Karen Refugees in the U.S.: Barriers and Integration

Introduction

The Karen people of Burma are made up of a number of separate ethnic groups that do not share a common culture or language. The majority of the Karen people live in Karen State, located in southern and southeastern Myanmar, and make up roughly 7%, or approximately five million, of the Burmese population. The majority of the Karen population has settled around or near the Thailand–Myanmar border. The Karen people have a rich history, with some living under the leadership of the KNU, or Karen National Union. Those influenced by the KNU have waged war since 1949 against the Burmese government, seeking independence. This has led to some Karen people leaving the country and relocating to the United States as refugees.

This literature review aims to understand the nature of the problem that resulted in the migration of Karen people to countries like the United States, what barriers they encounter upon relocation, and what is needed to bridge the gap. The review examines three key areas that provide a deeper understanding of the origins of the Karen refugee status as well as what happens after they transition to life in the United States.

Nature of the Problem

From 1830 to 1947, Burma developed as an official British colony. While the country — later named Myanmar — gained independence in 1947, it subsequently suffered through military dictatorship beginning in 1962, as well as the start of the Karen Civil War in 1964. The Karen people's first leader, J.D. Law, provided the foundation from which the Karen struggle against the Burmese government took shape (Ooi, 2004).

The Karen struggle has attracted international attention, particularly following the introduction of Karen refugees into the United States. One study documented the frequency of war trauma, torture, and mental health distress among the Karen refugee population screened upon entering the United States: "Frequencies of primary and secondary torture were 27.4% and 51.4%, respectively. War trauma was reported by 86% of the participants. Torture, older age, and female gender were significantly associated with increased total distress, posttraumatic stress, depression, and somatic complaints" (Shannon, Vinson, Wieling, Cook, & Letts, 2015, p. 577). The fight for independence among the Karen people has taken a significant toll on the population, revealing potential long-term problems that some refugees continue to face even after leaving the conflict in their home country.

Torture has emerged as a prevalent concern among Karen refugees in the United States. A 2016 study analyzed the potential physical effects of torture among this population: "We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure" (Hoffman et al., 2016, p. 1). Although no physical effects of torture distinct from general trauma exposure were identified, the study noted that the mental and emotional effects of torture are lasting and may provide a better understanding of what Karen refugees must contend with after moving to a new country. Resettling in a foreign country is inherently difficult, and additional research highlights the capacity of Karen refugees to navigate a new environment and culture.

Karen refugees who have relocated to the United States must not only acclimate to new cultures and communities but must also find ways to integrate their past traditions with new ones. A 2015 study revealed that Karen refugees adapt to their new environment by maintaining their cultural identity through family support, faith, community, and Christian values. One way the study found that Karen refugees preserve their cultural identity is through food: "Findings suggest participants identify with their culture through traditional foodways and desire to preserve native dishes, gardens and celebrations for the sake of familial relations and cultural identity" (Spivey & Lewis, 2015, p. 60). By preserving the food practices of their homeland, Karen refugees are able to maintain a degree of connection to their former lives and identities.

The Karen refugees have continued their cultural traditions within the United States. This is evident in the Karen community in Minnesota, which reflects various aspects of Karen culture from Myanmar — including how community members greet one another and how they understand medicine and food. The following section provides a closer look at the traditional and contemporary aspects of Karen culture in Minnesota.

Karen Culture in Minnesota

Some Karen people have migrated to the United States as refugees, residing primarily in Minnesota. The estimated number of Karen people in the United States is approximately 64,759 (Arnold, 2015). One of the main settlement areas for Karen refugees is St. Paul, Minnesota (Arnold, 2015, p. 781). Common cultural norms among this population include the absence of surnames; community members refer to one another through kinship terms. One notable cultural shift involves their beliefs about medicine — many Karen refugees in Minnesota tend to believe that Western medicine can cure any disease or illness. Additionally, the Karen people of Minnesota may not prioritize health insurance when they are not sick. Some members of the population use the betel nut as a means of staying alert and awake while performing job duties or household tasks, a practice shared by various other communities.

These observations were among those identified in a 2012 case study of the Karen refugee population. While researchers found positive outcomes associated with relocation for Karen refugees, they also noted a lack of effort on the part of authorities to help the population integrate more effectively into the culture of St. Paul: "However, it was found that there were also lessons to be learned from the Karen in St. Paul about limiting the detrimental impacts of the program, better supporting the integration process, and broadening participation in resettlement" (Harkins, 2012, p. 184). Karen refugees have also retained potentially harmful habits that could lead to long-term health problems. As noted, the betel nut has been confirmed as a dangerous plant when used regularly.

Regular use of the betel nut can cause oral cancer and is associated with early death as well as addiction (Furber, Jackson, Johnson, Sukara, & Franco, 2013). Understanding these cultural practices is important because it supports more effective communication with and care for Karen refugees. If Karen refugees retain unhealthy habits from their former lives in Burma and struggle to adapt to life in the United States, serious health consequences may follow. The reluctance to acquire health insurance, for example, poses a particular problem for members of this population.

This concern is not solely health-related; the federal government's mandate requiring all U.S. residents to carry health insurance (Amar, 2016) or face financial penalties adds a legal dimension to the issue. The absence of surnames also creates potential administrative obstacles for Karen refugees. Nonetheless, efforts have been made to bridge this gap. Organizations such as Guadalupe Alternative Programs offer assistance to those living in difficult circumstances in St. Paul, Minnesota, helping them build a future in the United States.