So my work here has been exciting with possibilities, frustrating, and confusing. When we first got here I was informed by the volunteer coordinator that I would not be working in the counseling center (the volunteers felt there were too many volunteers there already and my heart dropped- oh no they are going to ask me to teach English) but rather with them but in the boarding houses (heart soared yeah!).
The counseling center has 3 western volunteers working there currently. One, Nancy, a Clinical SW from New York is working for the Burma Border Project and will be there over a year total. Aung, a psychologist originally from Burma, but who moved to Australia for most of his life (he and his wife are working through an Australian NGO), and Heriko, a Japanese medical doctor with psych background- who is doing a lot the med monitoring and teaching the Burmese counselors how to prescribe these medicines. Aung and Heriko will be here for 6 months total until April. Nancy will be here until August (one month after I go). Nancy and Aung are compensated for their work here. They all came around the same time and have been here for almost 4 months. Their focus is on training the Burmese counselors so they can train others to make sure the counseling center (which opened in 2006 through Burmese Border Project funding) will be sustainable. There are about 10 Burmese counselors. One Burmese man (one of the senior counselors) manages the counseling clinic. There are 2 full counselors, a few more senior counselors, some junior counselors.
These Burmese counselors are playing a few different roles that in the US are broken down into different people: case manager (finding resources), counselor (providing care), and psychiatrist (dispensing medication). As you can imagine, this is a difficult position and they are also doing all of this with a few months of training and guidance versus 6 years or more for a psychiatrist. Anyway, kudos to these counselors. Most Burmese people are displaced and are not allowed to go to school. Some online classes in Australia will take them, but then all the course work is done in English sometimes the people’s 3rd language. Also remember how different Burmese or Karen language is to ours with the different characters etc. The keyboard is quite different. So the focus of this first group of volunteers is to build up the counselors and the clinic. My role was identified by Dr. Cynthia through the volunteer coordinator to be a bridge between the counseling center and the community, specifically focusing on 3-4 boarding houses.
The Beginning:
The next day the volunteer coordinator had me sit in on a 3 day training called “Opening a Foundation in Mental Health.” This training covered some basics of counseling skills, briefly addressed trauma and addiction and also a half day on medication dispensing. I mostly just sat and observed. A professor and psychiatrist from Dartmouth who is associated with the Burma Border Project came out to teach about medications. The last two days focused on role playing and group work where I helped out with facilitating some of this group work. The next week came and the volunteer coordinator had forgotten to arrange a meeting with the boarding houses staff and this boarding house work group to address my services and to hold a discussion about what is needed and what I could provide. The boarding houses had expressed a need for help with some troubled children in their homes. The meeting finally did get arranged towards the middle of that week. I prepared a short outline on what I could provide (play, art, narrative, sand therapy, group or 1:1, educational, setting up a mentoring program, etc). Also I described some basic things for teachers or boarding houses staff to look for in their children who may be struggling: fighting, withdrawn, never smiling, etc. I made sure to identify that this was based on Western info and that this may not be completely relevant to eastern culture. I was very excited for the meeting. I had been struggling with feeling inpatient (there were days I spent waiting for something to happen and you all know how inpatient I am!) and I did not feel a complete welcoming sense from the counseling center volunteers so I was anxious to get started on a project I could really take ownership in. The beginning of the meeting I made appoint to state a few Burmese phrases like nice to meet you (thaw ya da one twa ba day), etc. I took notes and recorded everyone’s names, phone numbers, and their associations. There were about 15 people present on top of Nancy and Aung and the volunteer coordinator. At one point Dr. Cynthia attended the meeting. It was very exciting to meet her. She is like a mother Teresa figure here in Burma and has meet with Laura Bush recently and been awarded many awards throughout the country. I shook her hand. Then after the introductions the meeting began. Obviously it was all in Burmese, but no translation was done. After about a half hour (the non-Burmese speakers) figured out the meeting was talking about the structure of their organization rather than my role. I then began to piece together that this was a new group. This group was one of 3 (the other two focused on health and school). There is a grant they received and improving the boarding houses was just one portion of this grant. After 2 hours, and one move to a new room, I was a bit more direct. I handed out my sheets and then the meeting began to circle back to mental health. I identified possibilities of my ideas and asked for input. Some of the boarding master described some wonderful strength they have implemented into their programs. They agreed to meet with me during the next couple weeks. When talking later with the volunteer coordinator she explained this round conversation is a typical Burmese meeting and thought being direct was the best way at times. She gave me some pointers on speaking more slowly and simplifying more words even more. Very useful advice (although I am constantly struggling to do this J ). (No more speaking Steffism hehe)
