Family Medicine Vital Signs

By Patricia Avelar

I was shadowing Dr. Kirby as he conducted a refugee screening with a woman from Somali and two of her small children.  As he asked the woman general questions about her and her children’s health, she explained through an interpreter that she had three other children in addition to the two present with her.  She was also approximately 16 weeks pregnant and her husband was back in the refugee camp with his other wives.

I found my mind begin to wander in amazement of this woman and her situation: How would she manage in this foreign country without a partner to help her or any knowledge of English?  How would these children get by?  Did they understand the totality of their situation?  I felt humbled by her presence and life experiences thus far, but also worried for her and her children all at once.  In her young life she had already endured more conflict, responsibility and change than most do in an entire life. However, for all my amazement, all I could do was stand behind the attending and try to hide my emotions behind a smile and playful gestures towards the two children for fear that my reactions and thoughts may somehow transfer upon her.  So I tried to remain calm and used the attending’s behaviors to guide my own. He methodically went down his list of questions and remained somewhat reactionless as she continued to respond, which I attributed to his familiarity with refugee experiences as well as his desire to “normalize” the histories he heard in order to build a relationship with the patient.

As I shifted back from my own thoughts, the screening and the children’s laughter, the questions kept coming, and the doctor soon asked: “often when people live in camps, they experience trauma or physical injuries.  Has this ever happened to you?”  The mother stoically answered no but then proceeded to share that her daughter (now seven), however, had been raped at one-and-a-half-months of age.  I found myself become numb as I watched this same beautiful little girl laughing with her brother.  She continued to giggle carelessly with her brother unaware of the bomb of information her mother just unloaded. The mother and attending continued giving and obtaining the rest of the family history, respectively.

Suddenly, the interpreter mumbled her words and ran out of the room, the attending chasing after her. He returned moments later, alone, relaying to me that the interpreter was not expecting to hear about the rape.  She had no idea despite having worked with this family since their arrival to the US.

Hearing about the interpreter’s reaction made me instantaneously question my own as I stood there quietly and tried to communicate with the mother about how beautiful her children were. Had my previous work as a rape trauma counselor prior to coming to medical school and hearing all of those stories of rape and sexual assault made me numb to this new story?  Or was I simply not trying to stir emotion in the family by reacting?  Or was I able to separate myself from it given my very tertiary role as a medical student?  Should I have left the room shocked as the interpreter had?  Was I callous for not having done so?

I had heard women’s stories of survival and accompanied them through their own very painful healing, but I have never in my life encountered a story so brutal.  How could anyone commit such a violent horrific act on such a beautiful defenseless child?  Did she or would she remember?  How would her body respond later in life? And why was mom so calm as she shared? Had she already grieved this or was she remaining strong for her children?

This specific interaction introduced me to some cultural practices of Somali families, such as having multiple wives.  It also introduced me to the experiences faced by women living in UN refugee camps around the world.  Although we didn’t find out the specific details surrounding the rape, it still brought up the many issues faced by women when living in the camps.  Women are inherently more vulnerable, as were this mother and her daughter, just by virtue of being women.  This interaction also made me think of the movie “God Grew Tired of Us.”  It made me think of the daily struggles faced by the lost boys and how this Somali mother must have similarly struggled to find enough food and shelter for herself and her family.  This woman also made me think of the struggles faced by women in the documentary when John’s father writes to him that his sisters are sick and naked and need help.  In this one small line, it very poignantly and succinctly described the situation women face in camps because they are women.  Overall, this experience made me realize how complex working with refugees can be.  Even though we are their medical providers, we need be prepared to expect the unexpected and become aware of our own experiences, emotions and biases in order to build a relationship with this population.

Patricia Avelar is a fourth year Medical Student at the University of Utah School of Medicine.