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Recovery from premigration trauma among recent immigrants from Africa : What helped? What did not help?.. Mmapatsi, Selebaleng S. 2004-12-31

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RECOVERY FROM PREMIGRATION TRAUMA AMONG RECENT IMMIGRANTS FROM AFRICA: WHAT HELPED? WHAT DID NOT HELP? WHAT WOULD HELP? by  SELEBALENG S. MMAPATSI B E d . , University o f Botswana, 1994 A THESIS S U B M I T T E D IN P A R T I A L F U L F I L M E N T OF T H E R E Q U I R E M E N T S FOR T H E D E G R E E OF  MASTER OF ARTS in T H E F A C U L T Y OF G R A D U A T E STUDIES (Department of Educational and Counselling Psychology, and Special Education; Counselling Psychology Program) We accept this thesis as conforming to the required standard:  T H E U N I V E R S I T Y OF BRITISH C O L U M B I A August 2004 © Selebaleng S. Mmapatsi, 2004  11  Abstract The principal aim o f this research study was to examine what immigrants and refugees from Africa experienced as helpful, unhelpful or what would have helped i n their recovery from pre-migration trauma. The sample included thirteen self-referred participants residing in the L o w e r mainland, British Columbia, Canada. Participation in this study was based on the following four criteria. First, the participants were immigrants, refugees and international students from Su-Saharan Africa who arrived in Canada between 1991 and 2003. Second, the participants had experienced trauma in Africa, which they volunteered to share. Third, they confirmed not to be undergoing therapy or psychiatric treatment at the time o f the interview. Fourth, participants were to be adults between 20 and 50 years o f age. The Critical Incident interviews were utilized to screen the participants, collect and analyze data. Incidents were further organized by placing them on a timeline methodology. The timeline categorizes the low and high points o f events that happen in a lifetime according to three main periods, namely; beginning, middle and end o f the process o f recovery from premigration trauma. Three hundred and twenty eight incidents were formed from 13 interviews including, 140 incidents helpful (42.68%) with the participation rate o f 70.77%, 119 unhelpful (36.28%) with the participation rate o f 64.10% and 69 would be helpful incidents (21.04), participation rate o f 53.85%. Most o f the incidents reported by the participants were based on refugee experiences. The findings suggest a mental health intervention that recognizes the social support, beliefs and security. Future research should aspects o f culture in the appraisal and healing o f trauma as well as tenets o f programs based on the context o f those served not  expert opinion. Experiences of health caretaker, support personnel international students who migrated under the auspices of the host Government's sponsorships need to be examined in order to develop a theory that is grounded on the lived experience.  iv  Table of Contents Abstract  ii  Table o f Contents  iii  List o f Tables  ix  Acknowledgements  x  Chapter I: Introduction  1  Migration Trends and History  4  Study Motivation  6  Justification for Research on Trauma  9  Purpose o f the Study  14  Assumptions Underlying the Study  15  Research Question  16  Overview o f the Thesis  17  Chapter II: Literature Review  19  Concept o f Trauma  20  Individual Trauma  23  Collective Trauma  24  Individual and Collective Trauma  26  Refugees and Trauma  27  Immigrants and Trauma  28  International Students and Trauma  29  Phases o f Migration  30  Summary o f Trauma  32  V  Research on the Recovery Process  ;  33  Factors that promote Recovery  33  Resiliency  :  -.33  Family Support  34  Community Support and Religion/Spirituality  36  Cultural Healing  38  Factors that Hinder Recovery  39  Separation from Family  39  Social Isolation  39  Summary  40  Critical Incident Technique  40  Analysis o f Critical Incidents Data  42  Selecting a Frame o f Reference  43  Forming Categories  43  General Behaviour  43  Validation Procedures  44  Professional Cross - checking  44  Participant Cross - checking  45  Category Comprehensiveness  45  Inter - rater Reliability  45  Expert Assessment  :  45  Literature Validity  46  Participation Rate  46  vi  Interpreting and Reporting Data  46  Critical Incidents Timeline  47  Chapter III: Methodology  49  Participants  49  Procedure  52  Orientation Interview  53  Critical Incident Interviews  55  First Interview Second Interview Extraction o f Critical Incidents (Data Analysis)  55 •  57 58  Extraction o f Incidents  58  Forming Categories  59  Validation o f Categories  60  Timeline Methodology  63  Summary o f Methodological Issues  63  Chapter I V : Results  -67  Description o f Basic Categories  67  What Helped Recovery  69  Security  70  Community Support  70  Resilience  72  Willpower  73  vii Family Support  74  What D i d N o t Help Recovery  76  Power and Control Isolation  76 .'  78  Security  79  Loss and Burial  80  Intimidation  81  Community Support  82  What W o u l d Help Recovery  82  Security  83  Appreciation o f new home  84  Relationship with home country  85  Religion/Spirituality  85  Community Support  86  Normalcy and Integration o f Suffering  86  Immigration and Refugee Services Validation Procedures  87 87  C I T Professional Validation  87  Participant Cross-checking  88  Category Comprehensiveness  89  Inter-rater Reliability  90  Expert Assessment  90  viii  Literature Validity  ..91  Helpful Categories  92  Helpful Categories  97  Participation Rate Critical Incident Timeline Summary Transcript for REF 1001 Summary of Critical Incidents Timeline Chapter V: Discussion Implications of the Study  99 ,  100 102 110 112 115  Research on Premigration Trauma  115  Development of a Counselling Theory  116  Limitations of the Study  117  References Appendices  125  ix  List of Tables 1.1 Basic and sub categories related to the three research questions  68  1.2. Helpful (What Helped) categories represented by percentage proportion o f participants  69  1.3. Unhelpful (What did not Help) categories represented by percentage proportion o f participants  76  1.4. Future Coping (What would Help) categories represented by percentage proportion o f participants  83  X  Acknowledgements The completion o f this thesis was made possible by the collective support o f many individuals and groups who contributed their time, knowledge and personal stories. Gratitude goes to m y research advisor, Professor, W i l l i a m Borgen who was a mentor and guardian; Committee members, Professor M a r v i n Westowood, Professor Norman Amundson for agreeing to serve in the committee. A l s o , Professor Ishu Ishiyama; who came in at the time when his help was much needed. I would like to thank the research participants and African communities in Vancouver, Canada for their hospitality and selflessness in narrating their personal stories to ensure a development o f a theory that recognizes their context. The University o f British Columbia and students and staff o f Counseling Psychology Department for their support through out this exercise. I am indebted to thank my wife, Gobona Patience Mmapatsi for her patience and untiring support, despite her pregnancy during this study.  xi  Reference  I  •  v.  xii  List of Appendices Appendix A Letter o f consent  18  Appendix B Demographic Data  50  Appendix C Poster for Invitation o f Participants  51  Appendix D Consent F o r m  53  Appendix E Participant Infonnation Form  53  Premigration Trauma  1  CHAPTER I INTRODUCTION This thesis examined the experiences o f recent immigrants and refugees from Africa who experienced premigration related trauma. The study provided the research participants with a conducive environment to voice their traumatic experiences and elaborate on what helped, did not help and would help them to recover from these experiences. According to the Statistics Canada Census Report (2001) about 5, 448, 480 immigrants arrived i n Canada between 1961 and 2001. The number o f African immigrants increased 23.24% over five years from 229, 300 i n 1996 to 282, 600 i n 2001. About 24, 700 African immigrants reside i n the Lower Mainland o f British Columbia. To integrate these individuals, specialized social and welfare services were set up through community initiatives, including Vancouver Association for the Survivors o f Trauma ( V A S T ) , Immigration Services Society, M O S A I C , as w e l l as hospitals. While acknowledging the effective contribution o f these services, the debate continues about the gap i n mental health provision and many see a need for methodologically sound studies based on the lived experiences o f this population, so as to understand the context o f migration distress and strengthen the existing network o f mental health and support services. Several programs that are created through community initiatives have proved to be helpful. However, some programs have been developed more from the expert views of the agencies and less on the lived experiences o f the clients. In most cases, studies o f the multicultural context either omit the experiences o f the African clients or over  Premigration Trauma  2  represent the homogeneity o f all collective cultures, assuming that there is a uniform worldview about illness and treatment, which requires uniform models o f assessment and recovery or healing. Bloehnlein (2002) alludes to the debate about importing treatment approaches for massive traumas, wars or natural disasters, "that do not take into account the historical, political or healing traditions o f specific cultural communities" (p.702). In agreement, Kleinman (1988) states: From the cross - cultural perspective, the fundamental question i n psychiatry - how to distinguish between normal from the abnormal; how disorder is perceived, experienced and expressed; w h y treatments succeed or fail; indeed the purposes and scope o f psychiatry itself - all are caught up i n reciprocal relationship between the social world o f the person and his body/self (psychobiology) (p. 3). Kleinman's assertion about people's unique perceptions, experiences and expressions o f illness is valid for the understanding o f illness and treatment, because in Africa psychology is based on collective religious practices and less on natural science. The beliefs in misfortune and spirits still form a basis for discovery and treatment o f misfortunes for the majority o f the people o f Africa, both i n urban and rural settings. Hence, traditional healing combines a number o f pragmatic approaches such as, "dream interpretation, pharmacotherapy, possession dance, exorcism and shock therapy" (Akinade, 1999, p. 372). In addition, according to Akinsulure-Smith & Smith (1997) in times o f emotional distress individuals from Africa naturally seek guidance from members o f the extended family such as elders, rather than from mental health service professionals. This research also noted cultural, religious, geographic, and economic differences within Sub-Saharan African countries and a long history o f social transformations bringing a growing move towards contemporary culture characterized by preference o f medical based models o f diagnosis and treatment o f illnesses.  Premigration Trauma  3  !  This study investigated the premise that while trauma is a universal human condition, the unique context o f the African appraisal o f trauma and beliefs about healing  r and recovery needs to be considered. L o c a l services geared towards helping African ji immigrants can only be effective with clearer .understanding o f premigration trauma. The current research examined factors that facilitated or hindered the recovery o f immigrants and refugees from elements which constrained their aspirations arid tied them down to ji  haunting past images o f premigration trauma. M o r e specifically, the study focused on what helped, what did not help and what would help in the survivor's day-to-day recovery from trauma. T o contextualize the research study, this researcher presupposed that in order to understand the psychological effects o f post migration stressors and to develop relevant mental health programs, there is a need first o f all to trace the background causes o f migration, including the experiences during migratiori. It is also essential to review immigrants' culturally constructed appraisal and beliefs about illness and treatment ;i < '., hi, -!. it;,- t protocols. Due to differences in geography, culture and politics within the African ill  ' •  I |  MI  1  i 'I  continent, the current research narrowed the experiences by focusing on Sub-Saharan Africa. In the midst o f these differences, common threads have been identified by several multicultural studies, which revealed noticeable cornmonalties between cultures, based on the fundamental emotions such as joy, fear, anger, sadness, disgust, shame and guilt (Akande, Baguma & Furnham, 1999; Friedman & Stamm, 2000; Mcfarlane, V a n der K o l k & Weisaet, 1996; Smith, 2003). In the context o f collective cultures there are common religious beliefs such as the connection between the mind, body and spirits, specific roles played by individual family members and extended family systems as well  Premigration Trauma  4  as the larger social networks, which are well recognized i n the diagnosis and healing o f trauma. Migration cuts the supply line o f these resources rendering the trauma survivors vulnerable to even minor psychological attacks. Although both voluntary and involuntary immigrants or refugees are known to suffer from traumatic premigration experiences (Fenta et al. (2001); the research focused on the refugees since they do not choose to migrate and end up with more mental health problems. M a n y refugees have experienced loss o f family, torture, abuse and fear in the. refugee camps as well as the entire migration process. Immigrants can often foresee the possibility o f returning to their countries while refugees' return is marred by fears o f rearrested and torture.  Migration Trends and History The U N ' s most recent population projections put the world's population, now at 6.3 billion, at 8.9 billion by 2050. Furthermore, the United Nations H i g h Commission for Refugees ( U N H C R ) announced that there were 10.3 million displaced people around the world at the beginning o f 2003 ( U N H C R official document, 2003). However, this number decreased from 19, 783, 100 refugees around the world i n 1999, (Mental Health Publication, 2000, p.2). From the 1999 figure about 4, 173, 500 refugees were in Africa alone (Migration News, 2003). Although the majority o f the refugees were from the Middle East, six million, some African countries had highest numbers. For instance, Sudan leads the list with an estimated 4 million displaced persons followed by Angola and Colombia (South America) which are estimated to have had 1.5 million internally displaced persons each.  Premigration Trauma  5  T o better understand the precipitants o f African migration one needs first o f all to trace why productive people leave their countries o f origin. Mensah (2002) characterizes the push factors for refugees as including, "armed conflicts, geographical struggles, environmental hazards, and straitened economic circumstances" (p. 65). H e further states that there are no simple answers to why people migrate. Most Africans move to Canada based on the belief that they w i l l obtain a high standard o f living and political freedom. The study, conducted b y Fenta et al. (2001) an epidemiological survey research o f Ethiopian adult immigrants living in the Greater Toronto i n 1999 to 2000, showed that their primary motives for migration to Canada were (a) "political reasons" (64.5%) for males and (37.6%) for females, followed by (b) "for a better life" (29%) males and (57.1%) among females. Overall, the above two reasons were the choices for 97% o f the total sample. The study consisted o f 203 (59.4%) men and 139 (40, 6%) women, mostly young adults between 30 to 49 years o f age (76.6%). B y implication, more men are pushed out o f their countries by fear o f their lives and need for political freedom; while largely economic pressures motivate women. However, further research is required to corroborate such data analysis with samples from other parts o f Africa. Blavo (1999) states that much o f Africa's resources have been poured into conflict and the continent is lagging behind i n development" (p. 11). There is evidence that when resources are diverted to control prolonged c i v i l wars, people are left without food and social services; particularly to manage the threat o f H I V - A I D S , causing people to consider moving to safer countries. Guluma, Macaulay, Monteira, and Peddle (1999) assert "the ravages o f war, continued from the influence o f colonial powers, degradation o f slavery and enforced  Premigration Trauma  6  uprooting have all affected social interactions and traditions" (p. 129). A more recent explanation o f migration b y Massey et al. (1997), i n Mensah (2003) "attributes international migration to the displacement o f peasant labour b y the penetration o f the capitalist market into peripheral regions o f the w o r l d " (p. 63). The social effects o f globalization mean that there is an increased rural-urban migration, free movement o f goods and information regionally or worldwide leading to the growth o f middle class in poorer countries. A l l these factors seem to contribute to creating internal frictions, which lead to migration o f people to other countries in search o f better quality o f life. These factors adversely contribute to the transformation o f social, political, economic and cultural networks that have always protected the people from exposure to trauma; including changes i n the understanding o f culture specific illness and treatment. It should be noted that change is inevitable and can be beneficial i f generated from dynamic social needs and aspirations o f service beneficiaries, with willpower to control external motivations.  Study Motivation Rising from the deep blue waters o f the rivers and desert terrain o f Botswana; under a bright African sunshine savoured by the aroma from the fauna and flora o f the tropical climate, I packed m y brown suitcase and left for Canada. O n arrival at the University o f British Columbia, i n Vancouver I remember one bright morning standing by the window o f m y apartment and looking towards the far shore, across the mountains and whispering softly but loud enough to be heard by someone within a short distance saying: "What a beauty". A s I began to settle down, I was engulfed by seemingly  Premigration Trauma  7  difficult academic questions, which required practical solutions and among these was the notion o f trauma. A s I continued to reflect on these questions several memories o f trauma that is suffered by the people i n the continent o f Africa as a result o f political terror, collapse o f national economies and multiple losses from H I V / A I D S and other epidemics ran through my consciousness. For instance in Botswana, it is estimated that 1 out o f 3 persons have an H I V infection and life expectancy is expected to plunge to 14 years o f age b y the year 2050 ( U N A I D S , 2002). Through the opportunities created b y m y program o f study in Counselling Psychology, I began to remember the traumatic ways under which I lost a family member, friends, relatives, countrymen and women. M y first reaction was, "Is this the Botswana that we are all proud of?" Realizing the increasing population o f African refugees and immigrants in Canada and around the world, I was immediately inspired to contribute m y acquired knowledge on trauma and counselling to create modalities for strengthening the mental health and support service structures. Further research on trauma diagnosis and healing could strengthen the research base in Botswana and other countries in Africa. I entered the current study with apprehension about what I was going to discover about the participants and how that would affect personal mental health. However, my desire to learn from trauma survivors exceeded m y own uncertainty. I started the first phase o f the research with excitement; then an overwhelming loss o f energy followed by a process o f healing over sufferings related to family, country and humanity. Through the data collection process, I kept a diary o f events that reflected on m y experiences from time to time. The hospitality accorded to me by the participants largely resembled a  Premigration Trauma  8  natural African community and livelihood. Evidently, most o f the participants were interested in knowing me before they could disclose secrets about their lives. This unique form o f rapport building and African ethical standards involved introducing me to other members o f their communities surrounded by humorous discussions about who I am, life stories about experiences i n Africa; sometimes not even inquiring about the proposed research. In these meetings there was food and drinks on the table. I could not swallow m y guilt mixed with pride over the expenses that were incurred for m y honor in the name o f hospitality as well as m y uneasiness over focusing on the wristwatch instead of the moment. A s I began to hear brave accounts o f atrocities that happened to the survivors and attaching faces to the stories, I realized that m y whole physiological faculties were immersed i n these sufferings. I 'paused' on realization that I was also beginning to appraise m y personal stressors and life pressures as traumatic! Through debriefing with m y research supervisor, I began to try to detach from this compassion related stress. In this memoir, I have acknowledged the common threads that underpin African culture and peoples o f African Diaspora; specifically, the role played by community networks i n times o f j o y and suffering. I began to struggle with theoretical positionality; especially i n using literature written i n other contexts to answer an African problem. However, the more I continued to read about this topic the more this literature began to fall into place and provoked further thought. I have rioted that i n the African culture, a story is a personal artifact and shared sensitively with family, friends and people whom you have common relationships. A memory does not only resemble cognitive capability of the psyche but a cyclic environment in which a life story is stored, analyzed and shared  Premigration Trauma  9  without copyright. Through this sharing, an injury to one member is an injury to all members o f the community as a way o f protection against perceived threat. Healing or treatment o f illnesses revolves around the knowledge recognized b y these cyclic relationships. This cultural platform cushions people from unknown sufferings; once the culture disintegrates, known and unknown attacks can cause abominations to a person individually or collectively. In the end,I can only reflect on these experiences and whisper to myself; "What a great honour that I was once  partofUBC!"  Justification for Research on Trauma Canada continues to accept immigrants from different parts o f the world in keeping with its humanitarian tradition and international commitments as well as in fulfillment o f its need for human resources. According to Statistics Canada (2001), the total number o f immigrants who arrived in Canada between 1961 and 2001 is 5, 448, 480. Although migration from Africa has existed for centuries, the current population o f immigrants from countries i n Africa, excluding children born in Canada is 282, 600 (Statistics Canada Census Report, 2001; Agibolosoo and Mensah, 1998). This is significant growth, considering the 1996 population, where the number o f people born in Africa was only 229,300 (statistics Canada Census Report, 1996). It should be noted that this categorization does not include other Blacks i n Canada; such as Afro-Caribbeans, African Americans and so on. Several metropolitan areas in Canada, such as the Lower Mainland o f British Columbia, have experienced noticeable increases. For instance, according to Statistics Canada Census Report (2001), there are now about 24, 700 immigrants from countries i n Africa in the Lower Mainland, compared with 21, 805 people i n 1996.  Premigration Trauma  10  These immigrants often migrate in two forms: "voluntary immigrants", popularly known as immigrants and "involuntary immigrants", known as refugees (Ogbu, 1991). Refugees often share a traumatic past, including exposure to war-related violence, natural disasters, torture, economic problems, and ethnic and political conflicts. Although immigrants chose to migrate, this decision is largely preceded b y stressful events such as collapse o f national economies, multiple losses and the threat o f infection from H I V / A I D S and other diseases. This research is based on the premise that people around the world are exposed to traumatic situations i n their lifetime. What differs is how they appraise the trauma and their beliefs about treatment, recovery and culturally constructed mechanisms o f resiliency (Bagilishya, 2000; Boehnlein, 2002; Peddle, Monteiro, Guluma & Macaulay. In Nader, Dubrow & Stamm, 1999; Rousseau, Mekki-Berrada & Moreau, 2001; Vontress, 1991). Studies conducted i n Africa reveal evidence o f trauma among community samples. Englund (1998) conducted a study on Mozambican refugees in M a l a w i reported a high level o f distress following war atrocities and some specific approaches to traditional treatment, such as mourning rituals and social support. The intensity o f trauma i n Africa was further emphasized in a study o f 201 participants in South Africa (Carey, Stein, Zungu-Dirwayi & Seedat, 2003). In this study corfnobidity between somatic reactions and depression with Post Traumatic Stress Disorder on current diagnosis was found i n 19.9% o f the sample o f women and 16.67% o f men. However, a lifetime diagnosis o f P T S D was made for 45.4% o f women and 42.3% o f men. A study conducted by F o x and Tang (2001) on Senegalese refugees who resided in a refugee camp in Gambia noted lower rates o f traumatic experiences. A m o n g 39 women and 41  Premigration Trauma  11  men who participated i n the study, 11.8% were exposed to trauma through personal experience; witnessing and hearing about it. While the average number o f only those events personally experienced was 5.11%. In general, men (mean = 6.02, S D = 1.9) had experienced more traumas than women (Mean = 4.15, S D = 1.8). Post migration studies conducted such as the one by N o h , H y m a n & Fenta (2001), have shown that prevalence o f major mental disorders including depression; anxiety, Post Traumatic Stress Disorder ( P T S D ) and somatization are often misdiagnosed. This assertion was confirmed by their studies among Ethiopian immigrants i n Toronto, which found  (6.9%) or higher prevalence o f P T S D among men than among women (4.3%). Although there are variations in the circumstances under which the survivors  experienced trauma, it is evident that traumatic situations do exist i n Africa. What is not conclusive is whether those affected would appraise their sufferings as traumatic or just a normal response to an abnormal situation. However, there is a growing body o f literature that migration, trauma, and torture can lead to multiple cognitive and psychological problems, which leads to symptomatology for Posttraumatic stress disorder (PTSD). According to Smith (2003), P T S D symptoms may co-exist with other mental health and medical disorders, and are often misdiagnosed as such. Major depression, pervasive anxiety, panic attacks, phobias, personality disorders, dissociation, and substance abuse are some o f the psychological disorders that may stem from the trauma experience, or may be superimposed on the post-traumatic stress (Zohar, Sasson, Amital, Iancu, & Zinger, 1998). During instability or as a result o f debilitating effects o f trauma, survivor's schema is modified and they begin to question the validity o f their cultural support  Premigration Trauma  12  structures (Boehnlein, 2002), their religion (Kaminer, Ogden, Seedat, Stein, V a n Kradensburg, 2000), while newly arriving immigrants demonstrate more resilient and healthier attitudes and behaviors, as they assimilate into the American and Canadian way of life and try to cope with post migration stressors, they adopt such unhealthy behavior as smoking, alcohol and drug abuse, and high-risk sexual behaviors (Fenta et.al., 2001), leaving the sufferers vulnerable and predisposed to several mental health illnesses, such as depression and posttraumatic stress disorder. The challenge i n the study o f trauma among African population is both underdiagnosis and overdiagnosis, as the tendency is to be overly sensitive to the possibility that anyone who witnessed violence may have been traumatized (NievesGrafals, 1995). A l s o there is the tendency to perceive immigrants from countries i n Africa as a homogeneous fragment group, notwithstanding the distinct ethnic and geographical differences, or to some extend washing down the commonalties between them and other citizens around the world. C o m m o n threads have been identified b y several multicultural studies, which revealed noticeable commonalties between cultures, based on the fundamental emotions such as joy, fear, anger, sadness, disgust, shame and guilt. The obvious benefit o f research on this sample population, including (a) assisting policy makers, immigrants' service providers, and mental health professionals to better understand the context o f migration distress and (b) creating modalities for mental health and support services that are relevant to those served. In support, Boehlein (2002) states "cultural psychiatry should not lose sight o f the uniqueness o f each individual who has suffered severe trauma and the goals o f its contribution to patient care, training and research" (p. 702). The question often becomes stigmatizing and judgemental "What is  Premigration Trauma  13  wrong with Africa?" as opposed to clinically assessing "What sort o f resilience and coping mechanisms must people utilize to help those who survive such harsh life conditions?"