As a resident who sees patients in our Refugee Health clinic, I have met scores of patients who have fled political persecution in their home countries. The transition to a new life in the United States is incredibly difficult for all of them. Not only have they left their families behind, often without knowing when they might again be reunited, these patients face intense culture shock with few resources at their immediate disposal to help them navigate their new world. While they might step off the plane with only the clothes on their backs, they are followed here by their past traumas. In clinic, I have listened as one patient recounted weeks of fitful sleep interrupted by nightmares. Another patient described to me the immense loneliness he feels trapped in his anxieties. Once, while a torture survivor from Uganda elaborated on the back pain she has as a result of being beaten repeatedly with a baton, she had a panic attack before my eyes. When I placed my hand on her shoulder as an offer of comfort, she recoiled in fear.
Post-traumatic stress disorder is an all-to-common diagnosis in our clinic, but I am encouraged by how many of my patients assure me that they feel safe in their new environment. The immediate threats to their lives have been removed, and they find some measure of peace in knowing that an ocean separates them from their perpetrators.
But what if the threat of emotional abuse, social alienation, or physical harm persists for a patient despite relocating to the United States?
This was the case for SM, a young man from Uganda whom I met in clinic last winter. He was well-educated and had made a good living working for his country’s current ruling party, the National Resistance Movement (NRM), for the previous three years. However, he had recently become dismayed by his government’s corruptive tactics and arrogance. He witnessed the violent crackdown on members of the opposition movement and realized that he could no longer support what had become president Museveni’s dictatorship. He and his wife subsequently joined the opposition party, the Forum for Democratic Change, which nearly cost them their lives. They suffered an onslaught of death threats, which ultimately prompted their escape to the United States.
However, because of their previous affiliation with the NRM, SM and his wife were not embraced by the Ugandan community here in Boston. In fact, they felt ostracized, intimidated, and unsafe having received threats of violence upon their arrival in the city. Their nightmare was not over. They were living in separate male and female homeless shelters at the time I met SM and had been rejected by a number of Ugandan church communities in the area. SM was suffering from severe depression and anxiety from the ongoing trauma he and his family were enduring. I could not offer him safety or peace of mind like I could my other patients, and I felt helpless.
Starting a new life in the United States is certainly not without profound hardship; but for most asylees, leaving their home countries is an opportunity to reclaim their safety. What is important to remember, however, is that this is not a guarantee. As immigrant communities continue to grow in our cities as a result of political unrest elsewhere in the world, the same risks of violence, intimidation, and abuse can resurface for vulnerable populations. As their clinicians, we need to be better equipped to help these individuals. Before we can assist them in recovering from their trauma, we need to help bring an end to their trauma. I’m just not sure how.