Response to: "Primary Care Management of Non-English-Speaking Refugees Who Have Experienced Trauma"
By Katherine Welch, M.D.
Cancer InCytes Magazine - Volume 5, Issue 1, Summer 2016
Managing Editor: Ben Lok, M.D.
This article is a response to:
Sandry S. Crosby. "Primary Care Management of Non–English-Speaking Refugees Who Have Experienced Trauma." Journal of American Medical Association. Volume 310, Number 5, August 7, 2013.
Refugees, asylum seekers, victims of human trafficking are among the most vulnerable people that health care professionals see in their practice. Trauma-informed care is the holistic approach and treatment of someone who has suffered complex trauma, such as torture. Trauma-informed care is part of a holistic approach to care that is patient-centered; appropriate for age, gender, and culture; and accounts for the impact of the violence on that person. It means advocating for your patient the care that he/she needs. It begins with caring interview techniques in creating a safe space for the patient and using caring interview techniques. Informed consent, repeatedly, is paramount. It is care that understands that a patient’s vague or inconsistent (or even belligerent) answers may reflect their reaction to trauma, shame, and mistrust, and not to be intentionally difficult.
This article is a helpful and practical summary of caring for refugees and asylum seekers, and the principles can also be applied to victims of human trafficking. It is a very comprehensive model of care and it would be good for clinics and hospitals to review and train staff to be prepared to meet the needs of those who may already be walking through their doors.
Some of the highlighted points of this article include asking us to prepare ahead of time, and the more you know about your particular patient, the better you can serve him/her. You can also be prepared, if your community is resettling people from a certain country or region. Understanding the types of physical and emotional trauma that are experienced.
Another important point regards the myriad barriers that can complicate the patient/physician relationship. It is important to remember several things during an encounter, whether or not you are aware that your patient is a refugee or not. Your patient may not self-identify as a refugee, and may not admit to having experienced shameful treatments. As the author points out, some are waiting for an invitation to speak about their trauma or tell their story. Others may not be so willing to talk even with an open invitation due to suspicion, lack of trust, shame, or other factors.
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Regarding the use of alternative and complementary medicines, it is very important that health professionals engage an open dialogue with their patients about their use of allopathic and traditional medicines as well as their preferences for therapy. Do not be afraid to discuss these therapies, even if you are not familiar with them - consider it an opportunity to learn and explore different ways of healing. Open communication will serve you and your patients better.
In my experience in working with refugees, victims of trauma, and survivors of human trafficking it is an enriching and joyful experience. Even if you don’t connect with the cultural clues 100% of the time, approaching each patient with sincerity, humility, and love is a way to communicate care and that you do have their best interests in mind.
Let’s not forget, however, that there are already patients that we see daily that do not present as obvious candidates for being a traumatized person that do not present as a refugee or a trafficked person, but could also benefit from the principles of trauma-informed care.
One of the fundamentals of providing trauma-informed care is that one must be prepared ahead of time. This included learning the principles and practice of trauma-informed care, researching the background of your patient (or potential patients), and learning identifying “red flags” for physical, mental, and emotional trauma.
A very practical article that focuses on the primary health care for the pediatrician is:
Seery T., Boswell H., Lara A. “Caring for Refugee Children.” Pediatrics in Review. Vol. 36, No. 8, Aug 2015, p323-338.
Another resource on the principles for interviewing traumatized people is: http://www.who.int/mip/2003/other_documents/en/Ethical_Safety-GWH.pdf. Although the title specifically addresses trafficked women, the article outlines ten points that are generalizable to a wider population.
Katherine Welch, M.D.
About The Author
Katherine Welch, M.D., is an American pediatrician based in Thailand. She works as a consultant in serving the health needs of abused, exploited and trafficked people. You can learn more about her work at www.gorelentless.wordpress.com. She is also an editorial adviser for the Department of Public Health & Social Justice at Cancer InCytes Magazine.