(Smith, 2003). Alternatively, the form o f coping mechanisms that people used in their countries can continue and be "recognized" as legitimate. O n one hand, the need for targeted research and treatment is very strong given the intensity o f trauma i n Africa, an event which could lead to modification o f individual and group resilience. M a n y challenges and benefits lay ahead for mental health services available to African immigrants as Africa is fertile for research on trauma and lessons learnt could be easily generalized into other sectors o f the Canadian population with similar antecedents. Y e t the number o f recent immigrants from Africa has increased dramatically and i f premigration trauma is left unchecked, it has the potential for debilitating effects on the individual's ability to adapt to their new "home" and put pressure on health service structures. There is need for effective mental health treatment based on the sensitivity and appraisal o f traumatic illness and healing practices from the context o f African immigrants. There is also a need for targeted research on the experiences o f refugees and immigrants from Africa. A t this point there are few, i f any, methodologically sound studies on the experiences o f the African population. Carey, Stein, Zungu-Dirwayi and Seedat (2003), reported that "only 6% o f studies are from the developing world with no single study from A f r i c a " (p. 230), not to mention that the tendency is to create social and psychological treatment programs for the stakeholders without involving them in the planning and delivery structures.  Premigration Trauma  14  In summary, conducting research on countries i n Africa is further justified by the presented rates o f prevalence arid incidence o f trauma i n the continent. The psychological treatment, which originates from a medical model is not only prescriptive but undermines the connection between the body, mind and spirit as w e l l as other unique contexts o f the beneficiaries o f services rendered. It seems proper that an effective way of offering support to immigrants is to trace their background and establish kinds o f resilience and coping skills they utilized when they began suffering or when the environment was familiar. Developing new strategies could act as a deterrent to future postmigration traumas such as unemployment, cultural transition and separation from family. However, premigration health care protocols should be adaptable and responsive to the available skills and training without compromising the health o f trauma survivors.  Purpose of the Study The purpose o f this study was to examine what immigrants and refugees from Africa had experienced as helpful and unhelpful incidents or what they thought would be helpful in their recovery from pre-migration trauma. The researcher opined that in order to help the survivors to recover from premigration trauma it was essential to explore how the survivors had helped themselves to recover from the traumatizing event when it happened. What is needed therefore, is a comprehensive understanding o f the tested and practical solutions survivors have utilized i n the past to free themselves from the sufferings. U s i n g the Critical Incident Technique (Flanagan, 1954), it was anticipated that participants would be able to answer the research question in their " o w n voices" by narrating incidents they perceived to be o f utmost importance i n helping or not helping them in their recovery from premigration trauma.  Premigration Trauma  15  Assumptions Underlying the Study The continent o f Africa has been under political terror, social upheavals and economic challenges for centuries. M a n y citizens o f African countries have been affected by these situations and are now traveling around the world i n search o f freedom and a comfortable life. Noticeably, the stressors on individuals during the transition o f migration from their countries o f origin are often omitted. This could be another stressful process, considering the dangers o f escaping from the perpetrators, crossing dangerous landscapes, and uncertainty about the future. Some may assume that once immigrants and refugees arrive in the host country they experience a sense o f relief, freedom, peace and a better life. However, a premise o f this study is that there is a likelihood o f certain adjustment stressors that new comers go through such as language, unemployment, social isolation and role reversal. Coupled with premigration trauma, these stressors could trigger past memories, causing a delay in one's recovery. Thus, on the basis o f the incidence and prevalence o f trauma o f immigrants and refugees, it was essential for this research study to retain or nullify certain assumptions about the experiences o f the survivors o f premigration trauma, as stated: 1) The quality o f family systems and social networks help survivors to recover from trauma and generate meaning and purpose in their lives. 2) Survivors' positive appraisal o f trauma and beliefs about treatment facilitates the process o f recovery from trauma.  Premigration Trauma  16  . 3) Immigrants or refugees who have experienced premigration trauma would be more affected b y lack o f understanding o f the socio-cultural context o f African migration by the mental health service providers. 4) Although the people o f Africa have gone through a long period o f social transformation, a culture - focused approach to healing o f migration trauma would be more effective.  Research Question In an attempt to understand the experiences o f trauma survivors from Africa, the current research study analyzed their narratives, looking at the critical incidents o f refugees, immigrants as well as international students. Therefore, the guiding research question for this study was: "What helped, what did not help, and what would help recent immigrants and refugees from Africa to recover from premigration trauma?" Interview questions covered participants' appraisal o f illness, helpful and unhelpful incidents, and future skills i n their recovery process. The following questions were asked; supported b y clarification questions as the situation prompts: (a) What major sufferings have you experienced before migration, (b) What helped you to recover from these experiences (positive incidents), (c) What did not help i n your recovery process (the negative incidents), d) What would have helped you recover from your pre-migration sufferings? Theoretically, survivors o f trauma, especially refugees have lost their voices through torture, imprisonment and subsequent traumatization. Thus, this researcher thought that the closing question would empower and accord participants the opportunity to decide the pace, time and direction o f their recovery process.  Premigration Trauma  17  Overview of the Thesis The principal focus o f this thesis is was to examine what immigrants and refugees who survived premigration trauma thought helped, did not help and would help them to recover from traumatic experiences. The thesis is divided into six chapters. Chapter 2 reviews literature on trauma research as well as culturally constructed modalities o f trauma identification and healing. This chapter denotes that the effects o f trauma stretches beyond the individual and affects ones family and community or nation. Chapter 3 outlines the phases o f a critical incident methodology (Flanagan, 1954), including methods o f data collection, analysis, categorization o f themes and procedures for ensuring that data is trustworthy. The current research acknowledges the usefulness of the Critical incident technique i n obtaining and analysing the narratives o f those affected by premigration trauma. Chapter 3 continues with the illustration o f the characteristics o f timeline methodology. Timeline methodology was used to strengthen the critical incident methodology. Basic participants' demographic data is also introduced; participants then place their incidents i n a timeline with a chronological sequence. The latter provides a strong base for identifying relationships between participant's reported incidents and to establish the tenants o f the proposed theory o f recovery from migration related suffering. It also notes flexibility o f both horizontal and vertical occurrence o f migration events. This process acknowledges that migration is not a one off event but a combination o f events that occur without a predetermined pattern. Chapter 4 presents the results o f the study based on the C I T and Timeline methodology. Due to the sensitivity o f the current study only one participant timeline  Premigration Trauma  18  w i l l be illustrated and discussed i n thesis chapter. Permission use his timeline has been sought and offered without coercion (See appendix a). Chapter 5 concludes the thesis with the discussion, which summarizes the results o f the study. This section introduces the limitations o f the study based on the cultural diversity and methodological implications. Contribution o f the research to the existing body o f knowledge as w e l l paving way for future research which focused on the development o f a theory and programs relevant to immigrants mental health.  Premigration Trauma  19  CHAPTER II LITERATURE REVIEW Chapter 2 reviews literature on trauma research including culturally constructed modalities o f trauma identification and healing; including factors that help, do not help and would help the trauma survivors to recover from premigration trauma. The concept o f trauma is defined on the basis o f its cultural conceptualization and appraisal. This view denotes that the effects o f trauma stretch beyond the individual and affects ones family, community and nation. The relationship between trauma and research samples is investigated; how premigration trauma affects immigrants, refugees and international students respectively. The chapter continues by making an attempt to help the reader to understand the phases o f migration and its traumatizing effects as presented (Silove & Cunningham, 1993). Migration can extend from abrupt and terrifying uprootment o f refugees from their familiar environment to gradual suffering and apprehension about the future among the immigrants. Chapter 2 continues by presenting research reviews on factors that are help (resiliency and social support, culture sensitive healing), does not help (Separation from family and social isolation) in the recovery from premigration trauma. This factors have in no way influenced the research results as they were merely based on common comments made b y immigrants and refugees which were not part o f the study as w e l l as literature on migration studies. This chapter continues by presenting the theoretical background o f the two methodologies used in the current study; namely Critical Incident Technique (Flanagan, 1954; Borgen & Amundson, 1984; Woolsey, 1986) and Timeline Methodology (Chell,  Premigration Trauma  20  1998; Schlossberg, Waters & Goodman, 1995; Baxter, 1999). It presents stages followed in Critical incident technique for data collection, analysis and presentation o f research results. The principal consideration for handling data i n this methodology is usability and validity o f data. Timeline methodology was used to enhance participants' memory recall and helping them to see their life stories illustrated as a continuum. This methodology categorizes the low and high points o f events that happen i n the process o f migration according to three main periods, namely; beginning, middle and end. 1) The beginning entails survivor's experiences o f a direct attack or difficult situation suffered by the family or community. 2) M i d d l e refers to the time when a survivor felt traumatized and tried various methods o f survival and 3) the end comprised o f the period when the survivor decided to flee or migrate from their countries o f origin until arrival in the country o f resettlement or host country. However, the researcher is aware possibility o f endless effects o f premigration trauma as post migration incidents could reverse the strides that survivors undertook i n their healing process. A l s o , this researcher's personal experience would be used i n this chapter to thread the empirical research as an indication that therapy and research on African survivors could be effective i f done with the input o f those with lived experience.  Concept of Trauma "Trauma is trauma, no matter what caused it" (Levine, 1997). The effects o f traumatic experiences was documented by doctors, historians and poets as far back as the days o f the ancient Greeks around 490 B . C (Matsakis, 1996) and later expressed by an Athenian soldier who became blind after witnessing the death o f his colleague (Veith, 1965). Herman (1992) alludes the original study o f trauma to a French  Premigration Trauma  21  neurologist, Jean-Martin Charcott, who discovered hysteria i n sexual abuse victims, whereas Veith (1965) asserts that a more intensive discovery o f a psychological phenomenon was initiated by Sigmund Freud and his associate Breuer around 1890s. It gained more attention from both cultural and natural science based research after the Second W o r l d W a r (Breire, 2002; F o a et al., 1992; Herman, 1992; Kleinman, 1995; Levine, 1997; Matsakis, 1996; Okpaku, 1998; V a n der K o l k , 1984; Yehuda, 2002). Despite historical and recent sufferings in the African continent such as multiple losses from H I V / A I D S and ethnic strife, state-sponsored political terror, unemployment of breadwinners, it is unclear whether the concept "trauma" exists or the form under which it is used. However, i n Botswana, certain words are used to refer to it such as "Selelo sa khuranyo ya meno" (suffering), or G o tlhoka lesego (misfortune). In support, Bagilishiya (2000) narrates the trauma and anger that engulfed h i m when he met with a young soldier who participated i n the killing o f his son during the Rwandan ethnic massacre o f 1994: Soldier: I should not be telling this, but people are quite upset that you are investigating the death o f your son's whereabouts. Bagilishya: What's all this? What are you saying? Soldier: Y o u r son is a hero.. .he successfully completed his mission and no one need to worry about h i m any longer.. . Y o u must leave.. . Y o u must believe me (p. 338).  Bagilishya further describes his psychological state after the conversation: Words cannot describe how I felt to have before me someone who had witnessed the murder o f m y son. After this revelation, flood o f terrifying scenario filled m y head. I felt as though I was the lead actor i n a horror film in which I helplessly watched as thousands o f babies, children, persons o f all ages, were put to death without mercy i n a genocide that they had neither provoked nor encouraged....  Premigration Trauma  22  The paralyzing revelation o f the death o f m y son transformed m y inner world into an ocean o f tears and sadness, buffeted by a storm o f anger that laid the foundation for thoughts o f bloody vengeance.. .The silence was so intense that m y mother, who had been discretely hanging back, decided to approach us slowly, bringing her hands to her breasts.. .After a few moments, m y mother turned to the young officer and said, 'don't forget that you are now a man, and that the tears o f a man flow within' (p.339).  The proverb cited above translates that the person should not express signs o f pain as this could lead to rage and vengeance. There is lack o f evidence whether African sufferers appraise their situation as traumatic. It is still uncertain whether the complexity i n the definition emanates from language omission or cultural differences i n the appraisal o f "illness". This situation negates viewing trauma as a concept but rather be understood within context o f the first hand experiences o f those affected, including both harm to the self, or witnessing harm against the family, friends, and community members. Levine (1997) states, "People don't need a definition o f trauma, we need an experiential sense o f how it feels" (p.24). A Sudanese teenager i n Bolea, Stow, Grant, George & Olja (2003) narrated: According to m y definition o f trauma .. .having no parents is a depressing thing in m y younger days.. .1 think it is 15 years now without m y m o m and dad and friends, without relatives around. So it's very, very, very hard to say. Another teenager stated, "Trauma is missing anything that is o f value about self (p.222).  The Bolea et al. study examined the trauma o f Sudanese refugee children i n the United States. It was comprised o f children younger than 18 in voluntary foster care homes and 2 parents from Sudanese community. The researchers tape - recorded eight qualitative interviews and coded them for emerging themes. It seems there is no definite definition o f trauma, as different researchers are influenced by their own theoretical orientations and practice. Helping professions tend to  Premigration Trauma  23  describe trauma i n terms o f the event that caused it instead o f defining it i n its own terms. Perhaps any definition o f trauma should note the context o f the individuals served and also how individual pain is experienced in a social context. But, what is trauma? To understand the precipitants o f migration trauma, it is essential to scrutinize the relational nature o f the African society and how trauma manifests differently within individuals and groups. Individual Trauma Individual trauma can be viewed as witnessing or having a direct attack on the individual, which could lead to an overwhelming experience. Traumatic events are described as feelings that are intense, inescapable, uncontrollable and unexpected (Foa et al., 1992) or as a collapse o f defensive and mental structures (Yehuda, 2002). Rachel Yehuda (Conference proceedings, July 26, 2004) defined trauma as "a situation where the person has inability to share the memories o f a traumatic event.  Then P T S D represents  a failure to recover from a universal set o f emotional reactions typically manifested by intrusive memories and nightmares i.e., I can't put the event away." Herman (1992) states "trauma generally involves threats to life or bodily integrity or close encounter with violence and death" (p. 33). The essential feature o f Posttraumatic Stress Disorder is the development o f characteristic symptoms following exposure to extreme traumatic stress involving direct personal experience o f an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity o f another person ( D S M I V , 1994).  Premigration Trauma  24  In this section, trauma is perceived as a personal experience when experienced directly by the individual, such as torture, detention and threats with death. M e k k i Berrada, Moreau & Rousseau (2001) prompts further discussions about the D S M I V criteria for limiting trauma to the nuclear family indicating that this excludes the frequency and severity o f attacks on the extended family. Several authors argue that reducing the effects o f trauma to the individual one may lose sight o f its political and social dimensions (Erickson, 1994; Giesen, 2001; Kagee, 2003). This argument is important based on the notion that in Africa the moral person is "a being entangled in relationships" (Englund, 1998; Trodeau, 2001; Vontress, 1991). The suffering o f a member o f the community or society is shared by a large majority o f the community to which they belong. For instance, it is a common practice i n many African societies that during the mourning period a bereaved family is given support with materials and labour as well as words o f wisdom to deal with their grief. Collective Trauma Collective trauma is characterized b y an attack to the basic social fabric damaging the bonds that have always tied the people together and impairing the prevailing sense o f community. Levine (1997) refers to a definition that should; encompass serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse or other close relatives or friends; sudden destruction o f one's home or community; seeing another person who is or has recently been injured or killed i n an accident or violence" (p.24). Giesen (2001) states that ethnic strife and discrimination, c i v i l wars, epidemic diseases, collapse o f national economies and forced migrations are "experienced as shocking events that not only cause great individual suffering, but may also result in the breakdown o f social order, that is, i n the collapse o f the most basic, 'taken for granted'  Premigration Trauma  25  social expectations". The author continues to say that under the impact o f shocking events, feelings o f hopelessness, apathy, fear, and disorientation spread i n the community. Erikson (1994) states that "trauma" can create a new community due to the realization that the community is becoming ineffective in the provision o f support and that an important part o f the self has disappeared. " I " continue to exist though damaged, yet I may be even permanently changed. " Y o u " continue to exist, though distant and hard to relate to. But "we" no longer exist as a connected pair or linked cells in a larger communal body.. ."(Erickson, 1994, p. 233). In a situation where the flow o f information is a collective response, the effects o f trauma can extend from the individual sufferers to other members o f the community who did not directly experience the traumatic event. A n d this is not some form o f a psychogenic or mass hysteria but a calculated societal response to a known or unfamiliar attack. Among the Mbukushu people in Botswana, Namibia and A n g o l a psychological issues are treated by either faith healers or traditional healers, and for them to perform healing rituals, members o f the community with special talents help with singing, drums and other special tasks. Other members o f the community attend these occasions; not in solidarity but to offer support to those affected or simply to execute a cultural obligation during times o f distress. According to Yehuda (2002), societies assign value tags to exposure to traumatic events and behaviour during exposure "(e.g., merit, virtue, and honor versus shame, cowardice or dishonor)" (p. 165). These social tags may provide coherent meaning to the event (Yehuda, 2002), thereby protecting the individual from uncontrollable emotions and hurt. Thus, Mekki-Berrada et al. (2001) define trauma as "a set o f extraordinary, stressful events directly associated with the context o f war or armed conflict in a refugee  Premigration Trauma  26  homeland" (p.43). Furthermore, Mekki-Berrada's definition still runs short o f the purpose o f the present study as it excludes non-political terror as w e l l as the mind and body connection, as "people from traditional cultures experience somatic distress following extremely stressful events (Friedmann & Stamm, 2000, p ). It is also essential to consider that some collective cultures such as i n Africa hold certain appraisals o f trauma and beliefs about treatment. Friedman & Stamm (2000) state that it is believed that illness can occur as a result o f misfortune or spirits rather than microorganisms. Individual and Collective Trauma Not all trauma survivors express their sufferings on the level o f the collective memory or on the individual level. Actually, given the homogeneity o f a group, some memories can remain enclosed in the individual mind and body or spirit (Giesen, 2001; Levine, 1997; Kleinman 1995; Erikson, 1995). Giensen states that i n contrast to individual trauma, social traumas are largely disconnected from individual experience and memory, but exist after some time only on the level o f public communication and culture. Sometimes these traumas are not visibly expressed in public for fear o f being misunderstood in expressing a behaviour that is not i n concert with a perceived current cultural understanding. The form o f trauma that is displaced from the individual and group memory could be more traumatic because it can be easily treated as historical antecedents and only experienced at the level o f collective unconscious. Therefore, emphasis on the study o f trauma i n collective cultures lies i n part on a thin line between the position o f the individual and the community. Individuals can act autonomously i n their own right but there are certain societal norms and mores that set the parameters in ensuring that the individual is sensitive to the peace and needs o f the  Premigration Trauma  27  larger community. Taboos are one o f the mediums o f communication sometimes used to transmit laws o f inhibition to the people. Refugees and Trauma The decision to migrate or flee can be a long and risky process as refugees "experience a progressive disruption o f .. .social facilities and sense o f threat to their lives and property and breakdown o f law and order... trace lost families while attempting to cope with grief, uncertainty and ongoing fear (Silove & Cunningham, 1993), resulting i n depression, anxiety, post traumatic stress disorder (PTSD) and somatization (Fenta et al., 2001). After migration to a host country, asylum seekers are expected to meet the refugee status determination criteria. This could be another lengthy process, characterized by uncertainties about granting o f asylum and reunion with family left i n the country o f origin. A s an illustration, Mensah (2002) states, "the refugee experiences a number and variety o f emotions including depression, uncertainty, guilt over leaving loved ones behind" (p. 65). Rousseau et al. (2001) research study investigated the effects o f the extended separation from family among Latin American and African refugees in Montreal and revealed consistency i n the effects o f personal and family trauma. Rousseau's research study also identified insecurity o f family back home, more specifically financial and health, among the most common concerns for African refugees. Immigrants and Trauma Immigrants are people who have been officially accorded residence in a country after they were born i n a country other than the one o f current residence. Immigrants are admitted to Canada on economic, social and humanitarian grounds. According to  Premigration Trauma  28  Citizenship and Immigration Canada, (September, 2000), recent immigrants are immigrants who landed during the period 1981-1990. Immigrants who landed during 1991 to 1996 are called very recent or most recent immigrants. Under both categories African immigrants i n Canada currently number 282, 600. Therefore, this research focused on immigrants who arrived between 1991 and 2001 as this narrowed the range o f experiences and helped the participants to effectively connect with their premigration experiences. Most immigrants are often pushed out o f their countries by unpleasant local conditions. African immigrants for instance, face harsh economic, political and social conditions before they struggle to raise sufficient funds for the family to move to the host country. O n arrival parents deal with the reality o f unemployment, education for their children, new cultural norms, lack o f social support common to collective cultures, and uncertainties about future life goals. In spite o f the discrepancy in the definition or appraisal o f trauma, the reality o f traumatic experiences among the refugee and immigrant population needs research on how these effects may be reduced or limited. Breire (2002) states "traumatic injury to the individual in the early life interferes with the acquisition o f self-capacities later on. Similarly, premigration trauma suffered by immigrants could tamper with affect regulation, and once having migrated the individual could be at risk for being more easily overwhelmed by emotional distress associated with the memories o f trauma, thereby motivating the use o f dissociation and other methods o f avoidance.  