people from burma living in chapel hill and carrboro an action-oriented community diagnosis

People from Burma Living in Chapel Hill and Carrboro

An Action-Oriented Community Diagnosis:

Findings and Next Steps of Action

May 25, 2007

Team Members: Rebecca Cathcart, Caytie Decker, Megan Ellenson, Anna

Schurmann, Michael Schwartz, and Neha Singh

Preceptors:

Susan Clifford, Orange County Health Department Meaghan Tracy, Lutheran Family Services in the Carolinas

Instructors: Eugenia Eng, DrPH, Kate Shirah, MPH, Dionne Smith, PhD, and

Jim Amell, PhD

Completed during 2006-2007 in partial fulfillment of requirements for HBHE 741 Department of Health Behavior & Health Education

School of Public Health University of North Carolina at Chapel Hill

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Acronym List AOCD Action-Oriented Community Diagnosis CFPC Community Forum Planning Committee DHHS Department of Health and Human Services DOS Department of State ESL English as a second language GED General Educational Development IOM International Office of Migration LFS Lutheran Family Services in the Carolinas NGO non-governmental organization OCHD Orange County Health Department ORR Office of Refugee Resettlement SPDC State Peace and Development Council R&P Reception and Placement Program TB tuberculosis UNC University of North Carolina USCIS United States Citizenship and Immigration Services

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TABLE OF CONTENTS EXECUTIVE SUMMARY.................................................................................................................... 6 1. INTRODUCTION.............................................................................................................................. 8 2. BACKGROUND................................................................................................................................ 12 Historical Context of People from Burma.................................................................................... 12 Historical Context of Refugees from Burma................................................................................ 13 Resettlement in the U.S................................................................................................................. 13 Introduction to American Society................................................................................................. 14 Arriving in the Triangle of North Carolina……………………………………………............... 15 The Community of People from Burma living in Chapel Hill and Carrboro……….….............. 16 The Towns of Chapel Hill and Carrboro…................................................................................... 18 3. METHODOLOGY............................................................................................................................. 21 Defining the Community, Gaining Entrée, and Team Observations…………………................ 21 Secondary Data Collection and Analysis...................................................................................... 22 Primary Data Collection through Interviews and Participant Observation ………...................... 23 Interview Guide Development……………………….………………………............................. 23 Conducting Interviews and Focus Groups.................................................................................... 24 Data transcription, Coding, and Analysis..................................................................................... 25 Planning the Community Forum................................................................................................... 26 4. FINDINGS.......................................................................................................................................... 28 Adult Education............................................................................................................................ 28 Community Member Perspective........................................................................................ 28 Service Provider Perspective............................................................................................... 29 Team Perspective................................................................................................................ 30 Comparison of Community Member, Service Provider, & Team Perspectives................. 30 Community Forum Discussion & Action Steps.................................................................. 31 Additional Team Recommendations................................................................................... 32 Community Organization.............................................................................................................. 32 Community Member Perspective........................................................................................ 32 Service Provider Perspective............................................................................................... 33 Team Perspective................................................................................................................ 33 Comparison of Service Provider, Community Member, & Team Perspectives................. 34 Community Forum Discussion & Action Steps.................................................................. 34 Additional Team Recommendations................................................................................... 36 Health Knowledge......................................................................................................................... 36 Community Member Perspective........................................................................................ 36 Service Provider Perspective............................................................................................... 37 Team Perspective................................................................................................................ 37 Comparison of Community Member, Service Provider, & Team Perspectives................. 38 Community Forum Discussion & Action Steps.................................................................. 38 Additional Team Recommendations................................................................................... 40 Interpreter Services....................................................................................................................... 40 Community Member Perspective........................................................................................ 40 Service Provider Perspective............................................................................................... 41 Team Perspective................................................................................................................ 41 Comparison of Community Member, Service Provider, & Team Perspectives................. 42 Community Forum Discussion & Action Steps.................................................................. 42 Additional Team Recommendations................................................................................... 43 Additional Themes........................................................................................................................ 43 5. LIMITATIONS................................................................................................................................... 45

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6. CONCLUSIONS................................................................................................................................. 47 REFERENCES................................................................................................................................... 49 APPENDICES.................................................................................................................................... 52 Appendix A: Interview Materials – Project Description, Guides, Fact Sheets............................. 52 Appendix A1: Project Description (English)...................................................................... 52 Appendix A2: Project Description (Karen)......................................................................... 53 Appendix A3: Project Description (Burmese).................................................................... 54 Appendix A4: Community Member Interview Guide (English)........................................ 55 Appendix A5: Community Member Interview Guide (Karen)........................................... 59 Appendix A6: Community Member Interview Guide (Burmese)...................................... 65 Appendix A7: Service Provider Interview Guide............................................................... 71 Appendix A8: AOCD Fact Sheet (English)........................................................................ 76 Appendix A9: AOCD Fact Sheet for Service Providers..................................................... 78 Appendix A10: AOCD Fact Sheet (Karen)......................................................................... 80 Appendix A11: AOCD Fact Sheet (Burmese).................................................................... 83 Appendix B: List of Interviewees................................................................................................. 86 Appendix C: List of Secondary Data Sources............................................................................... 87 Appendix D: Community Forum Materials.................................................................................. 92 Appendix D1: Community Forum Program........................................................................ 92 Appendix D2: Community Forum Invitation...................................................................... 112 Appendix D3: Community Forum Flyer (English)............................................................. 113 Appendix D4: Community Forum Flyer (Karen)............................................................... 114 Appendix D5: Community Forum Flyer (Burmese)........................................................... 115

Appendix D6: Key Words for Discussion Groups at Community Forum to be used as an Aid by the Interpreter............................................................................................... 116

Appendix E: Additional Themes...................................................................................................120 Appendix E1: Changes in Family Dynamics...................................................................... 120 Community Member Perspective................................................................................. 120 Service Provider Perspective........................................................................................ 121 Team Perspective.......................................................................................................... 121 Comparison of Community Member, Service Provider, & Team Perspectives........... 122 Team Recommendations...............................................................................................122 Appendix E2: Ethnic Identity.............................................................................................. 123 Community Member Perspective................................................................................. 123 Service Provider Perspective........................................................................................ 123 Team Perspective.......................................................................................................... 124 Comparison of Community Member, Service Provider, & Team Perspectives........... 124 Team Recommendations.............................................................................................. 124 Appendix E3: Education for Youth..................................................................................... 125 Community Member Perspective................................................................................. 125 Service Provider Perspective........................................................................................ 126 Team Perspective.......................................................................................................... 127 Comparison of Community Member, Service Provider, & Team Perspectives........... 127 Team Recommendations.............................................................................................. 127 Appendix E4: Divisions within the Community................................................................. 129 Community Member Perspective................................................................................. 129 Service Provider Perspective........................................................................................ 130 Team Perspective.......................................................................................................... 130 Comparison of Community Member, Service Provider, & Team Perspectives........... 131 Team Recommendations.............................................................................................. 131 Appendix E5: Domestic Violence....................................................................................... 132

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Community Member Perspective................................................................................. 132 Service Provider Perspective........................................................................................ 132 Team Perspective.......................................................................................................... 133 Comparison of Community Member, Service Provider, & Team Perspectives........... 133 Team Recommendations.............................................................................................. 133 Appendix E6: Institutional Literacy.................................................................................... 134 Community Member Perspective................................................................................. 134 Service Provider Perspective........................................................................................ 135 Team Perspective.......................................................................................................... 135 Comparison of Community Member, Service Provider, & Team Perspectives........... 136 Team Recommendations.............................................................................................. 136 Appendix E7: Knowledge of Community........................................................................... 137 Community Member Perspective..................................................................................137 Service Provider Perspective........................................................................................ 137 Team Perspective.......................................................................................................... 138 Comparison of Community Member, Service Provider, & Team Perspectives........... 139 Team Recommendations.............................................................................................. 139 Appendix E8: Language Barriers........................................................................................ 140 Community Member Perspective................................................................................. 140 Service Provider Perspective........................................................................................ 140 Team Perspective.......................................................................................................... 141 Comparison of Community Member, Service Provider, & Team Perspectives........... 141 Team Recommendations...............................................................................................142 Appendix F: Code Lists for Analyzing Primary Data................................................................... 143 Appendix F1: Code List for Community Member Interviews............................................ 143 Appendix F2: Code List for Service Provider Interviews................................................... 148 Appendix G: Interpreter/Translator Contract and Invoice Form.................................................. 153 Appendix G1: Interpreter Contract..................................................................................... 153 Appendix G2: Interpreter/Translator Invoice Form............................................................ 154

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EXECUTIVE SUMMARY

An estimated 250 people from Burma live in Chapel Hill and Carrboro, North Carolina.

Although their physical living conditions have improved since leaving Burma or refugee camps

in Thailand, they face many challenges in their daily lives in Chapel Hill and Carrboro. From

September 2006 to April 2007, a team of six UNC public health graduate students conducted an

Action-Oriented Community Diagnosis (AOCD) with this population. The purpose of the AOCD

was to assess the strengths and challenges of the community in order to recommend steps for

planned change. However, since the AOCD process has several limitations, which are addressed

in section 5, the findings presented in this document should not be considered comprehensive or

definitive. Rather, they are intended to inform a new beginning for community members and

service providers to collaborate on building and improving community strengths to support and

mobilize positive change in the community.

The team was guided by two preceptors: Susan Clifford, Senior Public Health Educator at

the Orange County Health Department and Meaghan Tracy, Triangle Area Manager for Refugee

and Immigration Services at Lutheran Family Services in the Carolinas. Throughout the project,

team members studied various secondary sources to educate themselves about the community

and its history, attended community events and recorded observations, conducted 2 youth focus

groups, and interviewed 40 individuals – 17 service providers and 22 community members.

These data sources were analyzed, yielding 12 themes, or recurring topics concerning the

community.

To discuss the findings and potential action steps publicly, the team recruited a small

group of interested service providers and community members to join in organizing a community

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forum. This Community Forum Planning Committee (CFPC) reviewed the 12 themes identified

through data analysis, and selected the following four themes, which were presented and

discussed at the community forum to generate key action steps:

• Adult Education – Community members want to attend English as a Second Language

(ESL) classes to improve their English, but ESL class scheduling conflicts with work and

family life.

• Community Organization – A lack of organization hinders the community's ability to

help new arrivals, maintain culture, and improve the lives of community members.

• Health Knowledge – Lack of knowledge about U.S. health practices around personal and

home care makes it difficult for community members to stay healthy and access the care they

need.

• Interpreter Services – The lack of interpreters for the Burmese and Karen languages in

Chapel Hill/Carrboro prevents access to services and reduces their quality.

The forum was conducted in three languages – English, Burmese, and Karen – with the

help of local community interpreters and headsets allowing for simultaneous translation. Team

members led 4 small groups to discuss the themes selected by the CFPC. Action steps resulting

from the small group discussions as well as additional team recommendations are available in

section 4 in this document. The eight remaining themes that were not discussed at the community

forum are available in Appendix E. They include: changes in family dynamics, ethnic identity,

education for youth, divisions within the community, domestic violence, institutional literacy,

knowledge of community, and language barriers.

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1. INTRODUCTION

From September 2006 to April 2007, a team of six public health graduate students from the

University of North Carolina at Chapel Hill conducted an Action-Oriented Community

Diagnosis (AOCD)a with people from Burmab living in the towns of Chapel Hill and Carrboro,

North Carolina. The goal of an AOCD is to assess the strengths and needs of a community

through the community’s own perspective as well as the perspectives of service providers and

others involved in the community from the outside.1 An AOCD attempts this assessment by

using existing networks within the community along with the examination of secondary data, and

then encourages the community to identify specific action steps to address and move toward

resolving the issues revealed through this process. This document reports the methods and results

from: reviewing secondary data sources,c team participant observations,d 17 service providere

interviews, 23 community memberf interviews, 2 youth focus groups, and a community forum

a An Action-Oriented Community Diagnosis (AOCD) is a solution-based process that involves community members and service providers in recognizing both the strengths and the challenges of a given community so the community can then conceptualize and prioritize actions to take to capitalize on strengths and overcome some challenges.29 b The team has decided to name the population “people from Burma” rather than “Burmese refugees” since some community members who have lived in the U.S. for a number of years and are now naturalized citizens prefer not to be called “refugees.” Furthermore, the term “Burmese” is not inclusive of all community members since it can mean a particular ethnic group in some instances, and some community members do not refer to themselves in this manner. Because this community is made up of people of varying ethnicities not limited to Burmese, Karen, Rakhine, Chin and Mon, the team decided that referring to it as a community of “people from Burma” is more inclusive and appropriate. c Secondary sources include books, films, newspapers, and public documents that give multiple perspectives on the community. d The team perspective reflects team observations throughout the project and knowledge gained from reviewing secondary data sources. e The AOCD process defines service providers as community outsiders who maintain relationships with the community for professional and service oriented reasons. Though this definition is true for most service providers interviewed, some service providers are also community members and therefore have dual identities. For example, “Co-Sponsors” are volunteers from within a faith community who are trained by Refugee Resettlement staff to provide additional support to newly arriving refugees. While they are providing services to community members, they are providing them on a volunteer, and often a more personal basis. The team chose to interview these individuals as service providers to gain an outsider perspective on the community. f Community members were identified by the team as anyone who is a person from Burma living in Chapel Hill and Carrboro.

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that generated action steps from discussing the findings. This document marks the culmination of

the AOCD, and is intended to inform a new beginning for both community members and service

providers to collaborate on building strengths of the community of people from Burma living in

Chapel Hill and Carrboro.

1.1 Preceptors’ Roles

Preceptors are individuals with knowledge of and connections to the community of

interest for an AOCD. In addition to helping the team gain entréeg to the community, preceptors

also serve as a resource throughout the AOCD.

The AOCD of people from Burma living in Chapel Hill and Carrboro was initiated

through a request from the Orange County Health Department (OCHD) to UNC. Susan Clifford,

Senior Public Health Educator at the OCHD, and Meaghan Tracy, Triangle Area Manager for

Refugee and Immigration Services at Lutheran Family Services in the Carolinas (LFS), acted as

co-preceptors for the team. Ms. Clifford was selected by OCHD for her experience as a preceptor

of past AOCD teams, as well as for her ability to guide the team in identifying and gaining

access to relevant providers of health care and other services in Chapel Hill and Carrboro. She

recruited Ms. Tracy for her knowledge and experience resettling refugees from Burma in Chapel

Hill and Carrboro, as well as for her direct contacts with individuals from Burma and local

families and organizations that sponsor and support them.

In October 2006, both preceptors guided the team’s “windshield tour,” a drive through

Chapel Hill and Carrboro to introduce the team to the geographical locations of where people

from Burma live, work, shop, receive services, and send their children to school to allow the

team to form its first impressions of the community. Both preceptors also introduced the team to

a few key community leaders by organizing a meeting in October 2006. In addition, the g To gain access, familiarity, or acceptance in a community.

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preceptors identified secondary data sources for the team to review, initiated contacts and

referrals for the team to conduct interviews with both community members and service

providers, supported the planning and holding of the community forum, and committed to

assisting in the follow-though of action steps where pertinent.

1.2 Team’s Role

Since the role of the team conducting an AOCD is that of an investigator, the team must

follow a number of processes to assess the strengths and challenges of the community through

the eyes of both community members (insiders h) and service providers (outsiders i ). These

methods include: collecting secondary data, attending and observing community events,

collecting and analyzing primary data via individual interviews and focus groups, and planning

and facilitating a community forum, during which time the community comes together to address

the team’s findings and identify action steps to address needs (for a more detailed description of

the team’s methods, see section 3).

An AOCD cannot be conducted without the involvement of the community throughout

the span of the project. Moreover, the team is responsible for organizing the community in such a

way that members can take steps to address problems. Guy Steuart, founder of the AOCD

process, iterated that public health professionals “are ethically bound to take action to address

problems, as physicians are ethically bound to ensure medical treatment for patients they

diagnose with an illness or disability”.2 The team working with people from Burma living in

Chapel Hill and Carrboro prioritized gaining the support and involvement of the community h The team defined an “insider” as someone with an intimate knowledge of the community of people from Burma. Insiders were always members of the community. An insider’s viewpoint is particularly important since s/he has an innate knowledge of the community that can be used in mobilizing the community, as well as identifying its strengths and challenges not apparent to an outsider. i The team defined an “outsider” as someone who is not part of the community of people from Burma. An outsider’s viewpoint is valuable since s/he can examine the community with a degree of objectivity and can help in identifying strengths and challenges of the community that might be overlooked by those who are a part of it. Outsiders were predominantly service providers and the AOCD team itself.

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throughout the AOCD to facilitate community ownership of the project, as well as its outcomes.

For example, the team generated shared community ownership and capacity building during the

community forum planning committee (CFPC) meetings and activities. Through this project, the

team had the opportunity to engage with community members and service providers and learn

more about the structure and organization of the community – both necessary components for

conducting an accurate and thorough AOCD.

1.3 Defining the Community

Before conducting an AOCD, it is necessary to define the community in question. Steuart

discusses three concepts of a community definition that are relevant to the team’s experience of

working with people from Burma living in Chapel Hill and Carrboro: units of identity, units of

solution, and units of practice.2 Units of identity are defined by the members of the group,

neighborhood, or community based on shared sense of belonging such as common history,

geography, religion, or other demographic similarity. Units of solution are collaborations of

several units of identity and are often political in nature, whereas units of practice are defined as

the social units that outsiders place on what they feel are the boundaries or groupings of a

community.1 Effective units of practice are often those that are also units of identity.

In the context of this project, the team was assigned to a unit of practice – people from

Burma living within the geographic boundaries of Chapel Hill and Carrboro. Gaining entrée to

this population, however, led the team to discover numerous units of identity. Through

interviews and informal conversations with the community, the team discovered that while some

community members identified as one ethnic group, such as Karen or Burmese, others did not.

Often, units of identity were based on religion and political views in addition to (or in

combination with) ethnicity. Keeping these varying viewpoints in mind, for the purposes of the

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AOCD, the team defined the community as people from Burma living in Chapel Hill and

Carrboro.

The following section, which has been primarily informed by secondary data sources,

provides background on the community and its past and present geographic locations.

