EP11 Mehreen Arif, NYU Gallatin Global Fellowship in Human Rights Recipient

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I AM GPH EP11 Mehreen Arif, NYU Gallatin Global Fellowship in Human Rights Recipient

EP11 Mehreen Arif, NYU Gallatin Global Fellowship in Human Rights Recipient

Deborah Onakomaiya: Hey guys and welcome to another episode of I AM GPH. I am your host Deborah Onakomaiya. In this episode we'll be talking to me Mehreen Arif, who's a second year MPH Global Health student. Mehreen is back on our show today to talk about the NYU Gallatin Fellowship Award in Human Rights. She received this award in 2017 and spent two months studying and assessing depression and PTSD among Tibetan refugees in Kathmandu. Fun fact about Mehreen is aside from being a beekeeper, she also speaks four different languages and can read five. Let's go to our conversation with her. Thanks for being here, Mehreen

Mehreen Arif: Of course. Anytime.

Deborah Onakomaiya: Yeah. It was fun to have you on our show where you able to talk about the Justice Initiative, and now you're back even with more interesting news. So, you received the NYU Gallatin Fellowship award. Can you please talk a little bit about what that fellowship was about, how you found out about the award and what was that process like for you?

Mehreen Arif: Sure. So I received the NYU Gallatin Global Fellowship in Human Rights and it's actually a funny story. I opened an email, and I'm usually really bad with opening emails.

Deborah Onakomaiya: Aren't we all?

Mehreen Arif: I know, and I think it was one that Andrea sends through GPH and it said, "Oh, apply for this fellowship." And this was back in September when we just started, when our cohort just started our MPH program, and I was like, "Okay, this seems like a really great opportunity, and it aligns with what I want to do in the future." So, I applied and what the fellowship basically entails is that it is a university wide fellowship. So, anyone can apply, whether you're a freshman in undergrad, or a master student, or I think even PhD students. Basically whatever project that you choose or whatever field that you choose has to have a human rights framework. That's how I applied. I was looking at the intersection of public health and human rights, more specifically refugee and migrant health and human rights.

Deborah Onakomaiya: Why exactly are you interested in human rights and refugees? Can you tell us why that is a focus area for you?

Mehreen Arif: Sure. So I myself am an immigrant to the United States, and I feel like there are so many things that are overlooked during a whole migration, or immigration process I should say, as is, but when you look at refugees and migrants who are forced to leave their homes, that process for them is completely different than being an immigrant, which is where you willingly choose to leave your country behind and start a new life in a new adoptive country. But I was always interested in refugee and migrant health because there are always these health disparities and health inequities between the health that migrants and refugees are supposed to receive and that they do end up receiving. I think it's a human rights issue because the inability to achieve health, whether it's physical health or mental health services is a human rights issue, and the more that we shed light on it, the more conversations will happen. Health and human rights is definitely an important issue because it highlights all of these barriers that we tend to overlook, and I think I mainly wanted to focus on Tibetan refugees because growing up in South Asia and Pakistan, we receive about 2 million Afghani refugees since the Taliban invaded Afghanistan, and what I wanted to focus on was Tibetan refugees because for Afghani refugees, Pakistan has been a safe haven. But for Tibetan refugees, India has been a safe haven, but the closest proximity to Tibet is the country of Nepal and in Nepal when Tibetan refugees crossover, they are basically stateless people. They have no rights. They have no identity per se because they're not granted residentship. They're not granted citizenship. They are not even really granted refugee ID cards, and ever since 1959 when the Chinese occupied Tibet, the Tibetan government and His Holiness, the Dalai Lama, moved to Dharamshala, India and that's where the Tibetan government is in exile right now. But the fact of the matter is that most Tibetans go to Nepal because, like I said, it's in close proximity first. So, they end up staying there and then there are generations of Tibetans who are born in Nepal who do not even have a passport, who cannot travel outside of the country, and who just have to try to cross the Indian border and somehow end up in India so that they can get jobs or even get an education. Most young Tibetans these days, go to India and South India to pursue nursing education, and then even though they come back to Nepal with a degree, they can't really practice. So, it has to be low key work where the person that is hiring them knows that they are Tibetan refugees and they can't essentially work. That's how, Tibetans, that's how their life is in Nepal. And I really wanted to explore that more and see why there are these health disparities, but moreover how this affects their mental health and how this affects levels of depression, PTSD and access and barriers to mental health services. And another thing with that, why I chose to do my fellowship in mental health in South Asia and why it's a human rights issue is because mental health has always been a taboo in South Asia. Always has been, and unfortunately it still is, and it started when people in villages thought that people who are suffering depression or have epilepsy have some sort of demonic power or other-worldly possession that sort of overpowers them. And they used to get chained to trees and they used to be dubbed manic people and that has always been the sort of environment that surrounds the conversation of mental health. One thing that I touched on before was why refugee and migrant health is important to me is because mental health is one of those barriers and it's one of those restrictions that we need to overcome, that we need to really talk about when it comes to refugee and migrant health because of the monstrosities that these refugees go through. Whether it's Tibetan refugees, or Rohingya Muslims now in Bangladesh, or Syrian refugees in Italy and whatnot. A lot is overlooked when it comes to mental health. So, this was my project basically assessing levels of depression, PTSD, and access and barriers to mental health services for Tibetan refugees in Kathmandu, Nepal. I was in Kathmandu for two months. The first month was basically me getting approval to actually do this study in Nepal because whenever you conduct research outside of the United States, or even within the United States, you need Institutional Review Board approval and approval from the host country where you are going to perform your study. So, I was waiting on approval from NHRC, which is the Nepal Health Research Council and the NYU IRB, which is the NYU Institutional Review Board, and the first month was just all of these bureaucratic hurdles. I had to reform some parts of my survey, some parts of my study, send them back for review and then receive them. So, that was the first month and the second month was actually doing the interviews, and initially I thought that since I don't have enough time, I can only maybe do 20 interviews. But I think the universe was on my side and I ended up conducting 41 interviews, which I don't think is a lot but given the short period that I was there for I think I have substantial data for it to be a good publishable study.

