Local Groups Supporting Refugee Mental Health in North Carolina

Burmese farmers Zar Ree, Lion Wei and their family at the community farm. Photo by Chris Fowler, provided by Transplanting Traditions.

By Kathryn Sanders

The Carrboro Farmer’s Market was bustling on a recent Saturday in November. Among the farmers selling carrots and lettuce, there was a stand tucked in the corner of the market selling crops such as pennywort, roselle and bitter melon. These farmers were refugees from Burma, and were part of a community farm project called Transplanting Traditions.

The group provides Burmese refugees in Carrboro, North Carolina access to land, healthy food, agricultural education and small farm business development. It also provides participants a much-needed sense of community and safety.

“Social isolation is a major issue within this community,” according to Sara Snyder, the VISTA educational programs coordinator at Transplanting Traditions. Many people were separated from their families when they went to refugee camps and were again separated when they were resettled in America. Trauma-related depression is common because of this upheaval.

“One hundred percent of the refugees that we serve report being less stressed after joining the farm,” Snyder said.

There are several reasons cited for the improvement in their stress including the opportunity to see friends, working outside in the fresh air, and being able to grow traditional and medicinal crops that remind them of home, Snyder said. They’re also able to teach their children about their heritage.

One hundred percent of the refugees that we serve report being less stressed after joining the farm.

Refugees, by federal law, are granted different kinds of support when they come to the United States, such as help finding a job and getting health insurance.

But mental healthcare is not a federally-mandated requirement for refugees, so community groups such as Transplanting Traditions are stepping up to fill in the gaps where traditional medical care is lacking.

Refugees settling in North Carolina

North Carolina ranks as seventh among US states for accepting people granted refugee status, according to an investigative report done by ABC11. More than 500 refugees moved to North Carolina during the first half of 2018.

And because the state has so many refugees, it consequently has a large number of people who may need access to mental healthcare.

There are several reasons North Carolina ranks highly for refugees, according to Monique Lohmeyer, a refugee services coordinator at Church World Services, a refugee resettlement program in Durham. One reason is due to the current economic level in the state for jobs and affordable housing, and another is because there is already a large community of certain refugee populations here.

Once a refugee arrives in the United States, they go to a resettlement agency, which is a group such as Church World Services in Durham, NC or Interfaith Refugee Ministry in Wilmington, NC, that orients the new arrival to help them get a job and apply for healthcare benefits.

Refugee health care options

A community member at Church World Service in Durham interacts with a refugee client. Photo by Kate Roberts, provided by CWS Durham.

In North Carolina, most refugees immediately qualify for either Refugee Medical Assistance, or Refugee Medicaid, or a different North Carolina Medicaid program, according to Interfaith Refugee Ministry’s NC State Refugee Health Coordinator Jennifer Morillo.

Refugee Medicaid lasts only for eight months upon their arrival here in the United States, Lohmeyer said. It retroactively starts the day they arrive even though it make take up to a week for them to officially apply upon their entry to this country.

“We reconnect with them around the six month mark, where we direct them to find healthcare benefits through their job, which is part of what our employment team focuses on,” Lohmeyer said.

The employment team at a resettlement agency targets employers that offer benefits. If there aren’t enough jobs available, they look into the Affordable Care Act, or a program such as Duke Latch, which is an outreach program that helps provide healthcare access to immigrant populations. But despite the efforts of these groups, sometimes it’s not enough for the refugee.

“It’s a population that is severely underinsured after that first eight months,” Lohmeyer said.

It’s a population that is severely underinsured after that first eight months.

Mental health care is not a requirement

There are certain boxes the resettlement agency must check off, such as getting the person immunized, helping get a primary care provider set up, housing, and starting English classes, among other things. But mental health care is not a requirement for resettlement.

“There are many resettlement agencies in the nation that have a focus on mental health and even have mental health services incorporated so it’s really a whole-person, holistic wellness model,” according to Marlowe Crews Kovach Marlowe Crews Kovach, MSW, LCSW-A, a program coordinator with the UNC Refugee Mental Health and Wellness Initiative.

In the Chapel Hill area of North Carolina, however, mental health is not incorporated directly with any of the resettlement agencies, which is how Refugee Wellness came exist. The UNC Refugee Mental Health and Wellness Initiative is a group that provides mental health services and support to refugees in the North Carolina Raleigh-Durham area.

