A Community Approach to Trauma in Ethiopia

In this episode Dr. Waganesh Zeleke discusses the focus of her Fullbright Scholarship, which is addressing trauma with individuals living in Ethiopia. She discusses the impact of war trauma, in all of its forms, on the people of Ethiopia, and the need for intervention. Dr. Zeleke also introduces the concept of a community approach to treating trauma. She discusses this approach in the context of the cultural values of the communities in Ethiopia, and how communities there provide support and healing.

Transcript

Welcome to CHP Conversations. A podcast series produced by the VCU College of Health Professions. This series includes conversations with faculty, students and alumni who exemplify our mission to create influential leaders in healthcare. Hi, my name is Jared Schultz and I'm on faculty in the Department of Rehabilitation Counseling in the College of Health Professions here at VCU. I'm joined today by Dr. Waganesh Zeleke, who is an associate professor in our department, the Department of Rehabilitation Counseling. She is a Licensed Professional Counselor in Pennsylvania, Montana, Maryland, and Virginia, and is National Certified Counselor as well. Dr. Zeleke's research focuses on the interplay between culture, context and mental health across healthcare educational systems. Current intervention work includes validating caregivers skills training, family well-being, mindful parenting, emotional regulation and positive psychology for immigrant families and individuals with autism. She's published more than 35 articles and book chapters and disseminated over 65 professional conference presentations in the areas of autism, parenting, trauma, and immigrant mental Health. Dr. Zeleke has been a principal investigator or co-investigator or various research grants and immigrant mental health, trauma intervention, autism and social skills training grants and welcome, it's so good to have you here with us. We're so excited to have you be a part of the department. Thank you. Thank you for having me, Dr. Schultz. You bet. First of all, in part in having this discussion, what I wanted to do was have you spent a little bit of time talking about your Fulbright Scholarship because you recently received a Fulbright and you're gonna be going over to Ethiopia to do some work over there. So please start at the beginning and tell us what you're planning and what you're gonna be doing. Right. First, I wanted to say thank you as a department chair to support me in this research. I know Fulbright is such a prestigious opportunity for scholars like me to go and do some research and teaching. So I will be going to Ethiopia to do both. I'm doing research and teaching and also consulting scholars in the field of psychology into university at the University of [inaudible] university to help them addressing mental health in a different way. So let me start from the research that I will be doing. You bet. Yeah. So the overall research that address is the outcome will be to develop a culturally responsive, mindful and trauma-informed intervention, trauma intervention for mental health intervention. As you know, Ethiopia is the second highly populated country in Africa with 115 million population. And obviously, poverty is at the highest. And mental health is one of the issue that never been addressed in many ways. Especially since 2020 there's a civil war in Ethiopia between the Ethiopian government and TPLF and that war brings a lot of effects, especially on the mental well-being of peoples. But the mental health aspect of individuals in Ethiopian never been given enough attention more than the physical harm of conflicts. So I would like to do more research in working with the mental health challenge faced by mostly children and woman. Because the recent research, for example, show that mostly women and children are highly impacted by the war, not only by the looting and the direct impact of war, but also when there's a situation, for example, where rape used as a weapon, woman and children are the most vulnerable. So I would like to understand how the society also support this traumatic event. And I'm doing more participatory research action where rapid participatory appraisal is part of a research methodology where we engage most community, not only the victims of that war rape or immigration, but also the community in general, like priests, leaders, or clinicians- how they understood trauma include in the work. Yeah. So there's a lot to unpack there. Yes. Yes. There's a lot to talk about. Um, let- let's go back just really quick. So you were talking earlier about how mental health has been not attended to as much as other elements of health care. So, are there systems in place in Ethiopia in terms of- you know, like, here in the United States, we think, you know, there's a mental health center down the street or usually people have access to something. There's a lot that don't, but there are clinicians, there are programs that stuff may or may not exist. So are there programs, services available? Right, that's really a good question, but before I answer directly, I want to provide context, right (yeah)? So the Western medical or mental health treatment is more structured and also driven more by a medical model. But in Ethiopia, mostly mental health issue addresses through traditional way. What does that really mean is, for example, there are only four