Deborah Onakomaiya: Even especially because it was qualitative in nature, you were interviewing, right?

Mehreen Arif: So no, it was not qualitative. Initially, I thought that it was going to be a mixed method study since getting results off of the Beck Depression Inventory Scale, or the PCLC scale, that's quantitative information. At the end of the survey, I had five questions on access to mental health services. So for example, have you ever received mental health help? Have you ever received counseling? Have you ever had medication for... Stuff like that. So, those were the five questions that I asked, but I'm in the process of doing data analysis and what it seems to be is I think all of my study is fully quantitative actually. Because when it comes to qualitative studies there's something that is so unique to qualitative studies, but doing qualitative studies is a huge feat when it comes to working with migrants and refugees because a lot of thought should go into the cultural sensitivity that will inform your qualitative questions. And for me to get a survey approved with my own qualitative questions, saying, "Oh when did you come from Tibet?" Or asking these sensitive questions would have taken a year for just the survey questions to be approved, which is why I had to use pre-approved quantitative scales like the depression scale or the PTSD scale. So, that is why my survey, now that I'm doing the data analysis, is fully quantitative, but I'm still working with my PI professor, Peter Navario, who has been great and helping me and guiding me. So, we are still figuring the ins and outs of this process.

Deborah Onakomaiya: For me, and I'm sure some of our listeners are interested in it, you mentioned two things that some of these Tibetan refugees, they cross over to India to do nursing. Why do they come back when they know they can't practice? Don't you think it might be better for them to stay on?

Mehreen Arif: Okay. So, with that, most of these Tibetans I would, after the interview or even during the interview, since I can't control what they say, I'm supposed to ask these certain set of questions in the survey, but at times they just overshare without even me asking that question since I can't because it's not in the mandated survey that was approved. But at times these refugees would just say and share information, and what most of them would say is we don't want to stay in India. We want to come back to Nepal, we want to come back to our family, we want to be with our family. And that was really interesting for me because what I noticed was that these Tibetan refugees are sort of in a very precarious identity crisis per se, because they do consider themselves Tibetans but there are some Tibetans that I interviewed who were second generation Tibetans, whose great grandparents or grandmother came from Tibet or grandparents came from Tibet and they were born in Nepal. So, they are sort of in this limbo whether they consider themselves Nepalese Tibetans, or just Tibetans, or just Nepalese, but they can't really consider themselves just Nepalese because Nepal does not grant them rights or status as citizens or even residents. So, I think why they choose to come back to Nepal is because they do have some extended family in Nepal, or if they came with their families, they have their families in Nepal, and moving whole families across borders, whether it is even across the Indian border to Shara or to Delhi is a big deal. They have to pass security, borders, without identity cards. Nowadays, even the Indian border control gives them a lot of trouble because they don't have correct paperwork. So, I think that's why they come to get degrees, or they come to like work for a bit in India, but eventually they go back to Nepal because Nepal is in essence their adoptive country.