The next week I arranged to visit Agape (a Christian run boarding house by a man named David). He is a very warm, welcoming and forgiving man. I like him a lot. He spoke very highly of his organization. I happened to meet one woman that day that was from a school in Canada whose school children had saved their snack money for a year and was able to donate a good portion of the needed money to purchase new land for the boarding house. (Isn’t that adorable!) David starts the day out with the children singing loudly and happily songs as he plays the guitar. It is really a beautiful sight. (It reminded me a bit of Africa). There are around 8 orphans, 48 boarding students, and 115 students all together. David makes trips into the border area by the bridge and recruits children to come to school (his or any). He tried to convince the parents to allow the children to attend school. Some of the children are used for work. The Thai police do not hassle children too much so they are good means of transporting drugs, etc across the border. Also, many of the parents are unable to work, so the children take up a life of begging. It pays well there are a lot of westerns here. Westerners are encouraged not to give out money to begging children otherwise they will continue to not attend school, parents may continue to force them to beg to raise money for their family, etc. (We see a lot of children working here: Burmese and Thai). He has trouble sometimes convincing children to stop working and attend school. They don’t see a point. Sometimes the parents are migrant workers and travel around the area and far away to find work and leave the children with David to car and receive education. Sometimes parents are in Burma working and send the children over the border to receive schooling for free in the makeshift Burmese schools in Thailand because there are not many options in Burma. Many of adults I have met were monks at one point for free education while in Burma. (One man talks about getting beaten by monks often during his ten years with the monkhood). Some of the parents are convinced to let their children attend school with much persuasion and then come back to take them later on. The child is sad. (Often this is a parent with some addiction, or other problem). Child protection is a problem here. These children situations are similar in all the boarding houses and schools. Shortly after arriving a Christian missionary group dropped by unannounced and a pastor gave a sermon to the students (a majority who are Buddhist according to David) and then passed out bracelets. They were on their way to preach to the community (who also were a majority Buddhist). One of the women asked if I had been saved, if I was Christian. I stated I was humanist and that all humans had strength and was as good as they could be and she asked me how I could say that when I listened to what SPDC generals were doing in Burma. She hoped I got saved because the work I would be doing was tough and I needed to fill myself with something J
Later that week I was invited to attend a child protection training offered by a professor in Australia. She held a 3 day conference with many of the teachers, boarding house masters, etc around the community. The idea was to introduce child rights and the idea that protection of children is important. This woman has been traveling around Thailand giving trainings and then using this in a paper back home about teaching with cultural differences. Child protection is not a formal process here. Often the village head interjects when abuse is happening and encourages the abuser to stop. Basically, I see her trying to break down the taboos of what happens in my family stay s in my family and she did exercises where social workers, teachers, neighbors interceded the abuse and also she introduced safety plans for the kids, woman, and man. “When my dad drinks I will stay at my neighbors house, when I drink I will go visit a friend and leave the home, etc). She was a really good speaker and had good ideas on how to demonstrate ideas even with some language barriers. She used a lot of visuals and had the participant’s model abuse through still pictures. It was fun. I met a woman Barbara who has been here for years working on a project to give Burmese baby’s birth certificates and registering them. (These are displaced person and Thai government does not recognize them as citizens and of course trauma does not). She is working (along with others) to be a go between the Thai government and the Burmese people and she works to bring awareness of why this certificate may be beneficial. For instance, it would be like us having no birth certificate or social security card. How do we prove who were are or how old we are without this? When Burma is not under this harsh military rule and the displaced people are allowed to return home, they can use this to help with their positions. Anyway the most interesting thing about her was when I stated she must be very passionate about this idea since she has stayed so long. She stated she does not get passionate about anything. She takes neutral stance and feels passion is a wasted energy. She urged me not to get involved in the politics of things. At one point we had an exercise we needed o write down strengths of each other. We both wrote out the opposite quality. I identified her peacefulness and calmness and she identified my energy and eagerness. I did some more networking with the people at the training and found a Labway who manages 1 of 4 CDC boarding houses (CDC is the school associated most closely with Mae Tao and where Ben teaches). He was the missing 4th boarding house at the meeting. Hehe I found him and initiated the visit myself.