Premigration Trauma International Students and Trauma A n obvious reason is that international students migrate to Canada i n pursuit o f further studies. However, historically parents perceived children as surplus labour owing to labour oriented lifestyles and social expectations. Transition from agricultural to cash oriented economies and poverty had exerted extra pressure on children as breadwinners to provide for their families and sometimes support the extended family and disadvantaged individuals i n the community. In these changing times pressure on children takes different forms: universities in developing countries often compete for minimal government resources with other pressing national agendas such as H I V / A I D S and other diseases, wars, poverty and as such operate under shortage o f human and material resources as w e l l as specialized programs. These local issues may undoubtedly create a strong motivation and heightened expectations for productive youth and adults to depart from countries of origin in search o f employable skills "suitable" for the domestic job market. In most cases migration can produce positive results such as acquisition o f advanced and needed skills and establishment o f international professional networks. Perhaps as a consequence o f the pre-sojourn motivation, students succumb to extreme psychological stress and traumatic conditions emanating from efforts to secure a suitable scholarship. Pre-sojourners and their families then put up with traumatizing scholarship conditions, involving intensive health screening, security screening, academic screening, family separation and anxiety related to traveling to a new country and culture. These procedures create  Premigration Trauma  30  apprehension and desperation about the outcome o f a scholarship application. Similar to other groups o f immigrants international students are known to experience traumatic situations emanating from multiple losses, collapse o f national economies and wars, as some students come as refugees with the support o f the Canadian Government and other humanitarian organizations. Relevant research is lacking, however, from the lived experiences o f this researcher, pre-sojourn motivations and subsequent processes can pose many challenges. The more the host country is widely differentiated from the student's home country, greater the chances o f impact-a situation befitting many African students. If left unchecked, a combination o f pre-sojourn experiences, academic pressures and transition stress at a host university may lead to unexpected psychiatric disorders such as anxiety, depression and panic disorders.  Phases of Migration In the current study, migration is viewed as a process o f varying contexts and levels that depend on the situation o f those affected. It can extend from abrupt and terrifying uprootment o f refugees from their familiar environment to gradual suffering and apprehension about the future among immigrants. Silove and Cunningham (1993) six phases o f refugee trauma and migration were considered as a basic framework i n the current study for studying migration, though liable to variations depending on the backgrounds o f those affected: Phase 1:  Survivors experience political terror, violence, and social upheaval in their home country, which results in the progressive disruption o f health, educational, and other social facilities. Militants and their families experience a sense o f threat to their lives and property and breakdown o f law and order.  Premigration Trauma  31  Phase 2:  Refugees and their families experience attacks, torture, imprisonment and the disappearance o f individuals and family members.  Phase 3:  Ex-detainees, fearing further reprisals against themselves or their families become fugitives or internal exiles i n their own countries. Families then struggle to trace lost families while attempting to cope with grief, uncertainty, and ongoing fear.  Phase 4:  Involves family members who flee the country i n hazardous circumstances.. .people who risked being attacked by pirates or militants, or dying from drowning, dehydration or starvation.  Phase 5:  The refuge gains entry to a country o f first asylum. For many individuals and families, this involves living i n refugee camps, or border camps where the individual suffers many deprivations, isolation, and uncertainties about the future. Individuals may have little or no knowledge o f the whereabouts or safety o f family members and often are subjected to crowded, unsanitary, and unstimulating circumstances in a milieu that is often hostile to the refugee's presence.  Phase 6:  Follows when refugees receive permission to enter a host country for resettlement, where they often experience problems concerning residency status, racial prejudice, and socioeconomic, educational, occupational and linguistic obstacles.... for all these reasons, it is important to recognize that, even in "safe" host countries, refugees are often i n a state o f "continual" stress because o f unresolved political and family calamities in the home country which are superimposed on the difficulties they have in adapting to their new and often alien environments (p. 752).  For the purpose o f the current study the above phases were consolidated into two main stages o f transition, namely; premigration which is represented b y stages 1 and 2; involving direct trauma to the survivor, survivor's family and community or culture. Migration trauma is typically illustrated by stages 3 and 4 referring to survivors becoming refugees first i n their own countries, then in refugee camps. This stage is characterized by increased fear for individual's life and that o f his/her family as well as starvation, crossing dangerous terrain and avoiding being recaptured. Future research w i l l deal with stage 5 and 6, which involve post migration psychological stress. Although  Premigration Trauma  32  arrival i n a host country provides some relief and protection from perpetrators, adjustment to a new environment can bring multiple psychological distresses emanating from problems with employment, language, role reversal, education and mainly social isolation. According to Smith 2003, the multiple losses, social dislocation, feelings o f fear, inadequacy, and disempowerment combine with cultural and linguistic barriers to form a difficult psychological reality for immigrants and people living in exile as refugees.  Summary of Trauma Lack o f a theoretical definition o f trauma as outlined i n this section is challenging, given the potential for misdiagnosis or mistreatment o f traumatized people. However, the gap in definition could also produce desirable results i f the definition is left with the sufferers themselves, to define sufferings in their own terms and personal experiences. The logic behind the definition based on the experiences o f the sufferer is supported by Levine (1997), who calls for "an experiential sense o f how it feels." (p.24). However, the understanding o f trauma should be located on a continuum ranging from individual context to immediate family, extended family, friends, to the larger community. It should be broadened from social relations and physiological reactions to the whole milieu o f mind, body and spirit formations as most people in collective cultures express feelings through somatic reactions rather than physical, emotion and cognitive connections. Finally, for the purpose o f the current research study, trauma has dual meanings. Firstly, it refers to 'direct personal suffering and witnessing or hearing about suffering experienced by the family, community or culture, rendering the cultural resiliency and recovery systems vulnerable and ineffective to deal with known and new attacks'.  Premigration Trauma  33  Secondly, It can be viewed as 'the creation o f the new meaning o f self, following the destruction o f the T and ' Y o u ' except ' W e ' . For immigrants and refugees this definition encompasses the social and political dimensions associated with migration related trauma. It recognizes the debilitating factors that push immigrants and refugees out o f their countries leaving personal property and family and relatives behind. Suffering extends to dangerous escape and guilt o f separating with the community as well as embarking on a long and uncertain journey across a couple o f countries. Arrival in new environment and culture poses many challenging effects for the individual and relations left at home country.  Research on the Recovery Process Recovery is seen as a non-linear process, characterized by both progressive and regressive movements, which the survivor may abort at any point (Zimmerman & Dickerson, 1994). Effective recovery allows for the traumatic event to be incorporated into one's personal narratives, affirming rather than destroying existing beliefs and assumptions (Kaminer et al., 2000). Several authors identified a number o f determinants of resiliency and recovery from traumatic reactions. When trauma strikes the person's resiliency is shattered and they are rendered helpless as life appears meaningless or purposeless. Thus, i n the process o f recovery the individual either personally or with assistance recharges the weakened schema o f resiliency to bounce back to "normality".  Factors that Promote Recovery Resiliency Resiliency refers to a person's "capacity to bounce back", to withstand hardship and to "repair" ( W o l i n & W o l i n , 1994). Blackburn (1993) describes resiliency as the  Premigration Trauma  34  ability to recover from or adjust easily to misfortune or change. It is the capacity o f the strained body and mind to withstand shock and recover without permanent deformation. In the context o f the current research, African survivors o f trauma would benefit from a sensitive approach that recognizes substantial roles played b y 1) family 2) religion/spirituality and 3) social networks. However, due to diversity o f African culture generalizations should be avoided depending on rural or urban living, level o f success, education, spiritual beliefs and exposure to western education. Peddle (1999) explains that African ethnic culture is currently influenced by religion and trade from Western, Eastern and Islamic cultures. However, it is evident that many people i n Africa still subscribe to their ethnic and national cultures especially during the times o f distress or disputes, and during ceremonies. Family Support The cornerstone o f the existence o f the people o f Africa is the relationship within social circles. A n injury to one family member is an injury to the entire family. A n individual family member plays a central position i n the family, sometimes as a breadwinner, heir o f the family asserts, having leadership expectations after the death o f the head o f the family or being the custodian o f family customs. F a m i l y and kinship elements bring meaning to an African community as activities and burdens are shared with the larger community. Family support aids recovery from, trauma, particularly because the presence o f family during trauma can transform adversity into a source o f strength and meaning (Mekki-Berrada et al., 2001) and a "shoulder to cry on". A s a consequence o f these family relationships, family trauma is more unsettling than personal trauma. Mekki-Berrada et al. (2001) relates family trauma to the  Premigration Trauma  35  sacredness o f a family to an African community, which considers an attack on the family extremely serious. Actually, i n Botswana as well as many other African cultures a person's lifeline progresses through four distinct stages; namely a) birth, b) puberty and c) marriage and d) death. Notably, other African traditions and religions believe i n the resurrection or existence i n the spirit formation; illustrating the visible and spirit worlds. The arrival o f a new baby is welcomed with celebrations, gifts and ceremonial rituals. Although eroding and only common i n rural areas, many cultures across Africa perform initiation rituals or "the rite o f passage". During the puberty period at ages 14 to 16, young men and women are taken to a secluded place for an initiation program. The young women's curriculum entails skills related to marriage; motherhood and home crafts as well as basic domestic chores intended to help them to look after their families. Certain human qualities such as compassion, patience and self-respect are also developed in the initiates. Boys are taught how to perform family and marital responsibilities. The skills o f leadership, courage and self-respect sustain the family on their daily lives, including during difficult times. O n return, those initiated are now regarded as men and women and they are met with a joyous celebration at a public gathering. Death not only marks the end o f life but also the end o f a journey traveled with courage or pride despite misfortunes and life difficulties. Englund (1998) notes that the death o f a young child or teenager is more traumatic compared to that o f an old person. The latter is celebrated with the performance o f funeral rituals, which could last several days in Southern Africa and up to three months i n West African countries such as Nigeria. The bereaved family is comforted with prayers and sometimes humour (Englund, 1998) and they are rested so that they can deal with their grief. Children are  Premigration Trauma  36  not allowed to attend funerals as a way o f protecting them from harmful emotions. Certain funeral rituals are performed after the funeral to avenge the troubled spirits, which could trouble the living through dreams and spirit possession. Englund notes "spells o f disorderly behaviour, inconsistent and unusual speech and the symptoms o f somatic diseases are common signs o f spirit possession". In collaboration with other community networks the extended family consults with the bereaved family. In times wars concerns about indecent burial or non-burial o f a family member can continue to perpetuate trauma among the surviving members. These rituals are organized and performed within family circles and community networks, which accords the family institution a unique status and purpose in the lives o f African people and could also be recognized as an important angle i n healing traumatic illness. Community Support and Religion/Spirituality Community networks are complex, diverse and organized according to unique interrelated structures characterized b y specific roles and responsibilities. These structures are comprised o f elders, chiefs, and leaders o f respective wards, traditional and spiritual healers. The composition o f the traditional family is changing and now encompasses government and non-governmental institutions that, i n many instances, operate with sensitivity to the local culture and customs. Overall functions o f these networks are to foster societal cohesion, peace, protection from misfortunes or enemies and support services which involves the,running o f traditional ceremonies, celebrations and support during adversaries.  Certain laws o f inhibitions are used to deter members o f  the community from undermining traditions and customs that identify a particular group.  Premigration Trauma  37  However, one can act independently as long as their behavior does not put the lives o f others and the society i n jeopardy. Based at the heart o f community structures and treatment o f diseases is religion or spirituality. Majority o f the African people pray to G o d or Ancestors. According to Peddle (1999), one can find religious beliefs from Islam, to " b o m again Christians" as well as traditional African religions. According to Blyden (Cited i n Peddle, 1999), traditional African religion honours the Supreme Being " G o d or Ancestors". Beliefs and practices are closely tied to the land and kin, both those living and dead. There is a connection between the spirit world and visible world, hence, in some cases music; dreams and omens are used to transmit messages between the spirit world and the visible world (Peddle, 1999).  In some cases churches, traditional healers and medical doctors  are consulted in the diagnosis and treatment o f the mental illness. A more recent illustration o f religion in transforming adversaries to protective measures is the Truth and Reconciliation Commission ( T R C ) in the post Apartheid South Africa, where A r c h Bishop Tutu identified "forgiveness" as the eventual product o f T R C . Forgiveness is seen as personal expression o f compassion, brotherhood and healing. Trauma recovery can take the form o f witnessing, testimony and reparation as occurred in South Africa during the "Truth and Reconciliation Commission" to process the psychosocial trauma caused by the apartheid political perpetrators (Bishop Tutu, as cited i n Friedman, 2000). It is important to note that sometimes trauma cannot be healed in the absence o f the perpetrator. This is in line with the traditional African custom o f using traditional healers and spiritual or faith healers to discern and prophesy the cause o f misfortune and how the spirit leads to the healing process. Hence, social testimonies are  Premigration Trauma  38  essential before healing can occur (Andermann, 2002). Bagilishya (2000) agrees that in Rwanda forgiveness as w e l l as laws o f inhibitions helped to quell the escalation o f the Rwanda ethnic conflicts. Thus therapists working with traumatized clients should note the dynamics and diversity o f African religions and spirituality. Hence personal healing should be considered as the connection between body, mind and spirit formations and the distinct roles played b y different community networks should also be taken into consideration. Cultural Healing Firstly, mental health professionals need to redefine their conception o f illness and trauma, relocating the appraisal and treatment o f trauma i n the context o f the individual's culture and history. For instance, Englund (1998) states that sometimes the interests o f the refugees and therapists are in conflict as a therapist, from a discursive orientation, wants the refugees to talk about their experiences, while refugees strongly wish to be silent about the pains o f the past and concentrate on the present and future livelihood and education. Secondly, political trauma is a dehumanizing phenomenon and lack o f proper burial o f those killed i n custody is largely immoral. A s a result, after migration clients could still be haunted by images o f what they perceive to be troubled spirits and desire to retain closure. In a situation where elders are not available to observe or perform funeral rituals under migration and war conditions, therapy may leave clients w i t h feelings o f vulnerability to vengeful spirits, characterized by dreams and seeing the face o f a dead relative, or spirit possessions (or somatic disorders). Depending on the traditional orientation o f the traumatized person, delayed spirit exorcism can lead to death or afflict  Premigration Trauma  39  others (Englund, 1998). Usually, exorcism is done within a culturally constructed framework, which mainly involves traditional or religious procedures o f body, mind and spirit cleansing. Hence lack o f understanding o f socio cultural networks and history o f illness by the therapist may harm the emerging relationship and contribute to the delayed treatment or non-treatment.  Factors that Hinder Recovery Separation from Family Separation from family happens as early as immigrants begin the process o f migration. This may bring uncertainty about the whereabouts o f family members, some may lack funds to travel with the entire family, or there may be a hasty departure where the immigrant leaves everyone behind. Mekki-Berrada et al. (2001) have noted that the delay in getting approval for asylum and visas for family members back i n the country o f origin has led to divorce, as costs o f communication became unbearable. Social Isolation Refugees have no direct route to a country that could offer them safety; they sometimes cross two countries or live in refugee camps before arrival at the country o f resettlement. This transition is lengthened by the asylum application process, which is usually complicated by lack o f official documents left behind by the applicants when fleeing from home countries. Blavo (1999) state, "Eligibility tests can be influenced by nationality and the absence o f identity documents; by social background - religion, culture, occupation, - military or political" (p.22). Although the host countries sacrifice their hard earned resources and safety to cater for the refugees, ineffective resettlement  Premigration Trauma  40  processes expose applicants to unrelenting struggle for food, education, employment and cultural adjustment - as both groups try to understand each other. Similarly, immigrants start the migration process with high levels o f stress or ambitions, hoping to have a better life in the host country. O n arrival they face challenges ranging from economic difficulties to cultural adjustment; issues that may have prompted them to depart from home countries.  Summary Premigration trauma has been researched over the years b y scientific and social researchers. O n one hand, scientific research proved to be effective i n treatment o f illnesses though ran short o f acknowledging that a human being is not only a product o f physiology but cosmic world.  O n the other hand, social research is proving to be  sensitive and relevant to social and environmental relations and how they affect wellbeing. However, there is need for a generic research that recognizes cultural scientific approaches based on the context o f the sufferer and social dynamics; their psychological reactions to trauma, useful religious beliefs and practice in coping with trauma. This researcher thought that an effective way o f ensuring relevance o f healing approaches would be to accord the sufferers a voice to express what they thought helped or did not help or would help them in their recovery process from premigration trauma. Therefore, the next section w i l l provide a theoretical overview o f two methodological approaches found relevant i n achieving the aims o f this research study.  Critical Incident Technique The Critical incident technique, a qualitative methodology developed by Flanagan (1954), has long been used i n the service industry to evaluate consumer satisfaction.  Premigration Trauma  41  However, more recently this methodology has been applied to the study o f refugee and immigrant experiences and the quality o f service provision and research (Mclachlan & McAuliffe, 1993; Kanyangale & Maclachlan, 1995). Flanagan and members o f the Aviation Psychology team developed the critical incident technique during the W o r l d War II to find cost effective ways o f training flight crews and to understand specific behaviors that led to the success or failure o f a mission. The more traditional methods were found to be complex and time consuming (Kemppainen, 2000). Incidents are defined as any "significant contribution" either positively or negatively, to the general outcome o f the activity (Flanagan, 1954). The term critical refers to the fact that the behavior that is described is important to the overall outcome o f the phenomenon under investigation. In this study, a set o f clear but intensive interviewing questions was used to collect incidents from the context o f respondents' experiences and meanings. Since the war, a number o f researchers have since demonstrated that it is an effective approach for a variety o f purposes, especially i n business, industry and other helping professions. The technique was mainly chosen for this study because it has been proven to be adaptable to cultural aspects o f trauma on refugees and this was evident in the studies concerning African respondents (Mclachlan & M c A u l i f f e , 1993; Kanyangale & Maclachlan, 1995), conducted on refugee counsellors i n M a l a w i . It has also proven to be effective i n the multicultural context (Hurdel, 2002) who understudied critical incidents in native Hawaiian peacemaking. C I T methodology involves the usage o f a consistent and flexible interview guide where verbatim reports from respondents are recorded. For the technique to be effective  Premigration Trauma  42  and useful three important pieces o f information need to be included: a) a description o f a situation that led to the incident, b) the actions or behaviors o f the focal person i n the incident and c) the results or outcomes o f the behavioral actions (Anderson & Wilson 1990, p. 90). Flanagan (1954) describes an "incident" as " . . .any observable human activity that is sufficiently complete in itself to permit inferences and predictions made about the person performing the act" (p. 327). A n incident is viewed as "critical" i f it makes a significant contribution' either positively or negatively to the event involved. Specific probing questions are asked to solicit responses from the participants, such as; What led up to the incident? W h y did the incident occur? W h o was involved? What were you thinking or/feeling? H o w did you attempt to deal w i t h it? A n d , i f the incident occurs again how would you attempt to deal with it? (Kanyangale & MacLachlan, 1995). Critical incident technique has several advantages, such as usefulness in the early stages o f research because it generates both exploratory and theory or model building (Woolsey, 1986). According to M c L a c h l a n and Auliffe (1993), another advantage o f critical incidents is that they offer the opportunity for shaping behavior by reinforcing problem solving behaviors. The authors further state that experiences in therapeutic settings offer a means o f establishing the content o f programs. This study follows the five steps o f a critical incident study (Flanagan, 1954; Woolsey, 1986; Kanyangale & McLachlan, 1995): 1. Determining the aim o f the activity; 2. Setting the plans, Specifications and Criteria; 3. Collecting the Data; 4. Analyzing the Data and 5. Reporting the Findings.  Analysis of Critical Incidents Data The main guiding principles for data analysis are usability o f data and competence o f the research judges. Flanagan (1954) wrote, "The purpose o f the data analysis is to  Premigration Trauma 43 summarize and describe data in an efficient manner so it can be effectively used for any practical purposes" (p.343 - 344). According to Flanagan (1954: 343 - 344) data analysis involves the following steps: 1.  Selecting the frame of reference  The importance of and relevance of categories plays an important part in the formulation and classification of incidents. Flanagan (1954) state, "The preferred categories will be those believed to be most valuable in using the statement of requirements" (pp. 344). 2.  Forming the categories  This procedure comprises of 5 steps: Step 1.  Sort a small sample of incidents into piles related to the selected frame of reference.  Step 2.  Briefly define these tentative categories and classify additional incidents into them.  Step 3.  Redefine and develop new categories. This process continues until all incidents have been classified.  Step 4.  Large categories are subdivided and incidents that describe similar behaviour are placed in the same group.  Step 5.  Define all categories as major headings are reexamined in terms of actual incidents classified under each.  3.  