War, torture, loss of family and friends, refugees arriving in the United States often carry heavy emotional baggage. Then they endure the strains of adjusting to a new culture. But questions about their mental health are often met with uncomfortable silence.

A group of Philadelphia agencies that serve refugees tried a new tool: cameras.

A new exhibit at Philadelphia's Magic Gardens gallery now showcases the stories refugee photos can tell.

One of the images shows two fingers, a face drawn on each, sticking out of the green leaves of a houseplant. It was taken by a young woman who came to the U.S. after fleeing Burma.  The fingers represent her and her brother fleeing through the jungle to the relative safety of a refugee camp.

Melissa Fogg coordinates the efforts of the Philadelphia refugee mental health collaborative -- a group of agencies working together to improve mental health services for refugees. She says, at first, the young woman couldn't say what the picture was about.

"As she went through the process and became more comfortable in talking about her experiences she told this story of flight of her uncle and brother," recalled Fogg, "running through the jungle from men with guns, these horrible things that don't typically come out in your conversations with clients."

Fogg says trauma is a major issue with her clients, but few speak about it. It's not just the language barrier -- it's the concept of mental health that often doesn't translate.

"The idea of Western mental health, going to a therapist, sitting on a couch and talking about your problems, doesn't always line up with the clients we work with," she said.

Questions yielded few helpful answers

Working at the refugee clinic at Thomas Jefferson University Hospital, family physician Ellen Plumb has come across lots of mental health issues.  She wasn't getting anywhere going through her usual list of doctor questions -- Have you been eating well? Have you been sleeping? How has your mood been? Are you able to concentrate?

"The way that we ask the questions definitely wasn't giving me any insight into what types of experiences people were having," said Plumb.

That's how the idea for the photo project was born. Cameras lessen the need for language, and can effectively document stressors and strengths in the lives of refugees. Burmese, Bhutanese and Iraqi refugees met over the course of several weeks, to take pictures, and to discuss them.

Fogg says the photo discussions turned into impromptu therapy sessions where people were comforting each other. "In some cases, they were crying over the burning of an art museum in Baghdad and really sharing these intense emotions that they didn't have an outlet for before," she said.

Culled from hundreds of images, the pictures in the Magic Gardens exhibit speak of longing for lost traditions. Food plays a dominant role, family members are shown. Photos document funerals and grieving.

But when refugees who participated are asked about the emotions in their photos, the conversation is halting, and awkward. Talk reverts back to the physical items in the photos. Finally, Bishnu Kamar, a 30-year-old refugee from Bhutan, takes a stab at describing the emotion that seems to seep from many of the images.

"Most of the people, there is sadness. The old people, they are always talking about his country. My sister, she live in Bhutan. I live in America," said Kamar. "That is why, some time I am sad, and when I think about my sister, I am sad."

How do you deliver effective mental-health services to a population not ready to talk about mental health?  Plumb says the photo project has brought her closer to answering that question.

"Now having this whole world opened, seeing into people's lives, into their houses, into their families gives me a different way to approach mental health," Plumb said.

Tapping community and tradition

For example, Plumb now asks different questions during medical exams -- How is your family? How are things going? How are things changing?

Fogg says the photos document the healing power of community and tradition, something mental health agencies in the collaborative are increasingly stressing.

For example, there's a new weaving project with Burmese women in which  they create traditional clothes. A collaboration with Philadelphia's Mural Arts project works with refugees to turn symbols and rituals into public art.

The exhibit "Envisioning Home: Persectives from Philadelphia Refugees" runs through Aug. 26 at Philadelphia's Magic Gardens Gallery, 1020 South St. Philadelphia.

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Photos by Emma Lee, for NewsWorks