Thousands of refugees have fled Mexico, Honduras, Guatemala, and El Salvador to escape violence, criminal victimization, and persecution as a result of the breakdown of public safety that has accompanied the rise of organized crime and drug-related violence. Many of these migrants have experienced torture, rape, abduction, forced labor, arson, and kidnapping. Caregivers and professionals who work with these refugees, including social workers, volunteers, attorneys, and advocates, have repeatedly witnessed severe trauma among refugees as the migrants recount horrific stories about their journeys. We conducted in-depth interviews with 31 individuals who have worked extensively and repeatedly with traumatized refugees. Participants completed the Secondary Traumatic Scale (STSS) and the Professional Quality of Life (ProQOL)-Compassion Fatigue (CF) scale. While most participants reported signs and symptoms of secondary traumatic stress, many also demonstrated high levels of compassion satisfaction. In addition, most were involved in self-care. Hispanic participants reported that elements of their culture were protective.

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Objective. To examine the experiences and perspectives on the disease and stigma from the vantage point of the persons affected by TB in El Paso, Texas, and Juárez, México to inform research on health-related stigma and interventions. Materials and methods. Semi-structured interviews to study TB-related stigma and the impact on access and healthseeking behaviors with 30 Mexican-origin adults (18 years and older) undergoing TB treatment. Results. Barriers to accessing health services for TB; emotional distress due to their deteriorated physical and emotional condition; reactions ranging from depression, sadness; doubt, anger, and fear of rejection; distancing, fear of contagion, stigma, and feeling of discriminated against, and isolation from loved ones were reported. Conclusion. Stigma associated with TB is a barrier to health care access and to quality of life in tuberculosis management. Stigma adversely shapes the experience of treatment and recovery. Stigma is not a naturally occurring phenomenon, but something created by people and as such it can be "un-done" by those people as part of a collective which comprises society. ResumenObjetivo. Examinar las experiencias y perspectivas sobre la infección por tuberculosis (TB) y estigma desde el punto de vista de personas afectadas en El Paso, Texas y Cd. Juárez, México para informar con base en evidencia sobre el estigma relacionado con la salud y las intervenciones. Material y métodos. Aplicación de entrevistas semiestructuradas para investigar el estigma relacionado con la TB y el impacto sobre el acceso y la búsqueda de servicios de salud en 30 adultos de origen mexicano (18 años y mayores) que recibían o recibieron tratamiento de TB. Resultados. Se identificaron barreras al acceso a servicios de salud para la tuberculosis, angustia debido a su deteriorado estado físico y emocional, reacciones que van desde depresión, tristeza, duda, ira y miedo al rechazo, además de distanciamiento, temor al contagio, estigma, sentimiento de discriminación y aislamiento de los seres queridos. Conclusión. El estigma asociado con TB es una barrera al acceso a atención de la salud y calidad de vida en el manejo de la infección. El estigma afecta de manera adversa la experiencia de tratamiento y recuperación. El estigma no es un fenómeno natural, es creado por las personas y como tal se puede abatir por parte de aquellas personas que son parte de un colectivo social.Palabras clave: tuberculosis; estigma relacionado con la salud; acceso a servicios de salud; frontera mexicano-estadounidense

This study focuses on the mental health and the role of resilience in Mexican refugees in the El Paso, Texas border region who experienced acts of violence, extortion, kidnapping, torture, arson, or other traumatic events in Mexico. This is an exploratory study that uses using mixed methods. We gathered data using: the Harvard Trauma Questionnaire and the O’Connor-Davidson Resilience Scale. We conducted extended interviews with adult participants (n=30) who escaped from the violence in Mexico to El Paso. Surprisingly, results did not show evidence of post- traumatic stress disorder. On the contrary, participants were highly resilient. Among the major themes that emerged from the interviews, cultural components identified by the participants consisted of: support to families (familism), the ability to talk to others about their own experiences (personalism), the idea that they have no control over their situation (fatalism), and putting things in God’s hands (faith), which mediate the effects of the experienced violence.