university- in my research, probably three years ago- there are only four university that addresses mental health issue and there are probably four to six hospitals, mental health hospitals who only focus for highly clinically populated population, which means someone with schizophrenia or psychiatric issue then the mental health. There is a high stigma about mental health issue in general in Ethiopia. So people don't talk mental health openly. But there is a traditional way to address mental health and well-being. And as you know, Ethiopia is more a collect- most of the culture is very collective and individuals live in this collective way. So when there's one traumatic event, for example, happened, it doesn't impact only one individual. It impacts the community and the community's togetherness is there. But recent events can challenge it. So in general, the Ethiopian Ministry of Health has a system in place, but the, there is no evidence or documentation that shows what are the treatments or approach, in my research when it comes to mental health, the dominant research, the dominant literature you're going to find about Ethiopian mental health comes from a psychiatric field which may focus more on the clinical population, not on the community level mental health service. There are universities like the University that hosts me, do some training about counseling and psychology and do, but in the training and the curriculum itself, there is a high need to make it more practical and cultural and contextually applied. So there is a gap, but the system is already in place. Yeah. Okay. It's in- so as you were talking about that, saying that they're, its- the approach is not necessarily this clinical Western medical model (Yes.) of diagnosis, intervention kind of a thing (right). Can, can you give us an example of how a mental health concern would be addressed within that community that doesn't include that intervention, Western medical model? So, you know, somebody is dealing with (right) what we would look at as being anxiety or depression possibly, or something like that. Right. How does the community addressed that, particularly without stigmatizing (Yeah) someone who might be experiencing that. Right, let me say this. The traditional way of understanding mental health comes from this. In Western society, for example, when we think about health, we have two stream, right? So the medical, the physical health, and mental health. And where it's different in Ethiopia, it's a [inaudible] where health involves both your spiritual wellness, your physical wellness, your emotional and relationship wellness. So mostly, the majority of the populations are very spiritual or religious. So which means the contemplative practices in their everyday living. So for example they may not diagnose someone as a person with ADHD or a person with anxiety, but without naming it, they have a different way of intervention. For example it could be holy water or prayer or meditation or using herbs as a holistic. So they don't separate one single part of the individual and address that or pointed out that way. But as a holistic, they there, they have intervention. Simple example, if one person is depressed in the family, everybody will know and they may not name it like why you're depressed, but they will offer support, that collective support, whether it comes from maybe going to priest or a pastor, or going to mosque or a church and pray or drinking a holy water, or taking herbs and talk to the individual. Because mostly everyone is more accessible to everyone in that collective gathering, socialization is part of their healing process. So without diagnosing or naming, they will treat it. And it doesn't mean that they all treat everything. But for example, the adverse experience of individuals in Ethiopia is, it's common. But everyone who experienced traumatic event may not develop post-traumatic stress disorder. And that's one of the thing that I'm interested to know and how we can make a balance like where two or three people's experience the same traumatic event and two of them develop more post-traumatic growth development, you can say or may grow out of that adversity and overcome. I would like to know what they use with that to help. So there is [not] that kind of structured diagonals for depression or anxiety, or maybe openly discuss about depression and anxiety. But everyone knows what's happening to everyone and they will offer support without naming it. That's my perception. So is it within that relational, that community relationship- It sounds like there's a benefit to not naming it to, you know, everyone's aware. But is there culturally a willingness to let other people into that space? You know, if if someone if someone came to me and said, "can I support you in some way?", Is that acceptable? Is that accepted and welcomed? Right. Depend on the context and   the situation and where and who is offering that, right? So for example culturally elder peoples, are the older, the wiser, have the right to offer any advice or any [inaudible]. But, um, my my curiosity now is for example, my interests about trauma and mental health and well-being in Ethiopia emerges in 2013. Where more than 100, I believe, women were deported from Middle East and South Africa to Ethiopia without any preparation. And when I witnessed that and when I go there, What I understand is the society doesn't understand this