General behaviour  Establishing the appropriate level of specificity and generality used in reporting the data analysis and findings is the first challenge. Commonly these methods include using  Premigration Trauma  44  data coding schemes, counting the number o f occurrences o f a particular response and describing any patterns, themes and clusters that could have emerged i n the interview. The following conditions are necessary when selecting category headings and specifications for generality (Flanagan, 1954, pp. 345). 1. Headings and Requirements must be clear cut, logically organized and discernable with an easily remembered structure. 2.  Titles require meanings i n themselves without detailed definition, explanation, or differentiation.  3. Headings for major areas and requirements should a l l be homogeneous, parallel in content and structure; and neutral. 4. Headings must all be o f the same type and importance. 5. Headings should facilitate findings being easily applied and maximally useful. 6. Listing of the Headings need to be comprehensive; covering all incidents that have significant frequencies. Finally, it is important to report limitations as well as the value o f the results. V a l i d a t i o n Procedures In order to reduce systemic error and biases, categories undergo several Critical Incident Techniques (CIT) steps to ensure that the data and study is both useful and trustworthy. Seven steps to test the validity and reliability o f the categories presented below w i l l be explained i n detail i n the methodology chapter: 1. Professional cross - checking Liaison or checking with a professional familiar with C I T to ensure that research procedure satisfies the requirements o f the methodology.  Premigration Trauma  45  2. Participant's Cross - checking According research participants the opportunity to check that the accounts o f their narratives have been accurately captured and not misrepresented. 3.  Category Comprehensiveness To determine whether category system was comprehensive and complete. Anderson and Nilsson (1964) recommended withholding 10% o f the total incidents until major categories were identified. Categorization stops when new categories or themes are no longer emerging.  4. Inter-rater Reliability Researcher compares category with another person(s) to confirm the level o f degree o f agreement i n their categorization. The researcher submits a randomized list o f incidents and categories to an independent rater (s). Anderson and Nilsson (1964) suggests that categorization is acceptable i f independent raters could correctly classify 75% - 85% o f incidents under the given categories. 5. Expert Assessment This procedure refers to using experts also known as 'judges' i n the field o f study to check whether or not they can relate with the categories or i f they find them wanting (McCormick, 1994; Alfonso, 1997 as cited i n Butterfield, 2001). This validation stage continues to be used (Barbey, 2000 & Morley, 2003).. If there is expert agreement between the researcher and experts, credibility o f categories is assumed achieved.  Premigration Trauma  46  6. Literature Validity Literature validity as asserted by M a x w e l l (1992) confirms whether there is available literature agreement about the descriptive and interpretive terms used. The main purpose o f reference to the previous studies is to ensure that there is soundness o f the category system as well theoretical agreement between the current study and previous studies. However, this is not conclusive as practical and creative ideas are acceptable to the body o f knowledge. 7. Participation Rate Participation rate refers to the number o f participants who identified a particular incident divided by the total number o f participants (Borgen & Amundson, 1984). Participation rate refers to the percentage o f participants reporting an incident and it is derived from the frequency; which shows the. number o f hits or participants reporting an incident. Calculating participation rate reveals the strengths or popularity between categories; thus, categories are reported in the order o f participation rate. For instance, categories with higher participation rates are reported first followed by the next high percentage.  Interpreting and Reporting Data Flanagan (1954) maintains that the main errors i n research do not necessarily emanate from "data collection and analysis but in the failure to interpret them properly (pp. 345). Similar to other section s o f the Critical incident technique, researcher's impartial judgement is important to ensure the credibility o f data other than the researcher.  Premigration Trauma  47  Reporting o f data should consider certain factors: 1. 2. 3. 4.  Agreement i n the main and sub aims o f the study True representation o f groups observed or clear description should be provided A i m as a statement relating to all groups observed not functional description o f activities carried out in the study Clear description o f the limitations o f the study to avoid faulty inferences and generalizations  In summary, credible reporting should resemble a) facts regarding behaviour interpretations rather than general impressions based on the collection o f interpretations, ratings and opinions; b) L i m i t reporting to behaviours which make a significant contribution to the activity as deemed by competent observers. Critical Incidents Timelines Once the critical incidents were isolated from the participants' stories, each incident reported b y the participant were placed on the timeline framework suggested (Chell, 1998; Schlossberg, Waters, & Goodman, 1995; Baxter, 1999). Timeline had many methodological advantages in this study. It enhanced memory recall as it provided a structure to aid participants to remember past traumatic incidents. It also assisted the participants to see their life stories unfolding as a continuum, which eased anxieties related to information processing and interview session. The timeline categorizes the low and high points o f events that happen i n a lifetime according to three main periods, namely; beginning, middle and end. 1) The beginning entails survivor's experiences o f a direct attack or difficult situation suffered by the family or community. 2) M i d d l e refers to the time when a survivor felt traumatized and tried various methods o f survival and 3) the end comprised o f the period when the survivor decided to flee or migrate from their countries o f origin until arrival i n the  Premigration Trauma  48  country o f resettlement or host country. This could be a long journey and it can either be traveled directly or through a third country and guaranteeing closure to these pains remains fluid.  Premigration Trauma  49  CHAPTER III METHODOLOGY The chapter begins by describing the characteristics o f research participants and various steps involved i n data collection, analysis and reporting o f data required by the Critical incident technique, as well as processes used i n the categorization o f themes and procedures for ensuring the trustworthiness o f data. It concludes with seven steps used to test the reliability and validity o f critical incidents and a summary o f methodological issues that arose i n the study. Additionally, timeline methodology was used to strengthen the critical incident methodology. C I T proved useful i n obtaining and analysing the narratives o f those affected by premigration trauma. The use o f a timeline provided a strong base for identifying relationships between participant reported incidents to establish the tenants o f the proposed theory o f recovery from migration related suffering. The application o f the critical incident technique to the problem o f premigration trauma had several methodological requirements. Firstly, an appropriate sample o f refugees and immigrants befitting the criteria for premigration trauma was defined. Secondly, the sample comprised African immigrants and refugees as w e l l as international students. It should be noted that the primary criteria for inclusion i n this study was traumatic experiences prior to migration. Thirdly, the sensitivity o f the topic under study and small number o f participants called for modification o f critical incident methodology by encompassing an empathically oriented approach.  Premigration Trauma  50  Participants Characteristics of the Participants Incidents were collected from eight male and five female participants. However, the initial sample included seven refugees; four immigrants and four international students were interviewed; (see appendix B ) . T w o participants, both international students, were excluded from the study after the screening interview. One o f them decided to drop because she was uncomfortable with the time line methodology. She found it too linear and as such could not remember the incidents. The other did not provide useful incidents about premigration trauma. The interview revealed that his suffering occurred when he was already i n Canada and he seemed to be experiencing active memory dissociation. The researcher thought it was essential to include more refugees in the sampling process because o f they are most affected b y traumatic experiences. Usually they are uprooted from their countries by life catastrophes or sometimes expelled by their own governments. Redundancy or exhaustiveness o f the critical incidents was achieved after interviewing five refugees. The exhaustiveness o f categories was evidenced by the similarity o f reported helpful and unhelpful incidents. It became clear that same issues kept on arising, however, two additional interviews were conducted to eliminate chances of systemic error. Then, immigrants and international students were added to the sample with the thought that new categories would emerge. Participation i n this study was based on the following four criteria. First, the participants were immigrants, refugees and international students from Su-Saharan Africa who arrived i n Canada between 1991 and 2003. Second, the participants had experienced  Premigration Trauma  51  trauma in Africa, which they volunteered to share. Although international students migrate voluntarily or i n search o f advanced academic programs, they were included in this study only i f they experienced trauma prior to migration. Third, they confirmed not to be undergoing therapy or psychiatric treatment at the time o f the interview. Fourth, participants were to be adults between 20 and 50 years o f age. In summary o f the above, criteria one and two ensured relevance o f the participants to the current study, whereas criteria three and four tested the readiness and safety o f the participants. The main identification procedure for participants was through a poster, followed by telephone conversation i f participants needed more information (see appendix C ) . Some participants were recruited through the researcher's professional networks as well as through African communities in the Lower mainland, British Columbia. Agencies that assisted in this research included those that provided mental health services to African immigrants: One participant was from Immigration Services Society (ISS) and two from the Center for the Integration o f African Immigrants (CIAI). Three were recruited through the Zambian community i n Vancouver. Eight participants were either selfreferred or referred by others who participated or read the research advertisement. It should be noted that Sub-Saharan Africa is a subcontinent composed o f people from different world nationalities and ethnic groupings. Some o f these groups lived i n places, which had long-term political unrest and it was necessary to respond to this diversity by soliciting participants from different socio-cultural backgrounds. Attempts to identify participants through a psychological clinic that helps mostly 'white South Africans' in North Vancouver were unsuccessful as there was no response to the research poster and invitation letter.  Premigration Trauma  52  The age range o f participants at the time o f a traumatic event was between 11 and 39, with the mean age o f 24.0. The number o f participants ranged from 1 - 2 participants per country and only Zambia had two participants (see appendix B ) . The current employment status o f the participants included students, Postal Officer, General Practitioner, Epidemiologist, Security officer, College Tutor, Unemployed and Selfemployed. Nature o f suffering with number participants indicated i n brackets, comprised o f detention n = 2, ethnic conflict n = 2, economic problems n = 3 multiple loss n = 2, grief n = 1, war n = 2 and military coup n = 1. The length o f suffering/trauma ranged from 1 to 7 years with the mean length o f suffering being 4.38 years. In addition, it was deemed essential that the study should indicate the extent and level o f suffering and this was achieved by adding the number o f migrations to the demographic data table. This is consistent with Silove and Cunningham's (1993) argument that migration is a process with multiple contexts and levels o f suffering. In the current study, the average number o f migrations is 2.69 with the range o f 1-5 migrations including migration to the country o f resettlement.  Procedure The process o f the interview encompassed three components: an orientation and screening (Piloting) interview, Critical Incident (data collection) interview as well as participants' cross checking interview. The former was a slow paced activity intended for rapport building, introduction o f aims and purpose o f the study, creating confidence in the research questions as well as the explanation o f researcher's motivation on the study. This was used to pave the way for the critical incident interview, mainly intended for data  Premigration Trauma  53  collection. A detailed description of these procedures is provided in the following sections.  Orientation Interview The orientation interview followed a couple of steps: First, the researcher introduced himself and highlighted personal motivation for the study. Second, participants were introduced to the components of the study, such as the informed consent form (see appendix D); which included information about the participants' rights, benefits, confidentiality and how the study would be conducted. Participants also understood that they could terminate their participation in the research without any consequence. Then participants were asked to sign the form if they agreed to participate in the study. Third, participants voluntarily completed the demographic data form also called the Participant Information Form; (see appendix E). It seemed appropriate that the demographic data form should be carefully crafted to capture essential information related to the study. It had to be consistent with objectives, interview questions, and criteria for recruitment of participants. Fourth, there was a full description of how the critical incidents timelines would be used. Fifth, samples of interview questions were pilot tested with three participants to evaluate the effectiveness of the interview procedure and suitability of the participants to the purpose of the research study. The main interview questions were: 1) What major sufferings have you experienced before migration (event or attack), 2) What helped you recover from these experiences (positive incidents), 3) What hindered your recovery (the negative incidents), 4) What would have helped you in recovering from your pre-migration sufferings?  Premigration Trauma  54  Follow-up questions were asked as prompted by the situation or participants' responses. To alleviate possible difficulty with terminology used i n the study, the researcher provided an overview o f the key concepts such as "Premigration", "Trauma", "Suffering", "Appraisal" and "Recovery".  Trauma and suffering were later reviewed, as  some participants preferred to say, "I was suffering" instead o f "I was traumatized". Later "suffering" was used as a descriptive word, "to suffer from" and trauma was used to indicate the extent o f suffering or illness. The orientation interview provided the researcher with ample information about participants' readiness level and suitability for the study. A s a consequence the researcher was able to determine the relevance o f the research questions to the current research study. It was evident that most o f the participants had difficulty i n grasping the additional question on the 'meaning' o f their experiences with trauma. It was unclear whether the difficulty in comprehension o f questions resulted from the linguistics or complexity o f the questions. O n one hand, this researcher can make a subjective claim that African languages do not encourage self-reflection as well as uses o f " F statements, as both are not perceived as signs o f strength. These could ultimately affect selfreflection and responses to questions that requires description o f emotions. O n the other hand, the researcher asked clarification questions where participants seemed unclear on their comments, acknowledging the importance o f clarity and specificity o f incidents (Flanagan, 1954). Data collected from one o f the three participants who participated in the piloting and screening interview was carried on to the second interview.  Premigration Trauma  55  Critical Incident Interviews Interviews were based on an open ended qualitative approach about participants' experiences o f trauma conducted b y this researcher. The researcher used personal cultural and clinical experience to ensure availability o f an environment characterized by warmth, acceptance, and absence o f judgements or exclusion and exercised understanding o f their situation; given the sensitivity o f migration related trauma. A l l interviews were audiotaped and each participant was awarded a code number. A confidential code was used to deter a possibility o f identification o f the participants. The audiotaping ensured that the information provided by the participants was fully captured and given due attention; factors that would show respect to participants' sufferings. Another benefit o f audiotaping was that it enabled the collection o f information for transcription, which was later used in the analysis stage and other related parts o f the thesis. First Interview The first critical incident interview lasted for approximately one to one and half hours and was divided into three segments: The first part focussed primarily on establishing rapport w i t h the participants and clarifying the purpose o f the interview. This was also the time to debrief the participants on the orientation interview and help participants deal with their comfort and readiness level, especially given that the interviews were audio taped. Despite these possible fears most o f the participants were comfortable with taping and shared the depth o f their experiences voluntarily. A few who had been finding the interview process suspicious became comfortable after rapport was created and with the understanding that the study was conducted for academic  Premigration Trauma  56  purposes. Audiotaping was supplemented by note taking, done with the permission o f the participants. There was a need to ensure an environment characterized by warmth, acceptance, and absence o f judgement or exclusion. This approach was a necessary platform for traumatized immigrants and refugees; largely because they had been harshly interrogated by police before migration and may equate interviewing to police interrogation. The researcher focussed more on the pre-interview process; sometimes participating i n informal conversations, characterized by humour and deafening laughter. Participants were assured that the interviews would move at their pace and comfort. The second part involved the introduction and instructions about the critical incident timelines; (see appendix F). Participants then drew timelines o f their experiences or sufferings as they could remember them. Each ascension o f the line indicated positive outcome (helpful incident) and descent marked unhappy outcome (unhelpful incident). A horizontal line drawing indicated that the situation was unchanged for the period shown by the chronological order o f the time line. Thereafter, participants referred to their time lines to answer interview questions; which lasted for about 30 minutes, or until the participants could not remember additional details o f trauma they suffered. After seven refugees seemed to have reached saturation of incidents as evidenced by the repetition o f issues, the sample expanded to include immigrants.  The same interview procedure used for refugees was repeated with  immigrants sample. Helpful incidents related to family, religion and community networks were popular in both groups. Common unhelpful incidents included economic problems, multiple loss and separation from family.  Premigration Trauma  57  Finally, international students were added to the study. Similar to the immigrants' sample, the international students did not yield many different incidents. Actually, the latter's responses were closer to those provided by immigrants than refugees. Further research is essential to confirm the degree o f difference between international students who are refugees and the general refugee population. Second Interview Second critical incident interview was organized on the basis o f availability and the timeline preferred b y participants. Careful consideration was made for participants who requested other modes o f reviewing and discussing their incidents. Person to person meetings were held with 8 (61.54%) participants. The remaining participants 5 (38.46%) requested to receive their scripts through e-mail, followed by telephone conversation with this researcher. The second interview session informed the participants about the progress of the study and categorization o f the incidents reported i n the first interview. It was beneficial to both the participants and the research study to open the session by asking the participants to share any new information since the last session. The usual practice for the Critical incident technique is to provide the participants with transcripts o f their interviews so that they can ensure that their narratives are accurately captured (Flanagan 1954 & Woosley 1986). This researcher chose to extract the phrases and themes that were clear and relevant to the current research study and placed them into a table under appropriate categories. Then, depending on the participants' preferences, tables containing summarized incidents were either e-mailed or hand delivered to the participants prior to the second interview. However, reference to transcripts was made when necessary or i f participants needed further clarification. The  /  Premigration Trauma  58  benefit o f this kind o f approach was time saving; while the loss might have been potential for suspicion i f there is no transparency for interviewees to refer to their transcripts or voice recordings at the second interview. Participants were also invited to propose modifications, share personal concerns or question parts o f the incidents they found inappropriate. A l l participants accepted the incidents, except one participant who added one further incident. The second interview paved way for the data analysis process and tables o f incidents and transcripts used were carried forward for further analysis.  Extraction of Critical Incidents (Data Analysis) The purpose of the data analysis is to summarize and describe data in an efficient manner so it can be effectively used for any practical purposes.... The preferred categories will be those believed to be most valuable in using the statement of requirements (Flanagan, 1954: pp.343 - 44). Relevance and usability o f data predetermined how data was analysed. Transcripts as w e l l as summaries o f transcripts were sorted out accordingly to ensure they met the requirements o f the study.  Extraction of Incidents The incidents used i n the second interview were further reviewed and supported with reference to the audiotapes and transcripts where essential. Flexibility was allowed to reclassify the incidents to see emerging common themes, an exercise Flanagan (1954) advices that it requires, "insight, experience and judgement" (p. 344). 340 incidents that seemed relevant to the current study were identified using the initial coding system. However, following Woosley (1986) model o f classifying incidents; 20 unrelated or loosely coupled incidents were excluded. A n additional 15 incidents were discarded on further checking, as they appeared too repetitive o f other existing incidents. Incidents  Premigration Trauma  59  were coded only i f one main event was clearly identified and singled out and the outcome appeared clearly related to the study (Woosley (1986). However, given that migration is a process characterized by overwhelming experiences, which has the potential to affect memory recall during the interviews as well as potential language communication difficulties, 13 paraphrased and unclear incidents were included tentatively awaiting clarification with the participants. In the end, 292 incidents emerged from the classification and were retained in the formation o f categories.  Forming Categories Formation o f categories followed a model suggested by Woosley (1986); firstly, similar themes were grouped together according to main categories. In the current study the main categories were: (a) what helped? (b) what did not help, and, (c) what would help. Previous research used paper based colour coding schemes to identify similar themes and creating categories. This researcher transcribed all the audiotape interviews with a word application program. Then used computer highlight keys to identify similar themes, patterns and phrases. Ambiguous incidents were marked as "unclear", subject to clarification with participants i n the second interview. The researcher used judgement to generate concepts that reflected the identified themes, which led to the creation o f main categories. Basic categories were then created to narrow down the main categories (see appendix G). Secondly, categories were redefined and additional incidents were classified into them. Thirdly, any main category that appeared to be too broad was subdivided into subcategories. Categorization continued until all incidents were sorted  Premigration Trauma  60  and placed in suitable categories. Fourthly, categories were re-examined i n terms o f the incidents placed within them. There was continued revision and modification until the data appeared to have reasonable 'face validity'. This led to the next stage involving validation o f categories; where all categories were re-examined for consistency, discrepancy between the objectives and data as w e l l as usability o f data.  