I don’t know what it’s like to be in a situation so terrifying that the best option is to leave everything behind and flee to another country on foot or by any other means available. Yet this has been the lived experience of every single one of my clients at the UNC Refugee Wellness Program over the past four years. On average, refugees spend 17 years in refugee camps before being resettled to a third country. When I think of the amount of courage and resilience needed to not only escape persecution and reach a neighboring country, but live in a refugee camp for years without knowing what the future brings, and then start over in a new and vastly different third country, I am truly humbled to know and work with my clients. As I reach the end of my time with UNC Refugee Wellness Program, I’ve been reflecting about what the past years have meant to me. If I had to characterize my experience, I’d describe my work as paradoxically both surprising and predictable.

I spend most of my day visiting clients in their homes, bringing them to appointments, and facilitating community support groups. While this may not seem surprising at first, given that I work with clients from many countries, I am constantly learning about new cultures and people. For a while I kept track of all of the idioms I learned. For example, an Iraqi client taught me: a bird in the hand is better than 10 birds flying overhead. In support groups, we’ve danced to clients’ favorite singers from Afghanistan, Iran, and Syria, as well as to Congolese drumming. I’ve tried new food that clients have generously shared with me and celebrated holidays I didn’t know existed. I’ve mistakenly committed cultural faux pas like bringing candles to a support group of Muslim women, who politely informed me that lighting candles was questionable in their faith. Clients’ priorities sometimes catch me off guard. I have gone to home visits to discover that what a couple from Afghanistan most wanted to discuss was where their family could be buried, or what a young man wants to focus on is writing a memoir about his life. Clients were interested in advocacy and meeting elected officials, so I learned alongside them and had positive experiences collaborating with city and state leaders. Oftentimes, I go to visit a client, and several neighbors or friends are gathered at their home. It’s a fascinating and exhilarating experience that sometimes feels like I’ve visited five countries in one day. I’ve found it’s best to anticipate being unable to anticipate.

At the same time that my work is a constant learning experience, there are some things that are all too predictable. Despite my clients coming from so many different countries, faiths, education levels, ages, and careers, they inevitably encounter the same structural oppression of poverty. After 8 months in the United States, childless refugee adults who are not elderly or disabled lose their health coverage and fall into the same coverage gap the rest of North Carolinians experience due to this state’s decision not to expand Medicaid. As soon as working parents earn more than 40% of the poverty line, they lose their coverage as well. This is exacerbated by the fact that globally only 1% of refugees are given homes in third countries – the most vulnerable people are prioritized for resettlement, including a high proportion of people with chronic health issues. Oftentimes these health issues result from chronic stress or injuries from abuse or torture. Refugees arrive in North Carolina expecting to finally receive reliable treatment only to find out that 1) they may have to wait several months for their first visit with a provider that uses interpretation services, 2) their access to Medicaid will soon end, and 3) they need to find a way to support themselves and their families without needed treatment or medication. This strikes me as morally shameful. As a country and as a state, we cannot offer humanitarian asylum to people with a priority on vulnerable individuals without providing health and mental health care.

Despite focused role on mental health, given the lack of health coverage for so many of my clients and the deep anguish it causes them, I spend a considerable amount of time navigating applications for Charity Care following emergency room visits, assisting clients with disabilities with the process of applying for Supplemental Security Income, and facilitating referrals to community clinics and affordable care act navigators. I think about the clients I met who were suffering in their homes, unable to work due to poor health, yet having no access to health insurance. After applying and being approved for SSI and by extension gaining access to Medicaid, their health, mental health, and outlook were improved significantly. To me, this is a matter of justice. Refugees with disabilities deserve access to disability benefits, but if someone doesn’t tell them about the SSI program and walk them through the process, how is a new immigrant who is unfamiliar with the system and language here supposed to navigate those steps? In my experience, they can’t.

