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At the heart of general practice since 1960

Working among the misery of refugees and asylum seekers

Dr Peter Lefeuvre describes the pain and joy of working with asylum seekers who in his experience are very far from the scroungers so often portrayed in the popular press

he young Iraqi man looked anxious as he sat down in my consulting room. 'How are you?' I asked. Flicking frantically through his dog-eared Kurdish dictionary, he began. 'Doctor, I have ....agony in my....(further furtive pouring through dictionary)....my soft palate.'

And indeed, he did have quite a nasty-looking throat, and, like many of my patients, was concerned about rheumatic fever and its consequences.

His communication, although not linguistically perfect, was nevertheless quite enough to convey what concerned him, to his obvious relief and, hopefully, my less obvious amusement.

Communication is, of course, the biggest challenge for medical personnel in their contacts with refugees and asylum seekers. It is a two-way process, and the onus is on the doctor as well as the patient to make the extra effort needed both to express oneself and understand the other person.

On another occasion, five people flooded into my consulting room. A Latvian girl had a cough. Her mum spoke Russian as well as Latvian. They had met a Mongolian couple ­ mother and daughter ­ in the Induction Centre in Dover.

The Mongolian mother spoke Russian and Mongolian, the daughter Mongolian and almost faultless English. Through Latvian, Russian and Mongolian we managed to communicate pretty well and had a good laugh too.

You need to be able to laugh to counter-balance the tide of misery that seems to fill some of my clinics. A Burundian man who has seen his entire family cut to pieces in front of him; a woman from Uganda who had been raped so many times that she has lost count and now had a new diagnosis of AIDS to remind her of the price she has paid; an Iranian man who hears that his brother has been tortured and killed, because he himself had escaped to England.

Faced with such misery, all you can do is be there and try to help as shattered lives slowly and painfully reconstruct themselves, sometimes because of what medicine can do.

To work with refugees on a regular basis means hearing new stories of racial abuse on the streets of

Dover and elsewhere, prejudice in the shops and public buildings, antipathy and disbelief at Home Office interviews.

Part of the process of working with refugees is involvement in advocacy on their behalf: advocacy to stop a refugee from being sacked because he missed a day from work or to ensure the police investigate an assault against him on the street.

Sometimes I find myself trying to prevent the deportation of a refugee only just coping with the depression and nightmares resulting from the past horrors they have experienced in the country to which they are threatened with return.

Quite often I feel real anger, and this anger has been fuelled in recent weeks by a new Government policy that removes support and accommodation ­ food and a bed

­ from any asylum seeker who

does not apply for asylum on arrival.

Pregnant women, survivors of torture, and AIDS sufferers are among those threatened with eviction and destitution. What is a doctor's role faced with suffering apparently sanctioned by the state?

Over the years, talking to patients and trying to counsel them have been the source of much of a GP's satisfaction with his or her job.

In recent years, these fundamental building blocks have become eroded by the demands of targets and protocols. But they remain at the heart of working with refugees, individual patients with stories to tell and lives to be led.

The privilege of helping these people on their journey evokes a powerful mixture of pain and joy.

At the end of almost every day I return home awe-struck by the people I have seen, whose strength and courage drive them to rebuild their lives despite the unbelievable horror and suffering through which many have lived.

What is a doctor's role faced with suffering apparently sanctioned by the state?~

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