Seattleite seeks to help fellow immigrants cope with trauma back home

At first, Ibtesam Elmadani couldn't stop watching the news. She frequently checked her email, and when she couldn't get to a computer, the TV.

After her 19-year-old nephew was shot dead during a protest in Tripoli earlier this year, Elmadani, her three children and her husband found their grief compounded by their distance.

"Every day we sit in front of the news and sometimes (we) can't do anything but sit and listen," she said.

Originally from Libya, Elmadani immigrated to Seattle in 1990 to join her husband. While she remained in close contact with relatives back home, she felt helpless in the wake of her nephew's death.

"It was the first time in my life I'd seen my kids crying, crying so hard until ... I felt very scared for them," Elmadani said.

She is joined by many other Middle Eastern and North African immigrants coping with escalating violence in their home countries.

In response to that stress and uncertainty, Amineh Ayyad began offering a six-session program of cooking and art classes to help women like Elmadani talk about their emotions in a supportive setting.

Ayyad moved to the United States in 1991 and considers herself an advocate for refugees and immigrants in the area. Her experience and interest in public health led her to create Adapt International, an organization that works to attain peace through psychosocial healing. Her support group for Middle Eastern and North African women is just one facet of this mission.

"Everyone has to keep up with the news," said Ayyad, a public-health adviser to the Eastern Mediterranean Public Health Network. "But inability to stay away from that, inability to sleep, to laugh, the ... inability for two months to engage in those things that help you relax and stay resilient and strong, they [weren't] aware how harmful it is to them."

A new kind of stress

Ayyad's program, Mothers Empowering Mothers (MEM), targets what she calls secondary trauma, such as the effects of the recent unrest in the Middle East and Libya on immigrant communities here.

"Entire families are affected emotionally," she said.

Though many of these women have not directly experienced the violence unfolding there, their immigrant status here isolates them. The difficulties of assimilation are further complicated by their limited social network and resources.

As a refugee herself, Ayyad knows all about this.

"Being surrounded by people doesn't mean you get that social support," Ayyad said. "People don't know what to say, to bring up something, to ask a question, what comments to make."

In 2002, she was in Gaza delivering medicine, removing bodies and otherwise providing services as a volunteer with the Palestinian Medical Relief Society. The support of her peers there allowed her to manage her emotions.

Ayyad contrasts this with her later experiences with trauma. In 2008, she was enrolled at the University of Washington when Israel launched a military offensive in Gaza as Hamas continued a campaign of rocket strikes in Israel.

"It was different watching the horrors of war from a distance," Ayyad recalled. "I became much more aware of the impact of things on me emotionally."

Though they were supportive, she found her colleagues could not relate to the stress she felt as her home country became engulfed in violence.

"I've seen (immigrants) be very isolated and not very well understood by our culture, so not very well supported," said Gerri Haynes, a nurse consultant who works with bereaved mothers in Seattle and travels to Gaza to train medical professionals in mental health.

Growing up in Palestinian refugee camps in Syria and Kuwait, Ayyad uses the social networks found in Middle Eastern villages as a model for her support groups.

During one MEM session, women held a potluck to discuss their coping techniques. One shares that she incessantly braids and unbraids her hair. Another allows herself to cry only in the shower. Still another woman cleans compulsively. And a fourth finds herself glued to her computer screen waiting for further developments in the Middle East.

The women nod as they listen to one another. Most have brought their small children and a dish to share. Over a medley of Arabic and American cuisine — including pizza, hummus, roasted chicken and sweet cakes — the women shift from light conversation to their concerns about the escalating conflict in their home countries.

Ayyad asks the women to describe an Arab dish that has many variations throughout the region: stuffed grape leaves, called warak enab in Libya.

To demonstrate the difficulties of articulating one's stress she asks each to contribute a description of the dish that is most familiar to them within their culture. The women, from as far away as Egypt, Morocco, Turkey, Iran and Jordan, laugh as they struggle for words.

"Imagine how hard it is for us immigrants to tell someone else who is not from our world," Ayyad said. "And (to tell someone who) doesn't have a point of reference about something that isn't even tangible, (like) emotions."

Seeing symptoms

After nearly two months, had passed, Elmadani noticed that her 11-year-old son was still struggling with the death of his cousin. She often found him crying or closely watching for her reaction as she read emails from home. One day he told his mother that an essay he had written about his family's loss had upset his teacher.

"I was scared for him," said Elmadani, who hadn't realized the magnitude of her son's grief. "Because he was so young for this, to start to think about killing and all that stuff."

Ayyad's similar experience with her son in 2001 spurred efforts to raise awareness about the effects of trauma. After Sept. 11, Ayyad's son, a teenager at the time, began skipping school and spending his afternoons blogging about the recent acts of terrorism.

"He was hearing and reading about how many Arab youth are being targeted or harassed at school," Ayyad said.

She was concerned that his fixation on current events was a symptom of severe stress, so she organized a night for Arab families to discuss psychosocial health. That initial meeting would later evolve into MEM.

Untreated chronic stress often manifests itself physically. Many of the women in Ayyad's support group, for example, have complained of pains in their pelvic region.

But mental illness is not recognized as a global-health initiative to the extent that chronic or infectious diseases are. Recent natural disasters like the earthquake in Haiti or the devastating series of events in Japan have prompted the international community to reassess its emergency-response services. Yet Ayyad worries that there are no plans to develop mental-health first aid.

She also recognizes that her efforts reach only a small audience. So far, MEM has been run without any funding. That isn't sustainable.

"I see this as an emergency," Ayyad said. "There's no system, there's no infrastructure to do this faster. And it makes me concerned."

Meanwhile, she is teaching the women in her support group to find simple ways to ease their stress. Volunteerism is a big part of Arab culture, so to cope with their anxiety, she has encouraged them to find small ways to get involved.

Elmadani is a community organizer for the Muslim Sisters' Group at North Seattle Family Center and is collecting headscarves for an auction she hopes will raise enough money to send home to families embroiled in the violence.

"To learn from each other, to encourage each other in the war situation," she said, "to help each other, this is very important."

As for Elmadani's son, Ayyad believes that art and storytelling have helped him make sense of his emotions:

"After two and a half months, finally the child [drew] a picture with him and his [cousin] ... and they're all together and they're happy," Elmadani said. "He accepted the fact that he died, and you can see he is on his way to recovery. He's progressing."

Celina Kareiva can be reached at celina_kareiva@yahoo.com

This article was originally written for a University of Washington global health reporting class.