2. BACKGROUND

2.1 Historical Context of People from Burma

Burma, now called Myanmar by its ruling military junta, the State Peace and

Development Council (SPDC), is in mainland Southeast Asia and shares borders with China,

Laos, Thailand, Bangladesh, and India. Isolated, developing, and mostly rural, Burma has been

in a state of civil strife for the majority of the past half century.3 Burma’s complex history,

politics, and culture have been shaped by its diverse population, which includes over a dozen

ethnic groups (Burmese 68%, Shan 9%, Karen 7%, Rakhine 4%, Chinese 3%, Indian 2%, Mon

2%, other 5%).3 The dominance exerted by the Burmese over minority ethnic populations, has

been the source of severe ethnic tension and has resulted in a number of separatist rebellions.4

The ethnic, political, and religious persecution plaguing Burma has resulted in an average of

10,000 deaths per year for the past forty years.5 Showing little regard for the rights and

wellbeing of the poverty-stricken inhabitants of Burma, the economic policies and management

by the SPDC has exacerbated the country’s social and economic welfare.6 As a result, more than

25% of the population subsists on less than $1 a day, healthcare systems are deteriorating,

preventable infectious diseases are the country’s greatest health problem, and the country’s

education system is collapsing.7, 8

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2.2 Historical Context of Refugees from Burma

Seeking refuge from poverty, famine, war, and massive human rights violations including

murder, rape, torture, forced displacement, and human trafficking, the large exodus of refugees

from Burma began when the military seized power in 1962. Migration beyond Burma’s borders

further increased in the late 1980s, when the SPDC annulled the results of a general election,

declared martial law, and used military force to subvert the political party led by subsequent

Nobel Peace Prize winner, Daw Aung San Suu Kyi, who had been democratically elected to

serve as Prime Minister.3, 7, 9

Due to these events, to date nearly 1.5 million people are internally displaced, millions

more are forced to live as illegal migrant workers in countries bordering Burma, and over

180,000 are living in refugee camps in Thailand and Bangladesh.6, 10-13 Refugees living in these

camps do not receive assistance from their host governments, are prohibited to work, and often

only find support from officially approved non-governmental organizations (NGOs).14

Frequently the targets of military attacks, crammed into tight quarters without proper sanitation,

vulnerable to the rampant spread of infectious diseases, and unable to leave the confines of the

camp, the life of a refugee camp resident is arduous.12

2.3 Resettlement in the U.S.

The U.S. admits approximately 70,000 refugees annually, and those coming from Burma

comprise a small proportion of them, with only 4,689 entering the U.S. between 1996 and

2005.15 In 2005, the U.S. began a large-scale resettlement operation for refugees from Burma.

However, efforts stalled due to the Department of Homeland Security’s interpretation of

restrictions within certain laws on entry for all immigrants into the U.S. People who were

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thought to have provided “material support” j to groups the U.S. recognizes as terrorist

organizations were often classified as ineligible to be considered as refugees.6, 12 However, in

May 2006, Secretary of State, Condoleezza Rice, granted a waiver to 9,300 Karen residents of

the Tham Hin refugee camp in Thailand – however, approximately 20% remain statutorily

ineligible for a waiver because they received military training or were actively engaged in

resistance against the Burmese regime.12, 16, 17 Thus far, 1,085 refugees from Burma have been

resettled in the U.S. in 2007.18

2.4 Introduction to American Society

Cultural orientation for refugees from Burma begins overseas with a program run by the

International Organization for Migration (IOM) and includes instruction on elementary English,

American customs, and “everything from what an American bathroom looks like to how to shake

hands and use a toothbrush.”6 Federal organizations involved in the resettlement of refugees pre

and post arrival in the U.S. include the U.S. Citizenship and Immigration Services (USCIS), the

Department of State (DOS), and the Department of Health and Human Services (DHHS),

through the Office of Refugee Resettlement (ORR). Through the Department of Homeland

Security (DHS), USCIS determines which refugees meet requirements to resettle in the U.S.,

while the DOS works with the International Office of Migration (IOM) to coordinate the

logistics of resettlement, and provides the funds to sponsoring agencies to manage the Reception

and Placement (R&P) program for newly arriving refugees. Upon arrival, the DHHS provides

more extended financial, medical, and social support services at the State level for refugees.19

Upon arrival, refugees receive initial core services (e.g. support for basic needs, referral

to social services, medical screening, etc.) through the R&P program and a single stipend of

j Material support can involve transactions including both money (even forced payment of taxes) and resources (e.g., a bowl of rice).

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$425 per person in the family.19, 20 Refugees are eligible for specific public benefit programs that

usually include a small amount of monetary support to refugees, and health benefits, typically for

up to eight months after arrival, at which point they are expected to be employed and

economically self-sufficient. Since refugees have the same rights as legal residents of the U.S.,

families with children who are minors can qualify for Medicaid and other benefits if financially

eligible. Furthermore, refugees can apply for permanent resident alien status (Green Card) after

twelve months in the U.S. and can qualify for naturalized citizenship after five years of

residency.6

2.5 Arriving in the Triangle of North Carolina

Lutheran Family Services in the Carolinas (LFS) serves as one of two primary reception

and placement agencies for refugee resettlement in the Triangle area (Chapel Hill, Carrboro,

Raleigh, and Durham) of North Carolina. Based in Raleigh, as a recipient of funding through the

R&P program, LFS is required to ensure that all of the initial services (housing, clothing, food,

referrals to medical and social services) are provided to newly arriving refugees during their first

90 days in the U.S. Resettlement agencies such as LFS also connect refugees to extended case

management services, employment, ESL resources, and integration programs funded by the

Office of Refugee Resettlement (ORR) within the Department of Health and Human Services

during these first few months. The U.S. resettlement program is designed to function as a public-

private partnership, with offices like LFS playing the key role in this process. Many resettlement

offices also work with church groups and volunteers from local communities in order to find the

private support in providing services, as well as specific needs such as initial rental subsidy,

winter clothing, and household furnishings. In addition, due to the time spent and the strong

connections made, these volunteers often become life-long friends of refugees, providing

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important orientation to community services, as well as other supportive services such as tutoring

children after school, and teaching families how to shop, use public transportation, access

General Education Development (GED) classes, among other things. The goal of all agencies

and volunteers working with newly arriving refugees is to assist them to become empowered and

self-sufficient within their new communities.19

2.6 The Community of People from Burma living in Chapel Hill and Carrboro

Exact counts of the number and demographic characteristics of the people from Burma

living in Chapel Hill and Carrboro do not exist. Since 1997, LFS has served over 250 refugees

from Burma who have resettled and/or relocated to the Triangle. In addition, the NC State

Refugee Health Program, which maintains a database of all mandatory health screenings for

newly arrived refugees, indicated that 71 refugees from Burma relocated to Orange County

between 2000 and 2006 and accessed initial health screening services.21 This number, however,

did not include those refugees who had relocated to Chapel Hill and Carrboro from other North

Carolina counties or other states where they had initially arrived, or children born after their

parents had arrived. LFS staff and community members roughly estimate that more than three

times this number live in Chapel Hill and Carrboro.

Although the Karen are an ethnic minority in Burma, they are a refugee majority in

Chapel Hill and Carrboro and in the Triangle. Of the 250 refugees from Burma who have utilized

LFS services since 1997, 100 (40%) were Karen and 65 (26%) were Burmese. The remaining 85

(34%) are of other ethnicities.22

The history of ethnic tension in Burma influences relationships in the local refugee

community. For example, the Karen have been fighting other ethnicities for a separate state since

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Burma gained independence in 1948.3 Locally, the differing ethnic and religious groups are

united by common experiences in the refugee camps, but there are still distinctions between the

groups not limited to language, food, religion, and traditions. For this reason, the idea of a

unified community is relatively new, as the team discovered through conducting the AOCD.

2.6.1 RELIGION

Religion plays an important role in the community of people from Burma living in

Chapel Hill and Carrboro. Almost 90% of the Burmese are Theravada Buddhist.7 In Burma,

about 30% of the Karen are Christian, with Baptist being the most common denomination. The

other Karen religions are Animism (30%) and Buddhist (40%).7 However, in Chapel Hill and

Carrboro, the percentage of Christians is significantly higher as represented by the team’s

findings showing a relatively large Karen Baptist Church congregation.

2.6.2 HEALTH

There are a number of health issues faced by the people from Burma living in Chapel Hill

and Carrboro, primarily due to the living conditions experienced in the refugee camps in

Thailand. For the refugees resettling in Chapel Hill and Carrboro, health data are limited to those

recorded through required screenings conducted at local health departments within refugees’ first

month of being in the United States. State reports show that the following issues are commonly

identified during the routine health screenings: tuberculosis (TB), hepatitis B, scabies, lack of

immunizations, and various parasites.21 Since the complete physical exams for recently arrived

refugees are conducted at locations other than the local health department, those data are not

always reported back to state or county staff and are not available in aggregate form.

Secondary data also indicate that the community’s cultural beliefs about health may differ

from those widely held in the U.S. For example, many people from Burma believe that diet is

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essential to health, and is the cause of most health issues that arise. A change in diet, rather than

taking medicine, is recognized as a common technique to cure illness.7

2.6.3 CULTURAL NORMS

People from Burma are traditionally family and religion oriented. In Burma, families are

extended and often live together in this manner. Smaller nuclear families are more commonplace

in the United States since only a small percentage of refugees from Burma resettle in the U.S.3

Locally, as well as in Burma, elders are highly respected and disobedience to a parent is

considered unacceptable. Politeness among community members is expected, as is respect for

other people’s feelings. The ethnicities present in Chapel Hill and Carrboro, including Burmese

and Karen, are patriarchal societies, as men are considered to be the heads of households.7

2.7 The Towns of Chapel Hill and Carrboro

Located in the central Piedmont region of North Carolina, Chapel Hill and Carrboro have

over the years become a resettlement site for approximately 250 refugees from Burma. Both

Chapel Hill and Carrboro have a more ethnically diverse population and have a higher number of

foreign-born residents than the average for North Carolina, making it a more desirable place for

diverse communities to live.23 The unique history and characteristics of the towns shape the

experiences of the refugees.

2.7.1 HISTORY OF CHAPEL HILL AND CARRBORO

The Town of Chapel Hill is named after New Hope Chapel which stood at the top of the

hill at the intersection of what are today known as Columbia and Cameron Streets.24 The history

of Chapel Hill has been closely tied to UNC. The Town of Chapel Hill was founded on October

12, 1793, the same day as UNC, and the founders of the university appointed a committee to plan

a supporting town.25

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Similarly, the history of the Town of Carrboro is inextricably linked to Chapel Hill. In

1882, Carrboro was formed when a railway company opened a station one mile west of Chapel

Hill to accommodate travelers to and from UNC.26 The Town was originally called West Of (as

in West of Chapel Hill), and later West Chapel Hill. The town renamed itself to its current name

in 1914, after the Julian Carr family bought a significant cotton mill in town, and donated

electricity and streets to the community.26

Today, these two towns in Orange County continue to be closely tied together. An

emblem of their coexistence is Franklin Street, the main street in Chapel Hill, which seamlessly

becomes Main Street in Carrboro, the central business thoroughfare of the town. One could

easily assume that s/he is in the same town when traveling from one into the other. While there

are some differences between the two towns, their histories, demographics, and cultures have

shared many more similarities, and describing them together is often appropriate.

Chapel Hill and Carrboro encompass 25.3 square miles in area. Chapel Hill comprises 21

of those square miles while Carrboro lies within the remaining 4.327 As of 2005, there were an

estimated 65,968 residents in the two towns combined (49,543 in Chapel Hill and 16,425 in

Carrboro).23 The 2000 Census revealed that 77% of the population in the two towns was white,

12% black, 7% Asian, and 4% Hispanic.23

Between 1990 and 2000, both towns grew significantly, and their demographics changed

over that time. According to the 2000 Census, the total population for Chapel Hill and Carrboro

increased from 50,272 to 65,497 between 1990 and 2000. 23 Much of this growth is attributable

to the growth of UNCk and the expansion of Research Triangle Park.l In addition, foreign-born

residents of the towns increased by more than 110% from 3,954 in 1990 to 8,396 in 2000. The k Student enrollment swelled in the second half of the 20th century from 6,000 to more than 25,000 and the university now employs more than 22,000 people.28, 30 l Between 1990 and 2000, more than 42 new companies established facilities in Research Triangle Park.31

20

influx of nearly 2,000 Latinos in Carrboro over this time period contributed significantly to this

trend.23 Since that time, the rate of growth in both towns has slowed significantly.

2.7.2 INCOME/COST OF LIVING OF CHAPEL HILL AND CARRBORO

There are 11,269 families in the two towns and the median family income is $69,800.23, 28

The cost of living in Chapel Hill and Carrboro is significantly higher than the U.S. average as

well as Raleigh and Durham, the other two cities in the Triangle area.27 In addition, the average

home cost is $331,794 and the average rent for a two bedroom apartment is $864 per month,

both higher than the U.S. averages.28

2.7.3 EDUCATION IN CHAPEL HILL AND CARRBORO

Secondary data show that education is highly valued in Chapel Hill and Carrboro, in part due

to the presence of UNC. More than 90% of residents ages 25 and older have a high school degree

and nearly 75% have a college degree or higher.27 The equivalent U.S. averages are 80% for high

school and 24% for college.23 Chapel Hill-Carrboro City Schools achieve very high student test

scores in comparison to the rest of North Carolina and has the lowest dropout rate of any system

in the state. The per-pupil student expenditure is $8,424.28

2.7.4 EMPLOYMENT IN CHAPEL HILL AND CARRBORO

UNC is the largest employer in the area. The university and UNC Health Care employ more

than 22,000 people, over 10 times more than any other employer in Chapel Hill or Carrboro.28

Other major employers include Chapel Hill and Carrboro City Schools, Blue Cross/Blue Shield

of North Carolina, Orange County Board of Education, and the Town of Chapel Hill.28

2.7.5 TRANSPORTATION IN CHAPEL HILL AND CARRBORO

Chapel Hill Transit provides extensive public bus services throughout Carrboro and

Chapel Hill. Since 2002, these services have been free for riders, paid for through city taxes and

21

UNC student fees. While service is frequent during normal business hours, buses run less

frequently at night and many routes do not operate on the weekends.

3. METHODOLOGY

The previous section discussed background information that the team felt necessary to

inform the AOCD. This section explains the methodology used throughout the AOCD process.

The team used numerous methods to gather information on the people from Burma who are

currently living in Chapel Hill and Carrboro. The group initially researched this population via

secondary data sources, and then began to collect primary data by gaining entrée to the

community, developing interview guides, recruiting key informants, and conducting qualitative

interviews with service providers and community members. The following section outlines the

methodologies used by the team to define the community, gain entrée, obtain both primary and

secondary data, develop interview guides, conduct interviews, analyze data and plan the

community forum.

3.1 Defining the Community, Gaining Entrée, and Team Observations

The team started the AOCD by assessing and defining the community of people from

Burma living in Chapel Hill and Carrboro. As mentioned in the introduction, the team’s first

contact with the community occurred during a “windshield tour” with the preceptors. The

windshield tour was particularly striking because all 6 team members lived within the geographic

boundaries of Chapel Hill and Carrboro, and yet they were outsiders in the community of people

from Burma living in Chapel Hill and Carrboro. The team made observations and discussed them

while driving around key areas of Chapel Hill and Carrboro. The windshield tour allowed the

22

team to observe different characteristics of the community such as housing, transportation,

healthcare facilities, education, history, recreation, businesses, and religion. Furthermore, the

windshield tour made the team aware of the relatively small size of the community of people

from Burma, and why they have often been described by many Chapel Hill and Carrboro

community members as “invisible.”

To gain entrée to the community, the team attended various events including, but not

limited to, a Karen baby shower, a Karen Baptist church service, an Asian vegetable market in

High Point, the Burmese Water Festival, and a fundraising dinner for a school in Thailand

serving migrants from Burma. Team members recorded individual notes after attending each

event in order to keep a record of their detailed observations and reflections on these activities

and the community.

In order to make the community aware of the team’s presence as well as of the project,

the team wrote a project description that was translated into both Burmese and Karen, two

distinct languages (see Appendix A-1 to A-3). These project descriptions were disseminated to

the community with the help of key community members as well as the preceptors.

3.2 Secondary Data Collection and Analysis

Secondary data were collected from sources including books, films, documentaries,

newspaper and magazine articles, websites, and public documents, giving multiple perspectives

on the community’s economic, cultural, historical, environmental, health, and demographic

conditions. In particular, the internet was an important resource in finding secondary data on

people from Burma in general and those living in Chapel Hill and Carrboro in specific. These

secondary data sources were collected and reviewed by each team member. One team member

23

was responsible for organizing and filing the sources. For a list of secondary data sources

reviewed, see Appendix C.

3.3 Primary Data Collection through Interviews and Participant Observation

Primary data were collected via qualitative semi-structured interviews with service

providers from Raleigh, Durham, Chapel Hill, and Carrboro, and with community members

living in Chapel Hill and Carrboro. The process entailed recruiting the interview participants

through a snowball technique,m conducting the interview by two members of the AOCD team –

one interviewer and one note taker – and coding and analyzing the interview transcript afterward.

The team recognized the snowball technique can be limiting, so it met several times through the

AOCD process to make its best attempt to recruit a diverse sample based on age, sex, ethnicity,

language proficiency, length of stay in the U.S., and past political affiliations in Burma and

Thailand. In addition, due to a relative shyness of women in the community, female community

members were always interviewed by female team members.

Consent scripts were created for both service providers and community members, and

were integrated into the body of the interviews guides. The community member interview guide,

containing the consent script, was translated into Burmese and Karen (see Appendix A-4 to A-6).

Burmese and Karen interpreters were also available when needed for an interview with a

community member who did not speak English.

3.4 Interview Guide Development

The team’s original service provider and community member interview guides were

based on those used by multiple AOCD teams in past years. These interview guides were

m This technique entails selecting cases based on previous ones. For conducting an AOCD, the team relied on interviewing key service providers and community members and individuals they had recommended. A limitation of the snowball technique includes only interviewing people who are in each other’s social networks – it is possible to overlook certain groups within a population.

24

modified to fit the needs of the people from Burma living in Chapel Hill and Carrboro (see

Appendix A-4 to A-7). The community member interview guide was translated into Burmese

and Karen to assist the interpreter during an interview. The service provider interview guide was

pilot tested with one of the preceptors and the community member interview guide was pilot

tested with a Karen refugee living in Raleigh. Pilot testing the interview guides was helpful in

giving the team feedback on the utility of specific questions and the flow of the overall guide,

thus allowing the team to make the appropriate modifications before starting the interview

process. For example, the team simplified many phrases and re-wrote many questions upon

learning that they could not easily be interpreted into Burmese or Karen as originally written.

3.5 Conducting Interviews and Focus Groups

In all, the team conducted 17 service provider interviews, 22 community member

interviews, and 2 youth focus groups. Interviews and focus groups lasted anywhere from 55

minutes to 2 hours. Each interview began with an introduction of the project, the interview

process, and an informed oral consent. The youth focus groups included the similar

introductions, but written informed consent was obtained from both the parent and child. A fact

sheet (Appendix A-8 to A-11) was given to each participant before starting the interview or

focus group. If they had an email address and were literate in English, Burmese or Karen, this

fact sheet was emailed to service providers and community members at least 24 hours before the

interview was scheduled so they would be familiar with the AOCD process when the interviewer

further explained it in person.

Team members asked permission of interviewees to take notes on a laptop, use a tape

recorder and an iPod recorder to supplement the note taker’s notes – recording on both these

devices began only after verbal consent was given. The interviews were semi-structured;

25

questions and certain probes on the interview guides were always asked, but the interviewer

often generated additional probes and questions spontaneously. Due to language barriers,

questions often had to be asked in numerous different ways or broken up into smaller

components to elicit an informed response.

3.6 Data Transcription, Coding, and Analysis

Data analysis was conducted on secondary data, team reflections, and interview

transcripts. To prepare the interview transcripts for analysis, the interviewer listened to the

recorded discussion, filled in information gaps from the notes, and highlighted pertinent quotes

from the session.

While interviews were being conducted, the coding team, consisting of three team

members, developed two code lists – one for the service provider interviews, and the other for

the community member interviews (see Appendix F). These codes were then used to link topics

between different interviews through categorization. Using ATLAS.ti software,n transcripts were

imported into the software and codes were assigned to sections of text so that data could be

arranged for analysis by common codes.o Sections of text falling under the same code were

compiled in code reports, which were then used to identify common themesp in the data. From

this analysis, the following domains were discovered: adult education, community organization,

health knowledge, interpreter services, changes in family dynamics, ethnic identity, education for

youth, divisions within the community, domestic violence, institutional literacy, knowledge of

community, and language barriers. Theme statements were then developed from responses coded

under these domains to accurately represent the information gathered. These theme statements

are explained in detail in Section 4 and Appendix E.

n A qualitative data analysis software. oWhen data were assigned the same code, the data were considered to have the same code in common. p Themes that fell under the same topic.

