The war inside

The air is filled with the jangle of coins and chains—swinging silver ornaments on hand-stitched dresses flashing in the sunlight. It’s a hot October day as hundreds from Butte County’s Hmong community pour onto a field to celebrate their New Year. Tassels sway on high hats and beaded tucks. Men stroll by in dark suits and sunglasses. Children fence with balloon swords. As people spread across the campus of Nelson Avenue Middle School in Oroville, the elders take time to publicly remember a lost homeland, a painful exodus and the seeds of a new beginning.

It’s a story that played out under the shadow of the Vietnam War and nearly everyone who made it through was scarred.

One of those people is Mai Yang, whose father was among the 30,000 Hmong recruited by the U.S. Central Intelligence Agency to battle North Vietnamese soldiers and Lao Communist insurgents on the Ho Chi Minh Trail. They would come to be remembered as “the Secret Army.”

Yang, who now lives in Oroville, can still remember her father carrying her on his back as he worked the fields. That was before he became a soldier, before their village in Laos was pulled into the regional fighting. Yang says when she was 6, some North Vietnamese spies learned her father was part of a U.S.-sponsored brigade and had a hidden cache of weapons. They moved into the village, murdering him as Yang’s mother rushed the children into the jungle.

As the war intensified, and Hmong villages endured attack after attack from Communist raiding parties, Yang’s mother became overwhelmed with despair. Her children watched her get sick and grow dangerously weak. Yang remembers her mother rolling around in pain, calling out for her dead husband. Soon, Yang and her siblings were orphans in a war zone.

“So, there was only the four of us left,” she recalled during a recent interview, crying.

When the United States ended its war effort in 1975, Yang’s village joined a mass exodus, fleeing from Communist soldiers seeking revenge. It was a vicious, running purge that killed thousands of Hmong people. Some were able to immigrate to the United States nearly immediately, while others resided in refugee camps for years, even decades. The final wave of refugee immigrants to the United States started arriving in 2004, and there are an estimated 200,000 Hmong living here today—mostly in California, Minnesota and Wisconsin.

Yet, when these war-scarred refugees first arrived, there were no government agencies or nonprofits trying to help them get counseling, or even explain the availability of therapy for what they’d been through.

It’s a story that second- and third-generation Hmong Americans know well, a public health legacy many of them—along with a number of medical experts—believe puts their elder community at a heightened risk for depression, isolation, paranoia, gambling addiction, domestic strife and suicide.

Dr. Carolee Tran, a psychologist in Davis who specializes in treating refugees from the Vietnam War—and, in fact, is a refugee herself—says there’s a serious issue with undiagnosed post-traumatic stress disorder (PTSD) among those who escaped that violence. Other clinicians in the area agree. At a Capital Region health forum in May, Norbee Xiong, a Hmong-American mental health counselor, said 90 percent of his patients are Hmong, and the most common diagnoses among the elders are PTSD and major depression. At the same event, Dr. Pachida Lo, a psychiatrist who treats Hmong patients, said stigma in the community about seeking mental health services prevents many from reaching out until they’re on the verge of taking their lives.

In Butte County, that picture is improving. The Hmong Cultural Center is working with behavioral health specialists to try to get suffering elders the help they never had. If you ask Yang, they’re succeeding in that mission.

A piercing past

The Hmong have songs and ballads that recall 15 years of ravaging war in Laos. One person in Oroville who still thinks about those years is Yang Bee Xiong, an energetic, often-smiling shaman with a yard full of darting chickens. The spiritual leader has an infectious grin, but he can still recall the time when fear was part of his daily existence.

Xiong was 20 in 1976 and joining his family on a dangerous flight from their village in Sainyabuli toward Laos’ southern border. The war had ended, and the Hmong faced indiscriminate killings by the North Vietnamese or reprogramming camps at the hands of the Lao Communist militants. Their only hope was crossing the Mekong River into Thailand. Xiong recalls sneaking through dense pockets of jungle, avoiding the roads at all costs.

