COMMENTARY

Evaluation and Treatment of Survivors of Torture and Refugee Trauma

Allen S. Keller, MD

Disclosures

May 13, 2009

In This Article

BT (Part V)

Dr. L explains to BT that his left-sided chest pain may be from a previous broken rib. "They kicked me there while I was on the ground," reports BT. Dr. L explains to BT that his current cough may be worsening the pain, and that the cough may be from acid coming up from his stomach (gastroesophageal reflux). Dr. L learns that BT never filled the prescriptions (acetaminophen and ranitidine) from his first visit to the clinic because he didn't know what to do with the pieces of paper that he was given.

Dr. L explains to BT that many of his complaints, including difficulty sleeping, recurrent thoughts about what happened to him, and feeling very sad, are common among individuals who have suffered similar experiences. Dr. L adds that although BT's musculoskeletal pains may be the result of injuries that he suffered, and the stomach pain could be due to an ulcer, these symptoms could be made worse by his mood and emotions. Dr. L also explains some additional tests that he would recommend for BT (PPD for tuberculosis, serology tests for hepatitis, stool for ova and parasites, and testing forHelicobacter pylori antigen).

Dr. L tells BT that treating his psychological symptoms either by taking medication or talking and getting support from an individual or a group can be very helpful. BT agrees to take medication that will help him sleep better and feel less sad and nervous. He also asks for a medication to relieve his stomachache. Dr. L gives him prescriptions for sertraline, ranitidine, and clonazepam. He instructs BT to stop taking the ibuprofen, which may be irritating his stomach, and take acetaminophen for pain instead. Dr. L reviews the instructions for taking these medications and their possible side effects. He gives BT an appointment to see him in 1 week at his regular medical clinic.

Dr. L asks a social worker to speak with BT. The social worker provides him with information about where he can get the prescriptions filled less expensively, and refers him to a social service agency that provides free English classes. Both the social worker and Dr. L had learned about torture and refugee trauma by attending a training program conducted at a hospital that cares for torture survivors and traumatized refugees.

Over the next several months, BT shows significant improvement in both his physical and psychological symptoms. Through the social service agency where he is taking English classes, he is referred to a lawyer who represents him free of charge in his political asylum application. Dr. L provides the attorney with an affidavit documenting BT's history, physical, and psychological findings. One year later, BT is granted political asylum. He starts taking courses at a community college while also working in a store.

Conclusion

Clinicians working with immigrant/refugee communities will come in contact with survivors of torture or refugee trauma whether they realize it or not. Information about prior trauma is often essential in appropriately evaluating and treating such individuals. Discussions that elicit trauma and abuse history can enhance clinician-patient relationships and lead to better clinical outcomes by enabling treatment of health conditions, such as depression and PTSD, which might otherwise remain undiagnosed and untreated. Empathy, effective communication skills, and awareness of the multifaceted health needs of survivors of torture and refugee trauma are essential. With these skills, clinicians can make important contributions to promoting the health and well-being of individuals from these vulnerable populations.

Acknowledgment

Allen S. Keller, MD, is Associate Professor of Medicine and Director of the Bellevue/NYU School of Medicine Program for Survivors of Torture (PSOT), New York, NY. PSOT provides comprehensive medical, mental health, social, and legal services to refugees and asylum seekers who have endured torture, traumatic events related to their refugee experience, and other human rights abuses. Since PSOT began in 1995, approximately 3000 men, women, and children from over 80 countries have received care. PSOT has established an international reputation for excellence in its clinical, educational, and research activities. Dr. Keller is on the international advisory board of Physicians for Human Rights. He is recognized as one of the leading experts in the evaluation and treatment of victims of torture and refugee trauma. To learn more about PSOT and provide much needed support for our Program, visit the Website: www.survivorsoftorture.org.

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