Una Tremenda Experiencia

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Una Tremenda Experiencia

Yo me llamo Rafael y quisiera compartir un poco sobre quien soy yo y sobre mi experiencia con el programa PASEO. Hasta los diez años viví en diferente albergues en Venezuela. Es difícil recordarme de los hechos que hicieron voluntarios extranjeros que tal vez me dieron regalos o donaron dinero. A la vez, es muy fácil recordar aquellos voluntarios quienes llegaban a los albergues y simplemente me daban su presencia total ligado con un profundo amor. Esa combinación de amor y presencia me ha impactado profundamente hasta el momento. Desde pequeño aprendí sobre la influencia positiva que puede tener una persona hacia los demás, como tuvieron otros conmigo. Desde aquellos tiempos en los diferente albergues yo he tenido una meta de querer darle a otros lo que me dieron a mi de niño, mi presencia total combinada con amor. Después de haberme graduado de la universidad, me fui en rumbo hacia un orfanato en Honduras por dos años y pico para lograr mi meta de amar a los niños con amor y presencia total. Fue una experiencia muy linda, la cual me dejo con ganas de repetirla. Después de un par de años mi esposa y yo fuimos a Perú por tres años para ser voluntarios en una escuelita de niños especiales, la cual también fue una experiencia muy bonita. Yo quería aun que sea tener la influencia de hacer sonreír a un niño por día; algo sencillo y pequeño pero a la vez muy grande para mi.

Mis experiencias en Honduras y Perú me fueron Excelentes! Por fin me siento que he logrado mi meta y que todavía puedo seguir lográndola con cualquier trabajo que se me presente. Desde entonces, he querido tener un impacto aun mas profundo todavía. No solo quisiera tener un impacto con individuales pero con la familia de esos individuales. Por ese motivo he decidido regresar a los estudios y ganarme una maestría en trabajo social con un enfoque en sistemas familiares y salud mental. Siempre me ha gustado trabajar con Latinos pero muchas veces no me he sentido capaz o bien preparado. Por ese motivo yo buscaba un programa que me pudiera capacitar aun mas para trabajar con población Latina.

Tuve la suerte que un día una amiga me conto de PASEO. Este programa era exactamente lo que buscaba para prepararme aun mas para trabajar con Latinos. Muchos me decían que yo ya soy Latino y que para mi este programa no tenia sentido o no era necesario. Resulta que ellos estaban totalmente equivocados. PASEO me ha ayudado bastante con respecto a la cultura Latina Americana, un vocabulario de psicología mas profesional, y me ha hecho pensar críticamente que no todas las culturas caben en un solo molde. Para tener mayor impacto se necesita estudiar la cultura y tener mucha practica expresándose con el vocabulario necesario de psicología. Así que para mi PASEO ha sido una tremenda experiencia, la cual valoro mucho por todo lo que me enseño. Brie es una tremenda profesora de psicología de alta calidad y aprendí mucho con ella.  Tuve la oportunidad de poner en practica lo que estaba aprendiendo y con supervisión en español, la cual es crucial. Cualquier persona que sea Latin@ y tiene aun que sea un mínimo interés en PASEO, yo digo que sin duda le valdrá la pena. El hecho de poder hablar Español bien simplemente no es suficiente.   

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Agradecida.

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Agradecida.

by Mojdeh Motamendi, PASEO Student, May - June 2016.

... As my interests are especially in global mental health and I have often travelled abroad, this experience has stood out as one of the most educational; it has allowed me to really get a better sense of services and personally get to know service providers abroad.

¡Que experiencia! ¡Que vida! Wow, what an incredible time it was with PASEO in Peru. I am so extremely grateful for the experiences I had with PASEO. As an Iranian U.S. immigrant, having grown up in Southern California, and having always been surrounded by other recent immigrants, I have always advocated for increasing mental health services among diverse, low resourced communities that struggle with stigma, especially abroad. Thus, it was a no brainer for me to apply to PASEO and I feel so lucky to that PASEO accepted me into the program despite my low-intermediate Spanish speaking abilities.

PASEO provided me with a unique window into a world of things I would have never experienced otherwise. Through PASEO, I had the opportunity to see how mental health is and isn’t addressed first hand from many angles and communities – from the perspectives of migrant, overworked mothers with limited resources; prevention programs delivered in urban schools; youth in new shanty settlement communities on the coast; and abused youth and their service providers with a history of living in the mountainous areas that were recipients of significant terrorism.  Across these contexts, I also had the opportunity to think through how to adapt the provision of services to be culturally appropriate and taken in within each subculture.

As my interests are especially in global mental health and I have often travelled abroad, this experience has stood out as one of the most educational; it has allowed me to really get a better sense of services and personally get to know service providers abroad. The classes PASEO offered helped supplement this as I was exposed more to global mental health models. While it is incredibly frustrating that global mental health services are still so limited, it is very exciting to see such admirable programs like PASEO. I am incredibly grateful for my experiences with PASEO as it has helped me better understand the realities of increasing the dissemination of mental health services in a culturally competent manner. Also, as a person who has been lucky enough to volunteer abroad several times, I was very impressed by the ethics and standards of practice that PASEO abided by. This experience has taught me to hold myself to higher standards for what and how to provide appropriate services. Through PASEO, I feel more aware and prepared for what it takes to provide services in low-resourced, culturally diverse communities. Living in a country as diverse as the U.S. and working in a mental health field which desperately needs to spread more into low resource communities around the world, such intensive emersion programs are a must for all mental health providers.

On top of all that, the beauty of PASEO was that not only everything one learns through the program but also, it was set in one of my favorite countries in the world, Peru. The culinary tastes, the amazingly warm-hearted people, the music, and the vibrant colors and diversity of fabrics, artisanal crafts, people and topography made for the perfect environment that excited all of one’s senses while participating in PASEO. It was truly a mix of special, heart touching experiences. Through PASEO and the amazing people I met (Peruvians and other people in the programs), I have grown so much in so many ways. I don’t usually visit countries more than once but this was my second visit to Peru and I fell even more in love with it. There is no question about the fact that I will return to Peru again as it captures my heart every time I visit. Hasta pronto, Peru! 

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Domestic violence threatens maternal and child well being in urban migrant communities in Peru

Poverty is becoming increasingly urbanized across low-and middle-income countries. Families are moving away from their rural places of origin in search of economic and educational opportunities and medical and social services not available in rural communities. In Latin America, ongoing civic violence in rural areas and a legacy of targeting indigenous groups has accelerated the push of migrants into cities. Despite seeking better living conditions, urban migrant communities face significant risk factors for ongoing poverty, poor physical health, family dissolution, and compromised mental health.
— Kohrt, Barrueco, & Pérez, 2015

In 2010 and 2011, PASEO’s director, Brieanne Kohrt, investigated the prevalence and correlates of maternal depression amongst urban migrant women in Peru. Findings revealed that nearly 2 in 3 women met criteria for clinical depression. The largest risk factor for depression- beyond poverty-beyond low social capital- beyond educational disparities- was present domestic violence. 66% of women reported experiencing some kind of domestic violence (DV) at the time the study took place- albeit physical, emotional, or sexual. This rate is higher than any other study to date in Latin America.

Increased overall violence in urban migrant communities, combined with low police presence, high access to alcohol and low job opportunities for men, and social marginalization of migrants likely creates an environment where IPV (intimate partner violence) is distressingly commonplace.

In addition, domestic violence impaired women’s parenting abilities. Women in situations of DV had less energy for parenting, were less warm, and engaged in fewer parenting activities crucial to children’s socioemotional and cognitive development. Children living in situations of domestic violence had greater levels of internalizing behaviors (e.g. depression or anxiety symptoms, social withdrawal, and low self-esteem). Impaired parenting partially explained the relationship between DV and children’s internalizing behaviors.

Latina women are embedded in a culture that places the utmost importance on the mother/child relationship, thus having a low level of warmth is rare and significant. Latina women who experience DV report less attachment to their children and more isolation than non-Latina mothers who experience DV.

Based on findings from this study, we have worked with our partner NGO, SKIP, to try to continue and further programs that slowly but systematically reduce the likelihood of domestic violence in urban migrant communities such as the community of El Porvenir, where SKIP works. This includes individual and couples therapy with women experiencing DV and their partners and social work charlas on what constitutes DV and where to get help in the community. However, this also includes indirect and holistic strategies, including classes for secondary students on characteristics of healthy and unhealthy relationships, psychoeducational groups for children on alternative methods for resolving conflicts to reduce aggression, working with new parents to encourage attachment behaviors with their infants, and providing economic development support, such as microloans and budgeting workshops, as financial stress and lack of job opportunities for men are thought to exacerbate DV.