“The [North] Vietnamese had come back to kill us,” he explained. “When it was dark, you slept with your shoes on and your backpack strapped onto your back. When you slept, you would just curl up in a corner to rest. So, whenever you heard gunshots, you could just get up and run.”

Not only were the Hmong being hunted, some were starting to die of starvation. Survivors also describe a terrifying scene on the banks of the Mekong. Many crossing the river either drowned or were shot by Communist patrol boats. Escapees who made it through the gauntlet were crowded into Thai refugee camps like Ban Vinai, described by memoirist Kao Kalia Yang as a cramped, filthy place plagued by hunger and the screams of people waking from nightmares.

Danger and troop movements caused Xiong to wait three years before crossing the Mekong. When he did, he, his wife, Mai Lor, and other family members ended up in Ban Vinai along with 20,000 other Hmong people without a home.

Not long after, in 1985, the first Hmong families arrived in Butte County. They settled in, made friends with local farmers and began sponsoring other refugees trapped in Thailand. Within five years, Butte County had a new, fledgling community weaving itself into the fabric of daily life. Over time, many of the Hmong found jobs in local agriculture. Farming had, after all, been an integral part of their culture in Laos for centuries.

During the recent New Year’s celebration, District 1 Supervisor Bill Connelly reflected on how versatile the Hmong proved to the county’s broader workforce. He said members of the community now excel at everything from landscaping, construction and auto work to small business management, health care and law enforcement.

While the Hmong Cultural Center is located in Oroville, Chico is the true epicenter for the local community, with over 4,000 Hmong living in the greater area as of 2010. In Oroville, there were 640 at last count. In 2012, community leaders in Chico decided to erect a statue of the legendary Hmong commander from the war, General Vang Pao.

This is the trajectory Butte County’s Hmong were on in 1990 when Xiong’s brother, Chai, immigrated to the area. Xiong followed him in 1996.

It wasn’t long before Xiong heard from other Hmong people that Butte County’s Behavioral Health Department provided counseling for anyone who was having difficulties with memories of the war.

“They explained to me that, if you’re depressed or afraid, they will take you out to explore and provide a counselor for you to speak with,” he remembered. Xiong decided to try the counseling. He says he found it useful.

According to Robert By Khang, one of the first Hmong resettlement specialists in Northern California, the kind of outreach that Xiong and other refugees were getting in 1996 for trauma was nonexistent in the late 1970s and early ’80s when the first Hmong people arrived. Though the mental health field had been studying the effects of war trauma since the early 1950s—with PTSD becoming an official diagnosis in 1980—Khang doesn’t recall that knowledge getting impressed on resettlement professionals of the era.

“The Hmong didn’t seek that type of support because they didn’t know about it, or know to look for it,” he explained.

Similarly, long before Dr. Tran was an expert at counseling Southeast Asian refugees, she was aware of that history of nontreatment. Tran evacuated as a little girl from Saigon. Her father, a commander in the South Vietnamese army, saw brutal fighting during the war. Her mother was forced on a heart-stopping escape from the Vietcong with her children. Yet when Tran’s parents arrived in the Bay Area, she didn’t recall any offerings of therapy or counseling.

“There was nothing of the sort,” she said. “There was not even [English as a second language]. Counseling was just the furthest thing on anybody’s mind. … There wasn’t even a symptom checklist.”

Tran stresses this legacy had consequences. In the 1990s, she and her husband, Hinton Ladson, conducted a study for the Robert Wood Johnson Foundation that compared PTSD rates in the general population to those in the Vietnamese refugee community. They determined that the rate of people suffering from PTSD in the general population was 3.5 percent, while the rate for their refugee subjects was more than double, at 7.5 percent.

