Before Theanvy Kuoch came to Connecticut and helped to found a well-respected refugee health organization, she lived through unspeakable horrors.
She was enslaved by the Khmer Rouge, the brutal regime that ruled her native Cambodia from 1975 to 1979. Nineteen of Kuoch’s family members died, among the more than 2 million people who were murdered or died from starvation or disease under the Khmer Rouge.
She was later separated from her young son when she went to search for food and ended up in the middle of a conflict, then taken to a refugee camp. They were not reunited for more than a decade.
Kuoch came to the United States as a refugee in 1981, arriving alone. The following year, she and three American nurses who had worked in the refugee camps began Khmer Health Advocates to help newly arriving Cambodian refugees. Kuoch later earned a master’s degree and became a licensed professional counselor. She serves as Khmer Health Advocates’ executive director.
The organization provides health care and counseling, and runs a treatment program for torture survivors. It has used a variety of innovative techniques to provide care, including a videoconferencing program that allowed people across the state to communicate with – and receive care from – those in the West Hartford office without having to travel. Another program paired the organization’s community health worker with a pharmacist who helped patients manage their medications.
The needs are significant. In a 2003 survey of 366 Connecticut residents born in Cambodia, Laos or Vietnam before 1971, 42 percent said they had been tortured. The study also found high rates of depression and symptoms characteristic of post-traumatic stress disorder.
A study published in 2013 found that the severity of trauma symptoms among Cambodians and Vietnamese Connecticut residents was linked to worse health outcomes including greater levels of heart disease and more health conditions, as well as more barriers to getting care.
“[T]he patients who may be in the greatest need of healthcare services – those with the greatest trauma symptoms – are the patients experiencing the greatest challenge in receiving services,” wrote the authors, one of whom was Kuoch.
She has been recognized for her work by a variety of organizations, including the United Nations and President George H.W. Bush, who named her as one of the nation’s Points of Light in 1991.
Kuoch spoke to The Mirror about her experiences in Cambodia and as a refugee, the evolution of Khmer Health Advocates’ work, and the impact of the Trump administration’s policies toward refugees on those living in the U.S.
Can you talk about the story behind the work you do here and how you got here and created this?
It was during the Khmer Rouge, and it was very difficult. I had been tortured and separated from my family, and 19 of my family died. Some of them were missing and some of them were killed and some of them died because of starvation.
[I was very thin from starvation.] Even walking on a little hill, I had to crawl. In that time, I kept moving. I would never quit to work as a slave during the Khmer Rouge.
The last thing that I began to see was my mother, when she was very sick, and then she was dying. She couldn’t close her eyes. That’s a cultural [thing]. They believe that when someone in your family is dying but they cannot close their eyes, they wait for the last word of peace. So I would pay respect to her and say, “As long as I live, I will take care of family.”
And then after everybody died, I only had my son and my niece with me. When the Vietnamese invaded and we were asked to move out, [it took] like 10 days and nights to get out from the Khmer Rouge regime. I was very, very thin, and I had to carry my son.
When I came back to my hometown, nobody recognized me because I was so thin. Until I began to talk, and then my nieces kind of recognized me, and my father, he was speechless. He saw how much I had been tortured.
We did not have enough food, so I left my son with my sisters and went to the Thailand border to get some. Along the way there was fighting and we had to run through landmines. There were dead bodies everywhere. When I got to the border, my feet got swollen and all of my toenails fell off. I couldn’t walk. The Red Cross came into the border camp and took me into the U.N. camp on the other side of the border.
The Red Cross was very kind. They gave us some food and stuff like that, and then I began to wonder if I could take care of people.
The people came from all over the world to take care of the refugees. And I was lucky enough, called to work at the German Catholic hospital. They taught me how to give the shots to the people. So I took care of a lot of the patients and by then I felt like I have some kind of power, I’m going back to being a human again.
I was trained to help the refugees who had been sick in the hospital, but the refugees always helped me. It was a give and a take. And they even, in spite of the hard work, they made some jokes and laughed. They always kept some food for me. In the morning they could help me put all the stuff together before I could go and deliver medication to them.
And I met a few of the Khmer Rouge that tried to take my son away, too. So when they see me, they kind of put their face away. But my heart is not, there is no revenge. I believe that a lot of people did not want to do anything bad unless they were sick or there was something wrong. But if I keep positive, I think that will help me to move forward. So when they came, I treat them the same way.
I was afraid to go back into Cambodia, and then I was given a chance to resettle in the United States.
I came to the United States in 1981 and was first resettled in Chicago. I had worked with Mary Scully in the refugee camp and called her to see if I could move to Connecticut. I worked with her and two other nurses who worked in the camps to establish Khmer Health Advocates.
When I came to United States, all I wanted to do, I wanted to work in the health care setting. But I thought, “How could I? I can’t drive a car. I can’t speak English well.” But I had a lot of people support me, including my landlord. He’s Italian. They would give me a chance to go to school, and then when I graduated from school, I began to work with the refugees again.