return immigrant and they don't fit. And they already also experience a horrible human trafficking and abuse in the place. And they were deported without a good care. And when they came to Ethiopia, they don't have a place to fit in. And they can't go back to their family because their families start to misunderstand them and label them, and that's where that experience was an eye-opening for me. What do I mean by that is- oh, there's a generational trauma, historical trauma. We don't talk about mental health in Ethiopia. But the community's behavior can show you that there is a traumatic symptoms. For example, when you see, as I said, since 2000 Ethiopia is in the Civil War and you see how many looting and immoral action than you- that's more severe action that doesn't really fit into what Ethiopians portrayed themselves or their value and you think like, obviously trauma is a reaction, right, or a response. And you see that as a common response to the social connection that relationship is, is now disconnect. So what does that mean is- this kind of context [inaudible] who can offer help to whom. Given the type of ethnic conflict there, the dynamic, the political and the contextual dynamic also ships nowadays especially, who can offer support to whom? And for any individual, I would say, to accept support from one, who you are and how you present relationships to accept or reject your support. That's very complex. Yes. So, you know, I mean, in particular, I find it interesting that there's, while you might not have the Western medical Diagnosis idea, where you're coming in and you're saying, here's symptom one, symptom to symptom three. Therefore, this is the condition, but there's still a monitoring and an awareness of when things are not as they should be or as they would expect them to be. So there's a deviation from the norm, right? Right. So I think that's why I feel [inaudible] approaching the mental health and well-being in Ethiopia has to start from the lens of trauma and from a community-based. Because when you think for example all this conflict and war brought a lot of like massive internal displacement, homelessness and financial and family loss and the disruption of culture and value. Even the value of [a]million peoples in many places is not changed. Because when you see that group reaction towards another group, you start to question like what happened, because behavior is a language, right? Feeling is the language of the body and their truth, their belief is also the language of their mind, where they are and what happened. So instead of asking like, "What's wrong with these people?", we need to start to reframe that question and say "What happened to these people?" That they developed their own value, they developed their own connection- What happened that there's so much disconnection and so much not only looting, but using rape as a weapon in using children and elderly peoples- that is not the value and the characteristics of Ethiopian for many years. And nowadays, it seems like common to hear those kind of brutal collective behavior that you can't point this person did, so this is a symptom of this person. Rather you're going to say this is a symptom of even a group of people that you can't identify are located. So all these really makes me to wonder that the level of poverty crisis really impacts the community in general. So now, not only obviously the WHO, for example, shows, there is a high prevalence of depression and anxiety in Ethiopia. Even though we don't documented by counting the symptom. But you can see the symptom on the collective behavior. Like how much group reaction towards another group impact. And we need to start to ask like, what happened to these people and how we can address that. Not only using a medical model, but mostly a community approach because at the same time or on the one hand, you can see Ethiopia being one of the poorest country in terms of resource and finance for many, many years. But the, the community grow and thrive through even limited access for many years. Because of the value they have and because of the connection they have to each other. And now you can feel even- that's what I'm reading mostly. Usually I'm here but I'm reading the literature and the social media. And people don't feel to move from one region to another region. There is so much internal displacement even for the last 3-4 years. And those are those are a traumatic behavior or symptoms, but we can't point it out for one individual. So that's why I say maybe a community-based approach to understand mental health in general is maybe the best way to address in Ethiopia. Instead of counting the individual symptom, I truly believe individual treatment is essential. But at the same time, community intervention is also part of the healing that may involve restoration of injustice or integrating the traditional healing or using more holistic approach. It's an interesting concept. I don't know if I've ever run across it, but I'm limited in my exposure to things, but I do find it intriguing the concept of a community mental health. I don't know that I've ever stopped and thought of that as kind of a separate thing. I've always thought of it as the aggregate of all of these individuals. Right. But it's an intriguing idea that perhaps there is a community mental health. Right. That's, that's interesting. Right, I agree with you. I never told there is part of