26

3.7 Planning the Community Forum

The end of the AOCD culminated in a large meeting, known in the AOCD process as a

community forum. The entire Chapel Hill and Carrboro community was invited to come

together to celebrate the people from Burma, learn about the team’s research findings, discuss

those findings, and work together to generate action steps to address key issues. Since the

community forum itself is a critical feature of the AOCD process, the team began including the

community and service providers in the planning of the event as early as possible. At the end of

each interview during the AOCD, community members and service providers were asked if they

would like to help plan the forum. In March, the Community Forum Planning Committee (CFPC)

was formed, comprised of twelve individuals, including Karen and Burmese community

members as well as service providers. The team scheduled and facilitated three separate CFPC

meetings to discuss the forum location, date, time, and program details.

During the third meeting, the team presented the twelve theme statements to the CFPC,

and asked committee members to select the four they most wished to discuss at the forum, based

on each theme’s importance and changeability. The CFPC chose the following four themes: adult

education, community organization, health knowledge, and interpreter services (see section 4 for

more detail).

Normally, six themes would be discussed (each group member would facilitate a

discussion), but the team felt it was imperative that a Burmese and Karen interpreter be present

for each breakout group, and there were only enough interpreters available and willing for four

groups. The week before the forum, a training session was held for the interpreters to familiarize

themselves with the interpreting equipment (headsets and microphones), the methods used in the

discussions, and to brainstorm “key words” that would likely need to be interpreted in the four

27

discussion groups (Appendix D). All speeches were finalized before the forum in order to have

time for them to be translated, allowing for easier simultaneous interpretation with the help of

headsets.

Flyers and invitations were translated into Burmese and Karen (Appendix D). Team

members went door to door in the community to pass out invitations. Key service providers and

elected officials were invited on multiple occasions. The team created a press release (Appendix

D), and the forum was publicized in the Chapel Hill Herald, The News and Observer,

Independent Weekly, WUNC (local NPR affiliate), the Daily Tar Heel (UNC’s student

newspaper), and a number of online message boards related to Burma and Asia.

The forum took place at Carrboro Elementary School on April 21 from 5:00p.m. to

8:00p.m., and was attended by approximately 125 people.q The paper program consisted of text

in English, Burmese, and Karen (see Appendix D). There was an opening speech by a Karen

pastor, followed by a presentation of the findings by the team. Next, the four themes were

discussed in small discussion groups to generate action steps. Dinner, which consisted of food

donated by over 20 local restaurants, was served after the discussion groups. This was followed

by entertainment, a presentation of the findings from the discussion groups, a raffle for prizes

(donated from over 18 local businesses), and two closing speeches - one from a team preceptor

and another from the same pastor who gave the opening speech. All speeches emphasized the

transfer of ownership of the project from the team to community members and service providers.

Based on the methodology of this AOCD, the following section reports the most

prominent themes uncovered through data analysis, the action steps generated through discussion

groups at the community forum, and the team’s recommendations.

q This is the number of people who signed in at the registration table. The team believes a larger number of people attended the community forum since not everyone signed in. In addition, most of the 40 children who attended were not signed in by their parents.

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4. FINDINGS

Upon analyzing the data, the team uncovered twelve themes. The four themes discussed

in four separate discussion groups at the community forum are presented below; the remaining

eight themes can be found in Appendix E. Under each domain and the associated theme

statement, this section includes: community member perspective, service provider perspective,

team perspective, and a comparison of these three views. The four themes selected by the CFPC

also include a description of discussion around the topic at the forum and the resulting action

steps. Although the team’s prioritized recommendation to the community is to implement these

action steps, the team has also provided additional recommendations for each theme based on

their experiences while conducting the AOCD.

4.1 Adult Education

Many people from Burma arrive in the U.S. with little or no formal education, which

makes structured adult education a new experience for them. Most adult community members

are eager to learn English, and ESL classes are the best means to do so.

THEME STATEMENT: COMMUNITY MEMBERS WANT TO ATTEND ESL CLASSES TO IMPROVE THEIR ENGLISH, BUT ESL CLASS SCHEDULING CONFLICTS WITH WORK AND FAMILY LIFE.

4.1.1 Community Member Perspective

Although community members expressed the need for ESL education, there were a

number of barriers preventing them from accessing ESL services. Many community members

stated that ESL class scheduling often conflicts with their work schedule. Others found it

difficult to balance working night shifts and parenting with attending ESL classes. As one

29

community member said, “Everybody knows they should know how to speak the language, but

… everyone has to struggle with their daily lives so they can only go to class at most once a

week - they have no time … ESL has its own schedule and it does not go together with their

work schedule.”

Lack of familiarity with the western-style classroom was also frequently reported. Some

community members started ESL or GED classes, but stopped because of unfamiliarity with the

material and the teaching style. This problem is further compounded by the difficulties of

balancing a busy schedule and acculturating to a new environment. Community members

expressed a desire for flexible delivery options, such as tutoring, so they can learn at their own

pace and according to their own schedule. Some co-sponsors and volunteers were able to provide

tutoring, but this service was not consistently offered to all community members.

Motivation was also difficult to maintain for adult community members. Most do not

need English skills for their jobs because they work with other community members. In addition,

many live together in the same apartment complexes. Consequently, the close-knit nature of the

community requires little English speaking. One community member expressed a concern that

the community, in general, was not making adult ESL education a priority, and that this was

impeding the development of the community.

4.1.2 Service Provider Perspective

Service providers held varying views on whether the people from Burma took advantage

of ESL services. ESL classes were offered on a semester basis and, once enrolled, students were

not allowed to switch to another class to accommodate changes in their work schedules. As one

service provider explained, “There are classes that are excellent, but they are limited, it’s

difficult to get a place. Timing is also important. They don’t want to start people off in the

30

middle of the semester.” Other service providers wished the community members had access to

better English language training in the refugee camps before coming here.

4.1.3 Team Perspective

Although the team found that the community values education in general, they noted that

high priorities of financial survival, parenting, and general adaptation into a new country can be

exhausting. For example, the team's many challenges in scheduling meetings and interviews

with the community members demonstrated the difficulty of finding common free time amongst

multiple people. Also, interview responses led the team to note that the absence of a support

structure from the traditional extended family for parenting and maintaining a household placed

additional strain on workloads. One young woman, so exhausted after work that she had no

energy left to attend ESL classes, hoped for the arrival of her adult relative from the refugee

camp to help out with household duties so she could attend ESL classes. For many community

members, this is the third country in which they have resided; many have lived in refugee camps

in Thailand before resettling in the U.S. Their accounts of learning to adapt to life in the U.S.,

which is vastly different from Burma and Thailand, were described as exhausting and

demanding.

4.1.4 Comparison of Service Provider, Community Member & Team Perspectives

Attending ESL classes was clearly important to community members, but the scheduling

and format of the classes clash with the demands of their busy lives. Although some service

providers and community members questioned the priority accorded to learning English, the

team witnessed and heard accounts of community members’ fatigue resulting from their daily

workloads and the energy expended acculturating to U.S. society. In sum, making ESL classes

31

accessible to the community is a challenging task for service providers given the community

members’ complex schedules and competing priorities.

4.1.5 Community Forum Discussion & Action Steps

The need for adult ESL classes was apparent throughout the project. In particular, it was

clear at the community forum that the majority of community members in need of interpretation

services were adults, rather than youth. Fifty-two people attended the discussion group on this

theme, including the Durham Technical College Coordinator of ESL services and several ESL

teachers in the Chapel Hill-Carrboro City Schools. The discussion group was divided into three

sections: English speakers, Karen speakers and Burmese speakers. One interpreter was assigned

to each of the Burmese and Karen speaking groups. All but three community members present at

this discussion group were non-English speakers.

Using the Force Field Analysisr technique, the group brainstormed ideas to better provide

ESL education in a way that community members can access and attend classes. The dynamics

of interpreting this discussion in three languages elucidated the difficulties community members

and service providers have in communicating with each other. A number of concrete action steps

were generated at the end of the discussion group, as shown in Table 1.

Table 1. Action Steps from Adult Education Small Group Discussion • Create an informational sheet on ESL classes and services that will be translated into Burmese

and Karen. This document would improve awareness of ESL services and classes within the community.

• Contact two apartment complexes and one employment agency to investigate the possibility of classes being conducted in a neighborhood and at a workplace, thus requiring little to no extra transportation.

• A non-English speaking community member offered his apartment as a location for ESL classes, and an English-speaking community member volunteered to liaise as an interpreter to investigate the possibility of classes at this location with Durham Technical College’s ESL coordinator.

r A method for listing, discussing, and evaluating the various forces helping and hindering a proposed change.32

32

Overall, the group was excited about these action steps, and seemed eager to accomplish them

since they knew doing so would have a positive effect on the community’s daily interactions

with the larger Chapel Hill and Carrboro community.

4.1.6 Additional Team Recommendations

• Establish a more flexible ESL system that offers multiple classes during the morning, afternoon, and evening with rolling enrollment offered on a monthly rather than semester basis.

• Promote educational opportunities for community members such as GED and on-the-job training.

• Establish a pool of ESL tutors made up of UNC students, sponsors, seniors, and community members.

• Offer childcare for working parents to attend ESL classes. • Provide transportation information specific to ESL class locations to the community.

4.2 Community Organization

Organization within the community could offer more efficient ways for community

members to help one another and coordinate resources to address community needs. There are

many ways that the people from Burma could organize. Other refugee communities, such as the

Carrboro Latino community, have demonstrated successful models.

THEME STATEMENT: A LACK OF ORGANIZATION HINDERS THE COMMUNITY'S ABILITY TO HELP NEW ARRIVALS, MAINTAIN CULTURE, AND IMPROVE THE LIVES OF COMMUNITY MEMBERS.


Many community members expressed a desire to organize and were disappointed that

previous efforts had not included all segments of the community. Community organization was

seen as a positive way to support new arrivals, guide young people to ensure that they do not get

in trouble, and connect community members with service providers to better coordinate access.

One community member said, “We realized that it is necessary to organize, to set up an

organization ... that would lead this community two years ago …We want this organization to

33

uphold our culture and help people in every area, including education and health … whatever we

need in this community.” Although opinions differed on how the community should organize,

the vast majority of interviewees expressed interest in doing so.


Service providers did not discuss this topic directly in interviews. However, they were

aware of some barriers to creating an inclusive and unified community: differences between

ethnicities, religions, education level, and type of involvement (citizen/victim versus soldier) in

the armed struggle in Burma. A unified community could also help service providers because

they would be able to get messages and services out to the community more efficiently and

effectively.


The want and need for a unified community, and the barriers hindering it, were obvious

to the team. Community members took care of each other; yet, at the same time it appeared that

there were divisions along ethnic, religious, and political party lines. These divisions posed

challenges for the team when working with the community, especially when working with the

CFPC, which was comprised of community members of different ethnicities. The team made

concerted efforts to spend equal amounts of time with the different groups within the community

to emphasize that the project was for the entire community, not just a subset. Sometimes, the

team’s presence as outsiders was an asset, lending neutrality and credibility to its efforts. One

team member noted, “In order to make the forum distinct from those other [community]

meetings, [we were told that] we would need to emphasize our status as ‘neutral’ organizers and

stress that the intention of the forum would be to get the entire community together.”

34

Certain groups within the community had been successful in organizing specific events,

services and meetings. For example, the Karen had their own church services and the Burmese

hosted a Buddhist New Year Water Festival. Key community members did a lot of work for the

community, including driving new arrivals to the doctor, interpreting, translating mail, etc.

However, the team observed that these key individuals were often over-extended, and therefore,

a more formal community-based organization was needed to coordinate and distribute the

workload. Community organization could raise the visibility of the community of people from

Burma and give service providers the information and connections they are lacking.

4.2.4 Comparison of Community Member, Service Provider & Team Perspectives

At first glance, service providers and the team saw the community as a cohesive group.

However, community members were well aware that the community is complex and

heterogeneous. All three perspectives indicated that the community could function more

effectively in identifying and addressing needs, if it were well organized.


The discussion of community organization at the forum generated lively conversation and

concrete action steps that could likely open communication lines among the various sub-

communities. In order to prepare for this complicated and potentially controversial topic, the

team met with an international conflict resolution expert, who helped the group develop the

facilitation technique (described in following paragraph). In addition, one Burmese and one

Karen interpreter were present in the discussion group to ensure that everyone’s voice was heard.

Key leaders from the community attended the session including the pastor of the Karen church

and the co-organizer of the Burmese Water Festival. Twenty-four people participated in the

35

discussion. Key service providers included the head of Blue Ribbon Mentoring Program and a

Refugee and Immigration Specialist from Lutheran Family Services.

The discussion utilized a technique similar to Forcefield Analysis Technique32. First, the

group brainstormed about what was already working well in terms of community organization.

Then the discussion turned to what could work better. Next, the group generated actions steps

(see Table 2) to address the list of brainstormed items. Certain discussion participants agreed to

implement action steps. Throughout the conversation, group members were given time to talk

amongst themselves and generate points for each stage of the discussion. This discussion time

allowed non-English speakers and interpreters to clarify their ideas before reporting back to the

main group in English.

Table 2. Action Steps from Community Organization Small Group Discussion • Identify people and resources for the creation of a unified community. • Create a list of community members to compile into a listserv. • Create a community website. • Call professors to find students to work with community members to build a website. • Share list of community members amongst community members and service providers. • Organize a town hall meeting with the whole community to try to involve more people. • Consolidate existing informal phone lists to include all members of community.

Although community members made a significant contribution, service providers were

more vocal during the discussion. This may have reflected an initial lack of clarity about who

was included in the term ‘community’ (e.g., all of Chapel Hill and Carrboro, just the Karen, or

all the people from Burma). The intended community for the discussion was the same as the

AOCD community: the people from Burma living in Chapel Hill and Carrboro. Nevertheless,

some community members indicated they were glad for the outsiders’ contribution since the

community of people from Burma is new and not well established and there is a need for

external input.

36

4.2.6 Additional Team Recommendation

• Service providers should educate themselves on the extended history of ethnic divisions within the community (see recommendations from “Divisions Within the Community” found in Appendix E).

4.3 Health Knowledge

Healthcare practices, including household sanitation and personal hygiene, vary widely

across cultures. In the U.S., the medical system places a strong emphasis on the importance of

clean living spaces and personal care in order to maintain a healthy lifestyle. In the refugee

camps of Thailand, many of which are overcrowded and do not have running water, life is quite

different than in the U.S. Therefore, fully understanding these U.S. practices can be challenging

for many of the newly resettled people from Burma.

THEME STATEMENT: LACK OF KNOWLEDGE ABOUT U.S. HEALTH PRACTICES AROUND PERSONAL AND HOME CARE MAKES IT DIFFICULT FOR COMMUNITY MEMBERS TO STAY HEALTHY AND ACCESS THE CARE THEY NEED.


Community members who resettled to the U.S. several years ago expressed concern for

the lack of health knowledge among new arrivals due to educational background, length of time

in the U.S., and level of acculturation. One resident from Burma who had lived in the area for a

number of years emphasized the lack of knowledge around proper home care by new arrivals,

explaining, "You have to understand cleanliness to understand health. Some people do not even

have a vacuum cleaner; there are cobwebs everywhere, [and] they have a nice car but they do not

understand how important it is to have a clean environment." Other community members

expressed similar concerns about new arrivals sharing dishes, not washing bed linen, or not

ventilating their houses after cooking. In addition, many community members stressed the need

for health education on self-care that would prevent illness, including dental and personal

37

hygiene. It was clear that community members felt that U.S. homes and lifestyles require a new

set of health and life skills to which it can be difficult to adapt.

When asked about health, many community members explained that in order to stay

healthy they must get sleep and “eat fresh meat and fresh vegetables.” The importance of routine

check-ups with a physician was only mentioned a few times; meanwhile, seeking emergency

care when sick was described by many. For some, this was a result of not having money to pay

for care, while for others it was a matter of not understanding how to navigate the U.S.

healthcare system.


Many service providers interviewees felt that new arrivals lack knowledge about dental

hygiene and general self-care. In addition, some healthcare providers expressed the opinion that

the health needs of new arrivals were largely due to the lack of knowledge about disease and

preventative care, as well as the exposure to illness in the refugee camps. One health provider

explained that refugees lived in close contact in the muddy camps and often did not have running

water, "There is a lack of hygiene within the Tham Hin camp. People have parasites and skin

problems. They don’t have knowledge about health problems and how things are spread . . .

Many have a compromised immune system." Once the refugees arrive, many service providers

are charged with explaining household sanitation and personal hygiene practices that are

common in the U.S. Many service providers felt that this process was often quite challenging due

to cultural differences and a lack of U.S. oriented health education among the refugees.


Although the team did not have much insight into this issue, as spring approached, they

did notice that many of the community members were having problems with seasonal allergies.

38

One male community member explained that when he first got here, “he didn’t realize it was

allergies and took cold and fever medication.” Another female community member, who had

more recently arrived, asked for advice about where to get care for the problems she was having

with her sinuses, which the team attributed to allergies. The team believed that the lack of

awareness surrounding allergies was an indicator of a more general lack of understanding of

other local health issues. Team members also observed insects in some of the apartments, which

could have been an indication of a lack of knowledge about hygiene and home care.


Overall, community members, service providers, and team members recognized the lack

of U.S. oriented health knowledge in the community. While those community members who are

not newly resettled have adapted to U.S. personal and home care practices, these customs may

not have been taught properly to the newly resettled refugees. Service providers struggled with

how to best communicate the need for better hygiene and sanitation to keep people in good

health.


The small group discussion on health knowledge had 19 participants. These participants

included service providers from several agencies in the area, including the Orange County Health

Department, UNC Family Practice, and LFS Carolinas. There were four co-sponsors from

different churches in attendance, along with six community members, five of whom were Karen

adolescents. At the start of the discussion, the three interpreters available determined from the

community members that they did not need interpretation services. However, the interpreters did

help with interpretation during the discussion and elicited responses when needed. The

39

discussion was guided with the ORIDs method by presenting two quotes as a trigger. The service

providers were more vocal at the beginning of the discussion and spoke at length about their

perspective of the community’s health knowledge. Meanwhile, the community members in the

group hesitated to speak, but with the help and encouragement of the interpreters, did share their

stories of learning about health when they first arrived in the U.S. The conversation flowed into a

discussion of what could be done in the community to improve the level of health knowledge

that community members have of U.S. healthcare practices. The most prominent ideas were to

develop a training course, a booklet, or to use lay health advisors from the community to teach

community members about health in the U.S. and to instruct service providers on how to

effectively present health information to the community. Another concrete idea was the creation

of a community garden where fresh vegetables native to Burma could be grown by community

members. From ideas discussed, several action steps were developed, as shown in Table 3.

Table 3. Action Steps from Health Knowledge Small Group Discussion • Form a small group composed of service providers from various agencies, co-sponsors, and

community members to meet and brainstorm ways in which to present health information to community members.

• Contact the health educator for the Chapel Hill-Carrboro City Schools to gather information on health education.

