Psychologists rush to help Kosovar refugees

Practitioners are assessing mental health needs, providing therapy and enhancing refugees' ability to help their peers.

By Rebecca A. Clay

Clinical psychologist Christina Moore, PhD, thought she was lucky when she got a proper bed to sleep in. When she first arrived in Kukes, Albania, she slept on the floor with other volunteers helping refugees displaced by ethnic cleansing in Kosovo.

"Nobody has forced me out of my home. I haven't been held at gunpoint. I'm not a refugee," says Moore, a Doctors Without Borders volunteer who arrived in Kukes in the earliest days of the Kosovo conflict. "But this is not an easy way to live."

Working with refugees is indeed a big change from Moore's life as a private practitioner in Chaplin, Conn. During the war, she was the only psychologist in the now-empty refugee camp at Kukes. The sound of bombing, shelling and occasional gunfire punctuated her work; the roar of NATO planes sometimes drowned out conversation altogether. Journalists wielding enormous television cameras barged into therapy sessions in search of stories. And when Moore reported to work in the morning, she carried her passport in her pocket, ready for evacuation at a moment's notice.

Moore is just one of many psychologists working with Kosovar refugees in Albania, Macedonia and other Balkan nations. Like Moore, they are assessing mental health needs, providing therapy and enhancing refugees' abilities to help their peers.

Now that the war has ended, many will follow the refugees home to Kosovo and help them face the psychological trauma of murdered loved ones, burned homes and ruined lives.

Fact-finding

Take Gordon Dodge, PhD, for example. In his everyday life, he's clinical director of an outpatient mental health clinic called Lakes Area Human Services in Forest Lake, Minn. When trouble strikes, however, he switches to his role as disaster psychologist for the American Red Cross. In April, Dodge traveled to Albania and Macedonia to assess the psychosocial needs of refugees and mental health workers.

The Kosovar refugees were struggling with grief, anger, fear, dread and avoidance, says Dodge, who has also represented the Red Cross in Bosnia, Croatia, Serbia and Slovenia. Some were already suffering from post-traumatic stress disorder.

Although the refugees' reactions paralleled those of people who have been through natural disasters or airplane crashes, says Dodge, the fact that Kosovo is a human-caused disaster adds another dimension to their suffering. Many have succumbed to disbelief, anger and loss of faith in humanity. Many dream of retribution, he adds.

The recommendations Dodge made as a result of his fact-finding mission formed the basis of the Red Cross' mental health response. To address what Dodge calls the "double whammy" of ethnic cleansing and life as a refugee, the Red Cross added extra staff to conduct stress debriefings in camps. It developed a mental health component focusing on the needs of staff, who work 18-hour days in stressful and often dangerous situations. It even provided training and support to villagers in Kukes, a town of 18,000 overwhelmed by a sudden influx of 120,000 refugees.

Some interventions might surprise you, adds Dodge, who plans to return to the Balkans soon to evaluate these services and re-assess needs.

"Some refugees were ready to sit down and go through traditional trauma therapy," he explains. "But the majority were better served by recreational and social activities that gave them a sense of security and add stability to camp life. Of course, we also try to reunite families. Before that happens, people are too preoccupied for therapy."

Meeting needs

Moore and other mental health workers from around the world were available to help refugees who were ready for therapy.

"Typically mental health services are seen as a luxury that you get to after people have water, food and tents," says Moore. "This time we were able to get to people very quickly."

According to Moore, the refugees' mental health needs fell into three general categories. About 80 percent of them were traumatized but fundamentally functional. Another 17 percent to 18 percent were so traumatized they couldn't cope with the demands of camp life. A small percentage had pre-existing serious mental illnesses, such as schizophrenia, and needed a new supply of medication.

During the war, Moore spent her days treating refugees at clinics in town and in the camps on the outskirts. She might explain to a worried mother that a little boy's aggressive behavior is a normal response to trauma. She might help women cope with the stress of being thrust into the unfamiliar role of decision-makers if their husbands have been killed or left behind in Kosovo. Or she might meet with a group of teen-agers keeping journals as part of their therapy with her.

Moore also trained refugees to provide stress-management and crisis-intervention services to their peers. Aimed at Kosovar doctors, teachers, social workers and similar professionals, the training sessions help ensure that refugees' psychosocial needs are met even after the relief agencies depart.

Deanna Beech, PhD, is also working to help Kosovars help themselves. Beech, a clinical psychologist from Fayetteville, N.C., is a volunteer consultant for a relief agency called World Vision USA.

Beech's interest in training grew out of her experiences during a 10-month stay in Bosnia last year. While evaluating World Vision's programs for children, she discovered that programs designed to transform refugees into mental health workers just weren't working.

"A lot of the relief agencies did two or three days of training, then left," she explains. "But the people being trained were too traumatized in their own right to be effective."

Beech is now in Montenegro trying to develop a more sustainable model of training locals to meet psychosocial needs. She plans to provide training to local "pedagogues" and establish an ongoing process of supervision that will prevent a gradual erosion of the training's lessons. Then she'll move on to Sarajevo, where she is attempting to establish a graduate-level program in clinical counseling. She hopes to persuade experienced American psychologists to sign on as teachers.

Getting involved

But you don't have to go to the Balkans to help the Kosovars, say psychologists working in the field.

Simply staying interested in the Kosovars' plight now that the war has ended can help, says Dodge. Volunteer your services to the 20,000 refugees living in the United States, he urges. And keep in mind that donations to aid agencies are always welcome. Most importantly, says Dodge, psychologists should find ways to prevent such conflicts from happening in the first place.

"I'm an old '60s person," he says. "Work for peace!"Y

Rebecca A. Clay is a writer in Washington, D.C.



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