community mental health, but when you see it, when people are together, the whole is always greater than the sum. And the behavior that man face this as a group is not the behavior that the individual man faced at the single level or an individual level. Yeah, um, so what does that mean? It's that also a reflection of lack of awareness about individual mental health and that also an indication of like the collective way of living. And obviously, trauma is contingent, too, right? So witnessing someone suffering can also impact any individual that witness. So the vicarious part  of  trauma, for example, here in the US, mostly if you work with individuals who are impacted by trauma, there is mostly chance for you to develop a vicarious trauma as a practitioner unless you do some take care, some self-care. But in Ethiopia, you witnessed that trauma. Like it's not only- because people live together, breathe together, work together. There is no individual space. So, addressing from that community perspective would help even to heal at the individual level. And so just the way that people live and they interact, (Yes.) it's not that that secondary trauma is vicarious (Yeah.) it's actually experienced. (Yes.) I mean, you're not the direct recipient of the traumatic act or behavior or event, (Right.) but you are participating in that in some way because of the collective nature of the- (Right.) interesting. Right. So let's talk, we've been, we've been talking a little bit about mental health in general. Trauma's kind of creeped in there a few times (Yeah.) in the conversation. Can you talk a little bit more specifically about treating or intervening in some way where the trauma is addressed in that community way. So somebody comes to- you know, the issue comes up that they experienced, as you pointed out, you know, either a physical or actually all physical, mental, emotional trauma as a result of the civil war that's happening there. What does that look like in terms of the community coming together? Wow, that's a really good question and I think that's what I'm going to explore (That's what you're working on). But the context is when you see the context, there is war, but there is also a gender violence. And what do I mean is, let me tell you one story, for example, there was this girl who'd been gang raped during the war last year. I mean that subject is part of our study. And more than the rape, what hurts is after the, like the community knows that she was gang raped. And instead of hoping, because they don't know that the psychological impact of being raped, they will really be insensitive for that and even expect her, like seeing as if that's her fault, instead of supporting. They will use different nickname to address that. And this young lady ran away from her village because of not only the rape, but because how, the [inaudible] her village and the other adults start to view her. And one of the thing that, that story it tells me is when someone is a victim, I mean, trauma can heal. And it's an emotional wound, but, and it's invisible. And when the community is not looking at that, and they don't talk openly, they focus more on this status quo. And overall functioning like the physical for that creates more anger and guilt, and more crisis and depression, and anxiety and all those kinds of mental health disorders. So I would say, um, the the, the thing that what's needed to be will be my interests that I'm still working. But at least as a framework, I would imagine the first thing would be to create an awareness that, as a community, there is a wound that never been discussed or healed and regulated that suppressed only at individual level, but it's also at the community level. So I would say that open dialogue and to create more awareness, especially that comes from not only due to the war and ethnic conflict, but also this kind of cultural understanding, but also the situation about gender, violence in the expectation and the mindset about women health and children health and well-being has to be addressed. Yeah. Yeah. As you were describing that scenario. I think that that experience of, really, dehumanization, of trying regardless of the motive. Yeah. Whether that the reason for changing the names and the words and whether that is malevolent or innocent (Yes) either way, the result is the same (Yeah) that I think that we see that kind of inexperience across many locations. Yes. But perhaps, you know, you said she ran away from her village. The act of running away from the village within a collective culture is a very different experience than (Right) what you might see here. Where, okay, well, I'm not going to maybe running away from home or something. (Right) I don't know. (Right) I'm just curious what your thoughts are. Right. It's different, right? So as I prepare for this project, one of the thing I've been doing is I was looking what happened not only at the community level, how the society addressed this dehumanized human reaction, for example the gang rape. And I found this two story- one that I told you that the upstart to run away. And what does that mean is when they ran away, they are also putting themselves at risk for a different environment, not only for another gender and human violence, because they'd go unless they have a support system. And on the other hand, I see, I saw this show was similar age, young lady who'd been gang raped and the community is