• Confirm a space for a community garden at Franklin Porter Graham Elementary School. • Conduct a meeting at the Orange County Health Department to discuss changing the routine

of health service provision for refugees. • Have a sign-up sheet at the end of the forum for participants interested in working on the

community garden or the small group mentioned above.

Overall, the discussion was focused and concrete action steps were developed. The most

tangible result of this discussion was a plot of land offered for a community garden. Group

s A discussion method using a “trigger” (such as a picture, video, quote, etc.) and a series of related questions to spark conversation surrounding four levels of awareness: objective, reflective, interpretive, and decisional.33

40

participants volunteered to follow through with some of the steps listed above, and all appeared

excited by the possibility that action would lead to positive changes in healthcare.


• Identify leaders in the community who can help service providers disseminate relevant health-related information.

• Service providers should learn more about the culture that the community members come from so they can be culturally sensitive when educating the refugees on U.S. health practices. This can include attending cultural events and meeting with community members outside of the service provider setting.

• One member of the UNC team should continue working on this issue for her summer practicum portion of her public health education.

4.4 Interpreter Services

The complexities of communicating across languages characterized the entire AOCD

process. The language barrier was a challenge to community members, service providers, and the

team alike.

THEME STATEMENT: THE LACK OF INTERPRETERS FOR THE BURMESE AND KAREN LANGUAGES IN CHAPEL HILL/CARRBORO PREVENTS ACCESS TO SERVICES AND REDUCES THEIR QUALITY.


All community members interviewed expressed a need for more interpreters. Although

several community members emphasized the necessity of having interpreters for newly resettled

refugees, overall, the entire community, regardless of length of stay in Chapel Hill and Carrboro,

desired enhanced interpreter services. Without help from interpreters, community members

expressed frustration surrounding the difficulty of communicating with people outside of their

own community. Lack of interpreter services not only caused communication barriers, but also

interfered with the community members’ ability and desire to access services and diminishes the

quality of the services received.

41


Service providers identified the need for more interpreters for the community. Service

providers noted that their ability to provide quality care is hampered by their inability to

communicate directly with their clients. Within the school system, service providers explained

the difficulty in relaying information to parents about their children. Healthcare providers

discussed the struggle to communicate with their patients without a trained interpreter. When

possible, healthcare providers often used the AT&T language line to communicate with their

patients from Burma, but as one service provider pointed out, “It’s very hard to find a dentist that

will use [the] AT&T language [line] or pay an interpreter.” Overall, frustrations with the lack of

trained interpreters in general and the challenges of finding those that are available led service

providers to question the quality of the services they can provide given the steep language

barrier.


Upon introduction to the community, the team immediately saw the prominence of the

language barrier as a challenge to this population. Interactions with community members were

often characterized by confusion resulting from difficulties communicating across languages.

The team struggled to find interpreters to help conduct interviews with non-English speakers.

Those individuals who were available to interpret had numerous other commitments, and thus

had a limited amount of time to commit to the project. Because of the lack of interpreters, the

team felt that it overworked the few that were available. As one team member said, “It seems

like all of the people who know how to translate or interpret get asked to do everything.” Indeed,

without the commitment of the team’s interpreters and translators, the project would not have

been possible. The team quickly learned that without an interpreter, communication with non-

42

English speakers was minimal. One team member explained, “It is very hard to get to know the

community members who do not speak English. If there is no one to interpret, then you are

limited to saying “hello,” “bye,” and “thank you.”t Thus, as outsiders to the community, the team

often experienced the same communication challenges that many of the service providers face

with this community.


Community members, service providers, and team members agreed that interpreter

services were lacking. Community members noted the need for improved interpreter services to

facilitate communication with people outside of their community. Community members and

service providers agreed that the deficit of interpreter services compromised access to, and

quality of, services rendered. Team members emphasized the necessity of interpreters for getting

to know the community and the difficulty of finding interpreters, particularly those who have

free time to provide services.


Since the entire forum was interpreted between three languages, the need for better

interpreter services was constantly reinforced throughout the evening. Eighteen people attended

this discussion group, including the coordinator of ESL services and dual languages for the

Chapel Hill and Carrboro City school system and the president of the Carolina Association of

Translators and Interpreters. There was also a recently resettled non-English speaking Karen

family as well as other community members present.

Using the Force Field Analysis technique, the group brainstormed ideas to achieve the

goal of finding ways to have more qualified Karen and Burmese interpreters available for service

providers. There was no Burmese interpretation needed in this group. However, Karen t The three phrases the team learned in Burmese and Karen.

43

interpretation was identified as a need, so a pair of Karen community members who did not have

any formal training interpreted the entire discussion into Karen and back into English. Though

this process delayed the progress of the session since interpretation was required in two

languages, the facilitator recognized this process as an important way to make the opinions of

non-English speaking community members heard. This process also became a visceral lesson on

the difficulties for community members and service providers in not being able to communicate

clearly with each other. Despite these challenges, a number of concrete action steps were

generated in the discussion, as shown in Table 4.

Table 4. Action Steps from Interpreter Services Small Group Discussion • Organize and run a short professional training for interpreters. This would enhance the skills

and abilities of the bi/multilingual community members in interpreting. • Identify graduating students from advanced ESL classes and students at local universities as

potential interpreters. • Annually update the list of community members to connect potential interpreters with service

providers.

The group was excited about these suggested actions, and the feeling was that, if

accomplished, they would make a big difference in improving the quality of life for the

community.


• Encourage and provide support to establish an agency or individual who could coordinate interpretation and translation services for the Burmese and Karen. Emphasis should be placed on community ownership of such a service, particularly amongst those who already have experience in interpreting and translating.

• Research how other communities such as New Bern are handling interpreter services and follow recommendations of how to best provide services.

4.5 Additional Themes Details on the following eight domains and their associated theme statements are reported in

Appendix E:

44

• Changes in Family Dynamics – Traditional parental roles are compromised by

community youth acculturating more quickly than their parents into the American

lifestyle.

• Ethnic Identity – Adults feel anxious that youth are losing their ethnic identities because

they adapt so quickly to American culture.

• Education for Youth – Due to the lack of tutoring outside of class time, families feel that

children have trouble keeping up with their studies.

• Divisions within the Community – There is a lack of unity between ethnic groups, which

hinders community cohesion.

• Domestic Violence – Domestic violence is present in the community, impacting the well-

being of the entire community.

• Institutional Literacy – The high cost of and unfamiliarity with health insurance leads to

many community members, especially children, not being insured and not seeking health

care.

• Knowledge of Community – Service providers want more knowledge about the

community and its culture so they can more effectively respond to the community’s

needs.

• Language Barriers – Family members are used as interpreters for each other in formal

and informal settings, even though this sometimes creates uncomfortable situations.

45

5. LIMITATIONS

The findings from this AOCD conducted with the people from Burma living in Chapel

Hill and Carrboro can serve as a valuable starting point for planning health promotion programs.

Nevertheless, as with all studies, methodological limitations warrant caution in interpreting and

applying the findings. First, language barriers were a notable limitation of this AOCD. For

example, key AOCD terms, such as “community,” do not have a counterpart in the Burmese or

Karen languages. Since the word and concept of “community” is integral to the AOCD process,

the team found it challenging to succinctly and accurately describe the project to non-English

speaking community members.

All documents were translated in a timely fashion and the team was able to communicate

with all non-English speaking community members interviewed through interpreters. This reach

into both ethnic groups was unprecedented due to the resourcefulness of the team in engaging the

skill and dedication of local multilingual community members, who were willing to serve as

interpreters and translators with little or no training in this capacity. At the same time, recruiting

an adequate number of Burmese and Karen interpreters for the community forum was

challenging; when approached, even with encouragement, many community members hesitated

or declined due to feeling unsure of their skills and being intimidated by putting those skills on

display in front of a group. Hence, of the 12 themes uncovered through the analysis, only four

could be addressed. Those who had agreed to serve as interpreters were forced to withhold their

own insights and contributions during the discussion groups. Nevertheless, an informal

debriefing with the interpreters indicated that they were pleased with the results of the breakout

groups.

46

A second limitation was the absence of an umbrella community-based organization,

which hindered the team’s progress and reach in gaining entrée to the entire community. As

mentioned in the introduction, the team was able to reach certain units of identity – such as the

Karen and Burmese – more easily than other ethnic groups since they are the largest in number

and organize gatherings, such as religious events, that outsiders are able to attend. Given

constraints of time and language, the views of ethnic groups, other than Karen and Burmese,

were not strongly reflected in the findings. For people of these other ethnic groups, further

investigation is warranted to determine if the strengths and needs revealed through this AOCD

are relevant.

Third, the team’s difficulty with negotiating cultural differences sometimes resulted in

miscommunication and misunderstandings with community members. Though the team used

knowledge and advice from the preceptors, key community members, as well as secondary data

sources to educate itself on the culture of people from Burma, it had some interactions with the

community that resulted in unintended consequences such as confusion and misunderstandings.

For example, there was a lot of variation in how community members chose to identify

themselves. Some identified by nationality (i.e., Burmese), while others identified themselves by

ethnicity (e.g., Karen). Thus, the team was uncertain how to refer to the community in an all-

encompassing way, and group members sometimes found themselves describing community

members in a non-preferred manner. The team eventually chose the name “people from Burma

living in Chapel Hill and Carrboro” to best address this issue, but it was still not the ideal way to

refer to some of the community members. The uncertainty and mistakes from the group may

have hindered entrée, and a better understanding of cultural differences would have been helpful

when conducting the AOCD (e.g., community members might have been more willing to reveal

47

sensitive information during interviews). On a positive note, the team hopes that mistakes like

these will be avoided by future service providers who read this document and educate themselves

about the cultural nuances and community preferences ahead of time.

Finally, the CFPC was also not reflective of all facets of the community. This resulted

from another limitation of the snowball technique – the team only asked those individuals

interviewed to join the CFPC. Although the snowball process helps to find leaders in the

community, it does not get at those groups that are silent or intimidated. Furthermore, due to

time and logistical constraints, the team was only able to have English-speaking Burmese and

Karen participation on the committee, which greatly limited the number of community members

that could serve. Finally, due to difficulties in scheduling a time that would work for both the

service providers’ and community members’ varying work schedules, a dearth of service

providers at CFPC meetings resulted in lost perspective. Thus, the four themes selected for

discussion at the forum may not have been the most representative of the entire community.

Nevertheless, informal discussions with community members revealed that most were engaged

with the topics discussed, and felt they were important to the improvement of the community.

6. CONCLUSIONS

Overall, the AOCD team is confident that the community is capable of taking ownership

of the AOCD’s findings, as community members at the community forum showed deep interest

in discussing and taking on responsibilities for following through with specific actions steps. The

team’s main recommendation to the community is to continue to build its capacity by:

establishing communication mechanisms among the various ethnic sub-communities and with

48

service providers in coordinating existing services, offering supports, such as childcare and

transportation, to make them more accessible; and creating awareness among service providers

of the history, strengths, and needs of people from Burma living in Chapel Hill and Carrboro.

The team’s main recommendation for service providers is to collaborate with the community in

following through with the implementation of action steps identified at the forum – doing so will

be a significant starting point for the community to work together amongst themselves and with

service providers. In sum, the completion of this AOCD offers findings on which to begin a

mutual partnership between the people of Burma in Chapel Hill and Carrboro, service providers,

other Chapel Hill and Carrboro residents, and service organizations in Chapel Hill and Carrboro.

Furthermore, the team hopes that this document will be a valuable resource for community

members and service providers to improve upon community strengths and to support and

mobilize positive change in the community.

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REFERENCES

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2. Steckler A, Dawson L, Israel B, Eng E. Community health development: An overview of the works of Guy W. Steuart. Health Education Quarterly, Supplement 1. 1993:3-16.

3. Kemp C. Burmese: Health beliefs & practices. Available at: http://www3.baylor.edu/~Charles_Kemp/burman.htm. Accessed February 18, 2007.

4. BBC News. Country profile: Burma. Available at: http://news.bbc.co.uk/1/hi/world/asia-pacific/country_profiles/1300003.stm. Accessed February 25, 2007.

5. Skidmore M. Medical assistance and refugee safety in contemporary conflicts. Lancet. 2003;362:75.

6. Asian Human Rights Commission. Burma: Over a million displaced-group says . Available at: http://www.ahrchk.net/pr/mainfile.php/2006mr/405/. Accessed February 26, 2007.

7. Kemp C., & Rasbridge. Refugee and Immigrant Health. New York: Cambridge University Press; 2004.

8. USAID. Burma. Available at: http://www.usaid.gov/policy/budget/cbj2005/ane/mm.html. Accessed March 1, 2007.

9. Petersen HD, Worm L, Olsen MZ, Ussing B, Hartling OJ. Human rights violations in Burma/Myanmar: A two year follow-up examination. Dan Med Bull. 2000;47:359-363.

10. Brown A. U.S. refugee admissions for fiscal year 2007, refugee council USA (RCUSA) recommendations for Burmese refugees and unaccompanied minors, June 28, 2006. Available at: http://www.refugeecouncilusa.org/2007-adm-burmeseminor-w.pdf. Accessed March 1, 2007.

11. Krause S. United states waives restriction on Karen refugee resettlement. USINFO. September 1 2006. Accessed February 25, 2007.

12. Refugees International. Thailand: Resettlement as a durable solution for Burmese refugees in Tham Hin. Available at: http://www.refugeesinternational.org/content/country/detail/2922. Accessed March 1, 2007.

13. Si NM. Democracy sleeps: Burmese refugee sleeps. Available at: http://nandhivarman.wordpress.com/2006/08/19/democracy-sleeps-burmese-refugee-weeps/. Accessed March 1, 2007.

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14. Crankshaw L. Evaluation of medical services in Mae Ra Ma Luang with respect to Burmese refugees. 2004.

15. Easterbrook M. Support needed for new refugees. The Chapel Hill News. March 13 2005:A1.

16. Faith. The Chapel Hill News. August 16 2006:B4.

17. Morse J. Burmese Karen refugees eligible to resettle in United States. USINFO. May 6 2006.

18. Cultural Orientation Resource Center. US refugee program: Statistics. Available at: http://www.cal.org/co/refugee/statistics/index.html. Accessed February 18, 2007.

19. U.S. Department of Health and Human Services. U.S. resettlement program-an overview. Available at: http://www.acf.hhs.gov/programs/orr/programs/overviewrp.htm. Accessed March 1, 2007.

20. Arounnarath M. Support needed for new refugees. The Chapel Hill News. August 16 2006:A1.

21. Morillo J. Burmese in North Carolina and Orange County. North Carolina Department of Health and Human Services: NC State Refugee Health Program; 2007.

22. Tracy M. Burmese refugee statistics; 2007.

23. Census 2000. American fact finder. 2000. Available from: http://factfinder.census.gov/home/saff. Accessed March 3, 2007.

24. Town of Chapel Hill. History of Chapel Hill. Available at: http://www.ci.chapel-hill.nc.us/index.asp?NID=6. Accessed March 3, 2007.

25. Chapel Hill Bicentennial Commission. A Backward Glance: Facts of Life in Chapel Hill. Chapel Hill, NC: Chapel Hill Bicentennial Commission; 1994.

26. Helvey J. Carrboro's history. Available at: http://www.carrboro.com/carrhistory.html. Accessed March 3, 2007.

27. Orange County, North Carolina Economic Development Commission. Demographics. . Accessed March 3, 2007.

28. Chapel Hill-Carrboro Chamber of Commerce. Community profile. Available at: http://www.carolinachamber.org/aboutchcar/community_profile.html. Accessed March 3, 2007.

29. Eng, E. and Blanchard, L. Action oriented community diagnosis: A health education tool. International Quarterly of Community Health Education. 1991;11:93-16.

30. Ryan ES. A brief history of Chapel Hill. Available at: http://www.ibiblio.org/chhistsoc/. Accessed March 3, 2007.

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31. Research Triangle Park. About us: Park history. Available at: http://www.rtp.org/index.cfm?fuseaction=page&filename=about_us_history.html. Accessed March 3, 2007.

32. Lewin K. Field Theory in Social Science. New York: Harper and Row; 1951.

33. Institute of Cultural Affairs. ORID discussion method. New York: Harper and Row; 1991.

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APPENDIX A – INTERVIEW MATERIALS

Appendix A1 – Project Description (English) We are six graduate students of Public Health at UNC collaborating on a project with local leaders of the community of refugees from Burma living in Chapel Hill and Carrboro, and the agencies that serve them. The purpose of this project is to learn about the history and strengths that refugee residents bring, the challenges they face, and the needs they can address in partnership with local agencies. To obtain this information during the upcoming months, we will be compiling available statistics, participating in local meetings and events, and interviewing service providers and community members. In April 2007 we will hold a community forum where we will bring together people from the refugee community as well as local service providers to discuss our findings and determine priorities for next actions. We hope this will benefit the community through increased awareness by both service providers and community members, thus facilitating better understanding and enhanced service. We invite you to join in this project by sharing your insights and suggestions on these important topics, and suggesting people and events to include. If you have any questions or advice, you can contact us by calling 919-966-3919 x4 or emailing [email protected]. Thank you very much. Sincerely, The UNC Community Assessment Team

mailto:[email protected]

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Appendix A2 – Project Description (Karen)

54

Appendix A3 – Project Description (Burmese)

55

Appendix A4 – Community Member Interview Guide (English) _________ thank you for taking the time to meet with us today. We know your time is valuable and we appreciate your participation. My name is _______and I will be leading the interview today. This is _______, who will be taking notes and assisting me during our discussion, and _________will be interpreting. We are a team of six graduate students of Public Health at UNC collaborating on a project with local leaders of the refugee community from Burma living in Chapel Hill and Carrboro, and the agencies that serve them. The purpose of this project is to learn about the history and strengths that refugee residents bring, the challenges they face, and the needs they can address in partnership with local agencies. To obtain this information during the upcoming months, we will be compiling available statistics, participating in local meetings and events, and interviewing service providers and community members. In April 2007 we will hold a community forum where we will bring together people from the refugee community as well as local service providers to discuss our findings and determine priorities for next actions. We hope this will benefit the community through increased awareness by both service providers and community members, thus facilitating better understanding and enhanced service. The reason we are speaking to you today is to find out your thoughts and experiences as a member of this community. We are very interested to hear what you have to say. There are no right or wrong answers. Different people in the community are likely to have different opinions about the community, and we want to gather as much information from different sources as possible. If there are any questions you don’t want to answer, please let me know. You may stop the interview at any time. You are not likely to experience any risks from being in this interview. Every effort will be taken to protect your identity. Your name and comments will remain confidential. There are six members of our team and we are the only people who will have access to the information that you give us. We will be summarizing comments made by community members and writing them in a report, but will not identify who said what, nor will we identify the names of the individuals we interview. The interview will last about 60 minutes and we would like to take notes and record this interview on a tape recorder. Your input is important and we want to ensure that we accurately record what you share with us. Again, you are free to not answer any question. You may also press the stop button on the tape recorder if you choose. After we are finished using the tapes for this project they will be completely erased. Is it okay with you if we use a tape recorder? If not, we can still do the interview, but just take notes. Do you have any questions about the interview or the project? First I’d like to share some pointers to keep in mind throughout the interview: 1. Please talk in a voice at least as loud as mine. We want to be able to hear you on the

tape recorder. 2. There are no wrong answers, just different opinions. We’re looking for different points

of view, so feel free to say whatever you think

56

3. We value your opinions, positive and negative, and we hope you choose to express them during the interview

4. Everything said is confidential and will not be repeated 5. We are interested in your perspective as a community member, so please keep that

in mind during the interview 6. If you have any concerns about this project, or your rights as a research participant,

please do not hesitate to contact any of the individuals listed on the consent form you received.

