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  • A model for helping refugees


    Refugees on Vancouver Island have a unique service to help them heal from trauma thanks to the leadership of Adrienne Carter.

     

    LAST YEAR, as medical student at UBC and future physician, I embarked on a research project to better understand the resettlement challenges that refugees have when coming to Vancouver Island, and the issues that physicians face in meeting refugee health needs. My research led me to the Vancouver Island Counselling Centre for Immigrants and Refugees and its founder Adrienne Carter.

    At the age of 12, Adrienne Carter became a refugee when her family fled Hungary to refugee camps in Austria before coming to Canada. Not only has she overcome tremendous challenges in her own life, but she has used these personal experiences to fuel her professional passions as a therapist, social worker and co-founder of the ground-breaking charitable organization Vancouver Island Centre for Immigrants and Refugees (VICCIR).

     

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    VICCIR co-founder Adrienne Carter

     

    During 15 missions with Medecins Sans Frontieres (MSF), Carter had helped to establish mental health projects for those traumatized by war and natural disasters. At home in Victoria in 2015, she recognized that refugees settling on Vancouver Island from places such as Syria and Sudan have devastating and complex issues like those that she helped to address while working abroad. She decided to apply her expertise and experience to support those arriving on Vancouver Island by enlisting the help of volunteer therapists.   

    Many immigrants, especially refugees, have suffered overwhelming experiences, including loss of their home, their country, and loved ones. Some have been exposed to shocking violence, including torture. The manifestations of unprocessed trauma are multifaceted: immigrants and refugees may suffer flashbacks, somatic aches, anxiety, and depression that impede their ability to lead a productive and peaceful life at school, work, and home. 

    To illustrate challenges that the VICCIR team faces in filling a gap that bridges both the complex psychological and medical needs, Carter told me about a young Sudanese refugee who had been working with VICCIR but was worsening. Unbeknownst to his team of counsellors and interpreters who had been struggling to locate him, the client had been admitted to the psychiatry ward in Victoria. Without any familiarity to his surroundings and unable to speak English, the client was in extreme distress. It wasn’t until his team of counsellors found him that he was able to understand how and why he came to be admitted, finally accept an examination and his medications. 

    While medical needs such as immunizations and dental care are adequately identified and addressed within the public health system, the mental health sector that already faces waitlists and shortages of services is overwhelmed with the additional issue of providing culturally appropriate translation. Despite the clear and pressing need to address and provide quality care, some doctors are unable to accept refugee patients because of the difficulty arranging translators. Even programs for children and youth who are not refugees are overburdened.

    Carter quickly found beginning a therapeutic relationship is impossible without opening a conversation in one’s own language. She realized finding and funding professional translations for dozens of languages would be a formidable task. The solution was to involve refugees themselves, encouraging them to turn to their own communities to recruit interpreters. The process was surprisingly simple as volunteers came forward eagerly, many of whom had personal experiences in displacement, conflict, and poverty. 

    Behind the scenes, innumerable hours are dedicated by members of the team. Even before clients are identified and referred by schools, sponsors, physicians, and public health nurses, funding and planning has taken place. Government funding subsidizes only 10 counselling sessions for first-year refugees; VICCIR goes beyond that to continue providing services for as long as clients need them—most are not able to pay but still receive an average of 45 sessions pro bono. 

    Regardless of family size, the centre provides individual and family group counselling for multifaceted mental health challenges related to armed conflict, abuse, displacement, and grief. Often, a group of counsellors trained in different modalities will work with the family unit, with each member receiving a combination of therapies to address the challenging nature of their issues. This holistic approach recognizes the intense stress placed on family and social relationships, and helps both individual family members and the unit as a whole heal together. 

    Beyond these services offered in-office (and online during COVID), VICCIR works with school teachers to help struggling students. They organize workshops to assist mental health workers, provide consultation to settlement agencies, collaborate with police and community services concerned with domestic violence. 

    In addition to the wide range of expertise that VICCIR counsellors possess in different modalities (Somatic, Eye Movement Desensitization and Reprocessing, Art Therapy, Narrative, etc.), there is an emphasis on support for the healthcare team to manage the emotional toll that trauma counselling itself can have. VICCIR provides training to its interpreters to work with counsellors, and following each session they have an opportunity for debriefing and consultation. Supporting and preparing members of the team in culturally sensitive and trauma-relevant practices has enabled the therapeutic relationship to be far more effective. 

    Since its inception, VICCIR has helped over 300 clients, with enthusiastic contributions from the community in setting up and sustaining its work. Originally operating out of a church basement, it has become a registered charity receiving grants to continue their work and has expanded into an accessible space in downtown Victoria for its 18 counsellors, 10 interpreters, and 2 consulting psychiatrists. 

    Research has shown that trauma and violence experienced in childhood have far-reaching adverse effects on all aspects of life: school, interpersonal relationships, health outcomes, even future generations. Studying trauma survivors has yielded insight into how trans-generational changes can either impart or prevent further maladaptive coping behaviours in offspring, depending on the environment and interventions. 

    From Carter’s perspective, this research parallels her real-life experiences working with trauma. There is no expiry date for processing trauma, and the consequences of suppressed experiences manifest in all aspects of a client’s life. The commitment of the counsellor-interpreter teams to each client is to help them process their emotions, develop resilience, and restore a sense of meaning to relationships and roles within the community. In Carter’s mind, VICCIR has made a lasting difference not only because of the interpreters and their training, but also forming relationships in the clients’ own language, providing services to all members of the clients’ family for as long as it takes, and extensive cultural and trauma processing training. 

    In response to the COVID-19 pandemic, VICCIR has successfully moved its work online and is now responding to referrals from other provinces. The centre has been working with researchers from the University of Victoria, hoping to document the positive impacts that the centre has had on clients and disseminate their findings to the larger academic and medical community. VICCIR has demonstrated that the efforts of a community in rehabilitating refugees is paid back many fold as productive and healthy refugees are able to, in turn, contribute as students, colleagues, and neighbours. 

    In 2019 alone, 80 million people fled war, persecution, and conflict globally, 68 percent of which came from just five countries—Syria, Venezuela, Afghanistan, South Sudan, and Myanmar. 107,800 refugees were resettled to 26 countries in 2019, with Canada accepting 21,150. Both the conflicts that refugees have fled and the resettlement challenges that they face, necessitate the improvement of existing resources for transition and integration. 

    With the federal government’s previous and continuing commitment to accept refugees fleeing conflict and displacement, communities must respond to the complex needs of this uniquely challenging population. The VICCIR model has the potential to inform policy and procedure for newly arriving and settled refugees and alleviating the immense barriers experienced by family physicians and specialists in communicating with refugees and understanding their needs. 

    Researching the fascinating story of the community surrounding VICCIR Services led me to understand that services such as mental health counselling should be able to be accessed by everyone regardless of language and cultural obstacles. Seeing the way that therapists and volunteer interpreters have come together to bring these much-needed programs to Vancouver Island refugees has taught me that starting small in my own community can make a world of difference.  

    Sabrina Yu is a medical student at UBC. She acknowledges Dr Mary-Wynne Ashford for being a wise advisor and supportive mentor, and Dr Jonathan Down for his input. For more information about  the Vancouver Island Counselling Centre for Immigrants and Refugees, see https://www.viccir.org/.


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