Maw Julie watched soldiers tie up and beat her father and brother, then found neighbors’ bodies in the middle of her village.
K’Paw Wah was arrested twice in Thailand just for working. He numbed his mind with Asian moonshine and, when he got to Buffalo, three 24-ounce Heinekens a night.
In refugee camps that were supposed to be havens, Maw Julie was raped and Win Han nearly choked to death by fellow refugees.
In a survey of 256 refugees from Burma, a University at Buffalo professor found that half experienced symptoms of post-traumatic stress disorder. That same survey found high rates of anxiety, depression and alcoholism. Yet of the 8,350 refugees from Burma who now live in Buffalo, only about 30 receive treatment from Lakeshore Behavioral Health Services, the main provider of psychiatric treatment in the West Side neighborhoods where most refugees live.
“We see a lot of domestic violence, alcoholism, depression, PTSD,” said Dr. Myron Glick, founder and medical director at Jericho Road Community Health Center, the primary source of health care in the West Side refugee community. “We’ve been taking care of refugees since 1996, and these are by far the most gentle, the most easy to deal with.
“You have to ask: Where do all the problems come from? Why is there so much domestic violence, so much alcoholism, so much depression? It must be from the devastation of all those years of ethnic strife.”
Maw Julie is 58. When she was in her mid-20s, the Burmese Army came looking for her aging father. They tied up her father and brother and beat them, accusing them of being part of the Karenni ethnic army. After the soldiers left, Maw Julie found the bullet-riddled bodies of friends in the center of her village. Her father refused to leave home. He stopped eating. Three months later, he died.
Maw Julie headed east through the jungle, living off the land, making her way to a refugee camp in Thailand: a city of bamboo huts filled with close-knit Karenni families as well as troublemakers.
A decade ago, she met a man she thought wanted to court her. Instead, he came to her hut and raped her, time and again.
An American aid worker put her in touch with the United Nations agency that resettles refugees. In 2012, she moved to North Carolina. With no English skills, unable to concentrate and unable to work, Maw Julie fell through a hole in the state’s social safety net and ended up homeless.
A nephew suggested she move to Buffalo, where she made friends in the local Karenni community and took joy in going to church every Sunday. Her doctor prescribed an antidepressant that helped.
Then, Maw Julie said, her landlord decided he didn’t want welfare tenants anymore. The property manager took to calling Maw Julie and ordering her to get out. When he called, she panicked.
The phone rang again on a warm morning this June when Maw Julie was packing her belongings. As the phone rang and rang, she got more and more scared. She rushed to the window of her second-story flat and opened it, hoping for fresh air. She blacked out – and fell out the window to the ground below.
Maw Julie woke up in Erie County Medical Center. After back surgery and months of rehabilitation, she is back home in another West Side flat. She spends her time in a wheelchair.
On a recent Saturday morning, her worries centered on an empty pill bottle on her coffee table. Her prescription antidepressant had run out, and she had no idea how to get it refilled.
Isok Kim, who has been studying the refugees from Burma who settled in Buffalo, said half the refugees he surveyed exhibited signs of post-traumatic stress disorder. Just under a third of Iraq War veterans suffer from PTSD, the U.S. Department of Veterans Affairs estimates.
“You can’t look at these refugees without talking about the atrocities they’ve gone through,” said Kim, an assistant professor of social work and a research associate for the Immigrant and Refugee Research Institute at the University at Buffalo.
Soe Reh, a Karenni refugee, stepped on a land mine in the jungle and lost a leg. Neih Thuai, a middle-aged Chin woman, endured a weekslong journey – including a two-day boat ride that was so hot and crowded that she thought her children would die – to escape the forced labor her husband faced in Burma. Thaw Yee, a Karen refugee, recalls a gun pointed at her head during an interrogation.
Such trauma can lead to mental health problems. A fifth of the refugees Kim surveyed showed signs of anxiety, and a fifth exhibited symptoms of depression. In contrast, the National Institute of Mental Health estimated that 6.7 percent of adults nationwide suffered a major depressive episode in 2014.
Kim’s survey also found 9 percent of the refugees showed signs of alcohol abuse. That’s only slightly higher than the nationwide rate, but Kim said refugees probably underreport the extent of their drinking.
K’Paw Wah wanted to work. A strapping man of 20 couldn’t just rely on the fish paste and rice rations of the Mae Ra Ma Luang refugee camp, not when he had a wife and young daughter to feed.
So back in the early 2000s, he snuck out of the camp to work in the fields – and was arrested for it twice. Both times, Thai authorities deposited K’Paw Wah and his co-workers in a war-torn territory in Burma, forcing them to sneak back into Thailand and walk through the jungle for days to return to their refugee camp.
