Every year New Hampshire takes in hundreds of refugees from all around the world.
They have fled wars, persecution, and even torture in their home countries, and some bear scars – both inside and out. After the trauma they have endured some refugees arrive with undiagnosed mental illness, but identifying and treating these patients is no easy task.
Take Colette Ramazani for example. She came to New Hampshire from the Democratic Republic of Congo in 2000. She’s in her thirties: short, well-dressed, and quick to smile.
Like many refugees, Ramazani saw some horrors before coming here. During some of the fighting she saw in her home country she says, "I saw a boy who was crying, and he got hit by a rocket and his intestine was all out. I look at him, I was questioning myself the same question, why am I gonna die here."
She lived through two of the most violent conflicts in African history. She was in Rwanda when the Rwandan genocide erupted in 1994, and she fled the killing there back to the Congo, just in time for two civil wars to break out. The first began in 1996, when tensions in Rwanda overflowed into neighboring Congo, and the second, now called the Great War of Africa, which claimed millions of lives.
During second civil war, Ramazani was working for the rebel government, and for the first time she found herself in the cross-hairs. She remembers when fighting first broke out her biggest fear was that she would wind up in a mass grave like the ones she saw in Rwanda. She says after hearing the first explosions, "I went back to my room and take my passports and my other IDs and put it in the pocket, just if I die, so they can identify me."
After coming to New Hampshire, Ramazani found her way into a psychotherapist’s office, and was diagnosed with Post-Traumatic Stress Disorder, or PTSD.
Sarah Mason is Ramazani’s therapist. She says that people with PTSD can suffer from debilitating symptoms like, "Anxiety, fear, feeling super-alert, hyper-vigilant, might have insomnia, appetite disturbance, avoidance of thinking about the event, intrusive thoughts and memories, bad-dreams."
She also says that working with refugees can be tricky since some of the patients come from cultures unaccustomed to western mental health treatment. Sometimes they don’t know there is help out there, and have been bottling up their mental anguish for so long, that they begin to experience physical pain. Some patients see their primary care physician complaining "you know headache or my stomach, you know whatever, or my back hurts, and the doctors say, I can’t find anything, we don’t see anything wrong with you," says Mason.
Treatment for PTSD consists of a talk therapy, confronting little by little whatever triggers fears, and perhaps medication.
Refugees who have been through trauma, like Ramazani, have a hard time participating in day-to-day life. Ramazani explains that in her experience "you are really afraid of a public, like a huge public, you just see each person like he’s gonna hurt you, because you have that fear already of being hurt."
She says her condition makes it difficult to stay employed. She left her most recent job because she was breaking into tears at the slightest provocation. "Any time you can have like a flash-back and that flashback immediately make you break down, and that is hard part to deal with," she says.
But Ramazani says that her therapy sessions with Sarah Mason saved her, and if weren’t for her medical team, she might have taken her own life.
It’s tough to say how many of the refugees that New Hampshire takes in have an undiagnosed mental illness, especially since it’s likely that many don’t come in for treatment. The state requires incoming refugees to have a health screening, and the doctor is supposed to assess mental health, but it can be difficult to decide after a single session if someone is not well mentally. New Hampshire is still working to create a standardized mental health screening.
But Sarah Mason, who specializes in treating refugee patients, keeps very busy: she has a caseload of about fifty at any given time, and if Ramazani’s experience is any guide, coping with this trauma when you are 6,000 miles from home is very difficult.
Ramazani's voice catches in her throat when she says, "any refugee, we miss home, and we wish we could go back home. I feel I don’t have a country, I don’t have a home."
But she is making progress here. She’s studying a Masters in Global Business at Southern New Hampshire University, and trying to put the nightmares behind her.