May 08, 2009

Student project grows into service initiative for refugee children from Burma

Artwork by refugee children from Burma reflects the trauma of violence and relocation, as well as hope and newly discovered pleasure.

Artwork by refugee children from Burma reflects the trauma of violence and relocation, as well as hope and newly discovered pleasure.

The seed was planted in a college medical sociology class when Meg Ellenson read a book titled The Spirit Catches You and You Fall Down (Farrar, Straus & Giroux, 1998).

Ellenson was deeply moved by Anne Fadiman’s story of a refugee family from Laos and their experiences trying to negotiate the U.S. health care system, resulting in a cycle of tragic misunderstandings, culture clashes, and medical errors. Ellenson knew — as soon as she finished the book — that she wanted to work in public health.

The journey she has taken since then has allowed her to conceive and give birth to a project that continues to make a positive difference in the lives of middle-school-aged children in Chapel Hill, N.C. and their families.

Ellenson enrolled in UNC’s health behavior and health education master’s program in 2006. During her first year, she took Dr. Geni Eng’s class in action-oriented community diagnosis, or AOCD (HBHE 742). As part of a student team, she evaluated the strengths and needs of people in Chapel Hill who had fled from the political turmoil in Burma.

“When I found out that AOCD was working with a refugee population, I was immediately attracted to the project,” Ellenson says. “I had grown up in Chapel Hill and knew a lot about the people who live here. The area attracts a lot of immigrants — there are good social services in place, there are numerous employment opportunities, and the town is welcoming. Religious organizations often sponsor and support new residents. But until the class, I had no idea about this group of people or how little support they had.”

Ellenson refers to the community as “refugees from Burma” rather than “Burmese refugees.”

“I learned a lot in the course of the assessment,” she says, “including that ‘Burmese’ refers to an ethnic group. The Burmese are an ethnic majority in Burma, but in the minority here. The majority of refugees here are actually Karen, one of the many ethnic group targeted by the atrocities in their home country. In the U.S., refugees from Burma are often lumped together as one people, despite differing ethnic identities and the resulting conflicts and tensions at home.”

In addition to the issues raised about viewing the refugees as one community, there were language barriers and challenges gaining entrée into the community. Ellenson’s team was able to conduct interviews and focus groups to gather sufficient information to develop a community assessment report.

“But mental health was a stumbling block,” she said. “Apparently, at home, they talked openly with family members about being sad or having bad dreams. But it was difficult for us to get close enough to talk about how they were coping.”

That unmet need was on Ellenson’s mind when she took a program management class (HBHE 733) with Dr. Carolyn Crump in the fall of her second year in the master’s program. Caytie Decker, a friend and AOCD teammate of Ellenson’s, had discovered the Art Therapy Institute, in Durham, N.C., and the Institute became the subject of Decker’s and Ellenson’s work in Crump’s class.

“As I learned about the Institute’s mission,” Ellenson said, “I immediately thought about the children from Burma. What potential this had as a healing modality for them!”

Ellenson describes art therapy as an alternative to conventional psychotherapy that is potentially less threatening and more accessible to refugee children. ‘Talk therapy’ can be less effective with those unfamiliar with Western concepts and beliefs.

“Besides,” Ellenson said, “these children may not have the vocabulary to talk about their thoughts and feelings in their native language, let alone the language of their host country.”

There are a number of reasons art therapy is effective, Ellenson said. “It can help refugee children construct meaning and identity, work through loss and come to terms with trauma. Also, the process of art-making in a group setting can provide social and emotional development and improve self-esteem.”

When Ellenson was able to see the Institute directors, local art therapists Ilene Sperling and Kristin Linton, in action, she remembers, “I had an ‘aha!’ moment — as in, ‘This could really work!'”

Dr. Jo Anne Earp, professor of health behavior and health education, and Elizabeth French, assistant director of academic affairs in the department, thought so, too. French wrote the nomination that won Ellenson the 2008 Robert E. Bryan Public Service Award, given by the Carolina Center for Public Service at UNC for outstanding engagement and service to North Carolina.

“Jo Anne’s and Elizabeth’s encouragement was a motivating factor,” says Ellenson. “They saw my proposal as an innovative solution to the mental health needs of refugee children.”

“Using Meg’s research, the Institute designed a group curriculum to help develop communication and problem-solving skills, increase self-awareness and help the children develop friendships with other students with similar experiences,” says Sperling, director of the Institute.

“We were always very impressed by the level of commitment and creativity that Meg demonstrated in her learning. She taught herself a lot about the theories and practice of art therapy with refugee children who have experienced hardships and trauma in their paths to resettlement in another country,” Sperling says. “The kids in this program love art and enjoy doing art therapy with their classmates. They have used their drawings to express dreams, challenges and past experiences. We are even planning an art show in late May or early June.”

As a student, Ellenson’s practicum with the Orange County (N.C.) Health Department, to develop a health education curriculum, was funded by a grant from a Chapel Hill foundation. That fall, the same foundation, Strowd Roses Inc., provided start-up funding for Ellenson’s long-hoped-for art therapy program.

Jennifer Boger, member of the board of directors of Strowd Roses, said that Ellenson’s project was one of the first the Foundation had given to an individual.

“Megan was the first to bring this group of refugees to our attention,” Boger said. “Since her grant, we have given to other projects that benefitted refugees from Burma, but Megan was the first to make us aware. This is the kind of grassroots effort we are excited to fund — when someone looks around and wants to foster this kind of effort that benefits the Chapel Hill-Carrboro (N.C.) community.”

Ellenson now works as a field coordinator for the Department of Health Behavior and Health Education, hoping to add insights about the way student teams interact with their assigned communities. She’s hoping, too, that the Chapel Hill art program can develop into a more permanent feature in the local school system — even that it might serve as a model for other towns and cities.

“Across the nation, I’d love for art therapy to receive more attention as a valuable way to address mental health needs and help with the interactions and acculturation of students,” she says.

Ellenson’s hard work and creative “thinking outside the box” allowed her to artfully weave community service into her academic curriculum. She earned her Master of Public Health degree in May 2008.

“What attracted me to the UNC Department of Health Behavior and Health Education,” she says, “was the guided field work. There’s great value in engaging a community in which you’re working. The skill set resulting from that is priceless.”

“The Department’s dedication to and legacy of fieldwork also gave me freedom to initiate something in my first year and build on it with a practicum and master’s paper. With that opportunity for continuity, I felt it was important to follow through.”

“And I love what I’m doing now,” she says. “It’s a privilege to work with amazing students and help them develop relationships with — and engage – communities.”

— Linda Kastleman

The Art Institute’s spring exhibit will be a fundraiser to benefit next year’s art therapy classes for children from Burma. For more information about the exhibit, or to make a donation, visit, or email

View more photographs about the art therapy project on our Flickr site.

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit