By Kendra Sitton
July 21, 2020 (San Diego) - An estimated 35,000 torture survivors reside in San Diego County. Only one torture treatment agency is accredited to serve this vulnerable population in our county: Survivors of Torture, International. East County Magazine spoke with Survivors’ Community Relations Manager, Katrina Pimental, about their clients’ experiences during the pandemic.
Many are facing job loss without access to government help. Mental health issues such as PTSD are triggered by lockdown measures which remind them of house arrest. Many don’t qualify for CARES Act benefits and are struggling financially. Some have gone without food for days. Their asylum claims are in limbo.
Our interview delved into these issues, as well as how the nonprofit is responding.
Q: What are some of the top issues your clients are facing right now during the pandemic?
A: To start with, for those who aren't familiar, we serve torture survivors, at this point from over 90 different countries who have fled government-sponsored, state-sanctioned or politically-motivated torture in their home countries. We serve anyone regardless of immigration status who has experienced torture under those definitions.
However, the majority of our clients each year have been asylum seekers. We've been serving San Diego County for 23 years, even prior to asylum seekers being more mainstream news. Since 1997, they've been the majority of our clients. So last year, over 80% of our clients were asylum seekers. [With] torture survivors, the focus of what we do is helping them navigate the mental health and physical health, trauma they experienced, and have continued to experience after torture and to help them heal. But with the asylum seekers, it’s also supporting them in that journey by providing forensic evaluations that can support their asylum cases, so it's kind of a wraparound care and services.
And the reason I expand on that is that the experience of an asylum seeker torture survivor, though it shares similarities with the refugee torture survivor, they have less support systems in place--and they have less access, or may not have access at all, to public benefits. So one of the first pieces is that — this is true pre-COVID-19 and has been highlighted even more greatly during COVID-19 — Survivors [of Torture] can often be for many of our clients not only the biggest support system, but sometimes the only support system or only safety net. So that also affects where they can get help and how they can get help. Survivors becomes their place of support, not only because they trust us and because they trust the process of Survivors to receive services there, but because often asylum seekers aren't a part of the conversation for other types of benefits.
Q: So how has Survivors adapted services to be virtual?
A: We wanted to provide as many services as possible that were virtual. That has grown and evolved. We have an office in Old Town and the services that we provide take place both at our office in Old Town, but [also] through a network of contracted mental health providers throughout the county to help decrease the barriers that clients could face via transportation or work schedule or location.
What it looks like with COVID is we realized that network would have to move virtual. First and foremost, we had to find a platform that would not only protect the mental health and private healthcare information of our clients, but also would support the sensitive nature of the fact that they're here because they were targeted in their home countries; we would never want the platform we were using to be a risk factor and people discovering where they were living or what they were doing, because often they could still become a target again, if that happened. It's not just their private health information, it's also the safety of where they are and that they're living here alone, often to flee [from] that.
So we found a platform that we could use and we started providing treatment over the phone or by video platform…The first few weeks was calling to see 'Are you okay? Do you still have your job? Do you have an income coming in? How's your housing? How are your basic needs being met? Or, how are you feeling about COVID-19? Do you have access to a face mask? Are you able to social distance? Do you understand that information that's being put out by the CDC or WHO?' because for many of our clients, they speak many languages. They're from 90 different countries. So, just as many languages and dialects. For some, maybe they do speak Spanish or maybe speak some Vietnamese or some of the other major translated languages, but they also speak in Creole or a language called Twi and they see that CDC information wasn't translated into their language. We use professional interpreters, so we also wanted to make sure that all of our clients have the up-to-date information about the pandemic so they can make educated and safe choices for themselves and their families.
That was the first step: 'Do you understand what's going on? What support you need from us?’ And what came out of those conversations is, for many of our clients [was], ‘I have been furloughed from my job.’ 'I worked in the hospitality industry. 'I worked in the service industry and I wasn't an essential worker and so I've lost my job.' 'I have no income.'
Another thing was, 'I don't have access to resources like a food bank because I take club public transportation. I don't own a car so I can't participate in the drive thru food things and I don't want to take public transportation because of the pandemic for safety reasons.' So one person said, 'I just had major surgery before the shelter in place. I have no access to leave the home. I haven't had access to food. I haven't eaten in over three days.'
Things like that started to come out from these conversations. Also, for some of our clients because of their immigration status, they didn't qualify for this stimulus check or other public benefits. They didn't have access to that. Their asylum case is still pending, they're still living in limbo so their access to services, often was limited to just Survivors. The first step was we started doing basic needs drop offs with food. Our clinical case managers jumped into action and started delivering in a socially-distanced, contact-free way, food and supplies to our clients. The more conversations and virtual services we had, those food deliveries turned into food and diapers, turned into food and hygiene products, turned into food and cleaning supplies. Volunteers started making face masks for our clients, so it turned into food and face masks and hygiene products and everything. We all have needed to stay safe during the pandemic. So that was the first step.
Then the second step was as the pandemic continued, so did the isolation. With increased isolation, comes increased mental health symptoms like stress and anxiety and depression, and some of the clients even said, 'It reminds me of house arrest back in my home country.' We recognize that of course we need to continue our individual therapy and our clients also still have access to virtual psychiatry with our partnership with UCSD. So, all the phones became virtual, because we are always client centric and the clients were saying we need these services and so we showed up to provide those services, just in a different format.
Q: With your regular services being client centric, it's very easy to tailor exactly what you do for each individual. Has that ability been flattened while everything is virtual?
