A 25-year-old athlete arrived at the Chicago clinic where I am a physician about four years ago, requesting pills for his muscular and stomach pain. He looked fine until I asked him to lie down to be examined.. When I did, his attitude changed, and he became frightened. Looking closer, I saw his skin was covered with multiple scars. He revealed to me that he is a former child soldier from Sudan.
The lesson for me was clear; as a physician, I acknowledged he needed pain medication, but what else did he need?
Health care providers have a responsibility to ask patients in a safe and sensitive way about a possible history of torture, trauma or rape. There are more survivors among us than people realize; many are living with post-traumatic stress disorder (PTDS) or depression.
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While there are no exact numbers on trauma survivors in the U.S. and globally, the United Nations high commissioner for refugees reports that in 2015, “an unprecedented 65.3 million people were forcibly displaced as a result of persecution, conflict, generalized violence or human rights violations.” Among refugees alone, between 5 and 35 percent are torture survivors.
I have been teaching about screening for torture and caring for survivors for almost 20 years at a public hospital in Chicago, starting the course with the Universal Declaration of Human Rights and its impact on the medical practice. Medical residents often ask, “How often will I find torture survivors in the primary care clinic?” And my answer is always, “Just ask and you will be surprised.” The answers may help the health care provider refer the asylum seeker, refugee or torture survivor to a specialized center like the Marjorie Kovler Center in Chicago and the National Immigrant Justice Center for legal aid.
I know firsthand about giving answers that surprise others. I was a desaparecida, kidnapped and tortured by paramilitary forces in my native country, Argentina, for four months during the late 1970s “Dirty War.” Later on, I was transferred to a maximum-security prison and held incommunicado for two years. After I was released following The Inter-American Commission on Human Rights’ visit to Argentina, I went back to continue medical school in Argentina 20 days after my release from jail.
While at the university, I suffered from sleep difficulties, anxiety and a fear of walking in the streets by myself. But with the support of my family and friends, I completed medical school. I did not seek any specialized help because there was none offered to me in dictatorial Argentina.
However, when I came to the U.S., Ana Deutsch, co-founder of the Program for Torture Victims, asked me to fill out a questionnaire used to screen for PSTD in survivors of trauma and violence. “My pain has a name,” I thought. Since then, I have made it my passion to transform the pain and confusion into fuel to inform and denounce injustice through art, speaking and providing expert medical care helping others in similar circumstances.
I know personally and professionally that across borders and across time, what has not changed is that trauma and torture not only affect individuals, but their families and the nation as well.
U.S. Immigration Policy Changes
Every fall, the U.S. president sets a refugee ceiling on the maximum number of refugees who may enter the country in a fiscal year. In 2016, the U.S. had a ceiling of 85,000 refugees and admitted nearly that many. For fiscal year 2020, the Trump administration has set a ceiling of 18,000 refugees. This decline comes when the numbers of refugees worldwide have reached the highest level since World War II.
The Trump administration also recently announced changes in asylum rules. Migrants coming from Central America who have passed through other countries en route to the U.S. will no longer be able to make a claim for asylum.
The UN High Commissioner for Refugees said the new rules are not in line with international obligations because they place the burden of proof on asylum seekers who have to prove persecution to government officials beyond the international legal standard.
Additionally, at my hospital, administrators urged us to inform patients that they should not stop visiting their doctors or leave Medicaid due to a new rule brought forward by the Trump administration. The rule — which faces at least six legal challenges nationwide — will allow federal officials to deny visa or permanent residency applications from immigrants who they believe could become a “public charge” or a person primarily dependent on government aid, based on their income or prior use of government benefits such as Medicaid and food assistance.
The new policy has spread fear throughout the immigrant community. Many people are reacting by dropping out of health care programs or taking their children off food assistance.
Doctors and all health care providers need to be informed, kindly educating patients about their rights, fearlessly advocating for them, speaking up on their behalf through medical institutions and congressional representatives. This honors the UN Declaration on Human Rights and the Hippocratic Oath.
There are many ways to continue the conversation about avenues to help people fleeing their countries because of poverty, persecution and often, imminent death. Closing the possibility even for application for asylum and decreasing the number of refugees allowed to enter the country are not solutions.
We in the medical community have a responsibility to help people, and we must work hard to make sure lawmakers in Washington don’t further add to migrants’ trauma.