School of Nursing helps Kansas City's Sudanese refugee community
January 22, 2014
By Toni Cardarella
Rebecca Mabior grabs a piece of paper and sketches a map of Africa to explain what life was like in her native South Sudan, a neglected east-central country that split from north Sudan in 2011. She draws a distinct line separating the two Sudans and talks about the destruction and trauma that come from perpetual civil wars, and the lack of infrastructural development, particularly in South Sudan.
Mabior, who works as a translator at the Samuel U. Rodgers health clinic, is now using her experiences in South Sudan to help University of Kansas School of Nursing assistant professor Martha Baird research ways to improve the health and well-being of South Sudanese refugees living in greater Kansas City.
"We survived war every day in South Sudan," Mabior says. "Going to the doctor when you're well is a difficult concept to understand."
More than 2 million people have died and an estimated 5 million Southern Sudanese have been displaced as a result of the ongoing Sudanese civil wars. The majority of the 20,000 refugees who have relocated to the U.S. each year are women with children, and that reflects the demographics of the estimated 2,000 South Sudanese refugees who live in the Kansas City area.
"Studies have shown refugee women have a high incidence of mental distress, such as depression and post-traumatic stress disorder," says Baird, Ph.D., who teaches psychiatric nursing in the School's nurse practitioner program.
Baird's work with refugees is centered on a community-based participatory action research (CBPAR) approach, a framework known for engaging community members as collaborators, not just as participants. With Mabior as a collaborator, Baird has translated the Hopkins Symptom Checklist-25, a well-known anxiety and depression-screening instrument, into the South Sudanese tribal language of Dinka.
"I've worked to make the checklist congruent with the Sudanese culture, and applicable and appropriate for the women who would be taking it," says Baird, PhD, APRN, CTN-A.
There were a couple questions unsuitable for the South Sudanese culture, she says, and eliminated completely. For example, questions about sex have no place on this version of the screening instrument, Baird says.
"Sex isn't talked about in the Sudanese culture. There isn't even a word for sex in Dinka."
Baird will use the translated Hopkins Symptom Checklist-25 to screen South Sudanese refugee women for symptoms and develop culturally tailored, community-based interventions. The project calls for informative and interactive sessions on issues in the community, such as post-traumatic stress disorder, depression, suicide, parenting children in the American society, domestic violence and divorce.
Baird says she will develop conventional and culturally congruent strategies to address their symptoms, including counseling, medication, and relaxation techniques such as mindfulness, guided imagery, dance and prayer.
The sessions will be held at a midtown Kansas City church that serves the South Sudanese refugee community. St. Paul's Episcopal Church was also the site of a health fair organized by Baird and others for the South Sudanese community.
"There is a real need for intervention research with refugees in the communities where they live," Baird says. "Culturally effective interventions, conducted in partnership with community members, can lead to sustainable health programs."
For example, the health fair held last summer was tied to a celebration honoring the founder of the new nation of South Sudan, the newest nation in the world. Attended by several hundred people, the fair offered blood pressure, glaucoma, cholesterol, and glucose screenings, as well as checks on stress management, behavioral wellness and reproductive health.
Sponsors included Heart to Heart International, Samuel U. Rodgers Community Health Center, Kansas City Free Health Clinic, the Missouri Department of Public Health, KU School of Nursing and the South Sudanese Women for Change Committee, a group formed by Mabior.
"I recognized there was a need to come together," says Mabior. "Women in our culture need to feel empowered, and find ways to be functioning here."
Baird says a Harvard University global mental health program session she attended this fall in Italy reiterated a theory she's learned working with post-conflict South Sudanese refugees.
"The trauma affects their mental health and well-being, and they need to tell their story, Baird says. "We can't treat mental health without understanding what they've gone through."