Thousands of Afghans suffer from PTSD. Advocates are trying to find culturally competent ways to help

From Texas Public Radio:

This story is part of a new TPR series Between Here and Home about how Afghans are navigating life in San Antonio after the war.

Chinar Sedeqi, his wife and his three children were among the around 80,000 Afghans who braved gunfire and explosions to get to the Kabul airport in August of 2021 and get out of a country that was no longer safe for them.

“When the government of Afghanistan collapsed, I heard that someone was searching for me. Then I left my home. And they [the U.S. government] contacted us to come to the airport because my family was in danger,” he said. “We heard a big sound explosion, and we heard that more than 200 people died in this area. And we were just in this place with my children, with my wife. You know, we all our whole family were there.”

They met an American soldier at the gate of the airport and were flown to Qatar to Washington D.C., to New Mexico, to San Antonio.

“So that’s one of the first real signs of trauma that we see in everybody, the collapse of their beloved country in a matter of days,” said Margaret Constantino, executive director of the Center for Refugee Services in San Antonio.

Constantino is also an expert in mental health who worked for many years as a counselor, and she says this population is vulnerable to post-traumatic stress disorder.

“They saw the explosion in the airport where all those people died during the evacuation. We hear stories from Afghans about how they had to hide because the Taliban were actively shooting people. So, I would bet that the incidents of PTSD are going to be much higher than 50%,”

Not everyone who had these experiences has or will develop PTSD, and PTSD is not a diagnosis that occurs on a specific timeline.

“PTSD manifests itself in many ways, frequently by depression, inability to sleep and ability to have your normal system functioning,” said Alexander Shepard, an attending doctor at the UT Health San Antonio Refugee Health Clinic. “There are negative symptoms and positive symptoms. The negative symptoms are you withdraw, the positive symptoms are you actively cry and so on. And so, we see a lot of that.”

The Refugee Clinic is student run, and offers basic primary care, but it also offers visits with a psychiatrist twice a month, where refugees can seek support and perhaps medication, if appropriate. The psychiatrist has a waiting list.

Sedeqi now works at the clinic. Back in Afghanistan, he was a doctor who directed a hospital and worked with the U.S. Army.

“I help Afghan people with health-related issue like translating or go to their homes to give them health education. But I miss my practice because I am a surgeon,” he said.

Loss of status — of identity — are also issues that can cause refugees to experience anxiety and depression.

“More than 80%, even in a woman more than 90%…they have deep depression.”

An Afghan woman, who goes by Sediqi, has suffered identity loss. She is college educated, in physical therapy and worked for the Red Cross for 15 years.

“I was working there as a prosthetic and orthotic,” she told TPR’s Military and Veterans Issues Reporter Carson Frame. “I was in charge there.”

She left her job behind. Her family. Everything. She had a baby and spent most of her time with her infant alone in her apartment while her husband worked.

“I changed to a professional life to be a mother or wife and in the house,” she said. “I think it takes time to get familiar with this situation.”

Afghan culture is still gender-segregated, even after more than 20 years of American influence, and Margaret Constantino said many women — like Sediqi — are suffering, in part, because they are isolated.

“We’ve seen women who have not gone outside the door in six months,” she said. “How does anybody stay healthy in that kind of environment?”

So Constantino said her organization starts there.

The Center for Refugee Services hosts activities like cooking classes, walking groups, and teas.

Women — some educated, multilingual Afghan women and some who can’t read or write in their own language — sit on thick rugs in a segregated area of an Afghan restaurant, watch their children play, break bread, and laugh.

Chinar Sedeqi, the Afghan doctor, said now that they’re safe from the Taliban, even with all their other challenges, the greatest obstacle to emotional healing is uncertainty — specifically their uncertain legal status.

“Because still now, you know, we don’t have permanent residency. We have just parole status. So, in this condition, we are not able to go ahead. We are still under pressure. My family is still under pressure because we don’t know about our future.”

If his family gets permanent residency, Sedeqi said he will immediately begin to do whatever it takes to become recognized, and practice, as a doctor in the United States.

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