Deborah Onakomaiya: That's really interesting and I would want to follow up, you've mentioned they have a lot of barriers, they're facing a lot of things. In the process of your interviewing, the process of your data analysis, which is still ongoing, are there specific mental disparities or mental health issues that are constantly being highlighted across these trends as you do data analysis?

Mehreen Arif: Yeah, most definitely. So, I have essentially three pieces of data. So, the first is on depression, the second is on PTSD, and the third is on access and barriers to mental health services, and considering the first section, depression, what I noticed was a lot of these Tibetan refugees were sort of in the borderline clinical depression to moderate depression scale and that's a Beck depression score of 20.21 and above. And the most depressed faction of all of these interviewees that I interviewed were women ages 18 to 39. So, within the young population, women had the highest Beck depression score and they were, the average was borderline clinical depression. So, a score of like 17.83. The other thing that I noticed was that the most variation in depression scales were in the middle aged group, men and women. So, ages 30 to 50, and that basically means that I had participants who showed levels of extreme depression. So, scores of 40 and above, then it had participants who showed levels of severe depression, borderline clinical depression, moderate depression. So, the oscillation and patterns of depression was the highest in the middle aged group of men and women.

Deborah Onakomaiya: And do you feel like they're more extreme depressions in these groups because they've had an extended period in Nepal or they experienced whatever transition that might've happened in 1959?

Mehreen Arif: So, one of the theories as to why the middle age group has a lot of variation in depression scores is that, you are right. They have been through a lot and they didn't essentially come to Nepal when they were really young also because some of them were married, some of them got divorced, some of them even had miscarriages during the border crossing. So, there's a lot of things that play into why there was this variation in depression scores. It just goes to show that we don't really talk to anyone about issues, I think, as we grow older because we just try to figure things out on our own or internalize it. Whereas when you're young, I think you really want to know what the issue is, whether it's physically with your body, or mentally you would want to talk to friends, but as you grow older there are so many other things that you need to focus on, whether it's kids, in-laws, family, that you try to internalize all of these issues. And I was seeing that a lot when I was conducting these interviews as when there were questions like, "Oh, do you feel like you're being punished? Or, "Are you sad?" Most of the middle-aged group would go crazy, like they would say, "Oh we are so sad." Or the participant, just giving an example, would say I am extremely sad because so and so. I didn't really ask why they're sad, I just asked, "Are you sad?" And they would just say, "Oh I'm so depressed. I don't know what to do. This is going on in my life and all." So it was just really interesting to see, and also extremely sad and depressing for me as well, because there are times when I was conducting these interviews and the participants would just burst out crying and I had to console them, and that was something that I was not really prepared for. And then I also obviously started tearing up during those interviews, and it just goes to show how delicate and how sensitive this information is. The need for mental health services, whether it's counseling or any type of local programs in Kathmandu City, specific to refugees, is needed.

Deborah Onakomaiya: And I'm guessing that's among your recommendations from...

Mehreen Arif: Yes, hopefully some of this, what I'm saying right now will probably be in my discussion for my paper, hopefully.

Deborah Onakomaiya: No, that's so amazing. It seems like you had a really impactful experience. It was a learning experience for you. You said you are from South Asia, but I'm assuming not Nepal. How were you able to adjust to that environment? It's so far away from the subways of New York City.

Mehreen Arif: I know, I know. Because I am from Pakistan, so I speak Ooredoo, and Punjabi, and English. Punjabi is the regional language of the province where I'm from but Ooredoo the widely spoken language and in India they speak Hindi. In Nepal they speak Nepali. It's an indoor Aryan language as well. It's somewhat similar to Hindi, but not completely. So, when I got to Nepal I was like, "Okay, what should I do? Should I just speak in English?" But people are not going to understand English in the shops or wherever I go. So, then I was like, "Okay, let me just try speaking Ooredoo." And as soon as I spoke Ooredoo, they thought that I was one of them and that was just the most brilliant feeling ever because I felt like I was Nepalese as well because everyone there spoke Hindi, and Hindi and Ooredoo are conversationally exactly the same. It's just written Hindi and written Ooredoo that are different, and also obviously if you go into classical Ooredoo and Ooredoo literature and Hindi literature, they're very different. But conversationally we almost speak, it's the same language that we speak, Ooredoo and Hindi, and everyone in Nepal could speak Ooredoo and Hindi. So, that was my means of communication and which really shed light on how language is such an important issue when it comes to public health work. You really need to know the language in order to understand the culture, and the culture of the informants or participants that you're working with. So, that was great. I felt literally almost at home, and the other thing with the beauty of South Asia is that we are obviously products of post-colonialism, whether it's Bangladesh, India, Pakistan, Nepal, things like growing up I used to eat these certain types of biscuits from Denmark, or cereal from England or whatever. We used to have these exports from England, Europe and Australia actually growing up, and I saw all of those things that I ate during my childhood in these grocery stores in Nepal, and I hadn't seen that for the past five years since I moved to the US. So, it was really heartwarming to know that there was a somewhat similar...

