What if you are called on to be a Good Samaritan?
Dr Juliet Cohen on her work with the Medical Foundation for the Care of Victims of Torture
My typical day starts with collecting an armful of files, typing and messages, just like any other clinic, except for the specialised nature of the work.
The Medical Foundation for the Care of Victims of Torture does exactly what it says on the tin. A variety of doctors: some specialists, some GPs, together with psychologists, counsellors, case-workers, physiotherapists and many others offer care to traumatised patients from around the world. We have patients whose trauma dates back to World War II as well as a constant stream of new arrivals. The majority of our doctors are volunteers as the foundation is a charity with no NHS funding.
As soon as possible I call in my first patient and, working through an interpreter, ask how things are going. With the benefit of trained specialist interpreters and appointments ranging from half an hour to 'as long as we need', it is possible to find out a great deal, often information that no one has heard before.
General practice is a great training for this work, as we need the ability to juggle requests and prioritise needs as diverse as chronic pain, lack of accommodation, overwhelming grief or how to apply for money to travel for an appeal hearing.
After addressing some practical issues I read back to my patient, a woman in her mid-20s from Cameroon, the draft of her medicolegal report detailing forensic evidence of her torture. We worked on this at her last appointment, and now I read it back to make sure there are no errors of date or location that may affect how the Home Office views her credibility.
Her detentions are detailed in the report, followed by an account of the impact on her current health, treatment she is receiving and a full examination listing all scars or injuries attributed to torture. Then follows a summary and my opinion as to the consistency of the history and examination findings.
The report, after checking by a lawyer at the foundation, will be sent to her solicitor and then to the Home Office as part of the documentation of her asylum application.
On to the next patient, a young man from Iran who has suffered a number of head injuries. His thoughts are scrambled, his memory and concentration hopeless. Although his educational level before his torture was low, he did have a basic literacy and numeracy.
Now when I assess his mental state he is unable to remember more than one out of three objects in the room and cannot count backwards from 20. His concentration is so poor he loses the thread of conversations easily and I keep my sentences short and of simple construction.
He had been sleeping on the street until he coughed up blood. I gave him a letter to take to his nearest hospital. Once diagnosed with TB he was helped to find a room near the hospital to enable him to complete treatment.
I work on through my appointment list. The next patient tells me she has been granted leave to remain in the UK and we spend the time discussing the relief she now feels, how her sleep has improved and how she should go about finding work now that she is entitled to do so.
From this brief respite I plunge into a crisis, as the next patient discloses to me that she is having frequent suicidal thoughts and feels utterly unable to care for her children, but would kill herself for sure if she did not have them to comfort her. Close liaison will be needed with community mental health services and her GP.
Finally, another patient for a medicolegal report, this time a woman from the Ivory Coast. As I listen to her relating her story something does not quite add up. The events causing her to flee seem relatively unthreatening, but she is evidently depressed, her hands restlessly fiddling with her clothes, her eyes red-rimmed from tears and lack of sleep.
It transpires she is so deeply shamed by her experience of a multiple rape in detention that she has not disclosed it until now. Her solicitor and the Immigration Officer that interviewed her are both men and she, a Muslim, was unable to bear revealing her shame in front of them.
Even now, she is reluctant to allow me to include it in the report, but after explaining about confidentiality she agrees. I have seen women who have not disclosed rape to their husbands for years because of their fear that their husband may be obliged to divorce them. At the foundation we always try to provide gender-appropriate matching of staff and interpreters.
We spend the rest of the appointment discussing treatment options for her depression and arranging screening for sexually transmitted infections and HIV. The report can be finished next time.
At the end of the 'clinic', like any other doctor, I gather up my files, my dictation tapes and paperwork and head for the door.
Juliet Cohen is acting head of medical services at the Medical Foundation for the Care of Victims of Torture if you would like to find out more about its work, please contact
her at 111 Isledon Road, London N7 7JW, or e-mail email@example.com