“We want to provide support directly because we see there is an unmet need and a gap. We train Masters of Social Work students in how to work with this population and how to collaborate with interpreters and navigate these barriers,” Crews Kovach said.

Refugee Wellness is a grant-funded program that not only links refugees to other providers, but provides some counseling services itself. For people who are struggling day to day to get their needs met, something like work might come up, and getting to their therapy appointment isn’t their top priority. Day to day survival is.

“That’s why it’s so important to have programs funded specifically for refugee mental health, because there are so many factors within this population that make it really hard for them to be able to access mental health services,” Crews Kovach said.

Barriers to mental health care

The North Carolina Center for Public Policy Research recently asked North Carolinians via their newsletter, “What do you think is the biggest barrier to seeking mental health care?” Some of the responses were lack of insurance, cost of care, not knowing where to get care, and stigma/embarrassment, among others.

For refugees, the barriers to seeking mental health care are more complex. They include lack of transportation, confusion about insurance networks, and cultural stigma, Crews Kovach said. But the biggest issue might be language barriers.

Barriers to seeking mental health are more complex for refugees. There are more logistical issues involved, such as lack of transportation and language barriers. Wordcloud created with wordclouds.com

Most mental health providers are required to provide services to people that need interpretation, or speak languages other than English and Spanish. But interpretation is very expensive, so that is not an option for many providers. Even though they are required by law to provide services, there is also a loophole law that says if it is a financial burden on the agency, then it is not required, according to Crews Kovach.

“Many people want to provide services, but interpretation is so expensive and in North Carolina, since Medicaid has not been expanded, interpretation is often not reimbursed at a rate that can cover interpretation,” Crews Kovach said.

The current state of North Carolina health care

As of November 2018, North Carolina is one of only 13 states that has not voted to expand Medicaid, according to the Kaiser Family Foundation.

Status of State Action on the Medicaid Expansion Decision
Map provided by Kaiser Family Foundation.

Yasmin Bendaas is science writer and community engagement specialist with EducationNC, a nonprofit associated with the NC Center for Public Policy Research. Bendaas said by email that there are members of the public health community that feel that expanding Medicaid in North Carolina would do more for people with mental health problems than simply increasing the Affordable Care Act, or remaking the current Medicaid model.

A Kaiser Family Foundation literature review on over 200 Medicaid studies reiterates Bendaas’s point, and shows that Medicaid-expansion states have shown greater improvements to access to both mental health medications and services than non-expansion states.

North Carolina is currently moving into a “Medicaid reform,” according to David Anderson, a research associate at the Health Policy Evidence Hub at the Margolis Center for Health Policy at Duke University. It will probably be in place by early 2020.

The system is transitioning from what is known as “fee for service” where the state directly pays doctors and hospitals for the care of Medicaid patients, to what is known as “Medicaid Managed Care” where the state pays a number of insurance companies a fixed fee per month, and then the insurance company pays the doctors and the hospitals to take care of the Medicaid patients, Anderson said.

Right now, North Carolina already bids out behavioral and mental health Medicaid services to Local Management Entities, or LMEs such as Cardinal Innovations Healthcare. Eventually, according to Anderson, the plan is to roll all health care into one contract, so nothing is carved out like it is now.

“Mental and behavioral health tends to be a very complex care management problem. In order to make the transition as smooth as possible, states tend to make that population one of the last to switch over,” Anderson said.

Refugee mental health care options, beyond insurance

Mental health support is important in all populations, but particularly for refugees, a group that is prone to stressful living and is cut off from their home community.

“If you’re focused on survival, if a person’s fight or flight response is highly activated and they’re just trying to make it through the day, it’s hard to focus on mental health, even though their emotional wellness is already impacting them,” Crews Kovach said.

Because of gaps in the federal program for refugee help, and because health insurance is so difficult to navigate anyway, community groups are looking to other ways of supporting refugees with mental health.

Art therapy

One of the newcomer “peer groups” at Art Therapy Institute. Photo provided by Art Therapy Institute.

Art therapy is a mental health care option that goes beyond traditional therapy. The practice is defined by the American Art Therapy Association as a “mental health profession that enriches the lives of people through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.” And it can be particularly effective for refugees.

Because refugees often have language or other verbal barriers, art therapy provides a safe space for them to express themselves, according to Courtney Powers, MA, LPCA, ATR, a clinician at the Art Therapy Institute in Chapel Hill, NC.

“Stories that people want, and need, to share will inevitably emerge,” Powers said.