Validation of Categories In order to reduce systemic error, categories underwent seven procedures to test the validity and reliability o f the categories. First, this researcher liased with the 'Research Supervisor', who has ample experience i n the methodology, throughout the period o f the study to ensure that the research study adhered to the requirements o f the Critical incident technique. A l s o , the researcher and supervisor double-checked to determine whether descriptive accounts by participants appeared accurate and well represented by the category under which they are classified. A t the initial stage o f extraction o f incidents and forming o f categories, a Masters of Arts student i n Counselling Psychology at the University o f British Columbia, with experience i n qualitative research and who had worked on several projects led by faculty members, independently extracted incidents according to the rating scheme provided. This provided the initial direction and trust in the emerging themes and classification o f incidents. Second, for participant cross - checking, the researcher arranged the second interview to offer the participants the opportunity to check that the accounts o f their narratives have been accurately captured and not misrepresented. A s already indicated,  Premigration Trauma  61  the researcher chose to extract the phrases and themes that appeared relevant to the current research study and placed them into a table under appropriate categories. Tables containing summarized incidents were either e-mailed or hand delivered to the participants prior to the second interview, with an option to refer original transcripts from time to time as requested by the participants. The second interview with the participants was conducted to revisit the categories in order to confirm accuracy on the three parts: (a) the source o f suffering (b) action taken to deal with the situation, and (c) the outcome. Also, the second interview was useful in ensuring validity because participants confirmed compatibility o f the categories with their contents; confirming the soundness o f the category titles and extent to which they captured their experiences i n their own "voices"; ensuring that the researcher had not distorted the accounts o f the participants. Third, for category comprehensiveness or to determine whether category system was comprehensive and complete, 10% (30) o f the total incidents were withheld until major categories were identified (Anderson & Nilsson, 1964). Categorization stopped when new categories or themes were no longer emerging. Fourth, for inter-rater reliability, the researcher submitted a randomized list o f incidents and categories to an independent rater (s). A P h D graduate from the Department o f Educational Studies, University o f British Columbia, with experience in qualitative studies was used as an independent rater. The independent rater was presented with a randomized list o f incidents and categories and was asked to place them under the main categories (What helped; What did not help; What would help) and further on basic categories (Resilience; Detention; Social Isolation.). A s suggested by Anderson & Nilsson (1964), standards for the degree o f agreement was confirmed after  Premigration Trauma  62  the independent rater correctly classified more than 90% o f incidents under the given categories. Fifth, categories were further tested for consistency by independent judges, selected on the basis o f two factors: 1. They had lived or had professional experience related to migration trauma. 2. They had no prior access to the study and its components. Three specialists i n immigration and refugee services were selected from the Lower Mainland; including M O S A I C , Canter for the Integration o f African Immigrants (CIAI) and a Psychology undergraduate student at the University o f British Columbia. They were all provided with randomized categories and incidents and asked to place them under the appropriate categories similar the ones discussed under inter-rater reliability.  N e w categories were discussed with the experts to confirm i f the data was  consistent with their experience. The level o f agreement between the three experts and this researcher further confirmed the degree credibility o f categories, which led to the incorporation o f categories into the existing classification. Sixth, for literature validity, relevant studies and articles based on migration trauma were reviewed and incorporated with the current study. The main contribution o f previous literature to the current research was to ensure soundness o f the category system as well theoretical agreement between them. The important information that was elicited from the literature validity process was added to the literature review and results sections as deemed appropriate by the researcher. More than half o f the basic categories were supported by literature hence reliability was maintained. However, an allowance was made to fill the literature gap with new ideas generated by the current research study, o f which new categories would form basis for future research on migration related trauma.  Premigration Trauma  63  Seventh, participation rate was calculated to further establish the soundness o f categories. This was calculated by dividing the number o f participants who reported an incident by the total number o f participants. It revealed the level o f commonality o f the incidents and the extent to which participants found the incidents helpful, not helping or could help i n the future. Timeline Methodology Timeline methodology (Chell 1998) was used to strengthen the critical incident methodology. Basic participants' demographic data were introduced; participants then place their incidents in a timeline with a chronological sequence. The latter provided a strong base for identifying relationships between participant's reported incidents and establishment o f tenants o f the proposed theory o f recovery from migration related suffering. It also notes flexibility o f both horizontal and vertical occurrence o f migration events. Thus, narrative timelines are an attempt to chronologically situate critical incidents in the broader context o f participant's recovery process (Chell, 1998). Although one o f the participants alerted the researcher that this methodology appears linear, this researcher noted that it acknowledges that migration is not a one off event but a combination o f events that occur without a predetermined pattern. Thus, events were plotted on the timeline from the client's perspective, as they occurred not the researcher.  ,  Summary of Methodological Issues The C I T and timeline methodology proved appropriate i n assisting the research participants to present what helped, what did not and what would help them to recover from premigration trauma. A suitable environment need to created to facilitate the flow o f sensitive information. Thus, the primary methodological consideration for this study  Premigration Trauma  64  was the participants' suitability, comfort, readiness and open approach to expected outcome befitting the context o f the research participants and fragility o f migration trauma. Based on this sensitivity, this researcher found it appropriate to modify the Critical incident technique by creating a normal environment closer to the one lived by participants before migration. Critical incident interviews are normally structured around the occurrence o f a particular event reported by the participants and checks how the sufferer helped or did not help themselves to recover from their experiences. In this research study C I T was supplemented with a combination o f narrative and empathic oriented approaches. This innovation was intended to fit the style used i n cultural communication and healing. Flexibility with noticeable direction illustrated above was essential i n ensuring that participants presented personal traumas with minimal urgency and reduced interruptions. The African culture has ample similarities and differences regarding the usage o f words and situations or space as characterized by 'Ubuntu Theology o f Desmond Tutu' (cited i n Battle, 1997). The researcher's judgement was very instrumental i n asking clarification questions i n a timely manner; especially when the participant paused or switched to a new area not directly connected to the one mentioned. It was interesting to note that i n the process, the content as w e l l as helpful or unhelpful incidents emerged naturally. The researcher also used opening and closing questions to add reliability to critical incident data. Often critical incidents and interview process would determine the order o f questions to be asked i n the interview. However, it seemed important to have common opening and closing questions to ensure that the critical content is captured.  Premigration Trauma  65  To supplement the specificity usually captured by the CIT, this researcher decided to use the Timeline methodology. It provided a structure to enhance participant's memory recall as it could have been depleted during the long periods o f suffering or simply changes o f brain chemicals following traumatic attacks. It also assisted the participants to visualize a picture o f their life stories unfolding as a continuum, which eased anxieties related to information processing and interview session. Visualization o f a life story can be viewed as an important catalyst for comprehension o f concepts in individuals who are not native speakers o f the language used for the interview. The secondary purpose o f both methodologies used i n the current study was to ascertain whether data collection; analysis and reporting would prove to be practical and usable. In this case, despite the fact that refugees, immigrants and international students were interviewed sequentially, the data analysis process treated all three-sample groups as a one unit, particularly because the common denominator was the experience o f trauma. Specific differences between three groups were not found. Targeted research is needed to further investigate possible differences among the experiences o f these groups. The usage o f experts in the field o f the research study to check the reliability o f categories is increasingly becoming a common practice (Barbey 2000; Flanagan, 1954; M c C o r m i c k , 1994; Morley, 2003). However, lack o f a clear cut criteria for identification of potential experts needs further review as so far this process is based on the professional experience o f such experts. This researcher argues that without a lived experience, professional expertise alone cannot provide sufficient conditions to ensure the credibility and validity o f research data. In the current study, the researcher used a psychology graduate who experienced premigration trauma as one o f the experts. Lived  Premigration Trauma  66  experience provides non-clinical perspective and it merges well with content and emotions generated b y the study. Another necessary condition is to include a sample o f caretaker personnel such as host families and settlement officers, to acquire feedback from non-mental health professionals who could have observed and lived with the survivor for longer period o f time i f compared with a relatively shorter period o f the research study; sometimes one or two interviews. This has the ability to alleviate the effects o f biases and un-collaborated data often common with qualitative research. However, the latter criterion was later excluded from the current research due to a limited number o f caretakers directly working immigrants and refugees from the African continent as well time implications to complete the research study. Finally, this chapter has illustrated the theoretical backgrounds o f the C I T and Timeline methodology i n soliciting information from the participants about what helped, did not help and would help them to recover from premigration trauma. The next chapter presents the results o f the study and an overview o f a new theory generated by these methodologies.  Premigration Trauma  67  CHAPTER IV RESULTS The current chapter reports the results o f the research study based on CIT. A n exemplary transcript summary o f a participated was presented to illustrate the usage o f the timeline methodology. The current chapter reports the results o f the research study, which involved a total o f 13 participants. Three hundred and twenty eight incidents were formed from 13 interviews including, 140 incidents helpful (42.68%) with the participation rate o f 70.77%, 119 unhelpful (36.28%) with the participation rate o f 64.10% and 69 would be helpful incidents (21.04), participation rate o f 53.85%. Most o f the incidents reported by the participants were based on refugee experience. The final categories are presented below:  Description of Basic Categories Three hundred and twenty eight incidents were arranged into related themes or clusters and organized according to What helped? What did not help? and What would help? These incidents were further clustered into 18 basic categories. General and broad categories were subdivided to form 33 sub categories to provide a common cluster o f incidents that helped, did not help and would help respectively.  Basic categories are  bolded and marked with alphabetical capitals such A , B , C . . .Subcategories are unbolded and marked with numbers 1, 2. 3 .. .It should be noted that what would help did not require subcategories, however, it was assessed for broadness and ambiguity and found both relevant and specific for readers' interpretation.  Premigration Trauma  68  Table 1.1 Basic and sub categories related to the three research questions WHAT HELPED  WHAT DID NOT HELP WHAT WOULD HELP  Basic and sub categories  Basic and sub categories Basic and sub categories  A. Security  A. Power and Control  1. Safety and Peace 2. Employment 3. Education Scholarship  1. Health 2. Another War 3. Resettlement  B. Community Support 1. 2. 3. 4. 5.  Religion Other community mbrs Humanitarian Orgs Traditional Healing Friends  C. Resilience 1. Power and control 2. Time Perspective 3. Appraisal 4. Humour  A. Security B. Appreciation o f new home C. Home Country D. Community Support B. Isolation E. Religion/Spirituality 1. Separation from Family F. Normalcy and Integration 2. Social Isolation G. Immigration/Refugee Services 3. Detention Experiences  C. Security 1. 2. 3. 4.  Safety and peace Employment Education Scholarship  D. Intimidation 1. Detainee 2. Detainee's Family  D. Willpower  E. Loss and Burial  1. Confrontation 2. Submission  1. Death 2. Personal Effects  E. Family Support  F. Community Support  1. Immediate 2. Extended  1. Humanitarian Org. 2. Other Community Mbrs  Premigration Trauma  69  What Helped Recovery Migration can be a lengthy process and provoke intensive suffering. In the interviews, trauma survivors illustrated this by volunteering to voice factors that helped them to recover from suffering while i n their home countries, during migration and after arrival i n Canada.  Table 1.2. Helpful (What Helped) categories represented by percentage proportion of participants Categories  Incidents  Participants  Percentage  Represented n=13  Participants Represented  A. Security  33  12  92.31%  1. Safety and Peace  ir  4  30.77%  2. Employment  10  3,  23.08%  3. Education  8  4  30.77%  4. Scholarship  4  2  15.38%  B. Comm Support  39  11  84.62%  1. Religion/Spirituality  13  4  30.77%  2. Humanitarian Orgs  9  2  15.38%  3. Other Comm Mbrs  7  2  15.38%  4. Traditional healing  6  2  15.38%  5. Friends  4  1  7.69%  C. Resilience  27  9  69.23%  1. Power and control  10  4  30.77%  2. Time Perspective  6  3  23.08%  3. Appraisal  6  1  7.69%  4. Humour  6  1  7.69%  D. Willpower  18  7  53.85%  1. Confrontation  7  4  30.77%  2. Submission  11  3  23.08%  E. Family Support  23  7  53.84%  1. Immediate  16  6  46.15%  2. Extended  7  1  7.69%  Totals Mean Average  140 70.77%  Premigration Trauma  70  Security The main reason many immigrants and refugees left their countries o f origin was because o f deteriorating security; which leads physical, psychological and socio-political sufferings. The sufferers then migrate i n search o f secure places around the world. Twelve survivors (92.31%) reported 33 helpful incidents related to peace and safety, which encompasses access to employment, education and scholarship. The research participants explained that the decision to go into exile was prompted by horrendous torture, detention and police investigation i n their countries o f origin. However, fleeing to another African country did not offer the anticipated security as political and economic hardships continued. This led the refugee and family to embark on another move to a country that was far away from home. Exemplary narratives from the survivors are quoted below and it should be noted that the age shown i n parenthesis represents the survivors age at the time o f a traumatic attack: Some [Refugees from home country] decided to form branches o f political parties in the refugee camp. I didn't want to j o i n them so they turned against me, saying that I was just a spy. Y o u know, "why can't you j o i n the struggle against oppression". "I don't want to j o i n anybody's struggle because I have to struggle for m y own life at least for now". The U N H C R [United Nations H i g h Commission for Refugees] said that I should come out o f the situation. It was like an emergency and they took us straight to Canadian Embassy. So, it was like an urgent matter or so, we had visas and we came here. "I ran away from a problem in [Home country], I came to Zambia and now I find so many problems again and I have to run again [laughing]". The worry was they thought we might end up being k i l l e d . . . So we came here [Canada] - it was up-lifting you know (Refugee, 32 years). W e l l you know I am at a cool you know now, that I have 10 years i n Canada I have solved all m y problems and have m y happiness within I mean 1 year is a long time. In that 10 years especially i n the last 4 years, I had the opportunity to go back home, a couple o f times and I just came back 6 months ago. A s I said before, I never made a choice to leave my country but now I have the opportunity to go back. It's m y choice to go back (Refugee, 18 years). Community Support Survivors reported 140 critical incidents (39 helpful) under community support. This comprises feeling o f connection with the community networks such as; friends,  Premigration Trauma  71  religious/spiritual bodies, traditional healers, humanitarian agencies and any other community members. Participation rate o f 11 participants (84.61%) for community support revealed the principal importance o f community i n the healing o f trauma and shared responsibility or solidarity during times o f suffering. Survivors reported receiving and experiencing support from the communities i n which they lived. This comprised o f experiencing connection with the community networks such as; friends, religious/spiritual bodies, traditional healers, humanitarian agencies as w e l l as any other community member I remember when m y brother fell into the fire; I didn't have money to take her to the hospital, or to buy medicine or to buy food. A n d when I took her to the hospital, she stayed for 2 months and it cost a lot o f money and the doctor asked when I was going to pay the money... The pastor and his wife were m y friends so I went and asked for money to buy food for the brother who was sick (Refugee, I I years). Survivors indicated instances when they received support from people they knew little about or not at all. They expressed delight when strangers came to their rescue: Eh, in the refugee's camp one thing that helped me before the process began is one family; they took me and I went to live at their house i n town. So there I began to feel like yea like now I am living but before, when I was in refugees camp I was thinking why I didn't die. What am I doing i n this world? (Refugee, 12 years). A n d again with other politician's wives o f course the talking, gossiping a lot about the past and how I w i l l refuse to be going back to the past and then current. It was a very excellent way o f healing ourselves.. .Looking back at what happened I see it [Gossiping] as an informal way o f counselling (Refugee, 26 years). H m m , another thing that helped was, because we were like one people, we were like family. So it was when other people sleep, others stay to see where the enemy w i l l come from. A n d when the others woke up, others sleep again (Refugee, 12 years). The extended family and other close relations realized their social obligation by extending their support to minimize the effects o f suffering on the individual and his/her family.  This obligation was performed through material gifts and i n kind: .. .So that was, I think very, very encouraging which helped us to pull through yea. A n d also you know, the people would just come to your home and say now  Premigration Trauma  72  we want to get your children . . . because they understand that at that particular time ehh you are a little bit stressed. They w i l l just go on and say well we want to have or to get these children for one week or two weeks. They w i l l come and stay with us and they w i l l get them. That was a gesture you know, just to show you that even i f they can't do more they are with you i n spirit. They just get the children and go away with them; without even telling us when they w i l l be back and that is ok (International Student, 39 years). In 1981 our area was facing this war situation in Ethiopia and the government was aggressively recruiting you know, young guys to j o i n the army. A n d the problem was none o f us believed i n the war, so that was a very scary moment. I mean that was really bad war you know, once you join the army, you get training for about six months and you pretty much sent to the war front. So... time was running out and anytime, any day they could come and get you to you know, to j o i n the army. So you know at that time almost 15 years planning to move to Sudan and finally i n 1984 you know, we managed me and 4 other friends you know, we had little bit o f time and you know to run away from the war and we left for Sudan.. ..We took the bus from home to another province going back to the boarder o f W e took the bus from home to another province going back to the boarder o f Sudan and then once we got there, we had a 9 day trip on foot. That was the hardest thing you know, we could endure, it was actually bad you know, we had to travel at night because day times were very hard. Y o u know the government might see you, so we were traveling at night. W e l l , i f we were captured then, they would transfer us back to the Ethiopia Officials that would mean more torture and even force us to join the army. The other way we could end up in .. j a i l and the care system there was very bad. I mean sometimes they don't even get your name ehh, you may not even have a file and you could stay in j a i l forever without anybody noticing. So you w i l l be captured and at the same time they could give you back to the [Home country] officials.. .But ultimately we made it to Sudan and went to the United Nations where we were issued with some refugee passports. A n d then the other problem was the language and the culture. A n d the living allowance at that time 20 to 30 U S $ and that was it. W e had to find our own way o f feeding ourselves, clothing ourselves, and that sort o f thing (Refugee, 18 years). What touched me the most was when I got to Lesotho, was that every body was so appreciating. So friendly you know; so like I had no fear. Everybody that I m e t . . . .for me I was very happy to be there. It was a totally different experience'.(Refugee, 18 years). Resilience Trauma survivors expressed how internal characteristics were part o f their recovery process. Nine (69.23%) cited 27 helpful incidents involving internal and  Premigration Trauma  73  external strength to deal with their sufferings. This also includes having power and control, positive appraisal o f suffering, time perspective and humour. One o f the trauma survivors commented, "suffering is a preparation for a better life" and one has to be initiated and strengthened for future challenges: So it was a really tiring journey we traveled for 9 days sleeping during the daytime and as we made it to the Sudan, but we were young and strong. W e had little food that we shared with the farmers who were accompanying us (Refugee, 18 years). Mentally you know there was something to worry about. I mean the war situation didn't get better, more people were dying because o f that and there were some drought that we faced. Y o u hear about it from a distance and you wonder like how your relatives are doing and your friends that sort o f thing. But then with time .. .you know with time, you know time kind o f takes away the pain a little bit (Refugee, 18 years). We used to laugh you know [Humour].. .and i f you go into the refugee camp, you w i l l find people who have really suffered and they are not crying, they are laughing. So who am I to start crying when I am with some [people] who did not have legs, because [Opposition military wing] had chopped off their legs.. .Yea, I shouldn't; it's like I have not suffered enough, because these are people who don't have one leg for instance, because [Opposition military wing] just chopped off legs o f so many people. A n d they are there, they have crutches and they are laughing, eating and they are going on with their lives. So I say, ugh at least I am intact [pause]. I can't feel the pain that they inflicted on me any more, you know except the pain o f feelings and thoughts (Refugee, 32 years). What I am trying to do is to focus on the future to say no matter how much it might hurt, no matter you know how much I did not like what happened I cannot reverse the situation. It's done so lets move forward. That's m y real focus now to look ahead and move forward you know. I am not saying you forget, you know I have m y mind and I even tell m y wife at times I wanna be alone (International student, 27 years). Willpower Seven (53.85%) research participants presentedl8 helpful incidents, composed o f adopting a w i l l power position which involved being assertive i n coping with difficulties; sometimes taking risks in finding closure to suffering. This category also involved confrontation or submission i n defiance to the demands o f the authority figures and suffering:  Premigration Trauma  74  So we had to think hard on how we gonna get out and at time, even i f we were just 18 we had to see things that way. One mistake where information leaks out even amongst our own group, i f the information leaks that we are planning to leave the country then that would be a problem. So we had to do everything without talking much and we got i n the house at nighttime. So we must come one at a time because i f the government officials see a group o f young guys 6 or 7 they probable anticipate problem (Refugee, 18 years). So, we tried to change ourselves because we spoke Swahili [the Congolese language] and we tried to do like we are Congolese. But like that i f you see a Congolese and Burundian or a Rwandan you can see that this one is a Congolese or this one is not. These things like to change ourselves helped us (Refugee, 12 years). It does, it does affect your self-esteem but again you just have to be positive in your thinking ehhh for example, I felt well I am not going to sit down here and sink down for ever. I w i l l find myself a means to earn income. Fortunately we were living in a house that had big space at the back. So we build a small structure there and we started doing poultry and then also we turned our servants quarters. Instead o f hiring somebody to work for us, we turned that into another wing and we kept poultry. So we had this poultry circulating, almost every two weeks we had something to sell. A n d i n fact, what was more interesting was that we earned more income from that project than we would earn from our employment. So that did alter the situation and then we said okay what about in the long term. W e decided, w e l l may be I should go to school. So I decided to go to school and I did m y university degree, m y wife too i n a particular field. She did her diploma in fashion and design and things started happening after that.. .And I worked on those roles with somebody who happened to have trained here i n Canada for both his Masters and P h D at Simon Fraser University and I worked with him.. .1 said well, I am going to gamble to do the teaching assistantship and whenever I can, save money i f I have no teaching assistantship, I w i l l live on the savings until I find some stability (International Student, 39 years). Family Support Survivors indicated that the presence o f family was provided crucial support in times o f life challenge's. Family members were source o f support i n situations ranging from detention, unemployment to grief. The presence o f family alleviated the effects o f pain, even i f they are not saying or doing anything. One survivor said "the presence o f family is better than counselling because they know who you are talking about and they  Premigration Trauma  75  can relate with your pain on personal basis". During the interviews, 7 (46.15%) participants reported 23 incidents, involving immediate and extended family support. One would have expected a higher participation rate given the central role played by family systems among many African nations. However, it is noted when political disaster strikes the family is separated and the culture disintegrates (Mekki-Berrada etl al. & Rouseau 2001; Peddle et al., 1999): ...So the problem was escalating and he had three accidents i n a row within a space o f two weeks.. .we managed to have a family conference and decided that this is the problem that we are confronting. So went into the process o f rehabilitation, where everything required the family participation. So we attended sessions after work and we would talk to alcohol anonymous through confessions. Y o u know myself and m y other brother stopped drinking and thought that we can do other things other than drinking (International student, 27 years). ... m y mother in law came and lived with me to look after the children because I was sickly. I think because o f the overwhelming situation so, that was helpful and also I was a teacher. She would help like going to the garden and also talking even the support that she is there took me through all the emotional and physical torture that I was going through. I did know that some adult is there someone who cares that i n all that and besides the son o f hers was i n prison. W e w i l l sit for about 6 hours drive. A n d when you go it was almost like going there every week taking the money and some other stuff that w i l l help h i m i n prison, so m y mother in law w o u l d stay at home with two little ones (Refugee, 26 years). I knew that even when I was away, they were thinking o f me. I could get letters explaining "your kids want you here", you know. So, that kept us together and my family [parents] used to write letters you know, encouraging me not to give up, things like that (Refugee, 32 years). M y brother i n law .. .oh i n many ways they would for example, maybe give us uhhm a ride to pick up uh the chicken feed or sometimes especially when we were starting up we would let uhm half all the capital to put into. They would give us money on the understanding that we would pay them without any interest (International student, 39 years).  