Though the research focused on the Vietnamese, Tran says her work with the Hmong, as well as Cambodian refugees who escaped the Khmer Rouge, reveals common trends around trauma. All of these groups witnessed extreme violence. Later, many, in raising children in the United States, dealt with disturbed family dynamics and abrupt intergenerational shifts in culture. Being targeted for racism, facing downward mobility and struggling to provide for their families often caused low self-esteem, especially with men, which Tran has found can retrigger memories of the war.

“All of these issues [elders experience]—the depression, the anxiety, the domestic violence, the gambling addiction—they’re all valid concerns when it comes to trauma in refugees,” she said.

Facing trauma together

Back at the Oroville celebration, dancers rang in the New Year, clapping, spinning and dipping with a sparkle in their sapphire shirts. These young Hmong-American performers are called Nkauj Hmoob Peev Xwm, or The Girls With Courage. They’re always a highlight of the festivities. Elected county officials, a congressman and even a member of the Lao royal family cheered as they cut across the stage; but to the side of the tent, out in the blinding sunlight, workers from the cultural center were missing the action. They held down the fort at an information booth, chatting with passersby.

The work they do may be quiet, but there is evidence it’s starting to reverse the trend of elder isolation and untreated trauma that’s plagued Hmong communities in America for decades.

The nonprofit center in Oroville was opened in 2000 with the aim of supporting and empowering families through culturally sensitive education, support and advocacy. Over the years, improving public health also became part of its mission. The center created Zoosiab, which translates in English to “Happy People,” a program specially for the elders. Yeng Xiong worked for that program for last four years and was recently recruited as a Hmong-speaking social worker for the county.

During her time with the Zoosiab program, she brought Hmong elders—considered to be anyone over 50—together every Wednesday for activities and discussions. She says a typical day involves 20 to 30 seniors doing arts and crafts, physical activities or getting help with English. Employees at the center pick the participants up and drive them home as needed. This free offering would be a standard bulwark against elder isolation in any community, but in Butte County it’s also created a safe place for participants to openly discuss what they’ve endured. According to Yeng Xiong, many times that leads to intense moments of catharsis.

“When they’re together in a group of people their own age, I think they’re more open to share,” she said. “We have a lot of them that do share their stories, whether that’s their post-traumatic stress from the war, or whether it’s just problems in their relationships or marriage. And we all cry together when they share those stories, because we’ve all been affected.”

Helping people avoid internalizing trauma is an obvious win, but the center’s elder program has had successes on another front: Yeng Xiong estimates that 90 percent of the attendees have learned about—and more important, decided to use—counseling services at the Behavioral Health Department. Given that many of them can’t read or write, Yeng Xiong says some haven’t heard of the department and others have only a vague notion of what it is. And while there are no words in Hmong for “mental health services,” just as there are no words for “stigma,” “trigger warning” or “post-traumatic stress disorder,” the cultural center’s employees have learned to translate the basic concepts in a nonintimidating way.

“The challenging part in the beginning is just building trust,” she noted. “Even though we’re part of the Hmong community, if they don’t know you, they might not trust you and they’re not going to attend … continuing to drop by and talk to them is the best way to get over that challenge, because it builds a relationship over time.”

In the course of building that confidence and credit, the center’s workers have observed that many elders are now blending American mental health concepts into their traditional belief system. The Hmong religion is one of animism, a faith that the spirit world and physical world are bridged in mysterious ways. Because of that, some people suffering from depression, listlessness, nightmares or flashbacks might view the challenge through a religious prism rather than a health-related one. But that generally hasn’t stopped those in the program from exploring how a counselor might help.

This evolution doesn’t surprise Pachia Lucy Vang, a Hmong-American ethnographer who’s interviewed refugees from California to Thailand. “The Hmong spiritual beliefs are pretty adaptable,” she said. “We’ve taken some things from other cultures and religions we’ve encountered over the centuries. It’s a belief system that’s always brought new ideas into it.”

