VCU news

By Mary Kate Brogan
School of Pharmacy

For Muna Saleh, the journey to better understand and address challenges around refugee health started close to home. The rising third-year Virginia Commonwealth University Ph.D. student had seen how the needs differ from other populations, both as a clinical social worker and in her own home growing up.

“I am a refugee myself, but I came to the U.S. when I was a year old,” Saleh said. “Still, I’ve had that lived experience. I’m in the community, and I see, first-hand, the challenges.”

While in graduate school for her Master of Social Work degree, she noticed how pervasive the health disparities were.

“I grew frustrated because a lot of the literature I was reading was talking a lot about individualizing the problem of why some refugees experience these disparities in health, and not very much of it has been researched – nor has it been used to contextualize some of the structural factors that are involved in refugee health,” Saleh said.

So, when she decided to join the Ph.D. in Social Work program at VCU’s School of Social Work, she was set on seeking ways to improve the health and well-being of refugees resettling in the U.S. She has since earned multiple national awards to support her research.

During the 2022-23 school year, the Robert Wood Johnson Foundation named Saleh one of 40 national Health Policy Research Scholars, a competitive interdisciplinary award that includes mentoring, networking, specialized workshops and funding of $30,000 for up to four years. She was also one of 10 students in the country selected as a doctoral student policy fellow for a fellowship jointly sponsored by the Council on Social Work Education (CSWE), the Society for Social Work and Research (SSWR) and the Group for the Advancement of Doctoral Education in Social Work (GADE).

The awards are prestigious, but for Saleh, the opportunity to learn from experts and inform policymaking is all in the service of advocating for her community.

“I wanted to research more about community-based participatory research, how communities see their own capacity to become resilient in their resettlement process and how they can inform policy later on down the road, since a lot of their voices are currently left out,” Saleh said.

The collective impact of trauma

Saleh grew up in Rochester, Minnesota, a first-generation Somali American in one of the largest resettlement communities of Somali refugees in the U.S. The challenges associated with resettlement – learning a new language, gaining employment, being apart from friends and relatives back home – were ones many adults around her were dealing with, but their impact on their – and their families’ – well-being was rarely discussed.

“Growing up in a refugee household, nestled in a larger refugee community, it kind of became a norm, some of the ways that trauma presented itself,” Saleh said. “I never knew the time before migration, but post-migration, there were people who were really struggling with their mental and physical health, and there was a shared collective, identity-based trauma. And even the way that trauma was taught to me growing up, it was very individualized – discrete events happening to you – and there’s not a lot of talk about these collective traumas and their relationship with physical health.”

After earning bachelor’s degrees in sociology and political science from the University of Minnesota, Saleh worked in a variety of roles, including as a child protection worker and mental health social worker. She earned her M.S.W. from her alma mater, completing her clinical training and gaining clinical experience in an internship at the Mayo Clinic. She noticed that many people from her community were presenting to hospitals with the same issues.

“In my work in clinical settings, I saw that a lot of refugees would use the hospital services or emergency services for things that shouldn’t have been emergencies, and there weren’t any [clear] medical reasons for them presenting to the hospital. But what we know about trauma and healing is that, a lot of times, that trauma can manifest in physical pain, and it can become somatic,” Saleh said. “People would present to the emergency room for those complaints, and service providers wouldn’t know what to do with them.”

As a social worker, she would work with these patients to connect them with services in the community. She noticed that many resettlement agencies were focusing on offering services that often covered only a small portion of refugees’ experience.

“Refugees don’t just go to refugee settlement agencies for their services: They use hospitals, they use mental health clinics, they use schools,” Saleh said. “They use a lot of different programs [where staff] don’t understand the experiences of refugees and some of the constraints that are unique to them that they are facing with the resettlement policy.”

She started to think: “How do we merge all of these services together so they have a seamless service delivery? And that promotes what the Robert Wood Johnson Foundation would call a ‘culture of health.’”

Promoting a culture of health was a major reason Saleh applied to the foundation’s research scholars program, as a vehicle to translate her research into policy and practice.

“For me, the impact that I would hope to have is re-envisioning or reimagining a refugee resettlement program that centers health and well-being – because right now it is an economic-focused one, so it just pushes an ‘employment first, self-sufficiency first’ model. It’s very clear cut – it doesn’t hide it – that that’s the goal of the resettlement policy,” Saleh said. “What if we reframe that as ‘health first’ or ‘well-being first’? How would that look, and how would services then be designed to push that goal?”

An ongoing commitment to equity

Denise Burnette, Ph.D., Samuel S. Wurtzel Endowed Faculty Chair in Social Work and professor in VCU’s School of Social Work, said Saleh’s work as a health policy research fellow and as the doctoral student policy fellow for CSWE, SSWR and GADE reflects her emerging leadership in social work working toward equity and advocating for her community. Burnette noted that Saleh is among several doctoral students, including classmates Aaron Kemmerer and Matt Morgan, who in the past year have earned national awards for their focus on improving access and advancing equity.

“Our Ph.D. program aims to prepare a diverse student body for research and educational leadership in and beyond the social work profession,” said Burnette, who serves as director of VCU’s Ph.D. in Social Work program and president of the national chapter of GADE. “Our students are our greatest resource and our most effective emissaries. Muna and her peers’ commitment to excellence, equity and impact are consistently reflected in their coursework and program milestones, and we are very proud to see these strengths increasingly recognized by highly competitive external grants and awards.”

As Saleh enters her third year in the Ph.D. program, she hopes to share knowledge gained from the fellowships with her social work peers as they address social challenges.

“I’m using the work I’m doing in my research program to look at some of the factors associated with collective health outcomes —aggregate patterns, rather than individual outcomes, which may better improve community-level well-being — as well as health policy recommendations,” Saleh said. “Being able to be in a room and in community with my [Robert Wood Johnson Foundation] cohort and mentors from the previous ones, learning the skills of how to disseminate very powerfully my research to policymakers, how to use and identify the policy actors in my research area and how to maximize research impact – that’s what I’m hoping to take away from this experience.”