There, at least one pleasure awaited him: a homemade liquor made of fermented sticky rice.
“Everybody drank it, for fun mostly,” K’Paw Wah recalled. “It was pretty strong.”
K’Paw Wah said he drank almost daily in the camp, far more than he does in Buffalo, where he settled in 2010 with his two daughters and his parents after his wife in the camp left him. Here, he would just meet with his friends and drink beer, lots of it, a few times a week.
He stopped for a few months in 2012 after his older daughter complained to her teacher about his drinking, prompting a visit from Child Protective Services and six weeks of alcohol counseling at Lakeshore.
The counseling didn’t stick. By the end of that year, K’Paw Wah was drinking again. “Because I’m used to drinking,” he said. “I have no other reason.”
One night in September 2014, he drank more than usual and came home at 3 a.m. still thirsty. He pleaded with his father for money so that he could go out for one more drink.
His father said no, and K’Paw Wah staggered out in anger.
The next and last thing K’Paw Wah remembers is seeing two men in front of him on Chenango Street. The police report said it appears that muggers attacked him. He woke up at Erie County Medical Center, paralyzed with his back broken.
K’Paw Wah spends his days and nights in bed in a nursing home now. He can speak and move his right hand but he will never walk again.
The vast majority of refugees from Burma don’t get mental health services, no matter how much they need them.
The reasons are money and culture.
Jericho Road, a bustling one-stop center for refugee health and community services, recently hired a social worker and a mental health counselor. Family physicians there also prescribe antidepressants.
For psychiatric treatment, Jericho Road refers patients to Lakeshore Behavioral Health Services, yet few refugees from Burma go there for help.
For its part, Lakeshore doesn’t seek those patients. The cost of hiring an interpreter is $55 to $100 per counseling session, which eats up Lakeshore’s Medicaid reimbursement, said Elizabeth Woike-Ganga, Lakeshore’s chief operating officer.
Cultural reasons deter refugees, too. The Karen people, who make up the majority of the refugees from Burma, don’t have a word for depression. They often seek treatment for physical ailments that are symptoms of a mental struggle they don’t understand, said Glick of Jericho Road.
Several refugees said they doubted counseling through an interpreter would work. Others feared they would know the interpreter, who would then know a troubled refugee’s secrets.
Jewish Family Service of Buffalo and Erie County has served 176 people through its Center for Victims of Torture and Trauma, said Marlene A. Schillinger, the organization’s CEO. But none is from Burma.
Pamela Kefi, who used to run the center as well as the refugee resettlement program at Jewish Family Service, described the refugees from Burma as polite.
“But I’m never sure what they need from me,” Kefi said. “They’re not asking me what they need. And I’m left wondering: What more can I do? What more should I have done?”
Win Han experienced the violence of a refugee camp and isolation in Buffalo. They combined to leave him on the edge of suicide.
But he did something rare. He got help.
Win Han and his family left Burma for a Thai refugee camp when he was 13. It was a rough place for a young boy who, by his own admission, looked like a girl. Kids bullied him. One day an older boy grabbed Win Han by the neck and choked him.
“I thought I was going to die,” Win Han recalled.
When his family moved to Buffalo a few months later, he felt every bit as much an outcast. Coming to terms with a new language and a new school and the fact that he is gay, Win Han fell into depression.
“I always felt like I was in the darkness, and it was all around me,” he said.
Unable to sleep, he would sneak out of his home in the middle of the night and go to Hoyt Lake in Delaware Park.
“I would sit here and cry,” he said. “I’d get mad and throw my phone in the water. I think three of my phones are in that lake.”
At his darkest moment, Win Han told a friend he planned to drown himself in the Niagara River. That led to an intervention, counseling, antidepressants and, eventually, a turnaround.
Win Han graduated as salutatorian at the International Preparatory School at Grover Cleveland High School, and he soon will be a SUNY Buffalo State graduate aiming for a nursing career.
Now 22, muscular and quick with wisecracks, Win Han works as an interpreter at Jericho Road. He has come to know that many refugees are so lost in their pain that they can’t focus on their goals.
“I know the thought that comes into their mind is that they could not bear the pain anymore,” he said.
But he also knows that the suffering can end – for the refugees who work to grow past it.
Editor's note: The Buffalo News is using the name "Burma," rather than "Myanmar," because refugees generally refer to the nation as Burma, as does the U.S. government. Burma's military regime revived the nation's ancient name of Myanmar in 1989 in hopes of defusing ethnic tensions.
In addition, refugees will be referred to consistently by their full names in this series. That is because natives of Burma don't have first and last names: their full name identifies them at all times.