Ok, with your permission, we’ll begin. (Start tape player) First, I’d like to learn about you. 1. What part of Burma are you from?

a. Is this where your family is from? b. How do you refer to yourself?

(E.g. As Burmese/Karen? As Karen?) c. Have you lived in other places besides Burma before coming to the US? d. Did you come through refugee camps? How many?

(I know there are some people who came through camps and others who didn’t).

The move to the area: 2. How long have you lived in the area?

a. Have you lived anywhere else in North Carolina? b. Anywhere else in the US? c. Who came with you when you arrived here?

(E.g.: spouse, children, parents, siblings, etc.) d. Has anyone else from your family arrived since? e. Do you have other family living in other areas of the states?

3. Do you have connections back home/in the camp or with other refugees in the US?

a. .Tell me more. How do you tend to keep in touch with them? By phone, email, other?

b. Did you join family or friends already living in the area? c. How has your life changed since you arrived in the US?

(E.g. Family life, employment, social support?) 4. Do you plan to stay in the area?

a. Do you plan to go back to Burma? 5. What are some of the good things about living in Carrboro/Chapel Hill?

a. What are some of the challenges of living in Carrboro/Chapel Hill? b. What would make your life better or easier living here in Carrboro/Chapel Hill? c. What else do you need?

57

Employment: 6. Could you please describe your job?

a. When do you work? Probe: What are your hours?

b. How do you get to/from work? Thank you for telling me about yourself, now I am going to ask you some questions about your community… Community 7. Please describe a community event.

a. Are Burmese and Karen people at these events? Chin? Hmong? b. What are the strengths of your community?

8. What would you say your community lacks?

(E.g. healthcare, transportation, English skills, employment, etc.) 9. How important is religion in the community?

a. How is life different for the Christians, Buddhists and Muslim members of the community?

10. How are people in the Burmese/Karen community dealing with their children

growing up in an American society? 11. How does your community organize to help one another?

(E.g. childcare, transportation, when someone is sick, language needs) 12. If there is one thing your community could do to make life better, what would that

be? (E.g., health, school, etc.)

Health 13. Tell me a little about your experiences with the health care system in this area. 14. Do you know where to get the health care you need?

a. Where do you go when you get sick? 15. How do you pay for healthcare?

a. Who is covered by health insurance? Probe: Are individuals, other family members, etc?

16. What is important to you in terms of health? 17. What are the specific health care needs in your community?

a. Are there any things that you think health care providers need to know about your community?

58

18. How does peoples’ health change when they come to the US? (E.g. Stress levels)

Education 19. What is the general level of education within the community? 20. Is the majority of your community able to read/write in Burmese? In Karen? In

English? 21. What level of education does most of the community hope to achieve?

(E.g. High School, College) a. What about for their children, what level of education does the community

hope their children will achieve? Community Relations 22. Is everyone in the community friendly with each other? a. Why or why not?

b. Are there any problems between the Burmese and Karen? The Chin? Hmong? Probe: How about the educated and the less educated? How about people coming from different camps? Wrap up 23. Is there anything else you would like to tell us about the community? Recommended Individuals to Interview We are hoping to interview several people in the community who know what is going on in the community and might be able to speak on behalf of the refugee community from Burma living in Carrboro/Chapel Hill. 24. Would you like to recommend someone else to be interviewed?

(E.g. Service providers, residents) a. Describe the specific person or organization. b. Why do you think their opinions and views would be helpful for us to hear? c. Are you willing to get permission for us to contact them?

Thank you again for your agreeing to do this interview. We have learned a lot from you. 25. Would it be okay if we contacted you later to invite you to participate in the forum in the Spring? If yes, get mailing address.

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Appendix A5 – Community Member Interview Guide (Karen)

65

Appendix A6 – Community Member Interview Guide (Burmese)

71

Appendix A7 – Service Provider Interview Guide

Carrboro/Chapel Hill Burmese/Karen AOCD Group Service Provider Interview Guide

Interview Protocol: _________ thank you for taking the time to meet with us today. We know your time is valuable and we appreciate your participation. My name is _______and I will be leading the interview today. This is _______, who will be taking notes and assisting me during our discussion, and _________will be interpreting. We are a team of six graduate students of Public Health at UNC collaborating on a project with local leaders of the Burmese and Karen communities in Chapel Hill and Carrboro, and the agencies that serve them. The purpose of this project is to learn about the history and strengths that Burmese and Karen residents bring, the challenges they face, and the needs they can address in partnership with local agencies. To obtain this information during the upcoming months, we will be compiling available statistics, participating in local meetings and events, and interviewing service providers and community members. In April 2007 we will hold a community forum where we will bring together people from the Burmese/Karen community as well as local service providers to discuss our findings and determine priorities for next actions. We hope this will benefit the community through increased awareness by both service providers and community members, thus facilitating better understanding and enhanced service. The reason we are speaking to you today is to find out your thoughts and experiences as a service provider. We are very interested to hear what you have to say. There are no right or wrong answers. Different people are likely to have different opinions, and we want to gather as much information from different sources as possible. If there are any questions you don’t want to answer, please let me know. You may stop the interview at any time. You are not likely to experience any risks from being in this interview. Every effort will be taken to protect your identity. Your name and comments will remain confidential. There are six members of our team and we are the only people who will have access to the information that you give us. We will be summarizing comments and writing them in a report, but will not identify who said what, nor will we identify the names of the individuals we interview. The interview will last about 60 minutes and we would like to take notes and record this interview on a tape recorder. Your input is important and we want to ensure that we accurately record what you share with us. Again, you are free to not answer any

72

question. You may also press the stop button on the tape recorder if you choose. After we are finished using the tapes for this project they will be completely erased. Is it okay with you if we use a tape recorder? If not, we can still do the interview, but just take notes. Do you have any questions about the interview or the project? First I’d like to share some pointers to keep in mind throughout the interview:

1. Please talk in a voice at least as loud as mine. We want to be able to hear you on the tape recorder.

2. There are no wrong answers, just different opinions. We’re looking for different points of view, so feel free to say whatever you think

3. We value your opinions, positive and negative, and we hope you choose to express them during the interview

4. Everything said is confidential and will not be repeated 5. We are interested in your perspective as a service provider, so please keep that

in mind during the interview 6. If you have any concerns about this project, or your rights as a research

participant, please do not hesitate to contact any of the individuals listed on the consent form you received.

Ok, with your permission, we’ll begin. (start tape player)

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Personal Information

1. What services does your organization offer? a. What is your role in the organization.

Role as Service Provider to Burmese/Karen

2. Who accesses your agency’s services? a. How do people in the Carrboro/Chapel Hill community access your services? b. Are there any barriers to access your services? e.g. Transportation

3. In what capacity do you work with the Burmese community? a. How long have you worked with them/ how often do you work with them? b. What are some barriers you have experienced while working with the Burmese community? e.g.: language, culture

Influence of CH/Carrboro

4. What are the strengths of the Chapel Hill/Carrboro area? 5. How is the Burmese community perceived in Chapel Hill/Carrboro?

a. In Chapel Hill/Carrboro, what services are lacking for the Burmese community?

Describing the Burmese/Karen Community

6. When you think about the Carrboro/CH Burmese community, what comes to your mind?

a. What is your impression of the Burmese community’s economic well-being? b. What are the unique values, customs or culture of the Burmese community?

7. What brings the community together? (e.g. Events? Culture?) a. Can you think of any factors that divide them?) b. How do different people within the Burmese community interact? e.g.; men and women? Older and younger? Different camps? c. How does the Burmese community relate with other minority/refugee communities in this area?

Strengths/Challenges/Needs

8 What are the strengths of the Burmese community? 9. What do you see as the primary challenges faced by the

community? a. How are these challenges similar or different from other

immigrant/minority communities? b. Can these other communities serve as a model for the Burmese

community? c. How have the needs of the community evolved over time? – optional,

depending on interviewee

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d. How do the needs of individuals within the community vary across age/gender/ethnic group?

e. What service enhancements, within your agency or not, would you make to better meet the needs of the Burmese and Karen community?

Education 8. What is the education level of the Burmese community?

a. Are the majority of the community members able to read or write in English? Burmese?

b. Do adults in the Burmese community aspire to higher education for themselves? For their children?

9. Is there sufficient provision of ESL services in the area? a. Do Burmese community members take advantage of the system? b. How big of a barrier is language in the daily lives of the Burmese?

Health

10. What health issues do you see within the Karen and Burmese community? a. Are any of these health or lifestyle issues unique to the Burmese and

Karen community? Do you have any examples? b. How has their stay in the camps affected their health?

11. Have you observed evidence of trauma within the community? a. If so, are you aware of any services and/or coping mechanisms to deal

with the trauma? 12. What is the impact of American culture on Burmese health?

Discussing the Ethnic Groups

13. Are you aware that there are two different ethnic groups – the Burmese and the Karen – among the refugee community in Chapel Hill/Carrboro? (if no, skip the rest of the questions in this section)

a. Do you notice any differences between the Burmese and the Karen? Can you give any examples?

b. Have you ever noticed disagreements between the two ethnic groups? Can you give any examples?

14. Does the difference in culture affect any of the topics we have discussed already today?

Wrap Up/Follow Up

15. Who would you recommend to interview within the Burmese community? 16. Have you worked for any other organizations that work with the Burmese

community? If so, for which ones and how long?

17. Do you have any recommendations for secondary resources to help inform us on the Burmese community?

18. Would you be interested in attending a community forum for the Burmese community?

19. Would you like to help us coordinate a community forum?

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20. We would like to interview some other service providers to the Burmese community to better inform our project.

Do you know anyone else who would be interested in helping us coordinate a community forum?

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Appendix A8 – AOCD Fact Sheet for Community Members (English)

WHAT IS AOCD? AOCD means Action-Oriented Community Diagnosis. AOCD is a community assessment designed to understand the

cultural, social, economic, and health experiences of individuals who live in your community. The purpose is to better understand the experiences of the members of your community. WHY ARE YOU PARTICIPATING IN AOCD? You are invited to participate because we want your ideas on the strengths and needs of the community of refugees from Burma living in Chapel Hill/Carrboro. Someone in your community identified you as a person who can talk about the views of the refugee community as a whole. WHAT WILL YOU BE ASKED TO DO? You will be asked to participate in an individual interview with two team members from the UNC School of Public Health. The interview is made up of a series of questions about life in the community of refugees from Burma living in Chapel Hill. An example of a general question is, “What is it like to live in your community?” There are no wrong answers or bad ideas, just different opinions. The interview will be one-time only and will take about 60 minutes of your time. If you agree to participate in the interview we will record your response on a piece of paper. Also, if you do not object, we would like to tape record the discussion to make we do not miss anything. Only members of our group will listen to the tapes. The tapes will be erased after

our study is over. You can ask us to turn off the tape recorder at anytime. If you decide to participate in this interview, you will be asked to sign an “informed consent/fact sheet” form. Being read the questions on the form means that you understand the purpose of the AOCD project and what you will be asked to do during the project. It also means that you understand that you can stop taking part in the project at any time you want to. WHAT WILL YOU GET OUT OF BEING IN THIS PROJECT? You will have the opportunity to share your thoughts about the future of the Chapel Hill/Carrboro refugee community. You will not be paid to participate in this interview. There are no costs for participating in the study other than your time spent during this interview. WHAT WILL WE DO WITH THE INFORMATION THAT WE GATHER? The team will summarize the information gathered from interviews and focus groups (small groups assembled to identify and discuss key issues in the community) and present it both written and verbally to your community.

YOUR PARTICIPATION IS VOLUNTARY AND CONFIDENTIAL. Any information that you provide will remain confidential. Though

your name and address may be collected, it will not be used in any way in the research study or linked to your responses. It will only be used to invite you to attend the community forum. To protect your privacy, all of the information you provide will be stored only with an

identification number, not with your name. Every effort will be taken to protect the identity of the participants in this study. However, there is no guarantee that the information cannot be gotten by legal process or court order. To ensure “confidentiality,” you can pick a made up name, if you wish, to use during the project so that nobody will see your real name connected with the study. Information such as age and sex may be gathered during the interview. These descriptive characteristics are collected only to help summarize our data. When we report the data, all identifying information will be removed. Your responses and comments will not be linked to you. The only people with access to all data are the members of the student team and the faculty advisors. All notes and audiotapes containing your interview responses will be stored in a locked cabinet at the School of Public Health and will be destroyed in May 2007 when the study is over. CAN YOU REFUSE OR STOP PARTICIPATION? Yes. If you agree to participate in this study, please understand that your participation is voluntary (you do not have to do it). You are free to stop participating at any time. You can refuse to answer any questions. During the interview you may ask that the recording be stopped at any time. Whether or not you participate in the research will have no effect on services obtained in the community or any relationship with the UNC. WHAT ARE THE RISKS OF TAKING PART IN THIS PROJECT?

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The risk to you for taking part in this project is small, as we will be asking you general questions about life in your community. Some questions, such as those about problems or needs in your community, may cause you to feel uncomfortable. Therefore, you can skip over any question which you do not wish to answer.

WHO IS IN CHARGE OF THIS PROJECT? HOW CAN I CALL THEM? If you have any questions, please feel free to contact us by

emailing us at [email protected] or by calling 919-966-3919 ext. 4. We are completing this project as a class assignment under the supervision of our faculty advisor, Dr. Geni Eng. You can call Dr. Eng, collect if you wish, at her office at the UNC – School of Public Health at 919-966-3909, or toll-free at 866-610-8272. Before the interview begins, you will be asked for your consent orally.

Thank you!

Would you like to

participate in an AOCD of your community?

Consent Information


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Appendix A9 – AOCD Fact Sheet for Service Providers

WHAT IS AOCD? AOCD means Action-Oriented Community Diagnosis. The purpose of an AOCD is to learn more about the strengths and

needs of the people from Burma living in Chapel Hill and Carrboro. We hope to do this by talking to you and other people about the experiences of community members and service providers. WHY ARE YOU PARTICIPATING IN AOCD? Someone identified you as a person who can talk about the people from Burma living in Chapel Hill and Carrboro. We want to hear your thoughts and opinions about community members derived from your interactions with them. WHAT WILL YOU BE ASKED TO DO? You will be asked to participate in one interview with two team members from the UNC School of Public Health. We will ask you questions about being a service provider to the community. For example we will ask, “In what capacity do you work with the Burmese community?” There are no wrong answers or bad ideas, just different opinions.

The interview will take about 60 minutes of your time. If you agree to participate in the interview we will record your responses on a piece of paper. Also, we would like to tape record the interview to make sure we do not miss anything. Only members of our team will listen to the tapes. The tapes will be erased after our project is over. You can ask us to turn off the tape recorder at anytime. WHAT WILL YOU GET OUT OF BEING IN THIS PROJECT? You will have the opportunity to share your thoughts about the future of the people from Burma living in Chapel Hill and Carrboro. We hope that the information will lead to improved services for you and members of the community. You will not be paid to participate in this interview. WHAT ARE THE RISKS OF TAKING PART IN THIS PROJECT? WHAT ARE THE COSTS? The risk to you for taking part in this project is small, as we will be asking you general questions about life for the people from Burma living in Chapel Hill and Carrboro. Some questions, such as those about problems or needs in the community, may cause you to feel uncomfortable. Therefore, you can skip over any question which you do not wish to answer. The only cost for you is the time it will take to complete this interview. WHAT WILL WE DO WITH THE INFORMATION THAT WE GATHER? Our team will summarize what we learn about

the strengths and needs of your community. At the end of the project, we will hold a community forum to share this information. We

will also include this summary in a written report that will be made available to members of the community. YOUR PARTICIPATION IS VOLUNTARY AND CONFIDENTIAL. You do not have to participate in this project. You also do not have to answer any of the questions asked during the interview. You are free to stop participating in the project at any time, for any reason. Any information that you provide will remain confidential. Your name will not be linked to any of your responses. We will only use your name and address, if you provide it to us, to invite you to attend the community forum. To protect your privacy, all of the information you provide will be stored only with an identification number, not with your name. Every effort will be taken to protect the identity of the participants in this study, and only members of our team or our faculty advisors will have access to the information you and others provide. However, there is no guarantee that the information cannot be gotten by legal process or court order. To ensure “confidentiality,” you can pick a made up name, if you wish, to use during the project so that nobody could see your real name connected with the project. Information such as age and sex may be gathered during the interview. We will only use this information to help summarize our findings. We may use quotes when we present our findings, but we will not link your name or any identifying information to your responses and comments.

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All notes and audiotapes containing your interview responses will be stored in a locked cabinet at the School of Public Health and will be destroyed in May 2007 when the project is over. CAN YOU REFUSE OR STOP PARTICIPATION? Yes. Taking part in this project is up to you. You have the right to refuse to answer any question or stop taking part in the interviews at any time. During the interview you may ask that the recording be stopped at any time. Whether or not you participate in the research will have no effect on services obtained in the community or any relationship with the UNC.

WHO IS IN CHARGE OF THIS PROJECT? HOW CAN I CALL THEM? If you have any questions, please feel free to contact us by

emailing us at [email protected] or by calling 919-966-3919 ext. 4 or toll-free at 1- 866-610-8272 ext.4. We are completing this project as a class assignment under the supervision of our faculty advisor, Dr. Geni Eng. You can call Dr. Eng, collect if you wish, at her office at the UNC – School of Public Health at 919-966-3909. If you decide to participate in this interview, you will be asked to give “informed” oral consent. Being read the questions on the form means that you understand the purpose of the AOCD

project and what you will be asked to do during the project. It also means that you understand that you can stop taking part in the project at any time you want to.

Thank you!

Would you like to participate in an AOCD of the People from Burma in Chapel Hill and Carrboro?