So the week after the training (after attending the Karen revolution), I met Labway at CDC boarding house. Ben came with because he wanted to see where some of his students live. Labway forgot, but Ben and I explored the area and found a boarding house (it ended up being the wrong one- it was the nursery CDC boarding house) but one of the teachers brought us to the right one. It is an all boys dorm of all ages. Ben got asked how to develop big muscles by one of the boys who wanted to look like the Rock while we were visiting. This boarding house has around 100 students. One of the students and Labway identified anger issues as a problem in this boarding house: lots of anger at the Burmese military. Many of the students lost love ones in war, the cyclone, etc. Labway did not want me to start until school session was over, so March and then I could “do what I want.”
The next day I visited SAW. This is the organization that has the Safe house, I and other volunteers, have been visiting since we arrived on Sundays to play with the orphans. I met Sigmone at the safe house (he also was late, but I got to sit in on the nursery class and see some of the children I play with attending to school). They were adorable. The safe house is specifically for disabled children and nursery age children. There is one really adorable boy with possible FAS? he has some facial characteristics). He was struggling the first time I met him with stealing others shoes. I had noticed the girls working had been letting him scream and yell and get his way. I gently brought him to one of the girls when I saw him steal some shoe and had him give the shoes back, he cried and screamed, but I remained firm. He then did not like me the rest of the day, but he stopped that behavior. There is one boy with CP and a few others with some delays (although it is difficult for me to tell if a child has disability unless it is physically represented with the language and cultural differences). Any way the girls that work there are former boarding house children themselves. Kind of like a mentoring program and using resources effectively. Sigmone arrived and took me to the primary school. A brand new local material playground had just been constructed by a NGO. The school has 2 rooms- 2 classes in each. They had applied for a building permit by Thai government, but were giving the runaround for weeks. Finally they decided to build. They waited and waited by no Thai authority came to reprimand, take apart the buildings, etc. So it has been a few years now and they are feeling a bit more stable. (Most of the migrant schools are hidden and out of sight and rent unused land from Thai owners). Across a busy highway is the middle school in an old house and down the road is the high school and the Crisis Home/ boarding house. It doubles as a crisis place for say woman and families needing shelter from domestic violence and a boarding house to over 50 children. Sigmone is one of the most dedicated people I have ever met. He was a former monk and is very compassionate and understanding. He is very dedicated to the children. (I met his mother from Burma when she came across the border to Mae Tao to have her eyes examined). Sigmone mentioned there were 2 children who act out (stealing etc), 3 children who act inwards (they are never interested in anything other than school), and 3 chidlren who appear to have some trauma.
The last boarding house I visited was far away about a 40 minute bike ride one way. It is called Raw Ka Htoo. It seems to be the less well know boarding house since it is so far away. The staff there speak no English and little Burmese. Annie is the boarding master for this house (she speaks very good English) but unfortunately she si only able to visit 2-3 times a month due to the distance from her home. I met with the teacher and Annie. The teacher and Annie identified 2 students specifically with troubles. One 13 girl had been orphaned and then was rejected by both her aunt and her husband and then her uncle and his wife. She was only in grade 1 educational wise. The other was a boy around 10 years who has a father with alcoholism. He does not want to go home every night, but his parents make him. He has the key to get into the house I afternoon and he is always fearful he will not make it home after school before his father arrives, so he tries to leave school early. The teacher noticed him because he understands the lesson and answers the questions at the end of the day, but when he returns In the morning he always forgets until later i nth afternoon.
