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In Dharamsala,
India, home of the Tibetan government in exile, travelers find rows
of mani wheels mounted next to paths. Spinning the wheels, also known
as prayer wheels, invites the blessings of Chenrezig, the embodiment
of compassion. But the wheels also represent movement and travel-visitors
spin the wheels as they walk slowly around sacred sites recreating
Buddha's clockwise path around the Bodhi tree where he attained enlightenment.
Buddhist monks also carry handheld mani wheels on long pilgrimages.
Along with the wheel, most carry much less than a Westerner could
imagine--sometimes only an alms bowl. But what they bring and where
they go are far less important than what they think. Using one of
Buddha's core teachings--With our thoughts, we make our world--these
monks strive to always embrace the present moment.
Linda Halcón, associate professor of nursing, follows a similar
path. She began her career helping people in Minneapolis. Since then
she has traveled the world working to improve the health of communities
in need. Her research and outreach work have taken her to Madagascar,
Kenya, Sudan, Iraq, Peru, and Dharamsala, India. She has worked out
of army tents, an embassy, a hotel, a family residence, small planes,
and trucks.
Today she works out of a sixth-floor office on the east bank of the
Minneapolis campus. She is satisfied with where she has landed and
she is embracing the present moment. And she is again working to improve
the health of people in need here in Minnesota.
What guides your world
The Twin Cities are home to thousands of refugees from countries with
a history of government or clan-based torture of citizens. For these
refugees, time and physical distance will never undo the past. The
memories, both physical and mental, can't be simply left behind at
the airport. The additional strains of living so far from home in
a new culture, climate, and civil system make life even more of a
challenge.
Halcón and fellow nursing professor Cheryl Robertson hope that
an innovative intervention can help. Supported by a grant from the
National Institutes of Health, they are assessing the feasibility
and acceptability of the Health Realization intervention in
Somali and Oromo refugee women.
The intervention, which has shown promising results in a variety of
settings and populations, teaches people to manage intrusive thoughts
by simply acknowledging rather than reacting to them. It helps people
to view thoughts as just thoughts--nothing more. And over time, practitioners
learn that with their thoughts, they make their worlds.
Halcón and Robertson believe this intervention can give people
the power to recover from the past and improve their own lives. "This
health realization model is about taking charge of your life--about
how what you think guides your world," she said. For her, this
project is another step in her own journey to help create a healthier
and more livable world for disadvantaged communities.
The real revolution
Halcón has always been drawn to community outreach work. In
the late 1970s and early 1980s she used her nursing degree working
as a sexually-transmitted-disease clinician, a nurse counselor for
sexual assault victims, a chemical dependency staff nurse, and a college
health nurse. In 1987, after completing a master's degree in public
health, she moved with her husband to Madagascar, off the southeast
coast of Africa. While he worked as an architect with a non-profit
architectural service, she worked as the administrator and nurse of
the U.S. Embassy health unit. As part of her work there she helped
a Malagasy physician to found the country's first chemical dependency
treatment program.
From Madascar the couple moved to Kenya where Halcón met a
representative from the International Rescue Committee (IRC) who convinced
her to travel to southern Sudan to help establish a refugee health
program. As the project coordinator and nursing supervisor, she helped
set up an immunization and child nutrition program.
In all she spent two years in Africa, which made a strong impression
on her. "Prior to living in Africa I was full of solutions for
the world's problems," said Halcón. The difficulties she
faced there, however, left her discouraged and cynical. "Later
I regained my optimism about the possibilities for personal and community
transformation anywhere in the world under any circumstances, but
now I know that the answers are within those communities. I understand
my role as one of helping people see their own health so they can
discover their own solutions. That is the real revolution."
When Halcón returned to Minnesota she was hired as public health
director for Isanti County, just north of the Twin Cities. But the
comforts of home were hard to come by. "The biggest shock of
living in Africa, especially Madagascar, was the slower pace of life
and the pervasive emphasis on relationships over consumerism and materialism,"
she said. "Afterwards it took me a full two years to readjust
to life in Minnesota. I still cannot walk down the cereal isle at
the supermarket without cringing."
Not surprisingly then, she again followed a path that led overseas.
At the end of the first gulf war she spent one month as medical coordinator
for the International Refugee Committee's Kurdish emergency relief
program in the town of Zakho in northern Iraq. That program supported
the needs of 40,000 refugees.
Her travels then led her from Isanti County and Iraq back to Minneapolis,
where she worked at Boynton Health Service, eventually serving as
interim director. But by then Halcón had decided to bring her
experiences into the classroom. She completed her Ph.D. in epidemiology
in 1998, and embraced teaching and research.
One of the first areas of research she explored was the use of botanicals,
especially plant essential oils, in treating infectious diseases.