Consent Information Enclosed


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Appendix A10 – AOCD Fact Sheet (Karen)

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Appendix A11 – AOCD Fact Sheet (Burmese)

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APPENDIX B - List of Interviewees Date Interviewed Interview Type Interviewer Note taker

January 19, 2007 Service Provider Caytie Anna January 19, 2007 Service Provider Anna Becky January 19, 2007 Service Provider Becky Caytie January 20, 2007 Service Provider Neha Meg January 24, 2007 Service Provider Becky Anna January 25, 2007 Service Provider Michael Meg January 26, 2007 Service Provider Neha Meg February 2, 2007 Service Provider Anna Caytie February 4, 2007 Service Provider Anna Michael February 9, 2007 Service Provider Caytie Anna February 14, 2007 Service Provider Becky Michael February 16, 2007 Service Provider Neha Meg February 21, 2007 Service Provider Anna Meg February 25, 2007 Karen Community Member Anna Michael March 2, 2007 Service Provider Neha Meg March 2, 2007 Karen Community Member Michael Neha March 3, 2007 Burmese Community Member Meg Anna March 4, 2007 Burmese Community Member Anna Neha March 5, 2007 Service Provider Meg Caytie March 9, 2007 Karen Community Member Becky Meg March 9, 2007 Karen Community Member Meg Becky March 13, 2007 Karen Community Member Anna Meg March 14, 2007 Karen Community Member Anna Meg March 16, 2007 Karen Community Member Meg Michael March 16, 2007 Karen Community Member Meg Michael March 17, 2007 Burmese Community Member Michael Meg March 18, 2007 Karen Community Member Anna Meg March 18, 2007 Burmese Community Member Anna Michael March 19, 2007 Karen Community Member Neha Anna March 20, 2007 Burmese Community Member Becky Caytie March 21, 2007 Burmese Community Member Michael Anna March 21, 2007 Karen Community Member Caytie Becky March 22, 2007 Burmese Community Member Neha Becky March 23, 2007 Rakhine Community Member Anna Neha March 23, 2007 Karen Community Member Becky Caytie March 26, 2007 Burmese Community Member Michael Anna March 28, 2007 Karen Community Member Michael Becky March 28, 2007 Service Provider Anna Caytie March 29, 2007 Karen Community Member Anna Neha March 31, 2007 Burmese Youth Focus Group Anna/Caytie Neha March 31, 2007 Karen Youth Focus Group Anna/Caytie Becky

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APPENDIX C – Secondary Data Sources

Resources about Our Community These are the resource most directly about our community. Department of Health and Human Services. Department of Public Health: NC Refugee Health Program. Refugee Health Data Collection (2006). County Resettlement Sites for Refugee Arrivals to NC: Between July 1, 2005 and June 30, 2006. Available from DHHS/DPH. Jennifer Morillo. Department of Health and Human Services. Department of Public Health: NC Refugee Health Program. Refugee Health Data Collection (2005). County Resettlement Sites for Refugee Arrivals to NC: Between July 1, 2004 and June 30, 2005.Available from DHHS/DPH. Jennifer Morillo. Orange County Health Department. (2005) State of the County Health Report: Orange County, North Carolina. Chapel Hill: NCPH. Southeast Asia Resource Centre, Southeast Asian American Statistical Profile, 2004 March 13, The News & Observer (Raleigh, North Carolina) Triangle gives haven to Myanmar refugees; 1 woman's journey spanned a decade - Michael Easterbrook Refugee & Migrant Health Care These materials will give us background information on the situation of refugee and migrant health, globally and domestically. This background will be important for us to begin to understand what kind of issues the refugees may face. Allden, K., Poole, C., Chantavanich, S., Ohmar, K., Nyi Nyi, A., Mollica, R. Burmese Political Dissidents in Thailand, American Journal of Public Health, 1996: 86:1561-1569. Alter, R. (1998). Mental health issues of resettled refugees. Retrieved March 28, 2006 from http://ethnomed.org/ethnomed/clin_topics/mental_health.html Burgess, A. (2004). Health challenges for refugees and immigrants. Refugee reports. 25(2). Retrieved March 19, 2006 from http://www.refugees.org/data/refugee_reports/archives/2004/mar_apr.pdf

Centers for Disease Control (CDC).a. Medical examination. Retrieved March 19, 2006 from http://www.cdc.gov/ncidod/dq/health.htm

CDC-b. Retrieved March 19, 2006 from http://frwebgate.access.gpo.gov/cgi- bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+8USC1182

http://www.refugees.org/data/refugee_reports/archives/2004/mar_apr.pdf

http://www.cdc.gov/ncidod/dq/health.htm

http://frwebgate.access.gpo.gov/cgi-%20bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+8USC1182

http://frwebgate.access.gpo.gov/cgi-%20bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+8USC1182

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Carlsten, C. (2003). Refugee and immigrant health care. Retrieved March 28, 2006 from http://ethnomed.org/ethnomed/clin_topics/refugee_health/carlsten.pdf

Gavangan, T. & Brodyaga. L. (1998). Medical care for immigrants and refugees. American Family Physician. 57(5). Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux. Fazel, M. & Stein, A. (2003). The mental health of refugee children. BMJ, 327:134. Retrieved March 19, 2006 from http://bmj.bmjjournals.com/cgi/content/full/327/7407/134 Hickey, G. (2005). “This is American get punished”: Unpacking narratives of Southeast Asian refugees in the US. Intercultural Education. 16(1), 25-40. Kang, D., Kahler, L. R., & Tesar, C. (1998). Cultural aspects of caring for refugees. American Family Physician. 57(6). Kemp, C. & Rasbridge, L. (2005). Refugee and immigrant health: A handbook for health professionals. New York: Cambridge. Quiroga, J. & Berthold, M. (2004). Torture survivors: Unique Health and mental health issues. Refugee reports. 25(2). Retrieved March 19, 2006 from http://www.refugees.org/data/refugee_reports/archives/2004/mar_apr.pdf Substance Abuse and Mental Health Services Administration. Retrieved March 25, 2006 from http://www.refugeewellbeing.samhsa.gov/ US Refugee Policy It is very important we understand the domestic policy environment regarding refugees and refugee settlement so we can properly understand the community’s entitlements under the current law, and recognize if any policies are adversely affecting the health of the community. Code of Federal Regulations. Retrieved March 29, 2006 from http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?title=45&part=400&section=93&year=2000&type=text Lanphier. C. M. (1983). Refugee resettlement: Models in action. International migration review, 17(1), 4-33. Martin, D. (2005). The United States Refugee Admission Program: Reform for a new era of refugee resettlement. Washington, DC: Migration Policy Institute. Office of Refugee Resettlement (ORR)-a. Retrieved March 23, 2006 from http://www.acf.hhs.gov/programs/orr/programs/rma.htm

http://ethnomed.org/ethnomed/clin_topics/refugee_health/carlsten.pdf

http://bmj.bmjjournals.com/cgi/content/full/327/7407/134

http://www.refugeewellbeing.samhsa.gov/

http://www.acf.hhs.gov/programs/orr/programs/rma.htm

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ORR-b. Retrieved March 23, 2006 from http://www.acf.hhs.gov/programs/orr/mission/index.htm ORR-c. Retrieved March 23, 2006 from http://www.acf.hhs.gov/programs/orr/programs/overviewrp.htm ORR-d. Retrieved March 23, 2006 from http://www.acf.hhs.gov/programs/orr/reporting/index.htm ORR-e. Retrieved March 23, 2006 from http://www.acf.hhs.gov/programs/orr/policy/02arc2.htm#_Ref532872905 Office of Civil Rights. Retrieved March 23, 2006 from http://www.hhs.gov/ocr/discrimrace.html US Citizenship and Immigration Services. Retrieved April 1, 2006 from http://uscis.gov/graphics/lawsregs/ina.htm U.S. Committee for Refugees and Immigrants. Retrieved November 28, 2006 from www.refugees.org US Department of Starte Bureau of Population, Refugees and Migration. Retrieved November 28, 2006 from http://www.state.gov/g/prm/ Zucker, N. L. (1982). Refugee resettlement in the United States: The role of the voluntary agencies. Legal studies, 178, 155-177. Global Political Context While our overriding interest is the needs of the local Carrboro and Chapel Hill refugee community, it would be amiss of us to not consider the wider context and reasons that brought them here. We expect the community to be very politically aware, and we want to be able to listen to and understand their ideological positions, and their sense of the forces that have shaped their situation. For this reason we have included a number of resources about Burma and the refugee camps in Thailand. Achiron, M. (2001). A Timeless Treaty Under Attack. Refugees, n.123, 2001, UNHCR, Switzerland, accessed from www.unhcr.org, on 22 November 2006 Aung San Su Kyi, Freedom from Fear and Other Writings, Penguin, London, 1996 Convention and Protocol Relating to the Status of Refugees, 1951 & 1967, UNHCR, http://www.unhcr.org/protect/3c0762ea4.html, accessed on 22 November 2006. Faiola, A. Misery Spirals in Burma, The Washington Post, 17n November, 2006, accessed 25th November, 2006: http://www.msnbc.msn.com/id/15757111/

http://www.acf.hhs.gov/programs/orr/programs/overviewrp.htm

http://www.acf.hhs.gov/programs/orr/policy/02arc2.htm#_Ref532872905

http://www.hhs.gov/ocr/discrimrace.html

http://uscis.gov/graphics/lawsregs/ina.htm

http://www.unhcr.org

http://www.unhcr.org/protect/3c0762ea4.html

http://www.msnbc.msn.com/id/15757111/

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Hus, A . (2006). Burma’s Trapped Refugees. The Wall Street Journal. Retrieved November 22, 2006 from http://www.theirc.org/news/burmas-trapped-refugees.html Husarka, A. (2006). The Patriot Act’s Terrible Toll: Stranded. The New Republic, retrieved November 22, 2006 from, http://www.tnr.com/doc.mhtml?pt=5b518kWc8X%2F%2BLyvYZ%2F2a2C%3D%3D Lee, T., Mullany, L., Richards, A., Kuiper, H., Maung, C., Beyrer, C. Mortality Rates in Conflict Zones in Karen, Karenni, and Mon States in Eastern Burma, Tropical Medicine and International Health, Vol. 11, No.7, pp 1119-1127, July 2006 McGeown, K. (2006). American Dream for Burmese Refugees. BBC News. Retrieved November 22, 2006, from http://news.bbc.co.uk/go/pr/-/2/asia-pacific/530176.stm Mc Kinsey, K. (2006). In Search of Freedom, Burmese Refugees head for New Life in America. UNHCR News Stories. Retrieved November 22, 2006 from http://www.unhcr.org/cgi-bin/texis/vtx/news/opendoc.htm?tbl=NEWS&id=44e5bdf72. United Nations High Commissioner for Refugees (UNHCR)-a. Retrieved March 25, 2006 from http://www.unhchr.ch/html/menu3/b/o_c_ref.htm UNHCR-b http://www.unhcr.org.uk/info/briefings/basic_facts/index.html Literature We have put together a list of fiction and non-fiction reading that provides insight into the history of Burma, and will attempt to read them over winter break. Ghosh, Amitav. (2002). Glass Palace. New York, NY: Random House. Larkin, Emma (2004) Finding George Orwell in Burma. New York, NY:Penguin Press. Tan, Amy. (2005). Saving Fish From Drowning. New York, NY: Putnam. Group Dynamics Further to our workshop on group dynamics, we have taken a more active interest in conflict and conflict resolution. This is because we want to be prepared for potential conflict or tensions within our community; we want to resolve conflicts within our group quickly, and because the very nature of a refugee community is closely tied to conflict – being the end result of political conflict or persecution. We are acutely aware that conflict has the potential to adversely affect the group and as such we see a role for the whole group in resolving any conflict that may occur. Anna Schurmann’s course on International Conflict Management has provided additional resources in this regard. Fisher, R. (1996). Beyond Machiavelli. London: Penguin Press. Stone, D., Patton, B., Heen, S. (1999) Difficult Conversations. London: Penguin Press. 1999

http://news.bbc.co.uk/go/pr/-/2/asia-pacific/530176.stm

http://www.unhcr.org/cgi-bin/texis/vtx/news/opendoc.htm?tbl=NEWS&id=44e5bdf72

http://www.unhcr.org/cgi-bin/texis/vtx/news/opendoc.htm?tbl=NEWS&id=44e5bdf72

http://www.unhcr.org.uk/info/briefings/basic_facts/index.html

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Ury, W. (2000). The Third Side. London: Penguin Press. Web Resources for Further Research Burma Resources • http://en.wikipedia.org/wiki/Burma • http://www.burmanet.org/news/ • http://myanmarburmainfo.co.uk Karen Resources • http://www.karen.org • http://www.karenemergency.org • http://www.freeburmrangers.org • http://www.kawthoolei.org/about.php • http://en.wikipedia.org/wiki/Karen_people • http://www.khrg.org/

http://www.burmanet.org/news/

http://www.karen.org

http://www.karenemergency.org

http://www.freeburmrangers.org

http://www.khrg.org/

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APPENDIX D – Community Forum Materials Appendix D1 – Community Forum Program

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Appendix D2 – Community Forum Invitation

The Planning Committee for People from Burma Living in Chapel Hill & Carrboro

Invites you to a

Community Meeting

April 21, 2007

5:00pm-8:00pm Carrboro Elementary School

400 Shelton Street Carrboro, NC

Dinner and Entertainment will be provided

Questions: Contact Meg Ellenson

[email protected] or 919-260-9560

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Appendix D3 – Community Forum Flyer (English)

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Appendix D4 – Community Forum Flyer (Karen)

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Appendix D5 – Community Forum Flyer (Burmese)

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Appendix D6 – Key Words for Discussion Groups at Community Forum to be used as an Aid by the Interpreter Adult Education: Community Members want to attend ESL Classes to improve their English, but ESL class scheduling conflicts with work and family life. English Burmese or Karen (language you

are interpreting in) Tutoring

Community

Educator/Instructor

Transportation

Schedule

Family life

Work Conflict

Motivation

Inspiration

Progress

Learning

Learning pace

Learning Style

Teaching

Speaking

Understanding

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Health Literacy: Lack of knowledge about US health practices surrounding personal and home care makes it difficult for community members to stay healthy and access the care they need. English Burmese or Karen (language

you are translating in) health literacy

Hygiene

Sanitation

Ventalation

Insurance

co-pay

Provider

Restrictions

Maintenance

follow-up

Preventative

Routine

Avoiding

newly resettled refugees

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Community Organization: A lack of organization hinders the community’s ability to help new arrivals, maintain culture, and improve the lives of community members English Burmese or Karen (language

you are translating in) Skills

Organization

Maintain

Improve

Build capacity

Leadership

Hinders

Prevents

Impact

Progress

Develop

Bring together

Tension

Mistrust

Unwillingness

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Language Barrier: The lack of interpreters for the Burmese and Karen languages in Chapel Hill/Carrboro prevents access to services and reduces their quality English Burmese or Karen (language you

are interpreting in) Community members

Service providers

Languages

Understanding

Meet Needs

Inappropriate

(Medical) Terminology

Complex terms

Communicate

Express yourself

Qualified

Helping vs. hurting

Importance

Changeability

Goal

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APPENDIX E – Additional Themes

Appendix E1 – CHANGES IN FAMILY DYNAMICS

The roles of family members in the community of people from Burma drastically change

after arrival in Chapel Hill and Carrboro. Community youth acculturate more quickly than their

parents into the U.S. lifestyle, causing a shift in power dynamics within families from Burma.

THEME STATEMENT: TRADITIONAL PARENTAL ROLES ARE COMPROMISED BY COMMUNITY YOUTH ACCULTURATING MORE QUICKLY THAN THEIR PARENTS INTO THE AMERICAN LIFESTYLE.

E1.1 Community Member Perspective Responses from community members about their children’s quicker adaptation vary.

Many are pleased that their children have multiple opportunities through school and are able to

learn English. Part of the reason many people stated that they took steps to escape Burma was for

their children’s future – for them, their children’s success is seen as an indication that they made

the right decision.

Community members also noted a change in parental authority. While strong physical

punishment of children is acceptable in Burma, it is illegal in the U.S. A number of parents in the

community mentioned that this was positive aspect of U.S. culture. However, community

members were overwhelmingly anxious about the impact of U.S. culture on their family

structure. In particular, one community member was concerned about the effects of the lesser

parental authority on kids’ psychology,

Parents don’t try to be educated, but the kids are educated. Kids become the parents’ advisor and translator. This is really bad. I would never say my kid for their opinion. He is smarter than me, I would tell him he is a really good guy, but it is bad for his psychology. There is even a book about it. This is common in migration. Kids go to school and learn English really quick. Parents never learn it … Parents do not even know what is going on with their kids at school. A lot of people are not aware of their kids’ education. This is the first generation, maybe in 5 years we will have a lot of drop-out kids … I am very worried about it.

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E1.2 Service Provider Perspective

Service providers did not talk about this theme directly. One service provider mentioned

that the children seem very respectful of their parents and other elders. Teachers also mentioned

that the children are very well acculturated, and do not share information about their ethnic

customs and culture. For this reason, the teachers find it difficult to learn about and to be

respectful of Burmese and Karen customs.

E1.3 Team Perspective

Changes in power dynamics and the erosion of the traditional role for the male head of

household were obvious to the team as it visited people in their homes and talked to them

casually. As one team member observed, “[An adolescent in the community] spoke to me today

about how he feels it is strange that he opens and interprets bills for this parents. I thought it must

be a strange power dynamic – for a culture that relies heavily on respecting parents and their

authority, to be in a situation where children sometimes have more authority must be strange for

the whole family.”

The team feels it is not just children adapting quicker to U.S. culture that erodes

traditional family structures – women working in the formal sector is also new for most families

and men are no longer the heads of households. This change in gender roles is clearly

challenging for men to deal with, as one team member observed, “[A community member] told

us that back home his whole family had respected fathers and husbands because they were the

breadwinners. Now women work as well, and men do not automatically get the respect they used

to. They miss this automatic respect.”

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E1.4 Comparison of Community Member, Service Provider & Team Perspectives

Overall, both insiders and outsiders recognize the changing power dynamics between

parents and children in the community. Community members, service providers, and team

members accept that children are more acculturated than their parents. Based on information

gathered during the AOCD process, it appears that little is being done to re-establish traditional

family structures and power dynamics within the community.

E1.5 Team Recommendations

• Service providers should provide meetings for new arrivals to acculturate adults to aspects of American culture such as bills, access to ESL classes, etc.

• Service providers should be aware of compromised power dynamics when interacting with community members.

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Appendix E2 – ETHNIC IDENTITY

Adults in the community do not always approve of their children acculturating to all

aspects of U.S. culture. Furthermore, they are apprehensive about community youth losing ties to

their ethnic culture and values.

THEME STATEMENT: ADULTS FEEL ANXIOUS THAT YOUTH ARE LOSING THEIR ETHNIC IDENTITIES BECAUSE THEY ADAPT SO QUICKLY TO AMERICAN CULTURE.

E2.1 Community Member Perspective

While many parents are pleased that their children adapt quickly, many of the longer-

term U.S. residents from Burma are concerned about the influence of certain aspects of U.S.

culture, especially the Western approach to familial life. In particular, parents are concerned

about pre-marital affairs and the high prevalence of family break-ups. Parents try to moderate the

influence of Western culture by letting their children adopt the good aspects and discard the

negative aspects, as one community member explained,

In America there is a good culture, but every culture (has some part that) is not good. Every nationality is good and not good for us … I have to control my children not to follow the bad ways of western culture, that’s why we have to celebrate our big holiday … we have to teach them the unique aspects of the family and culture … when they bring good culture we encourage them, when they bring home bad things we forbid them.

Parents are also concerned that their children will lose their native language ability. Often

when parents speak to their children in Burmese or Karen, the children reply in English. One

community member parent told the team that he does not talk to his children if they speak to him

in English.


This is an area in which the team did not get data from service providers.

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Team members were impressed at how well community youth managed to stay connected

to their culture. While there are clear differences between the children’s lives and their parents’

lives, there is still familial cohesion, despite young people speaking English and following

Western customs. One team member said,

I am very impressed by the young people in the community – they seem to maintain a real respect for their parents and culture, while adapting well into their lives here. The community is very new, so young people are still very close to their origins. We heard about some secret girlfriends and boyfriends – but it is difficult to share parents’ concern about this – it seems so normal and healthy to us. E2.4 Comparison of Community Member, Service Provider & Team Perspectives

Both the team and community noted that community youth acculturate more quickly than

their parents. However, there is a difference in the insider and outsider perspective – while the

team felt that children are connected to their traditional culture despite being acculturated to the

U.S., the community felt that they are adopting U.S. customs and values and forgetting their

traditional ones.