Annie and the teachers said that many if not most of the students have some difficulties. They suggested I teach English there to get to know the students and teachers better. (Oh shish kabobs). I hate teaching English!!!! It did sound logical and a good idea to build rapport, plus they never have volunteers. They are too far out and most of the volunteers are funneled into CDC school. I agreed to do it 3 times week (yikes long bike rides) for two classes level 1and 2 together and level 3 and 4 together. I will have to communicate with the teachers through written things in English (having a dual language person translate and write into Burmese) present the paper to the teacher and have them write their answer in Burmese and then bringing it back with me to have translated the next day by someone at the clinic. Yikes!!! Yikes yikes!! I said I’ll bring my Burmese dictionary for translations (mind you only one of the people really speaks Burmese- the rest speak their tribal tongue). Hey maybe I really will be able to speak some Burmese by the end. Anyway, whatever it takes. I start Monday.
A Surprising Barrier to my Work
I knew starting to provide mental health 9biopsychscoail) ideas into the boarding houses was going to be difficult and met with many barriers both cultural, language, time, etc. even though it is a service requested by the clinic (Dr. Cynthia herself, and the boarding houses) The actually implementing will be extremely difficult. I have asked around everywhere and out of the hundreds of NGOs there is no one doing this here now. I will be a pioneer J But I was really surprised by a barrier I have found at the beginning before even starting. The Counseling Center. So the counseling center appears to serve about 30 plus people since the time Nancy has been here. Many of these people are one time people looking for medication fix. (Plus they are a migrant population and many are crossing from Burma and need to go back). There are quite a few counselors, but not too many fully trained. Many of these counselors have other jobs that they do also (working in the HIV AIDs clinic, floating among the different department around Mae Tao) even Saw San Lwin, who manages the center doe not reside at the center, he floats also. Another barrier is that people come and go. They may be relocated internationally, they may move to a different area. The volunteers at the counseling center are trying to establish a strong foundation for the counseling center. They are working to train the trainers. I thought it would be a wonderful idea (a win win win situation) if one to two counselors (who are interested in the boarding houses and children’s health) to come with me for an hour or so a day into the different boarding houses and begin to introduce a generic therapeutic activity for all the students to participate in (I can’t really do this due to language barrier). Then once we have built up our presence and gained confidence we could then build bridges to the counseling center and working 1:1 with some of the students struggling more. I thought a counselor could learn skills from me and get tons of direct counseling experience, be the face for the clinic, and continue when I and the other volunteers leave! And even pass on info to the other counselors at the clinic if they desired. In turn I would also be helping to make those bridges that the clinic has asked me to do. Win win win!!!! Yeah. Nope!
The volunteers do not think this is the right time. One was very adamant that I would be taking his counselors and disrupting the synergy they have together. They stated staffing as the reason. They want people to make referrals through them and then possible the counselor would make home visits or would have the students come to te center. I offered the reasons why it is difficult for the boarding houses to bring students to the center (staffing on their end- 1 teacher to sometimes 100 students), distance, safety, and lack of understanding how the counseling center could help and a stigma of mental health. The center is associated with the HIVAUDS clinic (which is still a common misperception throughout many of the volunteers in Mae Sot at the various NGOs, visitors I spoke with, and some people even at the clinic even). Marketing is needed and I have been doing a lot of this: telling all the volunteers about it, trying to build up networks with the community. Ben’s VP at his CDC school was even open to having a group at school in some capacity for some of the distressed children (some had lost all their family in the cyclone, etc). (When I mentioned this to the counseling center volunteers, they talk about starting this next school year- I said but she is willing now and kids are hurting!)