also pointing out, and not being sensitive and addressing, but have a support system which means like, I have a strong mother. The mother moved her and herself to the city and even seek media and talk openly and get more support. And the resilience that I see with this young woman is amazing. And that's why I have a hope more for a community intervention. As you know, for example, trauma-informed care could be one way to address it. And in that approach to the principle is first, we need to recognize it. And then once we recognize we can realize the impact of the trauma, then we can respond and break the cycle. Obviously, I think the cycle continue from generation to generation. And parents who deal with trauma raise children based on their own trauma symptoms in children, the adversity and the impact of trauma can increase with children. So I would say, I think the best way, maybe to realize, first, to recognize that happen and how to prevent it because running away from a village is not an answer. Because this young woman, unless there is another support system, mostly in Ethiopia, I will say, mental health issue addressed by not community, a community organization or religious institute than community agencies because there is not that much established community agency. There is here and there, but they're not [indaudible] in terms of addressing or supporting them. And those people have their own limitation. Like they can give you advice or give you comfort temporarily, but they can't feed you or they can't give you shelter. So then it's hard, the first thing in trauma intervention is to make sure that the victim is safe and stabilized, but running away, even make it more unstable for this person. I'm going to switch gears on you just a little bit. Yes. I'm part of the conversation that we've been having as has been around the differences between the collective and community approach to things in Ethiopia versus, say, the western medical model. Right. Now, you're from Ethiopia. Yes. And you've been trained in that Western medical model of mental health. Right. How do you balance those? Just on a kind of a professional level for yourself. How do you look at those different things and make sense of that. Right. This is a question, I will tell our audience, I didn't prep her for. Oh, yes. So it's a little unfair of me, I acknowledge. No worries. But just as we've been talking about it. Yeah, I think that's a really good question because it requires self-reflection. And as I reflect, they think I see it more as an asset because I say I am reclaiming. For example, when we talk about mindfulness, I say "I reclaim that part" because I grew up in this collective community. Not only you just live together, but you contemplate together. And the major part is you grow up knowing that you are human and human means you have this physical, psychological, emotional and relational and spiritual self. And you are the whole of that. So everything that's going through the day, it doesn't matter whether there is adversity or not. But that feeds into your wholeness, right? So when you're trained in the Western education obviously, as you know, what medical approach, for example, treats your body. And we're of course now coming to this understanding every biological is psychological and every psychological is biological. But in our training, training was like, Okay, the biology is different than the psychology is different. But now come into this understanding on the contemporary psychology is, for me, a welcoming. (Yeah) It gives me an opportunity to welcome my own foundational lived experience, um, and of course, to realize that all what we have been enough, but what we need is to make it more scientific, which means to define it, to structure it, and, of course, to dissect the whole part. The way I integrate even in my teaching or research is to bring my own authentic self. And the contemplative practice I have in everyday life becomes more an asset whether in my teaching or research. So I think my journey, even becoming mental health counselor comes as a result of that reflection that we can separate the body from the mind or from the, from the spirit, and we are bigger than what we think and what we do. And finding that purpose or having a meaningful reflect- reaction (Yeah) is what the counselor [inaudible]. Yeah. It's a very intriguing discussion and I appreciate you sharing that and how your experience has been with it. You know, when you look back on the study of psychology, you know, back, I mean, going clear back to, you know, Locke, and you know, where there's this, there was this separation of, you know, saying, look, we can study people and separate the metaphysical? Yes. And we can study the psychology. And you had there this separation (Yes) and, you know, it took its track and it's gone. But I find that a lot of what we're talking about now in counseling is bringing back some of that metaphysical piece and some of the holistic view that we're not just talking about cognition, we're not just talking about emotions, but we're talking about that with more and more within the context of more of a balance. You see some of that in Adler's work, you see it. It's very interesting when you look at the health and wellness models. Right. Wellness models (Right) have all of those pieces in there. Yes. Some of it we do better (Right) at the western side of things and some of it we do (Right) not