E2.5 Team Recommendation

• Youth groups that reinforce ethnic identities and traditional cultural aspects of the community of people from Burma should be created.

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Appendix E3 – EDUCATION FOR YOUTH

All of the parents interviewed in the community value education for their children and

view their arrival in the U.S. as a way for their children to have a better future. However, the

refugee camps only provide education up to the 10th grade, and many children are taught in Thai

and not their native language. Therefore, parents and youth explained the need for tutors for

community youth21 in school. This need is a result of a few factors including different learning

styles, different educational level than classmates, not having enough help in school, and no help

outside of school.

THEME STATEMENT: DUE TO THE LACK OF TUTORING OUTSIDE OF CLASS TIME, FAMILIES FEEL THAT CHILDREN HAVE TROUBLE KEEPING UP WITH THEIR STUDIES.


For most community youth, entering the school system in Carrboro and Chapel Hill is

different from any educational experience they received in Burma and/or Thailand. One mother

explained that the way in which the children learn in the U.S. along with the curriculum is very

different than the youth are used to. During the two focus groups, youth also expressed the

challenges of being at different educational levels than their classmates. Often times they feel

behind in their understanding of certain material or concepts. One adolescent explained, “I don’t

like the thing when we are in class and because we are not equal with regular students yet, I

cannot catch up yet. Sometimes I just sit in class and think, I can do nothing.” Older youth

expressed that it is harder for them to learn than it is for their younger siblings.

The interviewed youth also felt that they did not receive enough help in school. There

was a general consensus that most teachers offered help when they could, but they did not

always have the time. Not only do community members think that there is not enough help in 21 Community youth refers to all children who arrived from refugee camps and are part of the people from Burma community.

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school but some of the adults realize that they themselves lack the resources to provide help to

their children. One community member explained that new arrivals who are much younger

cannot help their children in school and do not know where to find a tutor. Despite the challenges

that these youth face, many of them are persistent and optimistic in working hard.


Service providers conclude that community youth experience challenges within Chapel

Hill-Carrboro City Schools because the majority of them speak little to no English when they

first arrive and the schooling they have had in Burma and the refugee camps is very different.

As a result, community youth often struggle to keep up with their other classmates.

In the Chapel Hill-Carrboro City Schools, the first step in introducing the youth from

Burma is to teach them the basics of English and daily school life. Typically, this is done through

ESL classes. One service provider explains this process, “Children tend to come in a group at

first to get survival language skills, get paired with a buddy, get dictionaries if they have them in

the particular language,22 get them used to the layout of the school and the routine of the school

– make sure they are as comfortable as possible." After the initial introductions, children are then

expected to begin learning English at the same time as they learn other subjects, including math,

social studies, science, etc; all while using an alphabet that is completely different from their

own. The state requires students to take end of the term tests that many fail because the language

barrier is too difficult.

Beyond the different style of education, many of the youth from Burma enter the school

system with drastically varying education levels. Service providers explained that often students

are much older than the rest of their classmates because they had very little schooling in Burma

or in the camps. One service provider explained that the students are constantly challenged to 22 This service provider also explained that dictionaries in Burmese and especially Karen are quite hard to come by.

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“catch-up” to their classmates, as shown by the state testing requirements. Service providers

explained that addressing this issue is quite a challenge with the high number of ESL students

compared to the number of teachers.


Through conversations with community youth, the team realized that many of them are

much older than the average age for their grade in school. For example, it is not uncommon to

have 19 year old community member in the 11th grade, for which the average student age is 17

years. The reflections from the team concluded that these youth need extra help either outside of

or during school hours. Not only did the team observe the community youth talking about the

difficulties of learning at school, but they also heard them expressing the desire to have tutors to

help them learn more efficiently. Although these youth want tutors, they do not seem to know

where to find them.


Although not directly stated by service providers that youth from Burma are in need of

tutors outside of class time, their description of the challenges that these students face is clear.

Furthermore, from what service providers have expressed, this gap exists because it does not

seem feasible to add to the existing services in the school system to address these issues. Both

adults and youth in the community have recognized this gap and have called for tutors for the

school-aged children. They also understand that they themselves do not have the language ability

or education to help their children themselves. The team reflections further emphasized the

desire of the community for youth tutoring. It is clear that both the community and service

providers are aware of the need for tutors and desire this service.


• Create a curriculum for training in cultural competency for teachers.

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• Enhance the support system for newly arrived community youth in the Chapel Hill-Carrboro City Schools.

• Advocate state and federal legislature to account for the extenuating circumstances of newly arriving refugees.

• Partner with existing programs and establish a pool of tutors for sponsors, teachers, and families to contact for recently resettled and academically at-risk community youth.

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Appendix E4 – DIVISIONS WITHIN THE COMMUNITY

There are two primary ethnic groups within the community of people from Burma living

in Chapel Hill and Carrboro: the Burmese and the Karen. In Burma, the Burmese are the ethnic

majority; however in Chapel Hill and Carrboro the Karen are presently more numerous. This

shift in demographics, as well as a past history of conflict and mistrust, has created some

divisions within the local community.

THEME STATEMENT: THERE IS A LACK OF UNITY BETWEEN ETHNIC GROUPS, WHICH HINDERS COMMUNITY COHESION.


Community members seem to have a strong ethic of “not speaking badly of others.”

Consequently, not all of the community members spoke openly about the tensions between the

Karen and Burmese, even when directly asked. Those who did speak up shared stories of events

in the past as well as recent experiences to give context to the friction among ethnic groups. The

history of civil strife in Burma, particularly between the Karen and ethnic Burmese, contributes

to contemporary tensions between ethnic groups in Chapel Hill and Carrboro. As one community

member proclaimed, “I am Karen people. I am not Burmese, but I am interested in everyone.

Some Burmese people are racist toward Karen people.” Due to these feelings, some community

members object to forming a community with other ethnic groups.

In contrast, other community members are willing to resolve current and past tensions

and come together as a united community of people from Burma. Another community member

explained his viewpoint,

I don’t know what’s happened with the Karen, I think we need to talk. Basically we need discussion to trust each other. I try my best for the Karen people. I fight for freedom. There are more Karen people; they are very strong right now. We always try to organize together. I tell them very openly, it depends on you. We need to find a better way.

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As these individuals’ quotes demonstrate, there appear to be mixed feelings and

some conflicting perceptions about divisions in the community. Some community

members object to forming a community with other ethnic groups. Other community

members are willing to resolve current and past tensions and come together as a united

community of people from Burma


All service providers knew there was a difference between the Karen and Burmese. Most

who had sustained contact with the community knew there was also tension between the two

groups. One recounted that when filling out forms, the Karen wrote ‘Karen State’ to indicate

where they were from, thereby avoiding writing “Burma.” One service provider noted some of

the many differences, "there are lots of layers to community because there is a difference

between what your see and what is actually happening…The Burmese are from Rangoon [the

former capital city of Burma], they are urban dwellers and politically active, educated and older.

The Karen were living in rural subsistence farming situations, they were not city dwellers."


Team members were attentive to attending events held by both the Karen and Burmese.

However, the cultural differences were obvious, and posed a challenge to its work. One team

member stated,

[The Karen] seem to agree with most things that are said, but I often wonder if they are being overwhelmed by the more vocal Burmese. When it comes time for them to take action on things, they seem noticeably reluctant. I sometimes wonder if the Karen even want to form a unified community. We know that is not necessarily what they want for Burma, so why is here any different?

While many community members expressed a desire for unity, others displayed behavior that

appeared to be exclusionary or disrespectful toward other ethnic groups. The team’s impression

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was that little effort from any groups is being put into building trust that can sustain functional

and lasting working relationships. Due to this inconsistency, the team is not sure whether the

entire community wants to unite or not.


Overall, community members, service providers, and team members recognize a lack of

community unity, but little is being done to counter this. It is unclear if and how the community

wants to unite. Furthermore, if unity is desired, it is not known what would be done to facilitate

the community coming together.


• Mutual learning activities including leaders from both the Karen and Burmese ethnic groups (e.g., leadership training).

• Establish dialogue on terms with which both ethnicities can be comfortable. • Establish common ground within the entire community of people from Burma – write a

unified group mission statement. • Service providers should develop sensitivity and capacity for dealing with ethnic differences

among community members through a method such as cultural competency training.

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Appendix E5 – DOMESTIC VIOLENCE

The team heard stories of domestic violence by both service providers and community

members, including a number of incidents that have ended in jail sentences. Violent incidents

seemed to be initiated solely by males – the team only heard of husbands beating wives and

fathers beating children.

THEME STATEMENT: DOMESTIC VIOLENCE IS PRESENT IN THE COMMUNITY, IMPACTING THE WELL-BEING OF THE ENTIRE COMMUNITY.


Community members occasionally talked about domestic violence, usually about stories

of other people and not commonly about themselves. Some community members explained that

a husband hitting his wife or children was culturally acceptable in Burma or Thailand,

acknowledging that they knew it was illegal here. One woman explained the adaptation, “Some

things need to be learned. For example…in my country, my husband can hit me…(but here) he

hit me three times here and they put him in jail. Some things you need to keep, some you need to

change.”


Of the service providers that knew of spousal abuse occurring (or had at least heard

rumors of it), most were quick to point out that it is not unique to any singular population.

Several service providers explained that the majority of abused women they knew of in the

community did not report domestic abuse. One service provider explains:

[A] problem prevalent in the community is that men are violent with the women …If she doesn’t do what you want, if she doesn’t fix food, or do what you say, you can’t go hitting her …They don’t want to talk about it. A few women have come in and broken down about it, but for the most part they don’t want to talk about it and they say nothing.

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Throughout the project, the team often heard various stories of domestic violence in the

community. The team is aware of a number of men in jail for domestic abuse – at least one a

repeat offender – and the community makes an effort to coordinate to help these men and their

families. One team member recounted:

One community member told us that domestic violence was a private affair, and something that we needn’t interfere with because the wife could always call 911. There seemed to be no sense of possibility in learning other ways to resolve conflict, or that many women would be too scared to report their husbands. The same community members talked of the difficulty for men in adjusting to life here – previously they were respected as the sole breadwinner, and now women worked as well, and respect was no longer automatic. I was very glad another (male) community member pointed out that women now had to work at UNC housekeeping and also do all the housework at home. E5.4 Comparison of Community Member, Service Provider & Team Perspectives

Overall, it seems as though community members are aware of the presence of domestic

violence in their community, but not all service providers know that it exists. Service providers

and team members feel that significant challenges to dealing directly with domestic violence

include a respect for privacy within the domestic realm and the sanctity of families.


• Culturally sensitive family conflict resolution and mediation training opportunities and services.

• Mediation training for community leaders. • Provide sensitive informational support in both Burmese and Karen to people in the

community about options available to them if they experience domestic abuse in both Burmese and Karen.

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Appendix E6 – INSTITUTIONAL LITERACY

In the U.S., health insurance is a topic with which many Americans are unclear about.

For populations that are new to the country, health insurance can be a new concept. For many

new arrivals, including the people from Burma, understanding health insurance, how it is used,

and the importance of it within our society is challenging. Upon arrival, refugees from Burma are

issued Medicaid for up to eight months due to their official refugee status, but once this time

expires, many are left with little knowledge of health insurance or the medical coverage they

need.

THEME STATEMENT: THE HIGH COST AND UNFAMILIARITY OF HEALTH INSURANCE LEADS TO MANY COMMUNITY MEMBERS, ESPECIALLY CHILDREN, NOT BEING INSURED AND NOT SEEKING HEALTHCARE.


While many community members mentioned that they receive Medicaid or health

insurance through their employer, several of them explained that it is still expensive to get care,

which often prevents them from seeking services. During the interviews, community members

mentioned laboratory tests/procedures for which the full cost was not covered and high co-pays,

which discouraged some from obtaining medical care. Often if it is too expensive to visit the

doctor, community members explained that they will use herbal medicine or ask the advice of

fellow community members about what to buy at the grocery store or pharmacy.

For many of the community members, getting health insurance for their children and

spouses is extremely expensive. Even if one adult member of the family is covered through their

job, their children and spouse are usually not covered as dependents. The cost of premiums to

cover dependents and the copays and deductibles associated with use of the health insurance,

often cause financial barriers to families becoming fully covered. For this reason, many of the

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children in the community are going uninsured unless they qualify for Medicaid or NC Health

Choice due to their family’s size and income.


Service providers recognize the complexities of the healthcare system, especially in

utilizing insurance when it is available. Many service providers found that community members

are receptive to care and want to take advantage of what is offered.

Service providers encourage community members to use Medicaid, which they are

eligible for during the first eight months after arrival in the U.S., so they can take care of as many

health problems as possible while covered. Service providers realize that once Medicaid expires

for the refugees, there is often a gap in healthcare coverage. One healthcare professional noted,

"They have this margin of time that can aggressively help with health problems, when they have

Medicaid, but after that they fall through the cracks." Providers also explained that dental care

has been repeatedly mentioned as a source of financial stress for families because it is rarely or

minimally covered by health insurance.


Team members noticed that although some community members appreciated health

insurance and the healthcare offered, they often relied on herbal medicine or going to the local

pharmacy as a solution to health problems. One team member spoke to a community member

who expressed frustration with the fact that although he has insurance, he still has to pay

thousands of dollars in medical fees resulting from not all family members having health

insurance.

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Overall, community members, service providers, and team members expressed a need for

institutional literacy of health insurance. Although the community members could take

advantage of Medicaid while they have it, it is essential to provide very basic information on

how health insurance works and how to access care once Medicaid is no longer an option.

However, it should also be recognized that it is difficult for anyone who is slightly above the cut

off for Medicaid and/or NC Health Choice coverage to find accessible private health insurance

for their dependents. This is a larger, policy issue that is affecting many residents of the U.S.

Improving community members’ knowledge of institutional literacy can sometimes lead to few

positive outcomes, since at times there are no affordable options for community members within

the current system


• Form a group of service providers from the school system, healthcare system, social services, co-sponsors, newly resettled refugees, and established refugees to develop a curriculum to teach information on health insurance in the U.S.

• Translate informational materials on health insurance in Burmese and Karen. • Identify potential volunteers in the Chapel Hill and Carrboro community, such as student

organizations and retirees, to answer questions on health insurance and help community members fill out applications.

• Lobby policymakers to increase affordable health insurance options for people above the cut off for Medicare and NC Health Choice.

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Appendix E7 – KNOWLEDGE OF COMMUNITY

The community of people from Burma living in Chapel Hill and Carrboro is largely

invisible. Individuals who do not interact with community members as part of their jobs may not

know of the community’s existence. This has led to a gap in collective community knowledge

about the people from Burma living in Chapel Hill and Carrboro.

THEME STATEMENT: SERVICE PROVIDERS WANT MORE KNOWLEDGE ABOUT THE COMMUNITY AND ITS CULTURE SO THEY CAN MORE EFFECTIVELY RESPOND TO THE COMMUNITY’S NEEDS.


When asked the question, “Are there any things that you think healthcare providers need

to know about your community?,” many community members interviewed did not have an

answer. Those who did answer stated that their case histories were taken by doctors and medical

staff, and knew that this information was kept on file. For these community members, this

indicated that health professionals knew about them and understood their background. Others

wanted people outside the community to know that they did not have much money nor could

they speak English.


Many service providers interviewed were interested to know more about the community,

so that they can better serve the community's needs. Most service providers knew that there were

two distinct ethnic groups in Chapel Hill and Carrboro, even if they did not know much about the

nature of the difference. One service provider explained, "I don’t [know of any cultural

differences], but probably because I don’t have enough cultural knowledge. It was only through a

Karen community member that I learned Karen was a different part of the country."

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Service providers’ knowledge of the community was often limited by the capacity in

which they work with community members. Case managers and refugee health professionals

know about the specific situation of new arrivals. ESL teachers know about English learning

needs. Many service providers felt that there was much to learn about the community, but

language was a significant barrier to getting to know the individuals, customs, and traditions. In

addition, service providers often perceived some community members as shy or reserved. They

explained that this quality made it difficult to anticipate community members’ needs and put the

responsibility on the service provider to ask the right questions. One service provider was

shocked at the negligent care community members received from doctors who expected patients

to vocalize exactly what was wrong. In one instance, a doctor dismissed a case when told about

“a pain in the stomach.” It was later discovered that this community member had a grave health

problem.


Team members initially faced a steep learning curve in getting to know the community.

The complexity and diversity of the culture was difficult to fully understand and comprehend as

outsiders. The community is heterogeneous and has different needs and interests according to

how long members have been in the area and other factors such as previous education, family

and/or social status, etc. The team also realizes that there needs to be more dissemination of

knowledge about this community to the larger local community. This knowledge will raise

awareness, could ideally increase service providers’ quality of care, and ultimately improve the

community’s quality of life.

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There is a lack of knowledge about the community of people from Burma living in

Chapel Hill and Carrboro among service providers and the greater Chapel Hill and Carrboro

communities. In order to more appropriately serve the community, a better understanding of the

community’s history and background is required. An acknowledgement of the heterogeneity of

the community is essential to the delivery of high quality service. Service providers need to be

proactive about seeking this knowledge because educating service providers in this manner does

not come naturally to community members. However, community members would receive

significantly better service if they were able to build the confidence to speak up and make their

needs known, as this is an important life-skill in Western society.


• Create and disseminate fact sheets about the community. • Organize cultural trainings for service providers in collaboration with community members;

these can be led by either a service provider or a community member. • Continue to ensure service providers are invited to community events. • Service providers should attend community events.

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Appendix E8 – LANGUAGE BARRIERS

Due to language barriers, community members have to use whatever resources are

available to communicate with the outside world. This circumstance results in the use of friends

and family as interpreters and translators in situations commonly thought to be private and

sensitive by U.S. standards.

THEME STATEMENT: FAMILY MEMBERS ARE USED AS INTERPRETERS FOR EACH OTHER IN FORMAL AND INFORMAL SETTINGS, EVEN THOUGH THIS SOMETIMES CREATES UNCOMFORTABLE SITUATIONS.


Although frustrated that they could often not communicate in English, many adults in the

community did not express concern about using family members or friends as interpreters.

Rather, they seemed happy simply to have someone to interpret for them. It is common for

children, often as young as five years old, to interpret for their parents in the community. Some

community youth explained that they were responsible for interpreting over the phone,

translating bills, and taking care of other home administrative duties requiring contact with the

Western world. One adolescent said, “In my house, I am the only person who translates for my

parents. When they read, they don’t understand anything. I translate bills and letters. For me it is

ok to translate.” Other youth explained that it was a difficult task, but due to their superior

English proficiency as compared to their parents, felt that helping was necessary.


Due to concerns of confidentiality, the issue of friends and family members serving as

interpreters was important to many service providers. Service members explained that limited

resources sometimes force the use of friends and family members as interpreters. As one service

provider said, “Once I had to use a five-year-old as an interpreter in a healthcare setting. I have

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tried getting on the [AT&T phone line] and to find out if anyone can speak Karen, but people on

the phone [line] think Karen is Korean.” The use of friends and family members as interpreters

not only compromises patient confidentiality, but also compromises the patients’ and providers’

abilities to address private matters. Service providers spoke about not being able to address

sensitive issues with their clients because they had to communicate with them through a friend or

family member, one with whom the client may not be comfortable or legally allowed to share

personal information with.


The use of friends and family members as interpreters came up very often for the team.

