Kazito Kalima was 14 at the start of the Rwandan genocide. Over just a few months in 1994, hundreds of thousands of Tutsi people in his country were killed, including most of his family.
Kalima was bashed over the head with a machete, beaten up and left in a ditch filled with dead bodies. He escaped into the jungle, where he lived for three months eating grass and drinking swamp water.
鈥淚t鈥檚 hard to understand,鈥� Kalima says. 鈥淚t鈥檚 hard to understand it if you never lived through it.鈥�
It鈥檚 a horrific story. Unimaginable, for most people, including many of the mental health professionals Kalima met with to process his trauma.
鈥淪ome of the counselors I鈥檝e met, they would start crying when I talk. I鈥檓 like, 鈥榊ou鈥檙e supposed to help me,鈥欌�� he says with a laugh.
Kalima is the founder and executive director of the in Indianapolis. He came to the U.S. on a basketball scholarship after living as a refugee in East Africa. Now, the nonprofit he founded raises awareness of genocide and other human rights atrocities. It also connects immigrants and refugees to mental health resources.
鈥淓verybody who has been through any kind of civil war, any conflict, might have some sort of mental health issues,鈥� he says.
From home country to refugee camp
are people who come to another country fleeing persecution, war and violence in their homelands. the trauma refugees suffer before coming to the U.S., and the difficulties they face starting over in a new country, can cause anxiety, depression and other mental health issues.
Rates of post-traumatic stress disorder in refugees are especially high, says Diane Mitschke, an associate professor in the school of social work at the University of Texas at Arlington.
鈥淪ometimes as much as 10 times the rates we see in a typical American population,鈥� she says. 鈥淎cross the board we do see very high rates of depression, both major depressive disorder and temporal depression.鈥�
The reason for these increased rates starts with refugees鈥� experiences in their home countries. For example, about half of the refugees resettled in Indianapolis come from violence-plagued Burma, also called .
鈥淭here were a lot of issues with the military in Burma targeting and harming the people,鈥� says Chelsea Davey, mental wellness coordinator for , which has settled more than 1,600 refugees in Indianapolis in the past three years.鈥淭here was a lot of forced labor, a lot of violence, a lot of loss of land and property and acts against humanity that people fled from that area.鈥�
When people are forced to leave their country, they face period of rapid change. They move to refugee camps, often leaving family behind or splitting up family members. In the camps, there isn鈥檛 much to do, like work or school, to keep refugees occupied.
This can lead to substance abuse, says Mengxi Zhang, a Ball State University assistant professor of health science who studies refugee health.
"The drinking is a really big issue among, especially, the male population,鈥� she says.
Stressed in the U.S.
Once in the U.S., the stresses continue. as much as the trauma of life in a war-torn nation.
鈥淭hey probably think they have a really good picture of the life in the U.S., but the situation is probably different than they thought,鈥� Zhang says.
And there are barriers to getting help.
Sometimes it鈥檚 a cultural issue. Accessing health care in the U.S. is probably different than in refugees鈥� home countries. Davey says her clients face several challenges before they even see a mental health professional -- like getting reliable transportation and child care for appointments.
鈥淚f I have someone on the south side that needs to see someone in midtown, it鈥檚 at least two buses and it鈥檚 probably about an hour commute for a one-hour session,鈥� Davey says.
During those sessions, refugees who don鈥檛 speak English also need a quality interpreter, which is expensive for health care providers. Interpreters are also needed to explain basic information such as how doctors鈥� appointments are made, what treatment is covered by insurance and what fees are associated with treatment.
鈥淚t can be very difficult for our clients to navigate, and they feel frustrated and just kind of give up and just don鈥檛 go back,鈥� Davey says.
Battling mental illness and stigma
There are also clients with mental health needs who never get treatment. How refugees view mental health can vary widely, depending on their education level and if they come from poor or rural backgrounds, researchers say.
Some countries don鈥檛 have practicing mental health professionals, says Zhang. That leaves a gap in knowledge about available treatment -- and can contribute to a stigma.
鈥淚n some of the Asian counties, having a mental health issue is considered as crazy or some even worse words,鈥� she says.
That was Kalima鈥檚 experience in Rwanda, where he says people with anxiety and depression are described as being possessed by bad spirits.
鈥淭hey call it 'devil,'鈥� he says.
Without the words to describe their feelings and facing a stigma attached to mental illness, refugees often bring their complaints to a , Mitschke says. They that might not seem related to mental health.
鈥淥ne of the ways to get around the stigma in those particular groups is to talk about those physical manifestations,鈥� she says. 鈥淎 patient might come in complaining of headaches or dizziness or even severe back pain. Those are often signs of depression.鈥�
Kalima鈥檚 mental illness also first manifested in . His palms would sweat while he sat in class at Indiana University South Bend. And migraine headaches were routine. Once, he even blacked out while driving.
鈥淭he migraine headaches is something I had for years,鈥� he says. 鈥淭he sweating -- I would sweat a lot.鈥�
鈥淎 work in progress鈥�
Still, experts say it鈥檚 important to remember that not all refugees suffer from mental illness. Mitschke says refugee communities are remarkably resilient, and individuals lean on each other for comfort and support.
鈥淚 think so much credit needs to be given to the refuges themselves, who have lived that struggle and have learned about how to navigate life here in the U.S., and then are able to pass that on the newly arrived refugees,鈥� Mitschke says.
Kalima was eventually diagnosed with PTSD. He鈥檚 still grappling with memories of the genocide. Water dripping from a faucet reminds him of the months he spent in the jungle. Loud, violent action movies are another trigger.
鈥淚t鈥檚 been 25 years and I鈥檓 still having nightmares about something I saw when I was a teenager,鈥� Kalima says. 鈥淚 know where I came from and I don鈥檛 want to go back there.鈥�
Talking about his experiences in Rwanda has helped him cope. He speaks at universities, and in 2014 shared his experience at the United Nations.
It鈥檚 important for Kalima not to think of himself as a victim. That鈥檚 what he tells the refugees he works with. He says acting like a victim means your oppressors win.
鈥淚t鈥檚 a work in progress,鈥� he says. 鈥淩ight now I鈥檓 able to live a normal life.鈥�
This story was produced by , a news collaborative covering public health.
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