I have been feeling something, but was uncertain what it was prior to this. (I wondered if it was my age or maybe I was stepping on toes). No one went out of their way to welcome me or include me or discuss with me their plans or work, although they were nice and I like them all individually. I had made several attempts to try to learn more, I had asked for their input I had shared my impressions and what I thought could be done, etc. (During my conversation with Aung he mentioned that I could use the space that was no problem, but made it clear and stated he wanted to help and that he was not a barrier to this, but stated his help would be in the form of allowing me to ask for resources from them but never mentioning that I could share the knowledge I would gain of the situations in the boarding houses and the needs they are facing to them training the counselors in these needs and areas). I kept hearing about Nancy’s plans and discussions she had had with other volunteers 9not working in on mental health) but no attempts to communicate or offer aid for myself. It was awkward and I was confused. SO I was more direct. I’s like to set up a meeting to learn about your visions, to share what I have found, this is what I would need to bridge the counseling center and to begin doing outreach to the children in the community. (right now doing one activity in one classroom for one hour would reach more people than the counseling center appears to have reached in remaining only at the counseling center). Plus there is a huge need for the children. I of course did not state this in this way to anyone at the center. I did state that, I thought it is best to go to people and bridge and then begin to move back to the counseling center as rapport is built and awareness of them and their services. Then the clientele will increase (which is what the volunteers are wanting- that the people struggling will seek help), making it important to begin funding more counselors and training more people. Although every time I have been up to the center there has never been a client and there could be between 3 to 7 Burmese counselors waiting at the center unused. I also stated that I could pull for more resources if needed since I was brought on through Mae Tao to build this bridge and if more resources are needed all we can do is ask and see. (Another volunteer offered to help write grant to seek more funding for counselors, etc.) I hear everyone say this is needed, we want to help, etc. But then there is this barrier saying it is not the right time. Heriko had attempted to begin working in the boarding houses but after a short time she stopped and chose to focus on helping manage the medications at the center.
Next week I will have a meeting with Saw San Lwin, Heriko and Nancy and we will see what we can come up with. Aung will not be there, but he said he would brief Saw San Lwin on his thoughts prior to our meeting. I am not super hopeful about the outcome and I am disappointed. I at least know the barriers now rather than having this weird uncomfortable feeling. I have some ideas that are much less ideal. I can use a translator (request one for the clinic or maybe try to write grant for one) and bring he or she along with me to the boarding houses. This would be the least sustainable. Next, I could attempt to use my English speaking counterparts at the boarding houses and see if on top of the 24-7 job they do already with they would be interesting in taking on another project and helping to broaden and shape the way people look at children’s health.
Cross your fingers for me and the kids. The volunteers at the center are nice people and I like them. I am feeling frustrated by the situation at its current point, but I am trying hard to be professional and work within the system, problem solve, and strategize. I have been direct and stated the needs clearly. I am working to understand their perspective and to continue to show I respect their work, while trying to show how we could work together. I wonder in their “not yet” attitude, when the “Right” time will come. Maybe my optimism and energy can rub off on the pessimism and stuck thoughts I am finding. Hopefully things will improve and a sense of joining and working together will begin.
So several days after this, I ran into a man at the firebreathing juggling show we were watching and he works for World Education. He is setting up some trainigns for hte backpack meds around self care and mental health (they ar really dedicated Burmese people who sneal around Burma through jungles bring medical supplies to villages, peopl living in the jungle also, and some speicfically follow SPDC's raiding of villages to be as close as possible and save anyone they are able to. They often work in pairs, sometime solo and often their pairs do not remain the same. Some of htem have to perform amputations for landmine injuries without even a sharp knife and no anasthia) tough. I had met Lou earlier and I tlaked about some of my diffiuclties with intiating my work. He understood the turf issues I was having. He decided to connect me (after next week the training) with his college he supervises who has begun soem of this work in teh cmaps nad wants to begin to spread it into the baordign houses (yeah) so in two mondays he will connect me with her and we can perhaps begin to coordiante and work together. The project sounds to be coordindiated with Unicef and Lou used ot be a director of Care International. A good connection to have made.