In Butte County, it helps that an influential shaman like Yang Bee Xiong encourages his fellow community members to seek mental health services if they’re struggling. Having been personally impressed by the county’s health workers, Xiong sees no conflict between t;he help that he tries to render people in the spirit world and the assistance they can get from doctors and clinicians. Given what so many of the Hmong have been through, Xiong thinks sometimes it takes support on both ends.

“Helping them makes me happy,” he said. “But I can’t do it alone.”

New horizons

With the New Year’s ceremonies reaching their zenith, local Hmong leaders asked Ed and Georgie Szendrey to come up to the stage. The Chico couple have worked closely with the Hmong community for years, helping document atrocities carried out against them by Communist forces in Laos and Vietnam.

The leadership at Butte County’s Behavioral Health Department understands the gravity of that story, too. Their partnership with the cultural center is helping clinicians navigate the intricacies of a traditional Hmong perspective and define trauma outreach in an ethnically sensitive way. This approach to treating trauma and depression in the elders can sometimes include a blend of modern and traditional methods. Don Taylor, assistant director of Behavior Health, says group therapy in the form of social gatherings like potlucks and field trips is a good fit for a lot of the Hmong elders.

Behavioral Health has focused on outreach with the Hmong community since the early 1990s. Taylor remembers accompanying newly arrived refugees on community excursions when he was first hired in 1997. From his view, making them feel like they belonged in places like Oroville and Chico took the edge off the anxiety that often comes with resettlement.

“It was tremendous, the difference we would see in terms of people being isolated and withdrawn,” Taylor said.

Behavioral Health developed additional outreach strategies over time. Even though Hmong isn’t one of the languages that counties are mandated to print their literature in, Butte’s department has published numerous fliers, brochures and custom publications in Hmong over the last decade. Even more important, according to Taylor, has been its ability to hire trained clinicians who are bilingual Hmong-Americans. The county currently has four working in its Oroville office.

“A regular translator can speak Hmong, but they don’t always entirely understand the health concepts,” Taylor observed. “Having professionals who are trained in the field who also speak Hmong makes a huge difference.”

He added, “There’s been a pretty concerted effort for the outreach because of how much trauma was associated with the war, and because it doesn’t just affect the individual, but affects the entire family …. When it comes to tackling this, the Hmong Cultural Center has been a good ally.”

It was through the cultural center that Mai Yang learned of counseling at Behavioral Health. After being orphaned as a child, she and her siblings survived the wave of retaliation killings and ended up in the Ban Vinai refugee camp. Over the years, they bounced between Thailand’s various sanctuaries for the Hmong, staying in some until they were forced out by closures. Often, the family was dressed in rags. American doctors visited the camps less and less. Disease started killing more of the dispossessed. And, of course, Yang always remembers the hunger.

Eventually old enough to marry, Yang found a husband who was open to moving to the U.S. The couple were granted permission to immigrate, but just then, Yang got pregnant. Her husband was suddenly convinced it was too risky to start a new life overseas with a baby. Yang reluctantly put off her dream of leaving Thailand. She raised three children in the squalor of the camps, finding ways to eek out a life for them. When her husband fell ill and passed away in 2005, Yang decided it was finally time to “come to America.”

The family arrived as part of the last wave of Hmong refugees to settle in the Golden State. Yang says that, in Butte County, they found a community with open arms—and a host of wrap-around services that had been built up over a decade and a half.

“They gave my children backpacks for school and registered them in school, so they could learn,” she said. “I was sick, so I went to the doctor … I was so happy because I came, that’s why I’m alive.”

Yang began participating in the cultural center’s elder program and was eventually brought to a county counselor to discuss her trauma.

“It helped,” she said of the therapy. “There was an American [clinician] who really loved me and helped me out a lot.”

And so, as the Hmong New Year marks another turning of the seasons in an adopted homeland, elders like Yang are finding ways to heal from a painful past that’s never far away. For her part, Yang attributes the opportunity to find peace to everything from the generosity of the cultural center to the warmth of Butte County’s residents.

“How come we didn’t come earlier?” she asked herself, wiping tears away. “We suffered so much.”