While a start, this is not enough. Further research is needed on the men in this community- not only those who perpetrate abuse, but also those who ceased violent behaviors or never engaged in them in the first place, so that their resilience can be learned from and passed on to others. A better understanding of men’s identity- as fathers- as husbands- as Peruvians- as migrants- is needed to be able to promote healthy family functioning.

Finally, there is a greater need for mental health services in these communities. Two in three women met criteria for clinical depression in this urban migrant community- and while all will not require psychiatric or psychological support, having the option to seek such services is necessary. Less than 2% of the government health budget across Latin American countries goes to mental health, and little of this is channeled to domestic violence services or care for common mental illnesses such as depression or anxiety.

Treatment for depression in women in urban migrant communities needs to be creative. Women need to be empowered and educated- respected and heard. Holistic and systemic interventions- and a focus on training and task-shifting, are a crucial step. Programs that train trusted lay people in the community to deliver social support and skills-based treatments is feasible and has been successful in such places as Uganda, Pakistan, and India. However, there needs to be investment- financial and emotional- from governments, NGO’s, communities, and individuals, to make these types of programs effective and sustainable. Mental health for all needs to involve all. 

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Una pequeña saltamonte decide dar un PASEO por Peru

by Ali Guisto

Wow! I cannot believe my time is already up in PASEO program. My name is Ali. I am a rising 3rd year clinical psychology doctoral student who participated in the PASEO program and worked with SKIP for 4 weeks this summer.

I was initially drawn to the program for a number of reasons.  Personally and clinically, PASEO provided an opportunity to improve my Spanish to be able to conduct therapy and assessments with Spanish- speaking clients. While this is an ongoing goal of mine, it has been difficult to realize given the limited opportunities for Spanish-speaking training. As an incoming low/intermediate speaker, the opportunity to take Spanish classes increased my confidence in having the language tools to get the most out of an immersion experience. Supplementing such learning with an understanding of cultural competency and adapted evidence-based practice for Latino populations seemed like an integral piece to such training that was offered by PASEO. Further, the ability to learn and train in an immersive environment abroad seemed like a dream come true (cheesy, but true!). Lastly, the program also appealed to my research interests in global mental health providing not only seminars in the topic, but the chance to actually see mental health services abroad. Really only one of these reasons would have attracted me to the program, but having so many just compounded my excitement J.

Amazingly, over my time working with SKIP and in the program, all my expectations were met and exceeded. I feel that I have a much stronger foundation in language skills that will be the starting point from which to continue my training and learning.  General Spanish classes, those specific to psychology, immersion and exposure to the language all worked together to facilitate such a foundation.  (I would write the next sentence in Spanish but don’t want to show offJ). Classes in cultural competency, global health, working with Latino youth and families, and working in low-resources settings enhanced my appreciation for the immersion experience, the field, the people, and the immense need.  I felt that this all culminated to then being able to actually work and interact with youth and families in the area through service-learning. Teaching and working with the families themselves was invaluable. Being able to actually learn from the youth and families in the community with every interaction defined much of my experience in the program. (Also seeing the look on a child’s face when he or she does not understand you in Spanish is a quick way to really begin and try learning the language without embarrassment.) Further being able to observe and participate in groups and workshops for youth and mothers began to teach me how to use the language and clinical techniques specific to working in this community.  For example, watching how the psychologist would introduce topics such as discipline strategies or suicide in a safe and effective manner was important to my clinical skill development.

While I think it should be obvious by now my feelings about this experience, there were two more aspects of PASEO and SKIP that shaped my time. That was working and learning in Peru and the people. Being in such a culturally rich, welcoming, and warm country I felt flooded by opportunities to learn from everything around me. The families at SKIP further embodied such openness and welcoming. Lastly, the people involved in the program (and outside the program) were wonderful. I left the program with a network of individuals who are all passionate about contributing to minimizing the need for mental health services for Latino youth and families. I believe that this network, along with continued supervision of my individualized goals through the program, will help me improve as a Spanish speaker, clinician, researcher and student. The amount I learned through the experiences in this program is hard to describe, but I feel very agradecido por it all. I hope to be back soon!!

Ali and some SKIP volunteers go Sandboarding in Lago Conache, cerca de Trujillo

Ali and some SKIP volunteers go Sandboarding in Lago Conache, cerca de Trujillo

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