The Institute provides art therapy services to clients, training to other professionals, and peer support groups. The support groups, in particular, provide a sense of connection and belonging for refugees while they are negotiating acculturation, according to Powers.

Stories that people want, and need, to share will inevitably emerge.

Video courtesy of Art Therapy Institute

Peer support and community leader training

One of the community adjustment support groups UNC Refugee Wellness conducts is a curriculum called Pathways to Wellness. It’s an eight-week program that talks about adjusting to new cultures and the mind-body connection.

It also works to destigmatize mental health, and to give information about mental health while facilitating conversations about traditional beliefs and practices from whatever culture the participants are from. It’s designed to be an introduction to talking about mental health without people saying, “Oh, mental health, you mean someone who’s crazy?”

“It’s a good way to bring people together and it’s designed to be a peer support group, while also providing information about mental health,” Crews Kovach said.

One main goal for Refugee Wellness is to support and develop leaders within communities of refugees. So Refugee Wellness ultimately wouldn’t be providing the services; they would be training culturally-competent people from the community to provide services specific to the needs of their group, according to Crews Kovach.

The community groups are crucial, Crews Kovach said, because if one person is hesitant to discuss their trauma, but sees a friend helped by talking about their experiences, they’re more willing to try it.

“We get a lot of referrals, people bringing their friends and neighbors,” Crews Kovach said. “That’s why I think it’s so important to move toward this model of training community leaders in basic mental health first aid and awareness so they can also work to destigmatize mental health and be that source of support and connection.”

Taxi tell-all

As ride-sharing apps like Uber have come under scrutiny for safety, one local cab driver weighs in. 

Uber is once again making headlines, but not for sexual harassment issues. This time, it’s for safety.

The ride-sharing app is in the news again because the suspect in the recent New York City terrorist attack was a driver for Uber. He has since been banned from driving for the company.

This is not the first time Uber has received bad press for security issues. Drivers are required to take background checks before they can register to drive for Uber, but this is not foolproof.

Though ride-sharing apps are a global reality, some local cab companies still exist. And some drivers and passengers prefer working with cab companies.  

Posted by Kathryn Sanders on Saturday, November 4, 2017

Layla is a taxi driver for Tar Heel Taxi Inc., a Chapel Hill, N.C. cab company. She’s been driving for the taxi service for about nine years, and feels safer being a driver with a cab company than being an independent contractor driving for one of the apps.

To gain employment, she went through a rigorous background check, fingerprinting and a physical. According to Ubers website, potential drivers for their app only need to pass a background check.

And it’s not just Layla, as a driver, who feels safer with a taxi. She mentioned that some passengers feel safer in a cab than an Uber. At least with a cab, Layla said, there’s “some kind of system, people have been screened.”

Another possible reason Layla feels safer working for a cab company is because she has more of an opportunity to suss out “bad situations.”

She picks up street fares, as well as taking reservations by phone, so if someone was highly intoxicated and not making sense, she would have more of an opportunity to judge whether she wants to drive that person or not.

With an app, everything is automated and the driver doesn’t neccesarily have contact with the rider in advance.

According to Layla, the biggest security issues she has had to deal with involve beligerant drunk people not being able to tell her where they live.

She said that apps like Uber and Lyft have financially hurt Tar Heel Taxi, but not too badly. Other taxi companies in the area have shut down completely. Tar Heel Taxi is “still holding on, barely,” Layla said.

The company has lost some business to the apps from the UNC-Chapel Hill student population, but overall, its target market skews more toward the “working class” people.

Overall, Layla likes the job and says it is pretty standard, just “taking people where they need to go.”


A little bit of Eurasia in Capitol Hill

After academia, a local proprietor turns to rugs

Visitors to Capitol Hill probably don’t expect to stumble upon wares from Nepal and Turkey in the middle of Washington, D.C. But that’s exactly what happens if you’re lucky enough to find Woven History & Silk Road, a conjoined rug and gift shop.

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Instagram – Sign

Mehmet Yalcin, proprietor of the shop, grew up in Turkey and came to D.C. years ago to study international communications at American University. He then went on to get his Ph.D. in Inner Asian and Altaic Studies from Harvard.

However, he came back to his childhood love of carpets after realizing there was more of a market in carpets than academics.

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Instagram – Rugs

According to an article in Battle Creek Enquirer, most of the rugs in Yalcin’s shop are made by refugees, including Tibetans in Nepal and Afghanis in Pakistan. Woven History’s hope is to simultaneously help rekindle dying crafts and help refugees support themselves.