A: I would say yes and no in the sense that no, our bread and butter is individual client interaction and walking with each client on their individual path to healing. So overarching, our clients have a lot of similarity in the sense that they're all torture survivors. They were all forced to flee the countries they were living in to provide safety for themselves and their families. They of course have mental health, physical health trauma. When they come to this country, often they don't have access to services, outside of Survivors, or they're isolated. All of those similarities together, but each of our clients, their symptoms are different, their trauma is different, their story is different; why they were tortured is different, because of their identity — like where they're from, the color of their skin, the language they speak, their identity in America. They still navigate the United States differently because of who they are. We have to be nuanced about the ways in which we help them heal. That has translated that the case management is tailored, the clinical and medical case management is tailored to what the client needs and who they are, the individual therapy is tailored, and the psychiatry, if a client's participating, is tailored.
What has been difficult is we haven't found a way to effectively practice group therapy virtually. We're exploring things like music therapy that could be a way to do group therapy without needing to all speak the same language because in our group therapy, we each client often has their own interpreter and their own language. Over virtual, it's kind of a cacophony of sound. We're trying to explore how to be creative so that the clients still have that sense of connection. In person, we're able to offer healing clubs and get together in the community and do things like hiking or art therapy and we're trying to find a way to recreate virtually that sense of 'I belong,' that community through the group activity. Those are kind of the things that have shifted for us.
We also have a program in the school. We have children and family therapists in the Cajon Valley School District that we serve. We serve out of a middle school and elementary school. We work with refugee and newcomer youth, and we provide individual and family therapy at this school district, which we're very proud of. We've been able to continue to provide that individual and family therapy.
However, we also had a group in school and after school program with the children called Power Up. That's another program where we still need to get creative about how can we offer that service?
We're making sure we're providing all of our core services, that no client falls through the gap, and then shifting our thinking and the tools we use to try to get even more creative because we know COVID is a long journey. We want our clients to have access to as much as possible. It's still individualized but we're hoping to expand, even further the type of services we can creatively and effectively provide in a trauma-informed way. We don't just want to say 'Oh, we did group therapy in person so we have to do it virtually,' unless it's going to work and be meaningful for the client.
Q: How has the resilience of your clients played into how they've survived the pandemic?
A: Our clients are incredibly resilient. Our clients have survived, physical, sexual, psychological torture. They have fled those countries to protect themselves and their family, and they have often had to travel between handfuls to almost a dozen countries often before they find a safe border at Tijuana/San Diego. The amount of incredible resiliency to just survive the torture they experienced, to flee that torture and to make their way to the US, and to still be willing to engage in programs and services to create community, to have the ability to still want to connect after the incredible amount of inhumanity that was placed upon them, that the torturers placed upon them--it's just incredible to witness because they obviously experienced an extreme amount of trauma and deserve trauma-informed, culturally-responsive, holistic, individualized services.
I don't want to diminish the trauma, but I do want for people to walk into a client's shoes of everything they survived, and they're still getting up every day and going to therapy or creating community or parenting or being a spouse, being a hard worker, showing up to their jobs, holding all of that inside. The vulnerability and humility to engage with the mental health providers, to still believe in the American dream and to want to be a part of our community--it's just the definition of resilience. With treatment, with care, with specialized help, they flourish. Our clients have hope. They rebuild their lives. They are and continue to be wonderful neighbors and community members and an essential piece of the fabric of this county. COVID-19 is no different. They don't diminish the social responsibility of COVID-19. They recognize the need to be there for each other, participate in social distancing, to wear a mask, to do their part, but at the same time, they've already seen so much loss and grief and trauma in their lives that they bring themselves to continue working hard, to continue moving forward, to not give up. It is a privilege to do this work.
Q: That's all the questions I had unless there was something else you wanted to make sure I included?
A: Obviously this global public health crisis affects everyone, the whole entire world, the entire population of San Diego County. There are many vulnerable populations being affected and deserving of community support. However, I want to make sure people recognize that there are a significant number of torture survivors living amongst us. There's an estimated 35,000 torture survivors in our county and that population doesn't always get included in the conversation. They don't normally include it in the list of vulnerable populations.
With Survivors being the only torture treatment agency, we want to ensure that they are included in that conversation. That when people think of vulnerable populations during COVID and beyond, that that's a population that is considered and that there's support and planning around, because they have unique needs and they need that specialized care. I want to just make sure that they're a part of the conversation or a part of folks' hearts or minds when they're thinking about who's being left out of our community support right now.
I think it's important to recognize that our clients, when they come here, often they're isolated. Maybe some of them have their families with them but not all. Some of them create community but not all just because of unique needs. So often Survivors is that only sense of home, that only safety net, that the only support system. COVID-19 has just further exacerbated those barriers because what it does is it increases isolation and it increases economic instability and it increases the focus of them being left out of the conversation. That's why it was so important for me to share with anyone who reads this, that they're deserving of being included and uplifted.
Kendra Sitton is a local editor at San Diego Community Newspaper Group who also serves as the editor of San Diego Uptown News and Downtown News. A freelance reporter for ECM and other publications, she has won awards in 2019 for her articles on San Diego Police Department policies regarding transgender civilians and other LGBTQ issues. She holds a degree in mass communications with minors in sociology and global cultural studies at Concordia University Irvine. Her coverage for ECM has included border, immigrant and refugee communities, COVID-19 coverage, land use issues and the recovery of Deerhorn Valley ten years after the Harris wildfire.
East County Magazine gratefully acknowledges the Facebook Journalism Project for its COVID-19 Relief Fund grant to support our local news reporting including impacts on vulnerable communities during the COVID-19 pandemic. Learn more: #FacebookJournalismProject and https://www.facebook.com/fbjournalismproject/.
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