Premigration Trauma  What Did Not Help Recovery Table 1.3. Unhelpful (What did not Help) categories represented by percentage proportion of participants  Categories  Incidents  Participants  Percentage  Represented n=13  Proportion  A. Power and Control  40  13  100.00%  1. Health  18  6  46.15%  2. Another War  15  5  38.46%  3. Resettlement  6  3  23.08%  B. Isolation  31  13  100.00%  1. Separation from Family  6  6  100.00%  2. Social Isolation  8  4  30.77%  3. Detention Experiences  9  3  23.08%  C. Security  20  12  92.31%  1. Safety and peace  8  4  30.77%  2. Employment  3  • 3  23.08%  3. Education  6  3  23.08%  4. Scholarship  3  3  23.08%  D. Loss and Burial  12  6  46.15%  1. Personal effects  6  4  30.77%  2. Death  6  2  23.08%  £ . Intimidation  12  4  30.77%  1. Detainee  6  2  15.38%  2. Detainee's Family  6  2  15.38%  F. Community Support  4  2  15.38%  1. Humanitarian Org.  2  1  7.69%  2. Other Community Mbrs  2  1  7.69%  Totals Mean Average  '  119 64.10%  Premigration Trauma  77  Power and Control A l l participants, 13 (100%) reported incidents related to loss o f the ability and sense o f self-control to deal with the aftermath o f traumatic attacks as a result another war i n the country o f resettlement and complicated resettlement process. Forty (40) unhelpful incidents were reported across situations related to loss o f power and control. These involved, health problems, another war in the country o f first asylum, and life stressors on arrival i n the country o f resettlement. Refugees reported incidents related to the collapse o f health services, security and subsequent mental health illnesses typical to traumatic attacks. Some o f these problems such as fear, guilt and low self esteem followed the trauma survivors from their home countries and sometimes continued on arrival i n the country o f resettlement or host country: W e l l , when I was back in Africa I was a member o f parliament... and in 1985; when the coup happened, I was put in prison for 18 months. A n d that was a very painful situation that happened to me. I was emotionally affected, I was psychologically affected I lost self-esteem. I was a whole member o f parliament here in prison, no charges laid. A n d when I got out finally i n 1987,1 was again threatened to be rearrested. So when I heard there was a possibility o f being arrested again, I decided to leave and I went to Congo. N o w when I got to Congo I was arrested again. (Refugee, 29 years) W e stayed until 1996 when the war started in Congo too. In this war Rwandan Military with the Ugandan military and the Burundian Military were fighting together against Congo A r m y . . . when the war began we were not safe because these Burundian, Rwandan and Ugandan army, which came i n Congo, were the same that we left i n Rwanda. W e left Burundi because o f them and they followed us again when we were i n Congo... In Congo people wanted us to go because o f the war. People didn't like Tanzania because Tanzania was not safe. Refugees didn't have choice. W e stayed and just prayed saying G o d where w i l l we go what we can do. Ehh, after that the war continued, continued and continued. Then the army from Burundi, Rwanda and Uganda came into the town where we were. (Refugee, 12 years) O f course, it was very tough; it was very traumatising. I lost the trust i n almost everybody. I didn't trust anybody to see that the people w h o m I knew that were behind this manoeuvres, so it was very traumatising and I developed even acute stomach ulcers [voice trembling], Host weight, I was just there everybody trying to leave me except parents, m y own parents (Refugee, 26 years). •.. .it is so painful and to some extent you withdraw. If they are parties i n the department, the department sometimes ask everybody to go and do some activity.  Premigration Trauma  78  Because you know that when you show up there, some people w i l l have their families and it hurts to know that you cannot be with your family. So you would rather be alone. (Immigrant, 39) Isolation Thirteen (100%) participants cited 31 unhelpful incidents concerning isolation. Isolation included separation from family, social isolation, and detention experiences. Both refugees and immigrants reported similar incidents under isolation despite different migration circumstances. Exiled refugees expressed fear for the security o f their family members back home; immigrants as well reported suffering related to guilt and apprehension about separating with family due to limited finances, immigration requirements i n host countries and lack o f preparation before fleeing or migrating. Survivors reported making risky decisions so that they could reunite with their family members: I w i l l tell you again that to stay here in Canada .. .in comparison with Zambia was not so enjoyable without m y family. I could not enjoy the food... I was for example secured for a meal. I knew that I could have a meal anytime i f I want. I knew that I could see a doctor anytime I want to.. .it hurts me each time I try to enjoy a meal because I was conscious of, in fact, I was wondering at that particular moment what m y family was having. A n d it reached a point where I could not go in a restaurant and buy something to eat because m y conscience was killing me.. .But because I had m y family there I made m y proposal i n such a way that I would go back to them and do research there and it was a happy moment and I think it was a very enjoyable time for me. I would have regretted i f I had decided m y fieldwork somewhere other than where m y family was. A n d because of that the moment you reach there, I was able to strategize and we planned that we would come back together after I have done my research and we did so. (Immigrant, 39 years) Yea, you know, so these problems were like it is a new culture. It can be totally new. W e are used to mixing before coming to Canada you know and here you expected to work on your own thing but it's difficult. It's very tough, just tough but at least it doesn't threaten your life. (Refugee, 32) .. .some o f these people who were given to the crocodiles were not involved i n politics. It was just like, i f you steal something and steal for the third time and got arrested; they send you to the crocodiles. They w i l l say, you are a criminal and we don't need criminals here so. Yea, it was very scaring. It didn't look like a small thing because all the prosecution did not abide with that. So you are singled out. Y o u are called a bad person, you disagreed with the president, who allowed you to do that? (Refugee, 32 years).  Premigration Trauma  79  Security Twelve participants (92.31%) reported a total o f 20 incidents regarding security. This category involved lack o f safety and peace, employment, education, scholarships. Survivors reported feeling insecure right from the beginning o f life disruption and during migration until arrival at their host country. There was continuous threat to life and apprehension about the future as w e l l as difficulties with employment due to immigration or labour laws i n countries travelled through or arrived at for final settlement. Mostly international students and immigrants reported difficulties with access to employment and education i n their home countries. This was compounded by lack o f scholarships or funding to migrate elsewhere feasible:  There we prayed, we prayed and the army came and took some people and killed them. A n d we stayed praying, praying, praying to ask G o d that, " I f it is your w i l l that we die here take our hearts [Soul] or G o d help us. Yea, but the soldiers did not let us to pass. They were saying that they are checking i n our bags, our things to see what we had but the motive was not to check; it was to see who they can take and k i l l . Finally they opened the boarder, when they said that, "okay go!" we took our bags and we began to run until we were already on the side o f Burundi. A n d our family met us. Our parents had left for a long time, so they came to take us home and we relaxed .. .we began to feel relaxed (Refugee, 12 years). Yea, it was difficult. I didn't know where to go. Anywhere I went they w i l l tell you, "you refugees, you are enjoying life. W e [Citizens o f first country o f asylum] can't have this and you have this". So they forget that we have these things because we are not allowed to work. So i f we are not allowed to work then we should be helped. They w i l l say no you are allowed to work because but we don't give our jobs to refugees. It was a situation where you could not w i n anyway. They just gave a bottle o f cooking o i l anyway! (Refugee, 32 years) M h m , yea. and I remember when we had already left the town and we were in the village, so one military that was at the boarder said that all m y family can go but me I cannot go because I am not their child - not the daughter o f m y father and my mother! [Voice raising] So, it was really big discussion (Refugee, 12 years).  Premigration Trauma  80  I should say it [Political insecurity] contributed negatively to m y fear and anxiety. Not knowing whether the government would kidnap h i m because we were running from as we were just at the border. The world is sending some spies to come and find out where we are. (Refugee, 26 years) W e l l that's the main thing because you see, i n Sudan we were living i n fear. Because although we were registered with the United Nations and we had some kind o f legal rights to be there you know anything could have happened. Sometimes the tall tree fell and we are to clear it and they thought we were a threat to the economy. A n d any kind o f hardship they thought it was all because o f the refugees (Refugee, 18 years). So it was a little bit distressful, but compounding that there was a fact that m y wife at that particular point had also lost her employment maybe a few months earlier than me but because w e . . . But a made a bold decision because I was offered teaching assistantship. I said well, I am going to gamble to do the teaching assistantship whenever I can, save money i f I have no teaching assistantship, I w i l l live on the savings until I find some stability (International Student, 39 years). W e l l , Canada is good country to be, i f you don't have money becomes a problem - not everything is good. Though most o f the things are good because it's a safe country and you could have something to eat but me I didn't like, feel real safe but I ' m so happy to be here but I still have problems. I have to live on m y own; I have to find food for m y self but I . . . (Refugee, 11 years). Loss and Burial Six (46.15%) participants reported 12 unhelpful incidents under loss and burial category. This category regards to survivors loosing personal effects and witnessing or experiencing loss o f a family and community member. Survivors reported loosing their parents when they were engaged i n further studies abroad and could not return to accord them proper burial or help i n caring for them before dying. Survivors were also, haunted by seeing too many dead people lying on the streets without proper burial. When refugees were fleeing they travelled long distances, crossing rivers full o f with crocodiles, parents burying their children and friends who drowned or died from diseases such as malaria and fatigue as w e l l as cholera:  Premigration Trauma  81  W e l l , it was m y first time when I said why are there so many people dying and I didn't understand what was going on there. A n d even now I still don't understand why people came and started killing others Refugee, 11 years). I saw people dying i n the streets, I saw people k i l l each other people. What can I say.. .People killing each other, yes! people killing each other, it was the end o f the world o f course! It was the first time to see someone take the machete [Home made axe] and k i l l his friend. They were together for a long time but when the war began no friend, no family, nothing like this one was m y best friend or he was my nice neighbour.. . M h m h , so you ask yourself, what happened, what is this and you don't have the answer (Refugee, 12 years). M y mom passed away actually when I was away from home i n the [Host country of study] for m y studies and it happened eh second week after I left home.... So yea for me it was one o f the most painful events to happen i n m y life and unfortunately for me because I had just arrived in the [Host country o f study]; I couldn't even go back home for her funeral so that was sad until about a year later when I was able to go home, until about a year later when I was able to go home (Immigrant, 26 years). For us life was not good, we can't say that we had nice life because we left our houses, all our things (Refugee, 12 years). Intimidation Four (30.77) participants presented 12 incidents related to intimidation o f detainees and their families. Government agents operated b y mode o f arrest and intimidation o f political opponents. If opponents were found missing their families became targets even without evidence of political involvement: Yea, when they were looking for m y husband. He was no longer around they put instead m y brother i n prison and this was even more trauma. I was almost running nuts ' k o k o ' i f you know what it means. Almost getting naked to the point that [pause], I reached that point o f wanting to just take off m y clothes and walk on the streets naked, because this was betrayal after betrayal. (Refugee, 26 years) We ate one meal a day and i n darkness. The toilet was just flushing every two minutes even i f we were not using it. W h i c h means you can't sleep; it was very noisy, 'umpurr' [Sound o f toilet flushing system]. A n d the lights were kept on for twenty-four hours. A n d ehhh, that was very difficult. Around 6.00pm were not allowed to talk, we were just sitting there pretending to be sleeping. A n d ehh, early in the morning they would come and kick you up with their boots, "Hey, wake up, wake up!" After that we stay up until 3 p m when we had our meal -  Premigration Trauma  82  That was the only meal we had anyway. So sometimes we would hide part o f the food they gave us so that you could eat it i n the morning when we don't have anything to eat. O h it was very difficult (Refugee, 32 years). i  First the police went to m y wife and said that i f you are hiding h i m , we are going to arrest you and she said no he went to where he comes from to his village. ... when they were trying to force me to go to work after j a i l term. That was a good job, bu t it made me more angry because it was like they continue forcing me to be doing something that.. . Y e a and I said no give me a month at least. I need to rest and see m y family I can't just go back. O h no you have to go back so. They wrote a letter to the newspapers that I should go back to work right away. When I refused they interdicted me because you are not coming we are going to interdict you on half pay. A n d I said no problem but they never paid me. So when I got a letter saying that, I went back to [Home country] i n the night and got m y family out (Refugee, 32 years). Community Support Under normal circumstances community support becomes the primary structure to rally behind the sufferers. This seems not to be the case with some o f the refugee sample. Two (15.38%) survivors presented 4 incidents under insufficient community support. This category comprises o f lack o f support by community members and humanitarian agencies. Survivors were sad that there were times when they found the staff o f United Nations agencies and other humanitarian agencies unhelpful and i n fact, increased their sufferings: N o . Actually there was nothing because even the chiefs you know, they wouldn't want to talk to you. Instead, they would rather say, " H o w can you say bad things about the president. Can't you see that he is our best man here ehh, the education you have is because o f him, all these guys you see here is because o f him, you have chickens because o f him. So how can you say something bad like that" (Refugee, 32 years). It was very awkward and very surprising on m y part to see that the friends whom I drove with, who were always there in m y house to come and eat with me driving around, when there were rallies these are the women who went with me and body guarded me, Seeing them discarding me like that all o f a sudden; it was so dehumanizing (Refugee, 26 years). W h a t W o u l d H e l p Recovery Table 4 presents categories o f statements that reflect what participants believed would have assisted them i n their migration process. These were categories that survivors  Premigration Trauma may or may not have received but would be helpful to them i n the future to cope with premigration trauma. They range from feeling safe in the host country to efficient support b y immigrants and refugee agencies. Sub categories indicate the number o f incidents reported and percentage rates. Unlike the previous two main categories, what would help excludes sub categories; primarily because the main category proved selfexplanatory.  Table 1.4. Future Coping (What would Help) categories represented by percentage proportion of participants  Categories  Incidents  Participants Represented n=13  Percentage Proportion  A. Security  11  11  84.62%  B. Appreciation of new home  10  10  76.92%  C. Home Country  10  9  69.23%  D. Religion/Spirituality  9  7  53.85%  E. Community Support  12  7  53.85%  F. Normalcy and Integration G. Immigration/Refugee Services  12  4  30.77%  5  1  7.69%  Totals  69  Mean Average  53.85%  Security Eleven (84.62%) trauma survivors cited 11 incidents involving security. This category referred to experiencing peace and safety, access to employment as well as opportunities for self-employment and education. They indicated that education and employment would ease feelings o f apprehension about the future: I am i n level 3 E S L at school and I find it quite hard as most o f the people i n my class have gone to school before. M y goal is to get an education so I can be a  83  Premigration Trauma  84  nurse or work i n immigration so I can help other people have a better life i n Canada (Refugee, 12 years). I have never stopped ever since. I keep making myself versatile. I have finished my master o f science and I am going for a P h D i n August, I am teaching right now... The more I diversify the more I can compete with this environment. I have taken up professional memberships with several organizations. I am member o f the International Association o f Hydrology in Sciences, which is the kind o f work I was doing i n [Home country] (International Student, 39 years). I have a dream: M y mothers said walk, walk, and just keep walking. I feel safe here...It's amazing to be i n a country which is free. Y o u can do anything (Refugee, 12 years). Appreciation of new home Ten (76.92%) survivors indicated 10 incidents for appreciation o f their new home. This category referred to recognizing the benefits o f being i n a new country and establishing how one could be a productive resident/citizen. It comprises o f incidents related to peace and safety, choice o f residence and community service. Survivors commented that they would continue to recover now that they have a choice. They can choose to be responsible about their future as well their sufferings now that the circumstances i n their lives have improved. They could choose to remain i n Canada or return to home country when the time is suitable: In that 10 years especially i n the last 4 years, I had the opportunity to go back home, a couple o f times and I just came back 6 months ago. A s I said before, I never made a choice to leave m y country but now I have the opportunity to go back. It's m y choice to go back (Refugee, 18 years). The thing that I have to do is to serve G o d and to talk to people about what G o d can do. So I can help one person that thinks about drugs to see that the drug is not the solution but the drug brings more problems i n your life.. .Yea, mhm, and I can share m y experience with them to tell them that the difficulty you have, I had a bigger one but I never took drugs. I stayed praying, I stayed for fighting life and... I had a choice I wouldn't choose to be i n Canada, but with the realization that I am i n a position o f strength and I am able to assist, not only m y members o f m y  Premigration Trauma  85  immediate family but myself and m y immediate family b y being i n Canada (International student, 27 years).  Relationship with home country Nine (69.23%) survivors reported 10 incidents under relationship with home country. This category encompassed a renewed connection with the participant's home country. It included incidents such as acceptance by citizens o f their home country and a visit or eventual safe return to home country: ... .when I start like having little dreams I think o f going back to that place i f ever I would be able, may be to just make a small contribution. I was thinking the other day, of trying to raise money for their local school there. Y e a , just to i f I could get some photographs o f some people here [Role models],[...] so that next time I travel there go and perhaps build even one block so kids can go into a class. So this was the choice I never had before so now I am so much happy and I am more at peace and you now a little bit o f money at the time. So that it prepares me and give a choice when time is right 5 years from now, one day I wanna settle i n [Home country]. A n d I w i l l settle in [Home country] and i f I go back and have a life there it would be m y choice to come to Canada. So although, I faced so many problems i n m y life, at this point I am i n better position. I have 2 countries to chose from you know (Refugee, 18 years).  Religion/Spirituality Survivors presented incidents related to faith, inner peace, and traditional healing. Seven (53.85%) survivors reported 9 incidents about spirituality or religion. Survivors expressed that their sufferings had increased their faith and created a new person o f them. However, some reported disappointments and anger with members o f their places o f worship for neglecting them when they were suffering. They also tried traditional healing but could not confirm i f it was effective. However, those who benefited from their spirituality felt a greater need to continue to hold onto it: Even now i f I was to go back to Africa I would go to Congo than Uganda because o f the spiritual roots that I gained. It's i n Congo that I met Jesus or Jesus met me (Refugee, 26 years).  Premigration Trauma  86  .. .and enjoy your blessings. I still feel like ehm, I am very blessed i n a lot o f ways.. .and hold on to them (Immigrant, 26 years). The thing that I have to do is to serve G o d and to talk to people about what G o d (Refugee, 12 years). Community Support Seven (53.85%) survivors reported 12 incidents related to the survivors to continue to receive and experience support from members o f a community the survivor lives in. Survivors suggested the importance o f helping the community with their experiences and services. So when I started as a doctor I said, i f I go to [Home country] there are lot o f difficulties that are happening right now; I would go and place myself in a very vulnerable position and then I might be able to place myself in a position where I can render some help, but If I stay here and do this, I am placing myself in a position where I can actually help. The question o f finances I don't have much, but i f I could save money and with the exchange rate (International Student, 27 years). Y o u should also have friends especially friends who had the same problems. Y o u need a new door you know and friends provided that and they made m y situation lighter (Refugee, 32 years). So celebrate life, surround yourself with very good friends and enjoy your life (Immigrant, 26 years).  Normalcy and Integration of Suffering This category meant normalizing and integrating the past i n the current life in order to view suffering i n a positive context. This category includes factors such as community service and forgiving the self and others. Normalcy and integration o f suffering was reported by 4 (30.77%) and it generated 12 incidents: A n d this is what I tell all other people that I see suffering and they are tied into this suffering for a long time. I want to give them m y personal experience and tell them that it's doable. Y o u go down you shift a wrong bottle it's natural but you have to find means to bounce back (International Student).  Premigration Trauma  87  I think it has really made me a better person and also made me realize just how thin the line is between life and death and made me realize that you know life or death is a part o f life and all o f us are just here for a short time. Y o u never know when you are going to go and it really made me realize that and also not to be afraid o f death, I think that's what made me stronger (Immigrant, 26 years). Immigration and Refugee Services This category included provision o f relevant and sensitive services by the immigrants and refugee agencies. It included knowing immediate needs o f new comers such as suitable foster homes, cultural adjustment and accreditation o f foreign qualifications. One (7.69%) person commented on the immigration services category: Some o f the challenges that we had being new to Canada are: The language.. .having a mentor who can speak your language.. .1 think it is important to have support i n learning these new challenges. It is helpful to have support groups where you can share how things are going and also some o f the difficulties you might be experiencing .. .Also, refugee and immigrant youth face difficulties adjusting to the Canadian school system. I would like to see special programs for refugee and immigrant youth to help them integrate into the new Canadian school system (Refugee, 11 years). V a l i d a t i o n Procedures Seven procedures used to test the validity and reliability o f critical incident categories are presented below: 1.  CIT Professional Validation Throughout the current research study, the researcher consulted with the  supervisor who has ample experience in using the C I T i n research studies and in student supervision (Borgen & Amundson, 1984; Butterfield, 2001). The supervisor provided guidance i n the usage o f the C I T and any modifications to the methodology were carefully analysed to fit the requirements o f the methodology and participants' perspectives. The researcher and supervisor also cooperated on the extraction o f  Premigration Trauma  88  categories and both found that the initial process o f categorization and descriptive accounts by participants appeared accurate and well represented. A Masters o f Arts student in Counselling Psychology at the University o f British Columbia, with experience i n qualitative research and who has worked i n several projects led by faculty members, independently extracted incidents from ten transcripts according to the rating scheme provided. The rating scheme was a computer based colour coded scheme with headings that were relevant to the interview questions; namely, helpful incidents, unhelpful incidents, incidents that would help in the future. The student and the researcher then compared and discussed their categorization and there was agreement on 80% o f the total incidents. 