Yalcin told the Battle Creek Enquirer:

Each carpet has a character. They are like people, but, unlike people, they blend in. They respect each other’s character and personality.

Many of the rugs for sale are created at Woven History’s own looms. The wool used is hand-carded, hand-spun and hand-combed.

While Woven History specializes in rugs, the other side of the shop, called Silk Road, carries tribal and village arts. You’ll find jewelry, coats, shoes, dishware and more.

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Instagram – Silk Road

The Silk Road was a network of trade routes throughout eastern and western Asia, and stretched from the Mediterranean sea to Japan and the Korean peninsula. Not only were goods exchanged, but ideas, crafts and technologies were shared as well. Cities along the Silk Road network became hubs for learning and culture.

So it comes as no surprise that, though Yalcin runs the shop by day, he still pursues his academic interests. He lectures on Central Asia and has spoken about textiles at The Textile Museum.

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Instagram – Camels

The shop has been around since 1995, but Yalcin was selling items at the Eastern Market flea market since the 1980s. Now located in a row house, the mini-bazaar functions as a gathering place for locals.

Woven History has invited musicians from along the Silk Road route to perform concerts, and has also worked with D.C. institutions to organize art exhibits.

During working hours, the doors are flung open with carpets flanking the railings outside. A parade of llamas often stands guard by the front doors.

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Instagram – Llamas

Not to be outdone by the llamas, Yalcin’s cat sometimes hangs out on the weekends, as well, welcoming visitors to come in and learn a bit about history. Or, at least, check out some beautiful rugs.

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Regram – Cat

The world has changed, but Yoko’s “Wish Tree” has not

The world has changed a lot since 2007. A reality TV star is now President of the United States. People find hookups by swiping right. About three-quarters of Americans own a smartphone, and there’s an app for everything.

One thing that’s remained the same is Yoko Ono’s “Wish Tree” at the Hirshhorn Museum and Sculpture Garden in Washington, D.C. A gift of the artist in 2007, the tree is turning ten years old this September.

Yoko Ono’s “Wish Tree” at the Hirshhorn Museum and Sculpture Garden

Like much of Ono’s work, the Japanese Dogwood tree is an interactive exhibit. During the summer, guests of the museum are encouraged to write wishes on paper tags and tie them to the tree branches, located in the sculpture garden. In cold weather months, guests should “whisper” their wishes to the tree.

The D.C. tree is part of a series of Ono’s wish trees, which are also located in places like New York City, St. Louis, Tokyo, and Venice.

According to the Hirshhorn website, nearly 80,000 wishes have been collected in the past decade. Once the tree fills up, the wishes are shipped over to Iceland and buried under the Imagine Peace Tower, a public art memorial to Ono’s deceased husband, John Lennon.

Ono has said about the trees:

“As a child in Japan, I used to go to a temple and write out a wish on a piece of thin paper and tie it around the branch of a tree. Trees in temple courtyards were always filled with people’s wish knots, which looked like white flowers blossoming from afar.”

In honor of the D.C. tree’s tenth anniversary, Ono has two other works at the Hirshhorn called “My Mommy is Beautiful” and “Sky TV for Washington, DC”.

“My Mommy is Beautiful” is a wall lined with love notes to mothers. Museum guests can write something about their mother on a card and tape it to a forty-foot wall in the museum’s lobby.

“Sky TV for Washington, D.C.” is a 24-hour live feed of the sky, conceived when Ono was once living in a windowless space.

What’s interesting about Ono’s work is that, though the concepts are incredibly simple, her work packs an emotional wallop.

It’s surprising how moving her art is in person, particularly when standing under the “Wish Tree” when the wind rustles the wishes. The fluttering white tags are reminiscent of flapping doves’ wings.

D.C.’s tree’s branches filled with wishes, September 2017

Despite all the changes in the world since 2007, most wishes hanging from the tree are timeless, and broadly about peace.

A wish for health, happiness, and love.

But a few were personal, mentioning things like wanting to “be a princess,” getting good grades, and Superbowl picks.

There was even a wish for good traffic back to Virginia. In reference to that wish, a little boy visiting the tree said to his guardian, “that’s not really what you’re supposed to put.”

To which his guardian replied, “It takes all kinds.”


