Outside my comfort zone

Last week I had the blessing to spend half a day in a clinic for refugees. As it was explained to me, these are not just people who have come to America in search of a better life; they are people who have been forced out of their homes by persecution and are here in America because it has been deemed unsafe for them to return home. The stories the clinic staff told me left me flabbergasted and reminded me just how naive and sheltered I am. Few of these people speak English, and many of them know no one else here except for the family members who have fled here with them.

By the time the patients are seen in this clinic, they have typically been in the country for a week or less and are being seen by a doctor because some flag popped up on their initial screening exam by one of the nurses. Frequently this complaint turns out to be something very minor such as a cold or a knee ache from five years ago, but sometimes it turns out to be something more. During my visit to the clinic, a patient returned to the clinic for the results of blood work drawn a few weeks earlier. It turns out that this teenage patient had a chronic disease that we were the first to diagnose. The patient had initially come for evaluation of a cough and had no clue that we were about to present dramatically important news.

Had this patient been born in America, we would have caught this disease when the patient was less than a month old. Although there is no cure, we would have been able to provide close monitoring as well as therapy to help deal with the symptoms of the disease. I honestly do not know what the future will hold for this patient since I have never seen this disease diagnosed so far along.

I'm guessing my attending figured that since I will be through with my training in less than a year, I was qualified to deliver this news, and she reminded me to keep it as simple as possible since the family had likely never heard of the disease. When we brought the patient and the parents back to the exam room to speak with them, we quickly ran into an obstacle. Like most of the other patients in this clinic, the family did not speak English; we were prepared for this and used a worldwide translation phone line that we have available. Unfortunately the language spoken by the family is extremely common in their home country but barely spoken elsewhere; my attending informed me that there are only two or three workers in the entire world that are employed by the translation line who speak both English and this language, so when they are not working (as was the case this day), we were just out of luck. We ended up figuring out that the father spoke a little of another language in addition to his native tongue, so we used a translator to speak that language, and the father then had to translate into his native tongue for his wife and child. The situation was far from ideal, but I hoped that we were able to provide a little help to them.

The entire experience left me speechless for several days. I started residency two years ago with minimal comprehension of Spanish; now I'm comfortable taking a quick history and answering simple questions in Spanish, and even when I use an interpreter, I understand the majority of what is being said. Working in this clinic was completely different. I didn't have an interpreter readily available, and most of my patients that day did not have any resources whatsoever. The clinic was located where it was because most of the patients would be able to walk to it, and we had to figure out ways to get the medicines we prescribed for the patients rather than just writing a prescription and sending them on their way. I felt like I was almost practicing medicine in a third world country, yet here I was in the middle of one of the biggest cities in America.

Even with everything I see on a regular basis, I still am sheltered from certain parts of the world. I get to go back to this clinic again this week, and I'm looking forward to having my eyes opened again to something new.