She has since earned the A. Marilyn Sime Faculty Research Fellowship
and faculty seed grant from the Academic Health Center to pursue this
research. "Focusing on plants made no logical sense when I first
started my nursing career, looking at the usual modern nursing jobs.
But I have since learned that botanical therapies were historically
part of independent nursing practice and I would like to revive that
tradition," she said.
And because essential oils are inexpensive and accessible without
prescription, this research may be particularly relevant to health
planning in low income or uninsured populations. "I really believe
that the healthcare system needs something different. It needs community-based
solutions and alternative therapies," she said.
A simple approach
Halcón's current project with Somali and Oromo refugees began
several years ago with the Refugee Population Study, an epidemiological
study of refugee trauma survivors from Somalia and Ethiopia living
in Minnesota. Epidemiology professor Alan Lifson, and later Dr. James
Jaranson, surveyed 1,134 participants and estimated the prevalence
of torture and associated physical, psychological, and social problems
in these refugees.
When Halcón joined the research team midway as epidemiologist
on the project, she felt it was important to build on the survey results
to develop an intervention that could address the problems identified.
Access to mental health and social services is limited for refugees,
and cultural barriers are a major contributor to refugee's reluctance
to use Western-style services, despite self-identified psychological
and social needs. Therefore, Halcón needed to find an intervention
that would be accepted in the Somali and Oromo communities.
She had learned about the Health Realization Model and thought that
it had potential because it is a community-oriented, strengths-based
approach that helps subjects discover and use their own resilience
and coping resources. To test for cultural appropriateness, Somali
and Oromo outreach staff were given initial training in the model.
"They were incredibly enthusiastic and felt that it has great
potential for their people," said Halcón.
Along with pilot testing for feasibility and acceptability, the team
is developing a translated training manual in preparation for a full-scale
trial of the intervention. "I'm very attracted to this simple
approach and its ability to help people to change their lives,"
said Halcón. "We tend to focus on problems. Science shows
us that what we focus on gets bigger. If we focus on a way to enable
positive change, we can create that change."
To Dharamsala and back
With her personal focus on outreach, research into alternative medicines,
and a penchant for interesting travel destinations, Halcón
admits that there have been times when she wondered if an office in
academia was the best fit for her. But the University of Minnesota
has given her a chance to bring all of her diverse experiences together.
"I really value working with students, and I value being able
to do research," she said. "I have always been interested
in studying and working in health of disadvantaged populations. I
have always viewed botanicals as powerful medicine, especially in
their role as sustainable alternatives to rising antibiotic resistance
and especially in developing countries. And I have always been interested
in infectious diseases. This position allows me the luxury of exploring
all of these interests."
This broad-based approach can be seen in her academic appointments.
She is a faculty member in the Center for Adolescent Nursing, in the
Center for Child and Family Health Promotion Research, in the graduate
minor in complementary therapies of the Center for Spirituality and
Healing, and she is an adjunct professor in Epidemiology. For Halcón,
there is no one solution, no predetermined path. She finds her meanings
by looking within, wherever that may take her.
Last year her path took her to Dharamsala, India. The Tibetan government
in exile needed an epidemiologist to provide analysis of demographic
and health data from 100,000 Tibetan refugees in India and Nepal.
Halcón sent her C.V. and was accepted. She received a travel
grant from the Women's International Science Collaborative of the
National Science Foundation, and in January 2004 traveled to Dharamsala,
at the base of the Himalayas.
Unfortunately, she quickly discovered that the project required much
more than one person could provide. So with permission from the Tibetan
Department of Health, she presented the project to the U.S. Centers
for Disease Control (CDC), Department of International Emergency and
Refugee Health. The CDC not only agreed to undertake the project,
but they are providing training and development for the Tibetan Department
of Health Data Unit. "I couldn't do the project, but I am very
proud to have helped get someone with the resources to do this important
work," said Halcón. "It's perfect."
Back at the University of Minnesota, she insists that she is done
traveling, at least for now. But her previous travels continue to
inform her current work. "My experiences abroad definitely encouraged
my interest in refugees and their health," said Halcón.
"If it was that hard for me to reenter U.S. life with 40 years'
prior experience, I wonder what it must be like for new immigrants.
I want them to be healthy because I believe all of our collective
creativity and commitment is needed to truly move forward in this
new millennium."
Staying put does not mean that she is bound by the U.S. metaphor for
spinning wheels. Linda Halcón is a citizen of the world
and has been to Dharamsala where mani wheels represent greater possibilities.
With her thoughts and actions, informed by her past, she is making
her world. And in the process, she is helping to make a healthier
and more livable world for others.
WRITTEN BY BRIAN LIEB
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