The Hirshhorn Musuem and Sculpture Garden is part of the Smithsonian network of museums, which means (among other things) that it’s free of charge. The museum opened in 1974, after art collector and philanthropist Joseph H. Hirshhorn donated his collection to the Smithsonian.

The museum, in general, does not bombard the viewer with sensory overload. Thoughtfully curated, its collection is minimally displayed. Visitors can fully cover both the museum and sculpture garden in a few hours.


The Hirshhorn is open daily from 10:00 a.m. to 5:30 p.m.

Address: 700 Independence Ave SW, Washington, D.C. 20024

Phone: 202-633-1000

Some animals roam free at the zoo

Not all animals at the zoo are kept in cages. Some creatures are free to roam, such as chipmunks, birds, and even dogs.

Bella, a black and white Terrier-mix service dog, was one such animal at the Smithsonian National Zoo in Washington, D.C., on Monday.

Molly, Bella’s owner, said Bella’s favorite part of the zoo is the monkey exhibits, because they get interactive with her. “The gorillas will come up and touch the cage,” Molly said. “It’s really cool.”

In addition to Bella, the zoo was full of birds and chipmunks running free.

And it’s not just living creatures that roam the zoo. Even the occasional plastic giraffe gets out for a walk.

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New News on Old Shows

Dorothy, Rose, Blanche, and Sophia in doll form

I’m constantly surprised by what constitutes “news” in the world of The Golden Girls. Recently, the creation of action figures debuting at New York’s Comic Con was a super-big deal. A big deal to everyone except Betty White, that is.

Ms. White wasn’t readily available for comment. “There’s nothing really for Betty to say,” said Jeff Witjas, a representative for the actress. “She has not seen the dolls.”

Picture it: Off-Broadway, 2016

In other Miami Nice super-big deal news, there’s a Golden Girls puppet show in a limited run on Broadway, er, off-Broadway. I heard about the show and was immediately annoyed. I’m a bit of a purist, and, well, how do I say this? I don’t like puppets. However, for the love of the Girls, I forced myself to watch the trailer, and it’s lovely. They had me at Dorothy biting her knuckles. Kudos, Jonathan Rockefeller. Well done.

That Spelling show

Two things of note in the world of Spelling: Spelling Manor is up for grabs (all 123 rooms of it), and Tori is pregnant with her fifth child. I HOPE People paid her substantially for the story because homegirl’s in debt. BFF Jennie Garth was obviously around with congrats. I’m still sad their mystery show didn’t work out, but I’m more sad that they didn’t hire better writers for it. WOOF.

You Can Buy Lucille Ball’s Chandelier

Want to own something that lit up Lucille Ball’s life? Literally. You can buy a chandelier she owned for a mere $2,000.00 on Craigslist.


If you can’t swing the $2K, perhaps you’re interested in more attainable items that added a glow to the funny gal’s life:

Her perfume – The lady loved her signature scent. Her alleged last words were, “My Florida Water.” You can get yourself some on Amazon for around 6 bucks.

Her daughter singing – Lucie Arnaz, Latin Roots

Her son hosting a zoo tour – A Day at the Zoo

Her son singing in a pop music trio with Dean Martin’s son – Dino, Desi & Billy

I wrote awhile back about how Lucy was a bit of a ball-buster (among other things). A tough lady, for sure, but one who lived on her own terms and created quite a life for herself. A life that included children who love to sing and crystal Italian chandeliers.


Give Me Gillian Anderson Skin, Please


I always come late to new shows. I typically start watching a show two or three years after everyone else is done talking about it. And then I show up and say, “OMG have you seen ‘Dexter’?”

I just started watching The Fall (only one [er, two?] season behind, thank-you-very-much), and can’t get over Gillian Anderson’s skin. It’s luminescent. It’s the Cara Delevingne of skin. Her skin is the perfect compliment to her character – pale, beautiful and fearless.

According to Anderson’s AMA, she adheres to the following regimen:

It’s a mixture of Clarins scrub, the orange one, I don’t know which one that is, an Estee Lauder repair serum, and evening face cream, and then daytime I think it’s Clinique, there’s one that has a lot of moisture in it. And Laura Mercier tinted moisturizer is the best invention known to mankind since bread.

Anderson moisturizes to “within an inch of her life” to appease the show’s makeup artist. I am, tonight, starting my very own Gillian Anderson From The Fall skin care regimen and hope to have similarly glowing results.

And maybe I’ll even catch the new X-Files while people are still talking about it.