I had to go all the time, go to see people at home. And I had no car, nothing. But…the refugees were sponsored by the churches, and the churches developed a friendship.
And then we [got] an office and the people would come to Khmer Advocates. Later, they became very trustful to us because we don’t judge them and also, we work with them. Always partnership.
We are not only working on the mental health. [We focus on whole health, and beyond.] Sometimes the community says that, “I have a dream,” so we’ll work on the dream. And sometimes the community says that, “Well, I went to the Social Security office, they did not understand me,” so we jump in right away, try to help them to connect them by not escalating stress to them.
Through my experience, it doesn’t matter [if a person is] Cambodian, Italian or Hispanic. As soon as you talk with caring, right away, it does connect.
Q: You mentioned some of the work that you do here and when you started. I was wondering if you could talk about what were the services you were providing when you got started here, and how has that evolved over time?
A: When I got started, I have to build trust within the community. So I went to see the community at home.
We go to see the patient at home, but we don’t try to do anything. We just go. Mary Scully was with me the whole time and when the people arrive, we want [them] to know that, “Hey, it’s winter, you have a hair dryer, you have enough blankets,” just something that’s a basic need.
After that I begin to translate, and then we didn’t have an office yet, but we do a lot of home visits, and that’s how people got to know us and trust us.
Our psychiatrist, Dr. Richard Miller, he’s a really very gracious person as well. He listens to the stories, one after another.
Storytelling is very, very important. When the people are able to tell the story, that’s how their health begins, because you have so much story in your mind, but you just don’t know if you tell somebody and they will distort it to be a negative. And it’s shameful for them to talk about their own personal story. But here they can cry, they can talk and we always, always support them, always follow up [to see] if they are ok or not.
And then also, the Cambodian [community is] so silent. Because during the Khmer Rouge, they forbid them to talk anything. If you talk, you die. So when you came to the United States, and when you don’t talk, you die, because nobody knows what’s going on.
When you said when people are silent, you die, is part of your work encouraging people to speak up if there’s a problem?
I encourage them to talk. I say that when you talk, people will listen to you. They said before, they said, “Oh well, only [Theanvy] that can do anything.” I say that’s not true. I said that your voice is very, very important. We need to work together. I can’t work by myself.
When you started this organization and the work you’re doing, was it with a health goal in mind or was it about community and addressing all the needs, and then evolved into health?
A: Community. We listened to the community, what the community want.
We did a newsletter. And when we did the newsletter, we talked about health and we talked about, “We’re looking for the family.”
After the war, a lot of people were missing their family [some were missing in Cambodia or separated in refugee camps]. I sent [the newsletter] out and what was very interesting, that American people [were] very interested in health. They would send more letters saying, “What is going on? Can you get more information on that?” But the Cambodians were not interested in health at all, but they were interested in searching for their family. They even offered me [money to find their family]. And we found about 30-plus family…We got someone from Australia. I’m very proud that we did that, because the community wanted us to do that.
Later, the community said that [they were interested in], “My health.”
Right now, what do you see as the biggest needs in the community, both health and otherwise?
The health issue is mental health and chronic diseases.
And because the language barrier is very difficult, they don’t know how to speak. And because the lack of community health worker, translator and transportation, a lot of people, they won’t go to see the health care providers sometimes until they go to emergency, and sometimes they cannot save their life.
Because when you go to see the health care provider, if the health care provider does not have anybody who speaks [your language], even though they have a language phone, language line [a telephone translation service], it’s very difficult. Because the trust has been broken during the war. So you don’t know who’s on the phone, how they’re going to translate it.
Myself, I had a lot of problems with that when I first came and I’m using that as the lesson learned. When they would ask me to translate the Bible, [I thought], “How do I? I can’t understand the Bible.” So what I did, just kind of summarized a few words. I don’t think people understood, but because they trust me, they keep shaking their head. So that’s why it’s scary.
I went to a translator sometimes. They don’t know bladder and gallbladder. It’s very difficult. Especially when they say “operation,” and that really makes the Cambodians very anxious.
A few years ago, a 55-year-old Cambodian man who speaks a little English went to see his doctor. He thought the doctor told him he had to have surgery because he had cancer. He thought he was dying and went home and told his family to call his family in California to come see him before he died. His wife called us because she was so upset. I said that I would call the doctor and get more information. When I called the doctor, the nurse talked with me and said, “No, the doctor didn’t tell him that he had cancer, he told him he was 55 and should have a colonoscopy to make sure that he didn’t have cancer.” She wanted him to sign a release form for the procedure.
You have the kids [who translate for their parents], and maybe in their late 20s, early 30s. They don’t speak the language well. And a lot of times, they don’t translate back to their parents.
The mental health issues you’re talking about, are they largely trauma-related?
It is trauma-related, because the Cambodian people came from the war country, what you call the victim of genocide. They have a lot of things like nightmares and flashbacks, and sometimes their resources are very limited. Sometimes they just don’t even want to live, because it’s too difficult.
And they are traumatized and the family is also traumatized, and then the community is traumatized as well.
