November 15, 2013
By Aubrey Bittel
|Joseph Lemaster, M.D., M.P.H.|
For generations, practitioners of yoga have valued the discipline for its relaxation and health benefits. Now with the help and guidance of University of Kansas Medical Center faculty and other community members, a group of Nepali Bhutanese refugee women in Kansas City are discovering that yoga may be an effective tool in addressing the trauma of culture shock and the physical pain that many of them have experienced since coming to the United States.
The stress that accompanies the situation of being suddenly immersed in a new culture is almost inevitable. Joseph LeMaster, M.D., M.P.H., an associate professor in the Department of Family Medicine at KU Medical Center, says stress can have devastating effects on mental and physical health.
Lemaster is currently working with members of the Bhutanese refugee community living in Kansas City, so he sees firsthand the effects of this kind of anxiety.
"They come to America with optimism, full of hope," LeMaster says. "But the challenges soon set in. Not having the language, finding a job, paying bills, learning the culture. Their anxiety levels are very high."
Lemaster says that for about six months after arriving in their new home, refugees usually experience an intense culture shock, but eventually daily tasks and life in general become easier. He says once the refugees pick up some English, learn new skills and find work, their lives become easier. And as they are able to function in their new culture, stress levels decrease.
But Lemaster says serious problems can arise when there are obstacles to this acculturation process. Older adults have the hardest time adjusting. If they have had little or no previous education, it is much more difficult to learn a new language, which is often essential to finding a job. They may become dependent on children or other relatives who have had an easier time adjusting. But if they have no one on which to rely and no readily available resources to employ, they may easily fall through the cracks. Without proper coping skills, depression and anxiety disorders often set in.
Dr. LeMaster is doing what he can to help minimize these challenges and reduce anxiety among Kansas City's Bhutanese refugee community. Working with the Bhutanese community members, he and his team assess what will be most helpful to each person, including job-seeking support and education and language assistance. LeMaster also regularly sees refugee patients in the family medicine clinic at KU Medical Center.
One trait of the Bhutanese culture is a tendency to internalize mental and emotional problems, LeMaster explains. "Physical pain, however, is more acceptable for them to talk about." He sees patients complaining of muscle tension, headaches and migraines, osteoarthritis, and rheumatoid arthritis. But often after extensive testing there seems to be no physical explanation for their pain and little improvement is seen after treatment.
That is when Lemaster came up with the idea of leading an exercise class to help Bhutanese refugees deal with their stress. In what became known as the Chautari Intervention Program, members of the Bhutanese community with complaints of chronic pain that had yet to respond to medical treatment began taking part in an exercise class, which eventually morphed into a weekly yoga class. A small group of women are now led through yoga poses every week by Claudia Cardin, a yoga therapist advisor. Both Dr. LeMaster and his wife, Judy, act as interpreters.
So far the feedback from the participants has been positive. The relaxation techniques and the physical relief provided by stretching exercises have resulted in an improvement in chronic pain for many of the women.
"I feel stronger," says Ratna Chettri through interpreter Tika Siwakoti, both of whom have been involved in the classes since the beginning. "I have less stress, and I feel better."
Although it is too early to gauge what long-term effects the class might have on the health of the refugees, most of the participants say they are feeling more positive and optimistic. Whether caused by physical ailments or emotional distress, the chronic pain of many of the participants seems to be receding.
Dr. LeMaster and his colleagues hope to expand a version of the yoga class to other limited English proficiency groups in the Kansas City area.