The first thing most Americans notice about Shyqeri Bytyqi is that he looks more like a country club regular than a refugee. His hair is freshly cut, his khakis and Ralph Lauren polo shirt are crisply pressed, and his quiet smile lacks restraint.

But then they glance at his eyes, which pass from nervous to pensive to depressed within seconds, and they start to wonder what this middle-aged man has seen.

Bytyqi, a shepherd boy from southern Kosovo who grew up to be a well-known bank director in Pristina, knows about being a refugee. Questioned by the police over 300 times for alleged connections to the Albanian and American governments and forced by the Serb-controlled regime to flee his office job nearly a decade ago, Bytyqi understands better than most the challenges to living a normal life in the Balkans.

But now that he's trying to carve out a life for himself in the U.S., he faces new, different obstacles -- namely, overcoming his own feelings of doubt and inadequacy living in a country where he struggles to feel he belongs.

Bytyqi isn't alone. For the thousands of ethnic Albanian refugees who have fled to the U.S in the last year, mental health problems, brought on first by the war and later by the transition to a new culture, remain an important issue to be dealt with.

Tackling the Problem

For medical professionals, solving these mental health problems requires a crash course in Balkan history and culture. Some Kosovar refugees may not be aware of the counseling services available in the U.S., while others have cultural barriers blocking them from seeing certain medical professionals, said psychiatrist Linda Piwowarczyk. Others may have trust issues that keep them from confiding in a stranger, she said.

Piwowarczyk helps run the Boston Center for Refugee Health and Human Rights, which was launched in January by Boston University and Boston Medical Center and is designed to be a "one-stop" resource for refugees, offering help with legal and advocacy issues, mental health, and even dentistry. Counseling is a particularly crucial service at the center, she said.

The work Piwowarczyk is doing in Boston is slowly being taken up at other centers around the country, and advocates at the national level say that for the approximately 8,000 refugees who have chosen to stay in the U.S., it is crucial to deal with mental health issues now.

"When we're trying to save people from ethnic tensions, those are life and death issues," said Jacqueline DeCarlo, a program director for the U.S. Committee for Refugees in Washington, D.C. "But people have to move on."

DeCarlo coordinates a unique national alliance known as the Survivors Program, which provides support to mental health clinics and programs in Chicago, Minnesota, and Virginia. Three other link-up sites, in Boston, New York and New Jersey, are set to launch soon, said DeCarlo.

For clinics forging ahead into a relatively unprobed area, each case must be carefully dealt with, said DeCarlo. Domestic violence may flare up between family members who once had smooth relationships. Some individuals, such as Bytyqi, withdraw from contact outside their family circles, where familiarity breeds a relative degree of comfort.

"We're trying not to be too clinical," she said. "We try to help build their skills in dealing with their new lives in the U.S. so they can prevent the typical response to persecution. There's a lot of friction and tension there."

But even doctors and advocacy groups admit they can't break many of the barriers put up by traumatized refugees, and that's where religious and cultural organizations come in. For Bytyqi, his wife, and three children, that organization was the Islamic Society of Greater Worcester, which has helped about 75 refugees find apartments and learn basic English. At first, the group's work was daunting.

"There were no smiles on their faces when they arrived," remembered Samira Khan, the women's coordinator of the society. "They were very scared of us." Now, months later, she says, "they're a part of us -- they know about quicky marts, and Madonna, and they're with it."

The Islamic Society offers direct counseling to the refugees it has taken under its wing, says the organization's spokesman Tahir Ali. But it has also given the refugees the most elusive thing of all -- the semblance of a normal life. Intensive language instruction helps make the U.S. seem less foreign, and religious services and dinners at the society's mosque keeps families in touch with each other.

And now, almost surprisingly, life is starting to fall in place again for the Bytyqi family and the 70-odd refugees in Worcester -- as well as for others across the country.

"What they had gone through is beyond word, and the fact that they can even talk about it is a sign of improvement," said Ali.

Tara Yaekel is a professional writer living in Boston. Her work has appeared in The Boston Globe, the Daily Free Press of Boston University, and Women's Wear Daily. She was recently awarded an Honorable Mention from the Association for Education in Journalism and Mass Communication for her piece on ballet dancers April and Simon Ball, entitled "On the Cusp of Stardom."

10/24/99