I’m from war and torture and genocide, and here I work with the community who’ve been traumatized like myself. But I say luckily, luckily, I can’t say enough that God has taken care of me…If I fall apart, I can’t help them. I have to be the most hopeful and the most positive.
When the community came, I said that, “If I can do it, you could. But if you fall apart, that’s ok. You can get up and move again. But if you kind of sit down in the corner, you never get back. But the thing is, you’re not alone. You can call me anytime. We can work together.”
Can you talk a little bit about what the community health worker [one of the staff at Khmer Health Advocates] does?
The community health worker is really the core of everything. The community health worker is really the person who works very closely with the community, almost like a friend, almost like family, but the boundaries [are important].
The community health worker calls, communicates with the community all the time. And then they call and tell what’s going on, and the community can say everything with them. Say they want to go to Department of Social Services, the community health worker will do that. Sometimes he will even take them to get the food if they do not have family or they don’t know how to get transportation.
And also, the community health worker will translate and will advocate for them, will work as the liaison between the health care provider and also the state government to advocate. They will work with the psychiatrist, myself and the nurse.
The community health worker is like the extension of family to the community, because they trust and anything they need, they can call him.
And the community health worker will also educate them as well, educate them about how to take medication, educate on how to take the public transportation.
With everything that’s been talked about with refugees in the country now, what impact does that have on people who are here who came here as refugees?
I’ll tell you, with the Trump administration, it’s very, very hard, very frightening for the community.
In January, 30 people called. They wanted to have citizenship. We helped them to fill it out and send it to them.
People who have green cards are very, very worried about it. Even the people who have citizenship, they came to talk, [worried they will be deported].
And now we don’t even know how to educate them about if ICE has come, how can they protect themselves or they know what’s going on. I don’t even have literature on what we have to say, because people who have a green card, they are not citizens, but they are permanently here in United States. But because they don’t know, they’re very worried about it.
I think that Trump administration ban on refugees and immigrants is totally, totally insane. I think that some people are going to be really very sick, and then imagine the people who have PTSD, God only knows, if you have high blood pressure, you have diabetes, cholesterol, and what’s going to happen?
You mean the people who are here now, who are watching this happen?
Right. They always get a rumor from one another.
This has been a very bad time. And then the families who have a kid who sometimes they have a little criminal [record], sometimes they just drove past the red light, something like that, and they are now realizing what’s going on. The community are very, very panicked.
So what I’m trying to do, I’m trying to find the literature so I can kind of let them know what’s going to happen, how they protect themselves. Because a few of them have…said that when they go even to the store, some people say to them that, “You have to go back to your country.”
Just like strangers?
I feel like this is almost like some of my experiences with the Khmer Rouge. Seems like, “Hey, this is it, you cannot talk.”
People feel afraid again to talk?
A: Oh yeah, they feel afraid again. And this is going to retraumatize their PTSD.
The ban on refugees and immigrants, absolutely mind-boggling. And now I can feel like not only the Cambodians, but the other refugees, Syrians and other refugees. They just want to, they’re looking for the safety net. Because United States is the country of a dream.
The reason they’re fleeing from their country is because of war, persecution. Otherwise why would you want to leave your country?
And I tell you, I was very emotional when I heard that refugees are banned, because I remember when I first came. The first year I came and at night I couldn’t sleep. I was watching TV and they said the Statue of Liberty was something that needed to be fixed because it was broken. And I was, all the tears coming, because I read that, “I take your poor, and your tired,” you know?
When you came, only one set of clothes, and no family with you, and you’re so tired, you just want to have hope.
And now it doesn’t mean anything.
And I remember that I didn’t have much money, but I did send $2. Put it in an envelope and sent to them, to the people who were rebuilding the Statue of Liberty.
You’re so vulnerable. Like myself, I came here to this country all by myself. I was very sick too…I was very, very hopeless.
But the reason I exist today was a lot of support, a lot of support. And that’s what I’m saying, that refugees, most refugees could do a lot of things, but you need to be very positive and have hope on them, that they are not bad. They’re going to do something good, but if you don’t have that kindness in mind, you destroy them, because they are so broken.
Every time I do a presentation, I say that, “You are broken here, you can’t see it.” [She puts her hands over her chest.]
I mean, if I walk in the street, people wouldn’t think…but inside me is still, sometimes it hits me. I will never forget, which I’m glad because who I am, it’s who I am. That’s why when I’m talking to refugees I say, “You need to cry, you cry. If you need to get mad, go somewhere, to the bathroom, and scream as much as you could, and come back. That’s what I do when I really feel like I’m getting to something that I need to take care of myself.”
It doesn’t take long. The reason it doesn’t take long is because I have a lot of strength from the community. I say that my mission is not over until it’s over. So long as I can work, so long as I can try, I will continue to do that.
It is a blessing to have an organization to run, and be proud that a woman refugee could do things. But I could not do it alone. I have a lot of kind and compassionate people that support me and trust me all the way.
This interview has been edited for length and clarity.