Chinar Sedeqi was called to a local hospital to help an emotionally distraught mother who had just undergone major surgery.
He was called because he knows how to speak Pashto and the patient and her family could not understand what the doctors were saying.
The medical team believed the parents were refusing to be with their baby, which would not survive long in the NICU, but when he arrived he discovered there was a much bigger misunderstanding happening.
The mother told Sedeqi she was confused about why doctors performed a C-section to deliver her baby because the baby was small enough for her to deliver.
Sedeqi translated the doctors’ explanation that the baby was in breech position, meaning there was a risk the baby would be born bottom first, threatening both the mother’s and the baby’s lives, unless they did an emergency cesarean.
Once Sedeqi explained, she went to be with her newborn to say goodbye.
He walked away from the hospital that day knowing that the mother would likely need mental health support to process what had happened.
In Afghanistan, Sedeqi said, he was working as a surgeon but fled Paktika province because he was threatened by the Taliban. He evacuated to the U.S. in 2021 and about a year later moved to San Antonio.
The father of five was until recently the only Pashto-speaking community health worker visiting families in their homes.
In San Antonio, where nearly 6,000 Afghan immigrants including displaced refugees, evacuees who were part of the U.S.’s 2021 Kabul Evacuation and asylum seekers live, finding health care in Pashto is hard to come by. Finding mental health care in that language is almost impossible.
Pashto is natively spoken in northwestern Pakistan and southern and eastern Afghanistan, where many have fled for their safety.
According to the city, at least 2,919 Afghan immigrants came straight to San Antonio from Afghanistan between 2020 and July 2024. Others resettled in the city later, but no data is available for secondary arrivals.
Earlier this month, Sedeqi resigned from his position at the Center for Refugee Services for a better job in the medical field. This leaves a major gap.
A case manager, who is not yet a community health worker, will take over Sedeqi’s duties while they and two more interpreters work to become certified.
Currently, 13 interpreters who speak Pashto and Dari, another language spoken in Afghanistan, work to support local medical teams at the San Antonio Refugee Health Clinic. This walk-in clinic operates once a week in partnership with the nonprofit refugee center and UT Health San Antonio’s Charles E. Cheever Jr. Center for Medical Humanities and Ethics.
University Health also has a refugee clinic, but it runs by appointment only. One Pashto-speaking patient navigator is available. In 2022, the county hospital district started a medical interpretation program, which funded five in-person Pashto and Dari speakers to help patients at University Health hospitals and clinics.
“Not only is there an extreme lack of mental health providers in San Antonio and nationwide, but there’s an even larger gap in the number of Pashto-speaking mental health providers across the country and you feel that in San Antonio,” said Nadia Mavrakis, CEO of Culturingua, a nonprofit that provides support services for Middle Eastern, North African and South Asian communities.
Mavrakis explained that many Afghan immigrants are dealing with forced displacement, a harrowing journey to the U.S. and a challenging integration period.
“The best way for them to truly be integrated and be able to become prosperous, contributing members of our community, is to ensure their mental health needs are met,” she said. “Without enough Pasto-speaking mental health providers, overcoming those mental health challenges is so much more challenging.”
Pashto-speaking counselors located out of state can’t provide virtual counseling services because Texas law requires providers be licensed in Texas to treat patients here.
It’s an alarming issue, Sedeqi said, because more than 70% of his immigrant Afghan patients are actively experiencing depression and anxiety and “don’t even know it,” he said. Some have reported sudden heart palpitations, crying easily and insomnia.
But most of it is solved by talking, he said. Good communication is key to good health — and reliable translation is an essential piece of that.
“If some people have anxiety, depression, during this time they need Pashto [speaking counselors] to discuss, to convince, to talk. It’s really important,” he said.
A recently published study by the Urban Institute, Examining Afghan Evacuees’ Resettlement: Insights and Lessons for Future Humanitarian Populations, found that even though they’re grateful for peace and security in the U.S., language barriers contribute to stressors and evacuees’ poor mental health.
San Antonio’s Afghan community
In an empty lobby at the Center for Refugee Services after hours on Sept. 5, Sedeqi said refugees depend on updates to their immigration status in the U.S. to make plans for the future, wait for work permits and to apply for a driver’s license. At every point of the process, they face language barriers, transportation issues and job insecurity.
In the meantime, programs that provide peer support help women who have recently resettled from Afghanistan assimilate to life in San Antonio and find community. For example, Prince Harry and Meghan Markle’s Archwell Foundation Welcome Project offers the Sewing for Success program at Culturingua, which helps women make friends and develop sewing skills.
“Their whole focus on the program is the mental health and well-being of Afghan women and bringing them together in social circles,” Mavrakis said.
Findings from a 12-month study commissioned by the Archwell Foundation found that half of the women in the program report feeling little interest or pleasure in doing things or feeling hopeless for several days, anxiety or worry.
Culturingua also offers an animal husbandry program for Afghan refugees who were forced to abandon their farms back home. Through that program, they raise animals like goats.
And Culturingua’s MindWell peer support program added in the 2023-2024 school year is helping promote confidence among evacuee students ages 12 to 19 at Northside ISD schools. The program recently expanded into Earl Rudder Middle School and Marshall High School, in addition to Clark High School, and offers individual counseling in English in partnership with the Family Service Center.
The concept of peer support groups to promote mental well-being often works well for Afghan immigrants who come from collectivist societies, Mavrakis said.
“A lot of things are done in the context of the family and extended relatives,” she said.
MindWell program manager Riga Tarin, an evacuee, said the program is helping reduce anxiety and depression by helping people open up to each other.
“We have to be there to teach students that are struggling, thinking how to find their way, we have to tell them it’s OK, you can do it,” she said.
The program requires parental consent, so she often does the work of approaching parents to explain to them that seeking out mental health doesn’t mean their child is “crazy.”
Tarin was trained by Afghan mental health professionals from Cornerstone Counseling, a New Jersey-based national organization that focuses on mental health and well-being for refugee populations, which provided curriculum for the program and how to approach evacuee families about mental health.
When she talks to parents, they end up wanting their children to participate in peer support and counseling because they understand those spaces are about connections, relationships and sharing experiences for positive guidance.
Farah Ismail, MindWell’s program counselor, speaks Syrian Arabic and is learning Pashto but can’t provide counseling services in Pashto yet. In the first semester, 30 kids felt more connection through peer support, she said. About half of the students seek individual counseling.
“The only issue is the language barrier. That’s what prevents them from even calling,” she said. “We need translators for sure. … It’s so important to have linguistic diversity in mental health.”