10% o f the incidents appeared unclear and were either referred for future research or completely excluded from the current study. "Social Isolation" was later changed to "isolation" so that it could encompass all incidents related isolation such separation with family, detention o f a family member and cultural transition. 2.  Participant Cross-checking The researcher arranged the second interview with the participants to offer them  the opportunity to check that the accounts o f their narratives have been accurately captured and not misrepresented. It was an opportunity for participants to confirm the soundness o f the category titles and the extent to which they captured their experiences in their own contexts. It also helped to ensure that the researcher had not distorted the accounts o f the participants. It should be noted that the participants were not given the final complete final category system - but were given the initial category system that consisted o f three components; being what helped, what did not help and what would  Premigration Trauma  89  help in the recovery from premigration trauma. The researcher provided participants with a table containing the relevant extracts from their transcripts one week before the interview. Seven participants were available for the second interview and the remaining six asked to check their transcripts through the e-mail followed b y a telephone conversation with the researcher. In the second interview participants checked their material for accuracy and presence o f any comments they felt uncomfortable with. Two participants asked for changes i n their narratives; one for a comment she made, which she felt might disclose her identity and the wording was changed.  Another participant  requested for an addition to the script. After some discussion the participant noted that the addition would not add value to her narrative and experiences.  3.  Category Comprehensiveness This procedure determines whether the category system was comprehensive and  sound. Anderson and Nilsson (1964) recommended withholding 10% o f the incidents until all categories have been formed. Unclear and overlapping categories were not discarded but were added to the withheld categories. Immigration/refugee services under what would help, was initially excluded because o f low participation rate, however, a decision was later made to include it based on the number o f incidents it generated (5 incidents). A l l thirty o f the withheld incidents were successfully placed within the category system, so it was considered that the system was comprehensive i n reflecting the incidents related b y participants.  4.  Inter-rater Reliability The extracted categories had to undergo reliability confirmation by other raters  who were not part o f the study. This procedure clarified concerns about biases and  Premigration Trauma 90 inconsistency of the data categorization. The researcher submitted a randomized list containing 30% of incidents and categories to an independent rater; a PhD graduate from the Department of Educational Studies, University of British Columbia, with experience in qualitative studies. The independent rater was asked to independently sort the incidents into main categories as well as the list of basic categories. According to Anderson & Nilsson (1964) standards for the degree of agreement by independent raters, determine the reliability of data. Careful comparison of the researcher's categories with the independent rater revealed that 90% of incidents were correctly placed under given categories. However, the independent rater suggested changes to two category headings. One of the subcategories, 'Friends' was reclassified and placed under community support. The independent rater also suggested 'Motivation' as an appropriate category that would encompass relentless and sometimes risk taking behaviour by survivors to free themselves from migration suffering or attacks. However, the researcher commented that migration experiences in the context of the current study resembled a high degree of pain and motivation will not reveal this complexity hence 'Will Power' and 'Perseverance' were considered to suitable to capture this complexities. Finally, will power was adopted as it resembled survivors internal strength, confrontation and motivation to survive. 5.  Expert Assessment  Another way to test the soundness of categories was to use expert assessment. Expert assessment confirms whether categories are usable and valid. Three independent judges were selected on the basis of two factors: 1. They had lived or had professional experience related to migration related trauma. 2. They had no prior access to the study and its components. Three specialists in immigration and refugees services were selected  Premigration Trauma  91  from the Lower Mainland; including MOSAIC, Canter for the Integration of African Immigrants (CIAI) and a Psychology undergraduate student at the University of British Columbia. A l l the judges had lived experience with immigration and refugee trauma having migrated to Canada as refugees from Africa. They were all provided with 30% of randomized categories and incidents and asked to place them under the appropriate categories. They were briefed that they could modify or question any category that seems unclear to them. The level of agreement of 98% between the three experts and this researcher further confirmed the degree credibility and confidence of categories and the careful lengthy analysis undertaken to manage the data. One expert left out a category, 'Scholarship', because it overlapped with 'education'. 6.  Literature Validity  Another procedure used to check the validity of category system was examining the relationship of the current research with similar research carried out in the past. McCormick (1994) state, "If a category of the event agreed with previous research, there would good reason to be more confident that it is sound" (p. 73). It should be noted that research on premigration trauma is lacking. Available studies on premigration trauma have excluded the experiences of African survivors. Carey, Stein, Zungu-Dirwayi and Seedat (2003), state "only 6% of studies [Trauma] are from the developing world with no single study from Africa" (p. 230). However, an attempt was made to scrutinize related literature on trauma and other forms of human suffering to support the category system for the current study. The overwhelming majority of the categories were supported by literature, which lends credibility to them. The new categories generated by the current research study can form the basis for future research on migration related trauma.  Premigration Trauma  92  Helpful Categories Resiliency Resiliency refers to a person's "capacity to bounce back", to withstand hardship and to "repair" ( W o l i n & W o l i n , 1994). Blackburn (1993) describes resiliency as the ability to recover from or adjust easily to misfortune or change. It is the capacity o f the strained body and m i n d to withstand shock and recover without permanent deformation. Peddle (1999) notes that i n Africa there are certain rituals, beliefs and rites o f initiation that bring the society together and even protects them from different forms o f suffering. He states that individuals who lose the protective cultural resources would be more vulnerable to trauma than one enshrined i n the sharing o f communal resources. Similarly, refugees and immigrants have used the resources o f resiliency when the disaster struck them and they could still benefit from a healing approach that recognizes their past. Family Support The cornerstone o f the existence o f the people o f Africa is the relationship within social circles. A n injury to one family member is an injury to the entire family. A n individual family member plays a central position i n the family, sometimes as a breadwinner, heir o f the family asserts, having leadership expectations after the death o f the head o f the family or being the custodian o f family customs. F a m i l y and kinship elements bring meaning to an African community as activities and burdens are shared with the larger community.  Premigration Trauma  93  The notion o f family support aids recovery from trauma, particularly because the presence o f family during trauma can transform adversity into a source o f strength and meaning (Mekki-Berrada et al., 2001) and a "shoulder to cry on". A s a consequence o f these family relationships, family trauma is more unsettling than personal trauma. Mekki-Berrada et al. (2001) relates family trauma to the sacredness o f a family to an African community, which considers an attack on the family extremely serious. Actually, i n Botswana as well as many other African cultures a person's lifeline progresses through four distinct stages; namely a) birth, b) puberty and c) marriage and d) death. Notably, other African traditions and religions believe in the resurrection or existence in the spirit formation; illustrating the visible and spirit worlds. The arrival o f a new baby is welcomed with celebrations, gifts and ceremonial rituals. Although eroding and only common in rural areas, many cultures across Africa perform initiation rituals or "the rite o f passage". During the puberty period at ages 14 to 16, young men and women are taken to a secluded place for an initiation program. The young women's curriculum entails skills related to marriage; motherhood and home crafts as well as basic domestic chores intended to help them to look after their families. Certain human qualities such as compassion, patience and self-respect are also developed in the initiates. Boys are taught how to perform family and marital responsibilities. The skills o f leadership, courage and self-respect sustain the family on their daily lives, including during difficult times. O n return, those initiated are now regarded as men and women and they are met with a joyous celebration at a public gathering. Death not only marks the end o f life but also the end o f a journey traveled with courage or pride despite misfortunes and life difficulties. Englund (1998) notes that the  Premigration Trauma  94  death o f a young child or teenager is more traumatic compared to that o f an old person. The latter is celebrated with the performance o f funeral rituals, which could last several days i n Southern Africa and up to three months i n West African countries such as Nigeria. The bereaved family is comforted with prayers and sometimes humour (Englund, 1998) and they are rested so that they can deal with their grief. Children are not allowed to attend funerals as a way o f protecting them from harmful emotions. Certain funeral rituals are performed after the funeral to avenge the troubled spirits, which could trouble the living through dreams and spirit possession. Englund notes "spells o f disorderly behaviour, inconsistent and unusual speech and the symptoms o f somatic diseases are common signs o f spirit possession". In collaboration with other community networks the extended family consults with the bereaved family. In times wars concerns about indecent burial or non-burial o f a family member can continue to perpetuate trauma among the surviving members. These rituals are organized and performed within family circles and community networks, which accords the family institution a unique status and purpose i n the lives o f African people and could also be recognized as an important angle i n healing traumatic illness. Community Support and Religion/Spirituality Community networks are complex, diverse and organized according to unique interrelated structures characterized by specific roles and responsibilities. These structures are comprised o f elders, chiefs, and leaders o f respective wards, traditional and spiritual healers. The composition o f the traditional family is changing and now encompasses government and non-governmental institutions that, i n many instances,  Premigration Trauma  95  operate with sensitivity to the local culture and customs. Overall functions o f these networks are to foster societal cohesion, peace, protection from misfortunes or enemies and support services which involves the running o f traditional ceremonies, celebrations and support during adversaries.  Certain laws o f inhibitions are used to deter members o f  the community from undermining traditions and customs that identify a particular group. However, one can act independently as long as their behavior does not put the lives o f others and the society i n jeopardy. Based at the heart Of community structures and treatment o f diseases is religion or spirituality. Majority o f the African people pray to G o d or Ancestors. According to Peddle (1999), one can find religious beliefs from Islam, to "born again Christians" as well as traditional African religions. According to Blyden (Cited i n Peddle, 1999), traditional African religion honours the Supreme Being " G o d or Ancestors". Beliefs and practices are closely tied to the land and kin, both those living and dead. There is a connection between the spirit world and visible world, hence, i n some cases music; dreams and omens are used to transmit messages between the spirit world and the visible world (Peddle, 1999). In some cases churches, traditional healers and medical doctors are consulted i n the diagnosis and treatment o f the mental illness. A more recent illustration o f religion in transforming adversaries to protective measures is the Truth and Reconciliation Commission ( T R C ) i n the post Apartheid South Africa, where A r c h Bishop Tutu identified "forgiveness" as the eventual product o f T R C . Forgiveness is seen as personal expression o f compassion, brotherhood and healing (letting go).  Premigration Trauma  96  Trauma recovery can take the form o f witnessing, testimony and reparation as occurred in South Africa during the "Truth and Reconciliation Commission" to process the psychosocial trauma caused by the apartheid political perpetrators (Bishop Tutu in Friedman, 2000). It is important to note that sometimes trauma cannot be healed in the absence o f the perpetrator. This is inline with the traditional African custom o f using traditional healers and spiritual or faith healers to discern and prophesy the cause o f misfortune and how the spirit leads to the healing process. Hence, social testimonies are essential before healing can occur (Andermann, 2002). Bagilishya (2000) agrees that in Rwanda forgiveness as w e l l as laws o f inhibitions helped to quell the escalation o f the Rwanda ethnic conflicts. Peddle (1999) explains that African ethnic culture is currently influenced by religion and trade from Western, Eastern and Islamic cultures. However, it is evident that many people i n Africa still subscribe to their ethnic and national cultures especially during the times o f distress or disputes, and during ceremonies. Cultural Healing Firstly, mental health professionals need to redefine their conception o f illness and trauma, relocating the appraisal and treatment o f trauma i n the context o f the individual's culture and history. For instance, Englund (1998) states that sometimes the interests o f the refugees and therapists are i n conflict as a therapist, from a discursive orientation, wants the refugees to talk about their experiences, while refugees strongly wish to be silent about the pains o f the past and concentrate on the present and future livelihood and education.  Premigration Trauma  97  Secondly, political trauma is a dehumanizing phenomenon and lack o f proper burial o f those killed i n custody is largely immoral. A s a result, after migration clients could still be haunted by images o f what they perceive to be troubled spirits and desire to retain closure. In a situation where elders are not available to observe or perform funeral rituals under migration and war conditions, therapy may leave clients with feelings o f vulnerability to vengeful spirits, characterized by dreams and seeing the face o f a dead relative, or spirit possessions (somatic disorders). Depending on the traditional orientation o f the traumatized person, delayed spirit exorcism can lead to death or afflict others (Englund, 1998). Usually, exorcism is done within a culturally constructed framework, which mainly involves traditional or religious procedures o f body, mind and spirit cleansing. Hence lack o f understanding o f socio cultural networks and history o f illness by the therapist may harm the emerging relationship and contribute to the delayed treatment or non-treatment. Unhelpful Categories Separation from Family Separation from family happens as early as immigrants begin the process o f migration. This may bring uncertainty about the whereabouts o f family members, some may lack funds to travel with the entire family, or there may be a hasty departure where the immigrant leaves everyone behind. Mekki-Berrada et al. (2001) have noted that the delay in getting approval for asylum and visas for family members back in the country o f origin has led to divorce, as costs o f communication became unbearable. Social Isolation  Premigration Trauma  98  Refugees have no direct route to a country that could offer them safety; they sometimes cross two countries or live in refugee camps before arrival at the country o f resettlement. This transition is lengthened by the asylum application process, which is usually complicated b y lack Of official documents left behind by the applicants when fleeing from home countries. Blavo (1999) state, "Eligibility tests can be influenced by nationality and the absence o f identity documents; by social background - religion, culture, occupation, - military or political" (pp.22). Although the host countries sacrifice their hard earned resources and safety to cater for the refugees, ineffective resettlement processes expose applicants to unrelenting struggle for food, education, employment and cultural adjustment - as both groups try to understand each other. Blavo (1999) states: A warm reception and hospitality by host communities are crucial issues. The size o f the influx in hundreds o f thousands within a short space o f time - within a week exasperates the national community and creates a variety o f hostile attitudes against them. Differences i n ethnic, cultural and religious backgrounds may also influence reception (p. 29). Similarly, immigrants start the migration process with high levels o f stress or ambitions, hoping to have a better life in the host country. O n arrival they face challenges ranging from economic difficulties to cultural adjustment; issues that may have prompted them to depart from home countries. These problems are experienced in both countries o f asylum and resettlement countries. Loss and Burial Refugees usually leave their country hastily as the threats to their lives increases. In so doing, they abandon personal effects and sometimes without time to burry their loved  Premigration Trauma  99  ones. According to Cunningham & Silove (1993), after a political turmoil, families migrate to trace their loved ones while attempting to cope with grief and uncertainty. He states that refugees on the way to a country of asylum they continue to dies from dehydration, malnutrition and drowning. Security Blavo (1999) states that urbanization; educational systems and new methods of agriculture have transformed the economy of African people. During migration they succumb to new means of livelihood, which requires learning, practice and experience. For trauma survivors the economic pressure could exacerbate their sufferings and render them insecure.  7.  Participation Rate Participation rate was calculated to further establish the soundness of categories.  This was calculated by dividing the number of participants who reported an incident by the total number of participants. It revealed the level of commonality of the incidents and the extent to which participants found the incidents helpful, not helping or could help in the future. Participation rate for the helpful ranged from 41.16% (family support) to 91.31% (security). Participation rate for unhelpful ranged from 15.38% (community support) to 100%) (lack of power and control). What would help ranged from 7.69 (Immigration & refugee services) to 84.62 (need for security). On average the participation rate for this study was very high and as Borgen & Amundson (1984) state, "participation rate of 25% could still be considered sufficient rate for validity of the categories.  Premigration Trauma 100  Finally, more than 90% o f the categories were supported by literature. Less that 10% were unsupported and w i l l need further investigation. A m o n g these, "willpower" can often be confused with resilience and power and control. In previous research studies, categories related to willpower were referred to as determination, personal strength or perseverance (Silove and Cunningham, 19993). However, this researcher finds willpower more descriptive o f the desire to live and survive difficult circumstances that refugees and immigrants sometimes succumb to. Trauma survivors i n this study reported that they were helped b y the ability to separate the past from the future. Survivors indicated that they ignored their painful history and only focussed on the future with anticipated positivism. The concept o f choice i n premigration trauma was also not supported by literature. T w o refugee participants i n the current study commented they would deal with their suffering in helpful way because now they have a choice to choose either nationality or country o f residence. It should be noted that refugees do not usually have the time or autonomy to decide their future as they flee their countries under insecure conditions. In summary, the results o f this research study have illustrated the traumatic circumstances that can accompany migration from Africa. While immigrants choose to migrate they are also confronted with certain economic and social roles that they were not ready for. The modification accommodated by C I T has created a suitable environment for obtaining and analyzing data from people who otherwise were uncomfortable discussing closed parts or hurting parts o f their lives. The researcher had to employ some creativity to create rapport and collect required data. Further discussion on the current study w i l l be presented i n the next chapter.  Premigration Trauma 101  Critical Incident Timeline Incidents were further organized by placing them on a timeline methodology (Baxter 1999; Mishler 1991; Schlossberg, Waters & Goodman 1995). The timeline categorizes the low and high points o f events that happen i n a lifetime according to three main periods, namely; beginning, middle and end. 1) The beginning entails survivors experiences o f a direct attack or difficult situation suffered by the individual, the family or community. 2) M i d d l e refers to the time when a survivor, family and community felt traumatized and tried various channels o f survival and 3) the end comprised o f the period when the survivor, family and community decided to flee or migrate from their countries o f origin. Timeline methodology was found instrumental i n the recognition o f a premigration trauma as a process than a one off event; most importantly the development of a new mental health theory on recovery from premigration trauma. The participants were asked to place their incidents in a lifeline according the periods the events happened (See appendix F). The line was drawn in a descending and ascending order as determined by the emotions involved i n the critical incidents that took place. Ascending would mean the client was somehow in control o f the situation, which would lead to a follow up question about what incidents led to the improvement o f life. Descending characterises negative impact on the participant's life, also leading to a follow up question about incidents that led to unhappy situation.  There was no predetermined procedure and participants would decide to talk during or on completion o f their lifelines. They conversations were also flexible to move at any direction or pace according to the comfort o f the participant. The time line was  Premigration Trauma 102  helpful to assist the participants i n identifying significant decisions that they made to free themselves from the sufferings they experienced. These decisions could have been carried out individually or collectively as well either consciously or subconsciously. It was not obvious for trauma survivors to discover that they made an effort towards their recovery process. However, when they viewed that their times lines they remembered their stories better and had the insight on what helped, what did not and what would help them i n their recovery from premigration trauma. Refugee no. 1 ( R E F 1001)'s transcript summary and a lifeline are presented below to illustrate the process o f the lifeline methodology:  REF  1001  When R e f 1001 arrived i n Canada as a refugee with his wife and children i n 1991, he was 37 years old. When he came here, he already had heir law degree from [home country] before he fled to Zambia; however, now he is a college student. R e f 1001 's problems started while he was working for the Ministry o f Justice in [home country] i n 1986 when he was imprisoned because someone started spreading rumours about him. "Somebody went to the police and reported that I was planning to overthrow the government." A s a result, the police arrested him. According to R e f 1001, he stayed i n prison for about a year before they finally released him, "They didn't charge me for anything." A s a lawyer, he had been the one helping people to deal with legal issues. However, he was now i n trouble. "I didn't even know the case I was going to be charged with or even the penalty I was facing. H i s concern was " People could be held indefinitely, for.. .the president had the power to detain you indefinitely." H e pointed out that ' F o r that  Premigration Trauma 103  one year, it was just like ' h e l l ' because, there was no food; there was nobody to come and see me, which means you are not allowed to eat for even one week." R e f 1001 pointed out: "I was just lucky that I came out after one year" because i n addition to lack o f food, he and others were at constant risk. " I f you are troublesome, they w i l l take you and feed you to the crocodiles" i n the nearby Shire River. N o t only did he have to endure this threat, but prisoners were not allowed to go out. Basically, they just sat inside their cells. " W e ate one meal a day i n darkness. The toilet was just flushing every two minutes even i f we were not using it. Y o u can't sleep. It was very noisy, and sometimes the lights were kept on for 24-hours." Starting at 6 in the evening, they were not allowed to speak, and they "were just sitting there pretending to be sleeping. Early i n the morning, [the guards] would come and kick you up with their boots." Because they were only fed once a day at 3 p.m., the prisoners would try to hide some food for a breakfast meal. In addition, they were only allowed one family visit per week, and even obtaining permission for this was difficult. Once permission was granted, all visitors went in at once. A s R e f 1001 stated: "So there was no privacy, and we just talked by shouting because [their family] would be standing three yards away." It was impossible to talk, so they were just relegated to asking how each other was doing. According to R e f 1001, the entire process was meant to humiliate them, and it did, especially for men like R e f 1001, for he had been a lawyer with a position, power, and respect. The psychological pain resulted i n the loss o f  Premigration Trauma 104  respect. " Y o u feel like you are a bad person worth little respect." R e f 1001 said: "That was even more painful" than all the beatings he received. What helped R e f 1001 through his imprisonment was the support o f his family. In addition to his wife, R e f 1001 's 'brother, brother-in-law, and m y uncles always came as w e l l also some o f m y friends came to see me." H e pointed out others too were supportive: "people at m y home village were very, very involved. They went to a lot o f these traditional doctors so that they can help release me." Even " M y wife, m y uncle, and m y brother went to this witch doctor. They met this guy, and he gave them a lot o f hope." R e f 1001 was not sure i f it worked or not, but he was released. However, he mentioned that he also had faith i n G o d . O n the actual day o f his release, R e f 1001 "didn't believe that I was going to be released. In the morning, I [was] taken to police headquarters. I went there and sat there for about 3 hours. I didn't know what was happening, and i n m y feelings, it was like they are going to take me to the crocodiles. Finally, someone came and took me to a guy who was the Regional Police Chief.' H e told R e f 1001 that they were going to release h i m , but he was warned: " D o n ' t talk to anyone about hpw you were treated, about what happened to you, even about the issues you are not supposed to talk about because there are people who would understand what you are talking about, so the best thing is to shut up and keep quiet." Finally, about 8 o'clock that night, R e f 1001 was taken home. However, he was not happy because he could not share his experiences with his friends. What was even worse was "One o f the conditions was that I had to go back to work by force." R e f 1001 had "told them that I need some time' after his ordeal to rest and  Premigration Trauma 105  be with his family." However, "They were trying to force me to go to work after the j a i l term. That was a good job, but it made me more angry because it was like they continue forcing me to be doing something. "When he did not go back, "They wrote a letter to the newspapers that I should go back to work right away. When I refused, they interdicted me.. .they said because you are not coming, we are going to interdict you on half pay, and I said no problem, but they never paid me." What was even worse was that a "guy came and said can you give us the keys to your house, so I gave them the keys for m y house and moved out. That was so humiliating because we went from a good [house] to a small shunty compound. W e had so much property which couldn't fit i n there with no electricity or toilet." This is when R e f 1001 decided that his only alternative was "I can't go back there, so we just ran away' because no one could help, not even the chiefs because they would not talk to him, or they would take the government's side. Therefore, "I just sat. I think it was about a month, and then I ran away to Zambia." Fleeing [home country] affected R e f 1001: "When I ran away from [home country], I became sad again because I left m y family i n [home country] because I wanted to explore this territory alone." He could not go directly to Zambia, so R e f 1001 ended up going to his wife's parents' house "that is about 2 k m from the border w i t h Zambia." H e and his in-laws "just walked up to Chipata,; then, I took a bus that went to Lusaka i n Zambia. Chiapta is the next town before Lusaka, and m y wife had a sister there.  