids, symptoms of stress correlate with those of their mothers'," says Javanbakht. "This is one of the reasons we wanted to address mom-and-child interventions."
Lana Grasser
During nine weekly sessions, moms practiced yoga, while their children participated in either dance movement therapy or art therapy in a room nearby. Grasser says the results were positive, with many of the moms continuing to practice at home.

A follow-up study will include 60 participants doing high-intensity interval training, a form of exercise that switches between short periods of intense activity and recovery. Through a grant by CHMF, the team will test saliva and hair samples to determine treatment effectiveness. 

"They will be with us once a week for 12 weeks and have that skill for life," says Grasser. "If feelings start creeping up and traumatic memories return … they can always go back to breathing techniques, or dance, art, or exercise."

And the effects can last a lifetime. "These children, in 10 to 20 years, will be American adults. They could become productive, happy, strong contributors to this society, or they could be marginalized, damaged people, depending on what we, as Americans, do for them," says Javanbakht.

"It's on us to help them integrate and help them feel at home."

This article is part of "Children of Michigan," a series on the importance of health and wellbeing for Michigan's children. It is made possible with funding from the Children's Hospital of Michigan Foundation.

All photos, except where mentioned, by Nick Hagen.