as well. Right. And so I find that interesting. I find it interesting that the role that mindfulness has played more recently in the therapeutic environment (Right), that, that self-reflection or that meditative practice and those kinds of things are working themselves back into (Right) the therapeutic process and it's (Right)not as separate as it used to be. Right? I think I completely agree with you. When you think about everything, what psychology did, every piece are very important whether what Adler said or Viktor Frankl said or the existing [inaudible]. Like you can separate yourself from the environment and, or how you've taught also change or shape your behavior or feeling. Everything is really important, but it was just one piece at a time. And we are bigger than that. And we need to still find a better way to understand ourselves as a whole. Not only as viewing our [inaudible] or our behavior, or our feeling, or the purpose or the meaning that we are bringing out. But what does it really looks like when we are just being a human, just be. Not like the 'Being' a part, but also the 'Be' part is still, I feel like still we need to go to understand our nature and to do that, I think we need also to include all this kind of culture, especially what we labeled them, the traditional way of leaving. The connection they have with nature and how close being to the nature. And nowadays we, in the Western world, how far we are from the nature and what does that really mean will be resourceful. So for me, I really appreciate the science that we do in the Western World and understanding of dissecting behavior, dissecting truth, dissecting feeling, and intervening at that level. But I think we need also to go bigger than that and understand as a whole, as you say it. Yeah. So you have that kind of dichotomy? Yes. Tell me a little bit about the university systems in Ethiopia. You're gonna be working at two different universities while you're there. And part of your role is to (Right) come in and teach and to consult and hear some ideas and that sort of thing. What are the needs that they have, and what are the strengths and weaknesses? Perhaps, maybe that's a good question. What do they bring to the table that is really powerful and positive? And then what are the some of the needs that they might have? Right. I feel less qualified to answer that question, but I can just still put my two cents out there. Especially as someone who goes through that universities [inudible] and get my undergrad and graduate degree. Um, when it comes to mental health psychology and counseling. The science of psychology in Ethiopia seems, comes more from a Western- instead of building from inside out, it just comes from outside in. And I think that's the gap, in my perspective. Or recently, even though it European never colonized, physically. But I would say mostly, most of the education system is adopted from a Western instead of built from a [inaudible]. And that creates a huge gap because, especially when you work with human behavior. A simple example. Most of the trainings are very theory-based. And if you go and ask any graduates of psychology, they will tell you about each and every theory the basic core principle of theories and what technique they have. But when it comes to application, there is no system created. A simple example. They learn in English, but they go and practice in the local language. And emotion processed differently in a different language and they didn't get, they don't get even a chance to practice counseling, to practice therapy in their natural environment, in their natural way while they are living in their, in their natural setting. Because they have to- the medium of instruction is English. And so I see gap between theory and practice. So one of my hopes that I have to contribute when I go there is to figure out that and maybe start brainstorming and discussion with faculties how they can bridge the gap and help students, graduates to see the community and serve the community and how they can bring down that psychology into the ground, the grassroots level and see it. Because the problem of applying Western psychology in Ethiopian context is you can take is, and you're going to take all the symptom and you're going to look to check the symptom instead of understanding the whole person. And as you know, we need, not only, we need to understand the person and as part of our understanding, we may lay out, oh this is the symptoms. This is a [inaudible]. So we can work with the person instead of working with the person's problem. And, um, I think the gap is that. What is the [inaudible] for me, I feel like the culture is rich in terms of healing. The society is resilient. Resiliency is everywhere. And I am always impressed whenever I travel to Ethiopia, I'm impressed how children's are emotionally intelligent. Maybe I would say I would claim more than most of our children here in the US when it comes to emotional intelligence or physical intelligence. But when it comes to cognitive intelligence or spiritual intelligence, there is so much richness in terms of using as a resource for psychologist in Ethiopia. If they open up and go to the community, go to the grassroot level and start to observe how people live and function. Maybe there's a high chance to capture the root problem of all this violence, all of these crime, all these war and address it. Then I feel like