Deborah Onakomaiya: A little piece of home.

Mehreen Arif: A little piece of home. Yeah, yeah. So, that was really nice, plus I also want to highlight that where I was staying was this area in Northeast Kathmandu City called Jorpati, and that's where most of the Tibetan refugees in Kathmandu City live. So, I was living in Jorpati because the clinic where I used to conduct my interviews, the Friends of Shanti Bhavan clinic, FSB clinic, was also in Jorpati, and FSB clinic is this unique clinic that partners up with HealthRight International, the NGO that I work with for my fellowship. FSB clinic basically serves Nepalese ethnic minorities and Tibetan refugees and it provides care whether it's a doctor's visits, women's health visits, vaccinations. They also have a pharmacy, they have EKG services, they have an ultrasound machine, they have a whole biochemistry lab where you can get blood tests and urine analysis, and this is all within one building. So, when you go for a visit, if the doctor prescribes you a blood test or a urine test, you can literally get it done right there and then, and then go back to the doctor the same day for a followup and it basically serves the Nepalese ethnic minorities and Tibetan refugees. And when I reached FSB Nepal, I received such a warm welcome from the executive director, Mr. Sanjay Basnyat and everyone there who worked, like Miss Ishwori Shah was the finance chief. They really helped me and made me feel comfortable and part of the clinic, and we used to have a lunch every single day at the clinic and the clinic hours were Monday through Sunday, with Saturday being the only day off. So, we worked six days a week. So, it was almost like a little family. It was almost as if I was part of the Friends of Shanti Bhavan family, and that really made me very comfortable and I didn't feel like I needed to adjust.

Deborah Onakomaiya: Wow. Thank you so much. This interview has been amazing. I'm sure our listeners have probably even more questions. Hopefully you can come back on this show.

Mehreen Arif: Of course. I would love to.

Deborah Onakomaiya: Our final question for the show is that, for our listeners, like you said, you applied to this as you just got into NYU. What advice would you give prospective students or a student that might be interested in the Gallatin Fellowship Award, what advice would you be able to give them concerning applying for this?

Mehreen Arif: First off, I want to say that the Gallatin Fellowship in Human Rights has opened so many doors for me and I really didn't know that I would end up receiving this award, but I just had faith in myself, but more so faith in the project and the organization that I wanted to work with, HealthRight International, and that literally transformed this vision that I had into reality, and my advice would be just apply. Just do it, like the Nike slogan, Just Do It because there's no harm in applying to, even if you apply to 10 fellowships, or this also applies to internships. You will hopefully hear back from one or two, right? So there is never a disadvantage in applying. So, whether it's the Gallatin Global Fellowship in Human Rights, or whether it's any other fellowship that you come across as MPH student or even as an undergrad, if public health undergrads are listening to this, just apply and see where that takes you. And in regards to advice for the Gallatin Global Fellowship in particular, the NYU Gallatin team who heads this fellowship, they have an amazing advisory board of human rights lawyers and human rights advocates, and the administration is really helpful in trying to help you with your project and help formulate the project further apart from the NGOs that you're working with as well. So, just know that you will have a great support system. Just be focused in what you want to work with. Be passionate in what you want to work with. Have a genuine commitment to upholding human rights, and whether it's working with migrants or working with children or working with any other faction of society, having that intersection between public health, and this applies to just public health students, making sure that you get your voice heard when it comes to the fact that health is an essential human right. Just being advocates of this intersection of health and human rights and being advocates of the College of Global Public Health at NYU.

Deborah Onakomaiya: Wow. Thank you so much, Mehreen, for being on our show.

Mehreen Arif: Of course. Anytime. Thank you so much for inviting me, Deborah.