Mental Health issues with dr. nhial t. tutlam

Dr. Nhial T. Tutlam, is currently the Chronic Disease Epidemiology Manager at SAINT LOUIS COUNTY DEPARTMENT OF PUBLIC HEALTH in the Greater St. Louis Area, Missouri, United States.

Dr. Nhial T. Tutlam, 
is currently the Chronic Disease Epidemiology Manager at SAINT LOUIS COUNTY DEPARTMENT OF PUBLIC HEALTH in the Greater St. Louis Area, Missouri, United States. Thank you so much for agreeing to be interviewed by me on behalf of the youth. I want to focus on your educational background, upbringing and addressing mental health issues within our community. 

What is the meaning of your name in your mother tongue? 
My name means rain. I am told I was born on a rainy day. I was born in a town called Bedele about 280km from Gambella (175 miles from Gambella).

What kind of upbringing did you have? 
I come from a large family where we all lived together with extended family members. We were exposed to life both in the village and in the city/town. Like everyone one else we had cows and goats and I remember taking care of cows as a young boy both in Thiajak and Gambella and going to school at the same time. In Gambella we lived in Arak kilo where we grew up with a very diverse group of kids, rich, poor and everything in between. My earliest recollections about life goes back to when we lived in Thiajak/Adura.  

What were the values you’ve been taught? 
I was taught the value of hard work and accountability and we got that from both my mom and my dad. I remember every time I complained about being sent too many times, my mom would say, imagine you are the only one around and there is nobody there to help you. What would you do? I would say, I have no choice but to do it myself. Then she would say, do it as if no one is there. I also remember my dad used to ask what I wanted to be when I grew up. I would tell him I want to be a doctor. Then he would tell me, you are going nowhere with the kinds of grades you have. 

How was your educational journey in Africa and the United States? 
I started my primary education in Gambella. I attended Ras Gobena Elementary School. After the fall of the Mengistu government we went to South Sudan. Because the school where I was (Akobo) went only up to 6th grade, so I stayed home. Then, because there were no teachers around as many of them joined the liberation movement, anyone who could read and write was enlisted to help teach the young kids. So, when I was just a seventh grade student, I was hired to teach Math at Akobo Primary School. 

Some of my students were older than me. Then I came back to Ethiopia with my uncle, Dr. Koang. Upon our return, I resumed my studies at Miazia 23 Intermediate School in Addis Ababa. Then, we moved to a place called Nazareth, town 90 km outside Addis Ababa where my uncle worked, and I started my high school there. After only one semester there, I moved to Kenya in 1994 where I joined Ruiru High School. After my father passed away, we moved to the US. From there I joined college, first starting at a two-year community college (Nashville State Community College), then I transferred to Tennessee State University (TSU), an HBCU. After graduating from TSU, I joined Saint Louis University to pursue my Master of Public Health degree. After working for a few years, I decided to go back to St. Louis University for my PhD, graduating in May 2017. 

How have you managed to be so consistent and driven? 
Well, very early in my life, it was made clear to me that education was the key to achieving any success in life. I was fortunate than most because I had several role models right in my family to look up to. Both my dad and my uncle are medical doctors; so we saw the value of education right at home. I also had other role models and mentors whether it was my teachers or others who always encouraged me and motivated me to aim higher. 

Why did you choose to focus on Public Health? What were the motivations for pursuing your doctorate? 
Once I began to understand the impact that public health can have at the population level, I began to fall in love with it. Initially, when I started graduate school, I had this romantic notion, like many public health students, of some day working for the WHO, going to work in a refugee camp somewhere. The reality is more complicated. While in graduate school I started working at a university as a research assistant doing clinical research. I enjoyed what I did but in that kind of work, you are always working on research interests of the person who hired you. I always knew that I had to go back to school for additional training so that I can work on topics and issues that can have an impact on my community. 

Mental health is a public health issue and right now in the community, it is plaguing us. How can we manage and prevent further problems? 
Mental health is not only a problem in the South Sudanese community but globally it is a serious issue. The problem with our case is that we don’t like to talk about it. We pretend it does not exist. I think if we are to address it, we have to start by talking about it. This is part of the reason why exactly two years ago I wrote an article published on Sudan Tribune entitled the impact of war trauma on South Sudanese. In it, I talked about my own experience with trauma. We also have to conduct research to show people evidence that this is a serious problem so that we can then ask for resources to be able to address it. I have a paper currently under review and when it is published it will show that the extent of depression, anxiety and PTSD is very high in our community. 

Right now we have a big problem. Young boys and men are not focusing on school or work. It is important that we support them in getting better.
 
This is very important, and I would suggest that this is actually not a separate issue from the trauma we have experienced. There is a great deal of evidence that trauma can be passed from generation to generation. This has been seen among the children of the survivors of the Holocaust. In the 1960s, these children who never experienced the Holocaust themselves started showing up to clinics in Canada and the US with similar symptoms as their parents. At first we thought it was because of their parents talking about it. But now there is important research by scientists at Mount Sinai in New York showing biological mechanisms by which the trauma can be transmitted. I think a similar thing may be happening in our community. My own primary research question focuses on this problem and I hope to gather more data to show that it is indeed the case in our community. 

How can we best support our young boys and men from a Public Health perspective? 
We can start by giving our young people hope and programs that help them stay out of trouble. I am currently involved with an organization called Vitendo 4 Africa here in St. Louis that has a mentorship program connecting professionals with students in high school and colleges. 

What is the connection between epigenetics and the current crisis with the youth? 
I think it is important to start by understanding what we mean by the term Epigenetics: This refers to “all heritable changes in gene expression that are not coded in the DNA sequence itself 

As I mentioned earlier, there are studies suggesting that there is genetic component to vulnerability to PTSD symptoms. They demonstrate in their research of Vietnam veteran twins that heritability of PTSD symptoms are a significant factor in one’s risk of developing PTSD.  

More studies of the Vietnam Era twins from the same group also found that vulnerability to PTSD may be genetically mediated (Scherrer, Xian et al., 2004). This idea has been supported by other researchers. Specifically, Yahyavi and colleagues (2014) have further suggested that “biological vulnerability to PTSD may be transmitted across generations through maternal epigenetic programming during pregnancy.”  So, I would say that what our young people are experiencing may be something may be a problem that is deeper. But we also cannot rule out the environment plays. If a child is growing out in a not so good neighborhood and the kids they are hanging out with are doing things they should be doing, that is something that needs to be addressed. 

My own study of South Sudanese, for example, shows that Joint effects of maternal trauma and these trauma associated disorders in among the mothers is associated with depression among their children. 

What are some preventive measures we can take as parents to make sure the youth stay on the right path? 
Connecting the youth with good mentors is an important starting point. 
We also have to be involved in their activities. I know this is a serious challenge among many immigrants. Most of the time people are working many hours to keep food on the table, help family black home, or just to meet basic needs of your family here. As a result, we do not spend enough time with our kids. We don’t go to their games. We don’t attend their PTA meetings. We don’t help them with homework. We don’t ask for their grades. So, they are just left on their own. We need to be more involved.

Lastly, to conclude how can we best continue to support the youth going forward? 
As I have mentioned above, we have to be involved in their lives. Be there for your kids and understand some of the challenges they are going through. Sometimes we have a tendency to say, we experienced the worst things, you have no excuse. But the challenges they are facing are really different from the ones we faced and we have to be open and willing to try to understand them so that we can best support them.