A lot of refugees going through culture shock are so disappointed by the reality of living in poverty in the U.S. that they say they want to return to their home countries. They would take the risk of danger over what they see as the impossibility of success in this country. I can’t blame them. After addressing barriers alongside clients these past 4 years, I’m exhausted too, and my struggles are dwarfed by my clients’. For the most part, though, clients work through the culture shock and barriers and find a way to keep going. As one client said about our program:

The situation was really bad when my husband was sick and I was in the hospital. You were really helpful and comforting. Just your words helped a lot. I was thinking of going back to my country before, but then I started thinking I could do this. The advice you give is more than money or anything else. Money without advice—what do you do, where do you go? Advice is the most important thing to get from someone, especially someone who knows the system.”

A recent home visit captures the nature of my work. A couple of weeks ago, I visited an older client, planning to do a mental health screening and help her apply for a free phone. When I got there, I found her lying on the couch in pain. She explained that she had been injured in a car accident the day before, but had refused when police offered to take her to the hospital because she didn’t have health insurance. She had tried contacting her car insurance, but found out that her medical expenses were not covered. It took contacting the financial department of the hospital, learning all the criteria for applying for financial assistance, and equipping her with a letter in English explaining her situation before she felt comfortable going to the hospital for treatment. As we were making this plan, her friend, another client of mine, came over to check on her injured friend. A few minutes later, the friend got a phone call and left the room, returning soon afterward yelling in Arabic and crying. I feared something was horribly wrong, but the interpreter told me she had just received word that her son’s immigration case was approved and he would be joining her in the U.S. About a year and a half earlier, I had connected her with a lawyer to apply for her son, and his case had been approved only to be indefinitely stalled with the travel ban last January. Finally, after unnecessary heartbreak and barriers, mother and son will be reunited. His mother fell to her knees in prayer, then embraced all of us through her tears.

I will take away from my years with the Refugee Wellness Program an infinite amount of gratitude, respect, and admiration for my clients, whose strength in the face of adversity makes them the bravest people I’ve ever met as well as for my supportive and dedicated team – our brilliant and compassionate supervisor Josh Hinson and our incredible MSW interns past and present, who have each made lasting contributions to the project and our clients’ lives. I will also carry with me clients’ stories, which have strengthened my resolve to work against systems of oppression and advocate for justice for displaced peoples, people of color, people in poverty, torture and trauma survivors, and people with disabilities.

A few quotes that will stay with me forever…

“Because of your help […] it made me more comfortable, more comfortable in the society we are living in.”

“As a new person, it’s great to have someone care and talk to me. Also, seeing that I improved on the [mental health] screening helps me see that my life is getting better. I think it would be good if you kept doing this. In the group you talked about the stages of being a refugee, including the next stages that all refugees go through when things get better. It gives me hope to know that all refugees went through this, and that things will get better. I learned a lot and it was very helpful to me.”

“It was useful to talk about things. It felt really good when I talked about some of the difficult things in my past.”

“At that time we still felt what we went through, the bad things we witnessed. But now, everything has gotten better because we are not thinking about those anymore.”

“I think it’s been helpful because going to the substance abuse counselor has helped me to reduce the amount of alcohol I drink. I’m more focused on how to be successful in life.”

“I was feeling sick and bad but they showed us things to help us feel better and not sick. Today in my heart I feel better and good.”

“Before it was the sadness, the abandonment, and also the pain. The pain left. Now I come back to the thought that my struggles are normal and I have to get used to the situation. I need to start a new life now. [It helps] when you come each time and show us that in the beginning it’s normal for it to be hard. Your presence, your advice consoles us.”

“I would say you are very good listening ears. When we have problems we have a way to communicate them to you and that’s very helpful.”

“You told me your program doesn’t give money but I didn’t want money, I just wanted you to talk to me. When I arrived I was scared. You know sometimes you have a lot inside of you and you need to get it out to feel better and you asked the questions to help me get that out.”

“Thank you for coming to visit and understanding what’s in our heart.”

“When I started to go to group my problems started to go away. Through talking and discussing problems, that helped me feel better.”