Premigration Trauma 106  I stayed there for 2 days; then, I went back home to [home country]." R e f 1001 traveled alone because o f the roadblocks. A t one, a man recognized h i m saying, " O h , I know you. Where re you gong?" H i s response was "I am going to Lusaka." When in Lusaka, he began to think about his family, and how "they might be the victims, and I was making them the victims o f m y problems." In the interim, "the police went to m y wife and said that i f you are hiding, we are going to arrest you." However, his wife said that R e f 1001 had gone to his village and would return. W h e n R e f 1001 received a letter from his wife about government's intimidation he left for home country immediately. " I went back to [home country] i n the night and got m y family out." The next day when the police went back to his house, "they found that the woman and the kids have disappeared, and they were very angry." According to [Ref 1001] what helped hi through this was "I carried a Catholic hymn. That was just like m y insurance. It is a book that I was reading, and I was singing all the way up to Lusaka, so it was like I was missing nothing. I had G o d with me, so I missed nothing." In Zambia, they also had difficulties as refugees "were treated like we were rejects." They were not really welcomed even though "we had this Zambian Christian Society that was counselling us and giving us jobs and this and that," even [the] counsellors themselves didn't hide their negative feelings towards us." [Ref 1001] explained that the counsellors did not even hide their negative feelings, and they provided an odd type o f counseling by saying things like: "you have just come here to steal." H e maintained that, "The people who are supposed  Premigration Trauma 107  to help you are also part o f the rejection. Thy just want money." Therefore, it was difficult i n Zambia. The Zambians believed " Y o u refugees, you are enjoying life. W e Zambians can't have this, and you have this." [Re 1001] said that the Zambians didn't take into account " W e have this because we are not allowed to work.." What make people like [Ref 1001] feel worse it that they wanted to work, but the Zambians aid "we don't give our jobs to refugees." H e also pointed out that "it was a situation where you could not w i n anyway." What made things even more humiliating for [Ref 1001] was that on a number o f occasions when they were given clothing, "Imagine I am a man, but instead o f giving me a pair o f trousers, they would give me a dress." Despite the constant humiliation, he resolved this by "So what would we do? Y o u take a dress, and you sell it. That was the only solution." The ordeal caused h i m a great deal humiliation and psychological pain. H e often wondered what good his education had been to h i m i f he was suffering that much. However, what helped h i m though this was by comparing his own suffering to the pain o f friends and other sin the refugee camp with missing legs or worse experiences. H e noted: " I f you go into the refugee camp, you w i l l find people who have really suffered, and they are not crying. They are laughing, so who am I so start crying when some women did not have begs because U N I T A had chopped off their legs." H e thought: "It's like I have not suffered enough because these are people who don't have one let. They have crutches, and they are laughing, eating, and they are going on with their lives." Also, he and his family were still together. Another factor that helped h i m was "just the Christian faith also helped me. I  Premigration Trauma 108 always felt that whatever was happening, there was no way I could have avoided it. It was lit it was maybe ordained that I should go through all these things, and one day I would be Ok. So things like that I just felt like there are just small temptations.' Then, things changed on day. According to [Ref 1001], "One good thing that happened when I was i n Zambia" was that in addition to his true friends, he "had friends who were not friends." "Some nationals [home country] decided to form part o f political parties, [but] I didn't want to j o i n them, so they turned against me saying that I was just a spy.' They wanted [Ref 1001] to j o i n the struggle against the oppressions he and others had lived. However, they could not understand "I don't want to join anybody's struggle because I have to struggle for m y on life, at least for now." However, what happened was that they turned against [Ref 1001]. "it was like an emergency! The U N H C R said that I should come out o f the situation. They took us straight to [the] Canadain Embassy, so it was like an urgent matter, so we had visas, and we came here [to Canada]. Otherwise, the officials were worried that " W e might end up being k i l l e d . " [Ref 1001] pointed out that coming to Canada "was up-lifting. I ran away from a problem in M a l a w i . I came to Zambia, nad now I find so many problems again, and I have to run again." This time I became a refugee i n Canada. "It was actually a very big relief." Despite the relief o f coming to Canada, he and his family experienced some problems. Because "It is a new culture, here you [are] expected to work on your on things." I didn't know that I am trapped like a fish i n the net, and you don't  Premigration Trauma 109  know where to go anymore. It's very tough, but at least it doesn't threaten your life," so [Ref 1001] is thankful for the safety he and his family find here. However, he suffered because his children experienced difficulties in school because "they didn't speak good English. They had an accent. Actually, they didn't know English at all when we just arrived, so you see the kids coming home crying saying m y teacher said this; my friends said that." H e would try to comfort them and tell them that they were going to stay "forever.' Despite some o f their worries, R e f 1001] and his wife have decided to stay in Canada at least "Let's be here until they [our children] finish their education, first. That's when we can go home. But by the time they finish, we won't even think about it." In the meantime, [Ref 1001] is trying to recover from his own experiences o f being a refugee. H e has been back to [home country] twice now for a period o f two months each time. Despite the memories, "I can go there and talk about whatever I want to talk about." "It relieved me." [Ref 1001] explained: " N o w , I think I can relate to m y culture in a way I never did before." Having a renew connection "is helping me to recover, and it is helping me to feel proud again. I am a human being because when I was a refugee, I was stateless. Then, I cam here and gained Canadian citizenship." H e feels better because "I have gone back and felt that people appreciate whatever I did. People have also gone up to him and said, " Y o u are the people who helped us to fight [the president]. If it weren't your case, we wouldn't have known about it. Y o u r case has helped us because when you go out and tell people. N o w , [the president] is gone, and now, we have democracy."  Premigration Trauma 110  [Ref 1001] said that right now, he has no plans to return to [home country] to enter politics. H i s goal is to look at his experiences and "just to open up. Talk, chat with people, make it a joke, or just make it as something that helped you to come here [to Canada]." He concluded his thoughts by saying, " W e may have problems here, but at least, we have a better life, so [those experiences were] a bad thing, but it has helped you to come here." S u m m a r y of C r i t i c a l Incidents T i m e l i n e The usage o f the critical incidents timeline had several contributing factors to a new theory on discerning, healing as well a long process o f recovery from traumatic experiences. A new theory should consider that premigration events appear i n a pattern which as no predictive pattern or direction but has the beginning, middle and end o f the migration process. 1) The beginning entails survivors experiences o f a direct attack or difficult situation suffered by the individual, the family or community. 2) M i d d l e refers to the time when a survivor, family and community felt traumatized and tried various channels o f survival and 3) the end comprised o f the period when the survivor, family and community decided to flee or migrate from their countries o f origin. For example, 1) the beginning was the time when R E F 1001 was detained without charge. The detention experiences leads to generalized fear and uncertainties about the detainee and his family. 2) the middle is marked b y the period the detainee is released from prison succumb to additional torment and intimidation by government agents. 3) the end is characterized by the time when R e f 1001 went through an insecure process o f arranging for himself and family to flee their home country until arrival i n a country o f resettlement. It should be  Premigration Trauma 111  noted that all these stages are travelled unceremoniously and heightened uncertainty about the future or survival. This process implies that the new mental health theory should consider the historical development and context o f the sufferer. They should observe how individual and group decisions and efforts towards recovery from trauma are also punctuated both negative and positive incidents.  Premigration Trauma 112  CHAPTER V DISCUSSION  This chapter discussed the results o f the current study based on the experiences o f premigration trauma among African immigrants and refugees. It highlighted emergent themes and issues pertaining to migration related trauma. These themes informed a new theory on premigration trauma based on what the survivors thought helped, did not help or would help them i n their recovery from trauma. The implications o f the current study were discussed. Firstly, the African theorizing consistent with the gap i n trauma research and treatment approached were presented. Secondly, the chapter discussed the tenets o f the development o f a new theory on diagnosis and healing o f trauma based on the cultural context o f those served. Finally the chapter reviewed the limitations o f the methodological processes and theoretical standpoints. When trauma struck the cultural resources that protected the community in the past against known attacks is depleted rendering the community vulnerable both known and unknown abominations. Infact, survivors begin to question their culture and religion. The sense o f self is also put i n question, creating a new form personality i n the person. This researcher argues i n this study that psychological interventions are not universal owing to cultural differences o f those served, but there can be no conclusive evidence about this claim until the experiences o f those directly affected are effectively examined. Results o f the current research study reveal the difficulties faced by survivors in their recovery from premigration trauma. Migration can be a long process encompassing premigration, migration and post migration experiences. The experiences o f wars, torture, detention, social prejudices, epidemic diseases experienced at premigation stage  Premigration Trauma 113 haunts the survivors for a long time. The length o f suffering i n this research ranged from one to seven years; possibly more than that depending on the person and cultural awareness or appraisal o f illness. Silove and Cunningham (1993) illustrated the length and continuous sufferings that follow the survivors until arrival i n a country o f resettlement, although post migration experiences could pose even greater challenges. Security was the most common basic category under incidents that helped with a participation rate o f 92.31%.  In the context o f refugees, security is a broad concept,  ranging from residence i n a place that is not life threatening to availability o f education and employment. The principal reason for migration among many refugees and even immigrants was the search for security as the their home countries were hit by poor economies, political instability, epidemic diseases and acute social disintegration. When security was experienced whether partially or fully, the survivors experienced a change in their sufferings. Usually, for refugees and their families the security was experienced after fleeing their home countries and arriving at a country o f first asylum and resettlement. The least helpful incident was family support, due to separation o f families when they flee from perpetrators or finance for the family to travel together. However, i n instances where the family was available, the process o f support and healing was conducted at a family level.Under 'hat did not help', lack o f power and control (100%, participation rate) and Isolation  (100%, participation rate) were the most commonly  experienced by the trauma survivors. The survivors had a tempered sense o f control and personal power. One refugee, said, "The only reason w h y they [political opponents] put people i n prison it is to humiliate them so that they loose self-esteem, they loose credibility they just become nothing" (Ref 29, years). In support another mentioned that,  Premigration Trauma 114  "When I was in [refugee camp] I hated m y sister and myself.. .1 felt like nothing .. .1 was thinking why can't I just die" (Ref 12). Community support had (84.62% participation rate) under incidents that helped and also (15.38%) for incidents that did not help. One would be struck by the assumption that i n collective communities the community structures unit plays a pivotal role in caring for those affected b y disasters. However, trauma can be a powerful condition with ability to destabilize the social fabrics, culture and religion included, to the extent that cultural expectations become ambiguous. In support, but all the constituents the people whom you served you do not see them and that's terribly bad, it's bad. A n d that's one thing you know, you wonder w h y they can't even go and tell the government "why are you arresting this person", since he is innocent and we loved him. Nobody cares! (Ref, 29 years). R e f 1003 lamented, "I didn't think that it would be such a big deal until when the community, the people o f course who were against the government started rioting. Even coming to m y house trying to look for my husband so that they can k i l l h i m but good enough he was not around". Incidents that would help" appeared closely consistent with "what helped" also implying what participants expected to have helped them i n their recovery process. The highest participation rate was on security (84.62%) and the least being support by refugee and immigration services (7.69% or 1 person). The commonality o f the category o f security would imply that security stands important premigration, during migration and post migration. Insufficient life necessities and culture differences may hamper the process o f recovery from trauma. Consequently, the refugee and immigrants agencies play a greater role is resettling new comers, but this collaboration seems to subside when the new comers settle down. One can make a subjective conclusion that the need for  Premigration Trauma 115  such services decreases i n importance owing to the newcomer's familiarity with the new country o f residence and improved economic level.  In contrast data from this study  indicates contextual and cultural disparity between the refugees or immigrants and service providers. According to R e f 1001, "even counsellors themselves didn't hide their negative feelings towards us. They would say, "you have just come here to steal, you have just". There was no real counselling really. The people who are supposed to help you are also part o f the rejection you know". In comparison with refugees, the situation o f immigrants on the surface seems to be more organized with minimal migration stress. M y r d a l (1957) posits that each migration flow changes the social and economic context i n which subsequent migration decisions are made. These decisions could either be favourable or unfavourable. This notion stresses the need for continued review o f migration policies and services by host countries. Although these experiences cannot be elevated to the level o f trauma they are nonetheless very stressful and have the potential for mental health conditions.  Implications of the Study Research on Premigration Trauma The current research reveals the difficulties faced b y trauma survivors through out the migration process. However, i n the midst o f all these challenges, there were positive outcomes; especially for refugees who reported that migration resulted i n safety and a choice o f residence o f nationality, which they lacked when disaster struck. The results o f this study informs the research on trauma about the consequences of premigration trauma; which otherwise relegated by researchers as part o f history not important i n "the here and n o w " or too complex and subjective to analyze. The current  Premigration Trauma 116  study has reintroduced the understanding o f African migration and the reasons behind; both historical and current milieu o f the world's economic transformations. It provided evidence, that migration is a process and its effects extend beyond the individual and involves ones family, friends, community and culture (Levine 1997; Giesen 2001; Erickson 1994). Several learning points would need to be followed by future research, including choice as an important feature in the recovery process; how the community and culture could be both helpful and unhelpful i n helping the survivors gain recovery; how appraisal o f illness determines the persons response to its effects. Development of a Counselling Theory First o f all research on African experiences o f trauma is lacking, however, as a learning point, it is essential to note that there is no universal model o f treatment, and instead o f using an expert model, mental health workers helping traumatized communities could relate mental health theory to the culture o f those served (Blackburn, 1993). This approach suggested assessment o f those beliefs and practices in relation to scientific knowledge and the motivation to change, also, therapists can relate their approaches to the clients' worldview not the therapist's orientation. Within this context, the aim o f therapy is to help the client to regain sociality, which they cherished during the normal times. The understanding o f family dynamics could provide therapists with relevant and sensitive treatments based on the context o f their clients. For instance, post migration, failure to perform funeral rituals due to absence o f elders to conduct ceremonies could contribute to traumatic symptomatology and distrust i n therapy.  Premigration Trauma 117  Attention to the use o f T-statements and You-statement' should be paid attention as they can be used interchangeably. Self-reflection is least encouraged i n the upbringing of children, however, that level o f disclosure is usually performed at the family level or among trusted friends. Similarly, role-plays should be made close to practicability as* much as possible. 'Truth and Reconciliation Commission' i n South Africa was a perfect illustration that the culture prefers concrete methods o f communication and i f possible with the physical presence o f the perpetrator. The connection between the visible world and invisible world should be given access into current psychology; despite its complexity. Peddle (1999) state that at the heart o f therapy i n Africa is the religion. This is collaborated b y Smith (2003) referring to their work at the Bellevue/New Y o r k University program for the survivors o f torture, engaged the African group i n a ceremony o f "remembrance and thanksgiving" for families who have lost their members and friends due to death or displacement.  This  activity enabled the group members to exchange ritual and religious practices as well as renewed pledges to continue to support one another. Finally this calls for an integrated model that recognizes roles played by the society, humanitarian organizations and the resilient person i n the process o f recovery from trauma. Future research should look into the development o f programmes based on this integrated model. Limitations of the Study The current study has four methodological limitations and caution must be exercised i n interpreting results. First, small samples are limiting even though they are cost effective and have a high data precision; future research should consider broader  Premigration Trauma 118  categories o f those affected by premigration trauma as well as implications for a multicultural context. Second, participants from sub-Saharan Africa are not a homogeneous group. Each country has distinct ethnic, cultural, economic and geographical variations. However, there are also noticeable common threads, which links all elements o f the African Diaspora. Third, migration can be a long process, thus, interviewing immigrants who are already in a host country may pose subjectivity from memory recall and social transformations. Fourth, the sampling extension include international students who experienced premigration trauma challenges the conventional wisdom that all international students choose to migrate for better educational opportunities as w e l l as the assumption that trauma is prevalent on all African nationalities irrespective o f their origins. However, the theoretical disparities surrounding the inclusion o f the international students i n the current study is mitigated by trauma as a common denominator for inclusion. Lastly, limited time for completion o f these study resulted i n important modifications, which could have added value to the current research study. The researcher left out caretaker interviews. The initial plan was to interview therapists, foster parents and community leaders as well as other professional service provider assisting African immigrants to gather their perspectives on the survivor's recovery process. Future research should consider the experiences o f health caretaker and support personnel as well examining the experiences o f international students who migrated under the support o f host Government's sponsorships.  119  References Adjibolosoo, S., & Mensah, J. (1998). The Provision of Settlement Services to African Immigrants in the Lower Mainland of B.C. A research report prepared for the Community Liaison Division of the Ministry responsible for  Multiculturalism and Immigration. British Columbia. Victoria, B.C. Akinade, E. A. (1999). Problem Associated with Determination of abnormal behaviour of African (black people). Society for Student Counsellors in Southern Africa. Conference. Anderson, B . , & Nilsson, S. (1964). 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Washington D C : American Psychiatric Publishing, Inc.  125  APPENDIX A  Participant Gender Country Educ Job Marital Age at Code of Origin Background Status Status time of suffering REF1001 M Malawi B Law M College 32 Stud REF1002 M Ethiopia BSc Self M 18 Statistics Employ REF1003 F ESL 11 Burundi Stud S 11 REF1004 F Uganda M Social Grad Stud M 26 Work REF1005 F Burundi Grade 11 Stud S 12 REF 1006 M Uganda B Comm Postal M 29 Officer REF1007 M Angola Grade 11 Stud S 12 IMM1001 F Swaziland M A Nursing Self M 26 Admin Employ IMM1002 F Botswana Cert Hotel Unemploy M 24 Catering IMM1003 M Ghana B A P h y E d Security D 25 IMM1004 M Zambia B A Eco Unemploy M 25 M ISS1001 Zambia MSc Geo College M 39 Tutor ISS10002 M . Zimbabwe MHSc Ortho Stud . M 27  126  Imm Status on Year of Arrival in Arrival Canada  Nature of Suffering  Year of Length # of Suffering of Suffering 1986 4  migrations  Refugee  1991  Detention  Refugee  1993  War  1984  3  3  Refugee Refugee  2002 1992  Ethnic Conflict Military Coup  1994 1985  •7 6  3 2  Refugee Refugee  2003 1992  Ethnic Conflict Detention  1994 1985  6 4  5 2  Refugee Landed Imm  2001 1995  War Multiple Loss  1997 1988  4 6  5 2  Landed Imm  2001  Multiple Loss  1994  4  2  Landed Imm Work Permit Intl Stud  2001 2001 1999  Economic Economic Economic  1993 1993 1994  2 1 5'  1 4 4 1  IntfStud  1999  Grief  1998  .5  1 2.69  129  Right to Withdraw: I understand that my participation in this study is entirely voluntary and that I am entitled to share my experiences at my own pace and comfort. I may refuse to participate and withdraw from the study at any time without jeopardy. I consent to participate in this study and acknowledge that audiotaping o f the interview w i l l take place and I have received a copy o f this.consent form for my own records.  Participant's Signature Selebaleng Mmapatsi  Co-Investigator  Co-investigator's Signature  D r W i l l i a m A . Borgen  Principal Investigator  Date (please print) Thank you for your contribution.  Principal Investigator's Signature  130  Participant Information The Information you provide in this form is very useful. Omit information you feel uncomfortable sharing. Participant Code N o  (To be completed by the researcher)  Age: Marital Status: Country o f Origin (Optional): Countries Crossed During Migration: Date o f Arrival in Canada: Reason for Migration:  Immigration Status:  Family Members in Canada:  Employment Status: Educational Background: Socio-Economic Status:  Nature o f Trauma:  Year o f Trauma:  Age at the time o f Trauma:  Length o f Trauma:  

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