mental health and helping professionals can play a significant role in terms of bridging that gap and strengthening the weakness. For me, that weakness part is the psychology and counseling was not contextualized. It was just like going and, um, they still talk about Freud or they still talk about Adler or CBT. But how that CBT looks like, it's different. In Ethiopia, most culture, they are rich in terms of storytelling, but that's never been used in the classroom. Their everyday living is full of demonstration  [inaudible] and that never been used, the resource never been used in to the science of psychology. And I hope that both, students and faculty will be open for that kind of dialogue. And that would help in terms of creating a curriculum and contextualizing the approach of psychology and see how they can pick the sides and apply it to the Ethiopian context. I don't know if that answered your (Yeah) question. No, It's, it's, it's it's, uh, there's there's a lot to process there. You know, one of the things as I was, as you were talking about the power of the culture and the things that people demonstrate and that they bring to the table. You know, so much. We try to be culturally aware in our instruction and we try to always be aware. But I, you know, it's a very different question to say, you know, what does this person bring culturally that is critical to their healing process and to their to that. The other thought that came up for me, Waggy, as you were discussing, that was the relationship here in the US between therapeutic process and the business models of medical care? You know, I mean, I remember I remember I'm dating myself, but I I do remember the the development of of of managed care. The concept of 'you can't just go for counseling sessions once a week for the rest of your life and will pay for it'. We're going to start restricting care. You see that from managed care, businesses coming in and saying, Okay, here's a new model because we don't have unlimited funding. So you've got ten sessions. All of a sudden, treatment interventions magically started becoming ten sessions long, you know. Yeah. And there's a mirror there of the business model in terms of how things develop and end. As you were talking about the idea of getting to know the person (Yes), connecting with that person, joining with that person. Right. That may or may not be on a ten session (Right) schedule, right? It takes me back actually to really Rogerian stuff of spending time with people and listening and creating that empathetic environment. But it just an interesting thought to me was- we do see a connection between how we practice and the economics of it. Yes, yes. And perhaps in that kind of an environment where the economics, at the very least are very different. Right. We might be able to learn something. I totally agree. And I think that's why in the community, for example, tend to go mostly to traditional healer or religious leader or herbalists for to treat their wellness or to discuss their problem then going to psychologists or counselors. Because even the counseling and psychology practice is still adopting this, the marketing medical approach where you focus more reducing the symptom instead of healing the person or being like that fellow traveler to the person and help the person to help themselves. I, I, I agree with that. And one of my fear that I have is when you have this marketing model and you have, on the other hand, limited resource, it will be, each equation will be wastage. Because most psychologists in Ethiopia, after they graduate, they can't find a work. So they ended up going to a different agency work at the community development work or anything. But because there is this difference, okay? They don't know how to apply psychology in a community development work. So for Ethiopian contexts, for example, healing to trauma could be working on the development, maybe rebuilding the village, or maybe planting tree can be a healing because that is where the loss is magnified. But at least those people, those graduates of psychology that I talked to them, even they don't see that, that's part of the healing. Because here in our teaching, we are very mindful, not only mindful, intentional in terms of addressing culture and utilization. I think it's not a new movement, but it's a growing movement to use a cultural, cultural humility and cultural responsive approach. But one of the gap that I see is even though Ethiopia is a multicultural country, like there are more than 84 ethnic groups in more than 14 regions who speaks a different language have their own identity and culture. The education system is not built based on cultural and contextual understanding. Rather just more come from a western, at least in counseling and psychology. That's what I am seeing. And there's enough [inaudible] if we're open up and be more intention. Excellent. Yeah. I appreciate your time. We have gone way more than we expected to. Yes. And I've still got other questions, but maybe what we can do is when you returned from Africa, we'll do, we'll sit down and you can tell us everything you learned. Tell us where we went wrong in this conversation. Yes. And I'd love to have some additional conversations with you about your work with immigrants and autism (Yeah) and so much to unpack, but thank you, Waggy, for joining me today. It's been wonderful. Thank you Jared. Thank you so much for having me.