Effectiveness of CHWs Working Locally and Internationally with Migrants:

1. ULYSSES SYNDROME MENTAL HEALTH MENTAL DISORDER Effectiveness of CHWs Working Locally and Internationally with Migrants: Their key role in identifying and treating Ulysses Syndrome Alba Lucia Diaz, Ed.D.National University, Carolina Carmen Huerta, MPH. San Diego State University Research Foundation, Prevention Research Center, & Liliana Osorio, BA. Health Initiative of the Americas, University of California, Berkeley RESEARCH STUDY PROPOSAL ULYSSES SYNDROME INTRODUCTION The lives of migrants are compromised by various health problems, due to the migratory conditions that they are exposed to and lack of appropriate supports. The efforts to determine lasting solutions to this growing crisis have been many, varied, and often without consideration for the unique conditions of migrants. This study seeks to demonstrate how, through their practice, Promotores effectively educate, advocate for, and empower migrants to deal with the stressors associated with the ULYSSES SYNDROME. The theoretical framework of the following scholars on the subject of Popular Education, primarily PAULO FREIRE, provide the basis for the utilization of strategies that enhance the Promotores’ capacity to participate in educational, advocacy and empowerment. Cohesive Group Settings (Gutiérrez & Ortega, 1991) Groups of “similar others” or people who share common life experiences Common Belief System (Maton & Salem, 1991) Connection between people and common interests, ideologies, or values Opportunities for: (Holtrop, Price & Bradley, 2000; Maton & Salem, 1991) Knowledge and skill acquisition. (Keiffer, 1984; Maton & Salem, 1991) Leadership (Breton, 1990; Freire, 1977- 2000; Roe, Minkler & Saunders, 1995; Wallerstein & Sanchez-Merki, 1994) Experience and Political Awareness. I. PROBLEM STATEMENT IV. THEORETICAL RATIONALE “Ulysses spent his days sitting on the rocks by the sea, being consumed by tears, sighs and sadness…”. Odyssey, Song V. “In a world defined by profound disparities, migration is a fact of life and governments face the challenge of integrating the health needs of migrants into national plans, policies and strategies, taking into account the human rights of these individuals, including their right to health”. (WHO/HAC/BRO/2010.3) Ulysses syndrome is a series of symptoms that affect migrants with chronic and multiple stress. Interventions are needed around the world, to educate communities and assist migrants in their adaptation to new places. Health care providers must be aware, in order to avoid misdiagnosing. II. PURPOSE OF THE STUDY GRIEF RELATED TO MIGRATION: • Family and loved ones • Language • Culture: customs, values, etc. • Homeland: landscape, colors, light, temperature, smells, etc. • Social status: legal status, working conditions, housing, etc. • Social environment: prejudices, xenophobia, racism • Physical risks: dangers during the migratory journey. “Health literacy is crucial for people to know how and to teach others how to navigate the system. Health for all, but health that is founded in human dignity, loving care, and fairer distribution of resources and power.” (Werner, 1987) There are an estimated 1 billion migrants in the world today, of which 214 million are international migrants (UNDP Human Development Report 2009). The migration process is a journey that implies multiple challenges that affect the physical and mental health of the migrant. In some cases, the migrants present chronic and multiple stresses, which have been documented as the “Ulysses Syndrome”. This syndrome was identified by the Psychiatrist JosebaAchotegui, from the University of Barcelona, in reference to the Greek hero who suffered countless adversities and dangers in lands far from his loved ones. “We live in bad times where mere mortals have to behave like heroes in order to survive. Ulysses, who was a demigod , barely survived terrible adversities and dangers, but the people who are arriving at our borders are creatures of flesh and blood.” Dr. JosebaAchotegui (2010) In almost all human communities through history, people have relied on their close family members and friends for health care and health information. The Community Health Worker or Promotoresmodel has long been used to successfully address health concerns in migrant communities. Promotores are trusted members of the community and as such serve as cultural translators and are key in empowering community members to gain control of their health and improve their quality of life. Involving Promotores in helping migrants through their adaptation process is an effective strategy to prevent and alleviate the symptoms associated with the Ulysses Syndrome. CohesiveGroup Common Belief System Using Empowerment Theory(ET) Concepts to Identify Potentially Empowering Environments: Opportunities STRESSORS: • Loneliness and forced separation • Failure of the migratory goals • Survival • Fear III. PARTICIPANTS IN THE STUDY SYMPTOMS Sadness, recurrent worrying, nervousness, irritability, sleep problems, migraines, fatigue, disorientation, gastric & osteo-physical complaints. “The assertion that these immigrants suffer from a mental illness is not being made up. These immigrants exhibit anxiety and depression based on results to the Hamilton Questionnaire. The term indicates that they suffer a series of symptoms, which pertain to the mental health sector, which is a wider area than that of psychopathology. The Ulysses Syndrome forms a gateway between mental health and mental disorder. This syndrome is asubject’s response when faced with a situation of inhuman stress, stress of such a character that it is superior to the adaptation capacities of the individual (living permanently alone, with no way out, with fear etc.). However, if this situation is not resolved there is a great risk that it finally crosses the limits of illness”. Achotegui (2010). Potentially Empowering Setting Promotores, also known as Community Health Workers, are able to reach the “hard to reach” community members and to have an impact by educating, linking them to resources and advocating on their behalf. The proposed study will focus on the effectiveness of using Promotores as health educators and system navigators to reduce the stress levels that migrants experience as a product of the migratory journey and the efforts to adapt to the new country. RESEARCH METHODOLOGY Credit to: Dr. Ruiz, Y. (2007) DATA ANALYSIS Critical reflection Criteria of credibility “member checks” Criteria of accuracy Portrait of setting and of each participant Criteria of Trustworthiness Triangulation of data The study applies Paulo Freire’s theory and methodology to work with the Promotores model, focusing on the issues that affect migrants. The combination of Freire’s participatory methods with the Community Health Worker model and the development of a photovoice project will yield a clearer and instructive picture of the Promotores potency as effective agents of social education and disease prevention in migrant communities, both locally and internationally. Criteria of plausibility In-depth Dialogues Alba Lucia Diaz, Ed.D National University: adiaz@nu.edu Carolina Carmen Huerta, MPH S.D. Prevention Research Center: chuerta@projects.sdsu.edu Liliana Osorio, BA Health Initiative of the Americas: Liliana.Osorio@sdcounty.ca.gov Researcher’s observations Researcher’s engagement SIGNIFICANCE OF THE STUDY CONTACTS This research study will provide further information for strategic decision- making based on community’s perceived sense of empowerment, regarding Mental Health of Migrant populations.