The team often communicated through children and friends when talking to community members

with limited English proficiency. Without such informal interpreter networks, the team would

not have been able to communicate with a significant portion of the community. Despite the

necessity of using friends and family members to reach non-English speaking community

members, the team was concerned about the quality of interpretation. Given the absence of

formal interpretation and translation services, there was no way to assure accurate

communication across languages. The issue of accountability with interpretation became a

contentious issue both between team members and during the CFPC meetings. For example,

there is a great deal of concern that the interpretation services available do not meet certified

standards as compared to interpretation services for other languages spoken in Chapel Hill and

Carrboro.


Community members, service providers, and team members agree that English-speaking

friends and family members are relied upon heavily by both community members and service

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providers for communication purposes. The issue of who is interpreting is not perceived the

same way among community members and service providers. Community members accept that

using friends and family members as interpreters is not ideal, but view them as necessary to their

ability to communicate across languages. Meanwhile, service providers are challenged ethically

by risking breach of confidentiality through the use of informal interpretation in formal public

and governmental settings like schools, health clinics, etc. Moreover, Title VI requirements for

accessible Limited English Proficiency (LEP) services that they are required to provide often add

to health and human service providers’ personal ethical concerns about interpretation. Given the

lack of trained interpreters, service providers often have no alternative but to allow for friends

and family members to interpret. Team members struggled with the absence of formalized

interpreter services. This circumstance diminished the quality of communication across all

groups.


• Encourage agencies to create/clarify protocol for handling situations where interpreters are necessary detailing when it is inappropriate to have friends and family members present as interpreters.

• Ensure that qualified interpreters are available for situations where patient confidentiality is a concern.

• Seek funding so that interpreter services are not a barrier to accepting Burmese and Karen clients within service agencies.

• See recommendations for interpreter services in Section 4.4.

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APPENDIX F – Code Lists for analyzing Primary Data

Appendix F1 – Code List for Community Member Interviews

Topical Coding List for AOCD Burmese/Karen Interviews with Qualitative Community Member Participants

Concept Code # Code Name Code Comment Demographic Codes

!D1.1 Service Provider Apply this code to all baseline data collected from Service Providers.

!D1.2 Community Member

Apply this code to all baseline data collected from Burmese/Karen community members.


P1.0 Apply this code to information on the participant that is important to capture, but does not fit within any of the sub-topical codes below.

P1.1 Burma Apply this code to what part of Burma the participant is from and whether this is where their family is from. Apply this code even if the participant is unaware of what part of Burma they came from and if their family is from there.

P1.2 Self Reference Apply this code to how the participant refers to him/herself. This includes whether they refer to themselves as Burmese or Karen, etc. Apply this code even if the participant doesn't refer to themselves as Burmese/Karen.

P1.3 Coming From Refugee Camps

Apply this code to information on if the participant has lived in other places besides Burma before coming to the US. This includes if they came through refugee camps and how many refugee camps. Apply this code even if the participant has not lived in other places besides Burma or refugee camps.

Settlement S1.0 Apply this code to information on the participant's move to Carrboro/Chapel Hill that is important to capture, but does not fit within any of the sub-topical codes below.

S1.1 Arrival Apply this code to information on how long the participant has lived in the area. This includes information on whether the participant has lived anywhere else in North Carolina or anywhere else in the US. Apply this code even if the participant hasn’t or doesn’t know if they have lived anywhere else in North Carolina or the US.

S1.2 Family in the Area Apply this code to information on participant’s family (if any) living in the United States. This includes

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information on who came with the participant when they arrived here: parents, children, spouse, siblings, etc. This includes information on if anyone else from their family has arrived since their arrival, and if they have other family living in other areas of the states. Apply this code even if the participant is not aware of any family who came over with or after them or living in other areas.

S1.3 Connections with Others

Apply this code to information on whether the participant keeps in contact with people from back home or in the camp or with other refugees in the US. This includes information on how they keep in touch, i.e. by phone, email, or other modes of communication. This also includes information on whether they joined family or friends already living in Carrboro/Chapel Hill. Apply this code even if the participant does not keep in contact with anyone from home, camps, or other refugees in the US.

S1.4 Life Changed Since in US

Apply this code to information on how the participant's life has changed since arriving in the US. This includes: family life, employment, social support, etc. Apply this code even if the participant's life hasn't changed since arriving in the US.

S1.5 Plans to Stay in the Area.

Apply this code to the participant's plans to stay in Carrboro/Chapel Hill or to return to Burma. Apply this code even if the participant is unaware of their plans to stay in the area.

S1.6 Good Things About Living in Carrboro/Chapel Hill

Apply this code to information on what the participant thinks are good things about living in Carrboro/Chapel Hill. Apply this code even if the participant does not know of any good things about living in Carrboro/Chapel Hill.

S1.7 Challenges of Living in Carrboro/Chapel Hill

Apply this code to information on what the participant thinks are challenges of living in Carrboro/Chapel Hill. This includes what would make life easier and what else is needed. Apply this code even if the participant does not know of any challenges or needs of living in Carrboro/Chapel Hill.

S1.8 Needs Apply this code to information on what would make life easier or better or what else the participant thinks he/she needs. Apply this code even if the participant does not know about needs.

Employment J1.0 Apply this code to information on employment that is important to capture, but does not fit within any of the sub-topical codes below.

J1.1 Job Description Apply this code to information to the descriptions of

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the participant's job. This includes the hours that they work, how they get to/from work, etc. Apply this code even if the participant is unable to describe aspects of job.

Community C1.0 Apply this code to information on the description of Burmese/Karen community that is important to capture, but does not fit within any of the sub-topical codes below.

C1.1 Bringing Burmese/Karen Community Together

Apply this code to the participant’s description of a community event. This includes whether Burmese and Karen people are at these events. Apply this code even if the participant is unaware of community events.

C1.2 Burmese/Karen Community Strengths

Apply this code to information on the strengths of the Burmese/Karen community. Apply this code even if the participant is unaware of the Burmese/Karen community’s strengths.

C1.3 Community Lacks Apply this code to the participant’s opinion of what the Burmese/Karen community lacks. This includes healthcare, transportation, English Skills, employment, etc. Apply this code even if the participant is unaware of what lacks in the Burmese/Karen community.

C1.4 Religion Apply this code to the participant’s knowledge of how important religion is in the Burmese/Karen community. This includes information on how life is different for Christian, Buddhist, and Muslim members of the community. Apply this code even if the participant is unaware of how important religion is in the Burmese/Karen community.

C1.5 Children in American Society

Apply this code to the how are people in the Burmese/Karen community are dealing with their children growing up in an American society. Apply this code even if the participant is unaware of how people are dealing with children growing up in American society.

C1.6 Community Organization

Apply this code to the participant’s knowledge of how the community organizes to help one another. This includes forms of childcare, transportation, when someone is sick, language needs, etc. Apply this code even if the participant is unaware of how the community organizes to help one another.

C1.7 Improvements to Burmese Community

Apply this code to the participant’s knowledge of one thing the community could do to make life better. This includes what they think it would be, including: health, school, etc. Apply this code even if the

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participant is unaware what the community could do to make life better for the Burmese community.

Health H.1.0 Apply this code to participant’s knowledge health that is important to capture, but does not fit within any of the sub-topical codes below.

H1.1 Experience with the Healthcare System

Apply this code to the information on the participant's experience with the healthcare system in Chapel Hill/Carrboro. This includes if the participant knows where to get the care they need and where they go if they are sick. Apply this code even if the participant is unaware of where to go for what they need or where they go when they are sick.

H1.2 Pay for HealthCare Apply this code to information on how the participant pays for healthcare. This includes if they have health insurance and who is covered under their health insurance, including individuals, other family members, etc. Apply this code even if the participant doesn’t have health insurance or is unaware of how they pay for healthcare or who is covered by insurance.

H1.3 Health Importance Apply this code to participant’s knowledge/opinion of what is important in terms of health. Apply this code even if the participant doesn't know what is important in terms of health.

H1.4 Healthcare Needs of the Community

Apply this code to information on specific health care needs of the community. This includes information on what they think health care providers need to know about the Burmese/Karen community. Apply this code even if the participant doesn’t know about varying needs.

H1.5 Health Change Since Coming to the US

Apply this code to information on the participant's knowledge of how peoples’ health in the community changes when they come to the US. This includes stress levels, improvements on health, health knowledge, challenges to health, etc. Apply this code even if the participant doesn’t know of any change to health since coming to the US.

Education E1.0 Apply this code to information on education that is important to capture, but does not fit within any of the sub-topical codes below.

E1.1 Education Level Apply this code to information on the education level of the Burmese/Karen community. This includes whether the majority of the Burmese and Karen are able to read and write in English, Burmese, and/or Karen. Apply this code even if the participant doesn’t know about education level or literacy of the

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Burmese/Karen community. E1.2 Educational

Aspirations Apply this code to information on whether adults in the Burmese/Karen community aspire to achieve higher education for themselves and/or for their children. This includes high school, college, etc. Apply this code even if the participant doesn’t know anything about the community’s educational aspirations.

E1.3 ESL Services Apply this code to information on whether there is sufficient provision of ESL service in the area. This includes whether the Burmese/Karen community takes advantage of the system. Apply this code even if the participant doesn’t know about ESL services.

E1.4 Barrier of Language

Apply this code to information on how big the barrier of language is in the daily lives of the Burmese community.

Community Relations

R1.0 Apply this code to information on community relations among the Burmese/Karen that is important to capture, but does not fit within any of the sub-topical codes below.

R1.1 Community Friendliness

Apply this code to information on if everyone in the Burmese/Karen community is friendly with each other. This includes why or why they may not be friendly. Apply this code even if the participant doesn’t know about friendliness in the Burmese/Karen community.

R1.2 Community Problems

Apply this code to information on any problems in the community. This includes any problems between the Burmese and Karen, the educated and the less educated, and people coming from different camps. Apply this code even if participant doesn’t know of any problems in the Burmese/Karen community.

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Appendix F2 – Code List for Service Provider Interviews

Topical Coding List for AOCD Burmese/Karen Interviews with Qualitative Service Provider Participants

Concept Code # Code Name Code Comment Demographic Codes

!D1.1 Service Provider Apply this code to all baseline data collected from Service providers.

!D1.2 Community Member

Apply this code to all baseline data collected from Burmese/Karen community members.


P1.0 Apply this code to information on the services that the organization offers that is important to capture, but does not fit within any of the sub-topical codes below.

P1.1 Role of organization

Apply this code to the services the organization offers and the participant’s role in the organization.

Role as Service Provider to Burmese/Karen

RS.1.0 Apply this code to information on the role of service provider to the Burmese/Karen community that is important to capture, but does not fit within any of the sub-topical codes below.

RS.1.1 Access Services Apply this code to information on who accesses the organization’s services. This includes hoe people of Carrboro/Chapel Hill community access services. Apply this code even if the participant doesn’t know how people access their services.

RS.1.2 Barriers to accessing Services

Apply this code to the participant’s explanation of any barriers to accessing organization’s services. This includes transportation, language, etc. Apply this code even if the participant is not aware of any barriers to accessing services.

RS1.3 Capacity of working with Burmese community

Apply this code to information on the capacity that the participant works with the Burmese community. This includes information on how long they have worked with them, how often they have worked with them, etc. Apply this code even if the participant does not know how long/often they have worked with the Burmese community.

RS1.4 Barriers to working with Burmese community

Apply this code to the participant’s explanation of barriers that they have experienced while working with the Burmese community. This includes language, culture, etc. Apply this code even if the participant does not know of any barriers.

Influence of Chapel Hill/Carrboro

ICH1.0 Apply this code to information on the influence of Chapel Hill/Carrboro that is important to capture, but does not fit within any of the sub-topical codes below.

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ICH1.1 Strengths of Chapel Hill/Carrboro

Apply this code to information on the strengths of Carrboro/Chapel Hill area. Apply this code even if the participant is unaware of the strength of Chapel Hill/Carrboro.

ICH1.2 Perception of Burmese

Apply this code to information on how the Burmese are perceived in Chapel Hill/Carrboro.

ICH1.3 Service lacking in Carrboro/ Chapel Hill

Apply this code to information on information on services that are lacking in Carrboro/Chapel Hill. Apply this code even if the participant doesn’t know which services are lacking in CH/Carrboro.

Describing Burmese/Karen Community

BK.1.0 Apply this code to information on the description of Burmese/Karen community that is important to capture, but does not fit within any of the sub-topical codes below.

BK1.1 Carrboro/CH Burmese Community

Apply this code to information what comes to the participant’s mind when thinking of the Carrboro/CH Burmese community. Apply this code even if nothing comes to the participant’s mind.

BK1.2 Economic Well-being

Apply this code to the participant’s impression of the Burmese community’s economic well-being. Apply this code even if the participant is unaware of the Burmese community’s economic well-being.

BK1.3 Customs, values, culture

Apply this code to the participant’s knowledge of the Burmese community’s values, customs, or culture. Apply this code even if the participant is unaware of the Burmese community’s values, customs, culture.

BK1.4 Bringing community together

Apply this code to the participant’s knowledge of what brings the Burmese community together. This includes holidays, festivals, celebrations, venues. Apply this code even if the participant is unaware of what begins the Burmese community together.

BK1.5 Interaction of groups

Apply this code to the participant’s knowledge of how different people within the Burmese community interact. This includes groups of men and women, older and younger and different refugee camps. Apply this code even if the participant is unaware of the how different people within the Burmese community’s interact.

BK1.6 Relation to other minority groups

Apply this code to the participant’s knowledge of how the Burmese community relates to other minority/refugee communities in the area. Apply this code even if the participant is unaware of the how the Burmese community relates to other minority communities in the area.

Strengths/ Challenges/Needs

SCN.1.0 Apply this code to participant’s knowledge on strengths, challenges, and needs that is important to

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capture, but does not fit within any of the sub-topical codes below.

SCN1.1 Strengths of the Burmese community

Apply this code to the strengths of the Burmese community. Apply this code even if the participant is unaware of strengths of the Burmese community.

SCN1.2 Challenges of the Burmese Community

Apply this code to participant’s knowledge about the challenges faced by the Burmese/Karen community.

SCN1.3 Compared Challenges to other immigrant communities.

Apply this code to participant’s knowledge of similarities/differences between challenges faced by Burmese/Karen and other immigrant/minority communities. This includes information about other communities that can serve as a model for the Burmese/Karen community. Apply this code even if the participant doesn’t know about similarities/differences between the Burmese/Karen and other communities.

SCN1.4 Needs of Burmese community

Apply this code to the differing needs of the Burmese/Karen community – how needs have evolved over time, how needs vary across age/gender/ethnicity Apply this code even if the participant doesn’t know about varying needs.

SCN1.5 Service Enhancements

Apply this code to service enhancements within and outside of participant’s agency that could be made to better meet the needs of the Burmese/Karen community. Apply this code even if the participant doesn’t know of any service enhancements that could be made,

Education E.1.0 Apply this code to information on education that is important to capture, but does not fit within any of the sub-topical codes below.

E1.1 Education Level Apply this code to information on the education level of the Burmese community. This includes whether the majority of the Burmese community are able to read and write in English, Burmese, and Karen. Apply this code even if the participant doesn’t know about education level or literacy of the Burmese community.

E 1.2 Educational Aspirations

Apply this code to information on whether adults in the Burmese community aspire to higher education for themselves and for their children. Apply this code even if the participant doesn’t know anything about educational aspirations.

E. 1.3 ESL services Apply this code to information on whether there is sufficient provisional ESL service in the area. This includes whether the Burmese community take advantage of the system. Apply this code even if the

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participant doesn’t know about ESL services. E1.4 Barrier of

Language Apply this code to information on how big the barrier of language is in the daily lives of the Burmese community.

Health H1.0 Apply this code to information on health of the Burmese community that is important to capture, but does not fit within any of the sub-topical codes below.

H1.1 Health Issues Apply this code to participant’s knowledge about what health issues are seen within the Karen and Burmese community. This includes any health or lifestyle issues that may be unique to the Burmese and Karen community. Apply this code even if the participant doesn’t know about the health issues seen within the Karen and Burmese community.

H1.2 Stay in Refugee Camps

Apply this code to information on participant’s knowledge about how the stay in the refugee camps has affected the health of the Burmese community. Apply this code even if participant doesn’t know about how the stay in the camps has affected health.

H1.3 Trauma Apply this code to participant’s knowledge about trauma in the community. This includes services and/or coping mechanisms to deal with the trauma. Apply this code even if the participant is unaware of trauma within the Burmese community.

H1.4 American culture Apply this code to information on participant’s knowledge about the impact of American culture on Burmese health. Apply this code even if participant doesn’t know about the impact of American culture on Burmese health.

Discussing the Ethnic Groups

G.1.0 Apply this code to information on different ethnic groups that is important to capture, but does not fit within any of the sub-topical codes below.

G1.1 Ethnic Groups: Burmese and Karen

Apply this code to information on the participant’s awareness of the two different ethnic groups (Burmese and Karen) among the refugee community in Chapel Hill/Carrboro area. Apply this code even if the participant is unaware of the two different ethnic groups.

G1.2 Differences between Burmese and Karen

Apply this code to information on any differences between the Burmese and the Karen. Apply this code even if the participant is unaware of differences between the Burmese and the Karen.

G1.3 Disagreements between Burmese and Karen

Apply this code to information on any disagreements between the two ethnic groups. Apply this code even if the participant is unaware of any disagreements between the two ethnic groups.

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G1.4 Difference in Culture

Apply this code to information on how the difference in culture affects any of the other concepts. Apply this code even if the participant is unaware of how the difference in culture affects other concepts.

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APPENDIX G – Interpreter/Translator Contract and Invoice Form Appendix G1 – Interpreter Contract AOCD Carrboro/Chapel Hill People from Burma Interpreter Contract This agreement has been drawn up to make sure that nothing that is said during the interview can be repeated elsewhere. By signing this, you are agreeing to not repeat anything that is said. We value the work of the interpreter, and the perspective you provide. Your work is vital to this process. If you need to change the wording or explain any of the questions to ensure the interview subject understands what is being asked – that is fine – but please keep as close as possible to the original meaning of the question. However, for the answers, we would like to hear exactly what the interview subject says. If you have any comments about the interview, we would be very glad to hear them – after the interview. Please sign this agreement before the commencement of the interview, in the presence of the interview subject and the interviewer. Please explain the contents of the agreement to the interview subject. I commit to abiding by the following guidelines while interpreting for this project:

• I will keep all contents of the interview confidential

• I will interpret exactly what the interview subject says; I will not paraphrase the answers or commentate during the interview. I will not censor what the interview subject says. (this does not apply to the questions, questions may be rephrased).

• If I have comments about the interview procedure, or the content of the interview, I

will tell the team members after the interview is over.

• I will be respectful to the interview subject, and do whatever I can to make them feel comfortable with the interview process, and to allow them to answer the questions to the best of their ability.

• I will explain to the interview subject the contents of this agreement

Name of interpreter: Signature of interpreter: Name of interview subject: Name of interviewer: Name of note-taker: Date:

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Appendix G2 – Interpreter/Translator Invoice Form

Interpretation/Translation Invoice (Independent Contractor) Bill to: Department of Health Behavior and Health Education Campus Box # 7440 Chapel Hill, NC 27599-7440 For: Name: Social Security Number: Address: Phone number:

Job description: Hours worked: For the dates: Payrate: $25 / hour Total owed: $ ____________________________________________ ________________

Contractor’s Signature Date

people from burma living in chapel hill and carrboro an action-oriented community diagnosis

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