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Day in the life: Dr Angela Burnett, lead doctor at Freedom from Torture

Dr Burnett talks Pulse through a typical day at the charity for the treatment and rehabilitation of survivors of torture and explains how their data is influencing international research

Name Dr Angela Burnett

Age 52

Location North East London

Role GP and lead doctor at Freedom from Torture

9.30am

After dropping my younger daughter at school I set off on my bicycle to Freedom from Torture’s office in Finsbury Park. Cycling is often the quickest way to get around London plus it’s cheap and good exercise.

I started volunteering at the human rights organisation in 1995, ten years after it was founded, when it was the Medical Foundation for the Care of Victims of Torture. I work here two days per week and the rest of the week I work as a GP with people who are homeless and vulnerably housed.

At Freedom from Torture I work as one of the lead doctors in the Medico Legal Reports Team. Freedom from Torture’s doctors, the majority of whom are volunteers, have an important role in assessing the health of survivors of torture. Those in my team write medico-legal reports (MLRs), documenting medical evidence of a person’s physical and psychological torture. The reports are commissioned by legal representatives and are submitted as expert reports – to the Home Office, for first instance asylum decisions, or to the Tribunal, for appeal cases – to help their case for protection in the UK.

The account of torture is assessed in accordance with international guidelines set out in the Istanbul Protocol, asserting the consistency of the evidence with the individual’s account of torture.

10.00

I catch up with our administrative team who provide excellent support, obtaining and processing important documents and importantly sending the finished reports to lawyers. Our multi-disciplinary team also includes lawyers, so we have a rich mixture of expertise.

10.30

I catch up with the other doctors and legal colleagues and discuss any challenging cases and urgent deadlines of an imminent court hearing 

11.00

All our MLRs are independently checked by a medical specialist reviewer, of which I am one, and also by a legal specialist. Each report takes about an hour to review – I need to check that no relevant details have been omitted

13.30

I chair a monthly meeting for doctors where we discuss clinical and administrative issues arising from the work, workload and anything that the doctors wish to raise. It’s also a good opportunity to catch up with each other.

14.00

I’m meeting my mentee who is a GP from London who started working here six months ago.  As the work is so different from what doctors have done before we offer all new doctors a mentor who works with them 1-2-1 and offers guidance and support. All the doctors who work here are driven by a passion to help and support people who have experienced trauma that most people would find impossible to comprehend.

A few years ago I set up peer support groups which meet monthly so doctors can meet to discuss the challenges of the work, exchange thoughts and ideas and gain support. The issues discussed with mentors and peers are practical and emotional, as the work doctors do here can be highly stressful.

A doctor will typically see a patient for three, two hour assessments – though these can be longer, where they document the account of torture in detail. This involves noting down a full history of their ill-treatment, which may include beating, burns or rape. Physical scars are assessed and other injuries such as badly healed fractures, lacerations, burns, damaged ligaments, or chronic bone infections, including where they are on the body, are meticulously recorded. They also document evidence of severe psychological problems. This is why we allow such a lot of time. It is important that the patient does not feel hurried or pressurised and they can disclose at their own pace - it’s crucial we build trust with patients so they feel able to reveal even the most distressing things that happened to them.

Many clients require interpreters and we have a skilled team with whom we work. To enable patients to get the best care and support we may refer them to Freedom from Torture’s clinicians who can provide them with the long-term psychological help and support they may need.

Doctors also liaise with a patient’s GP, (if given consent to do so) which is an important part of the work. As a GP myself I am fully aware of the pressures which many GPs work under – lack of time, lack of continuity and poor access to interpreters. A letter from one of our doctors here can be extremely helpful for a GP who may not even be aware of a patient’s history of torture.

15.30

I meet with a colleague for her appraisal. Many of our doctors are retired or have a portfolio career, and may therefore not have an NHS appraisal. We have our own Responsible Officer and can therefore offer appraisals and revalidation for any of our doctors who need this.

18.30

I head home. My daughters are home from school and college and my husband cooks dinner as he’s home before me (I’ll be doing some cooking at weekends). He’s a fantastic support for me – he works as an imaging assistant in hospital. In the evening I’ll help my daughter with school work and do a bit of reading to stay on top of the latest research.

Our department works with Freedom from Torture’s policy and external affairs team where our MLRs form the basis of our research reports, which aims to hold torturing states to account. Our most recent report on torture in Iran was based on evidence from the MLRs we produced for Iranian patients. The UN Special Rapporteur on Iran, Dr Ahmed Shaheed, drew on, and included, our research in the report he presented to the UN Human Rights Council in March.

Our MLR team is commissioned to write about 600 reports a year and we’re currently looking for more volunteers in London, Manchester and Birmingham. Volunteers work a varying amount of time - the minimum required is a session (at least four hours) per week or fortnight. The work can be intensely stressful, as you’re dealing with such extreme accounts of brutality. The doctors we recruit are suitably qualified and are trained in the methods of documentation of torture. We’re currently looking for volunteer doctors who are looking for the challenge of working here and the extraordinary help you can provide to survivors of torture - you can see the job descriptions online.

Readers' comments (3)

  • Long time ago I was impressed with the work carried out by the "Medical Foundation for the Care of Victims of Torture". I wanted to join them as I have a large number of asylum seekers and refugees. As I speak their language, I became more friendly and familiar with my patients.

    I realised that 99% of them are economic migrants. The real refugees are in their country. People who have money or have a relative in this country managed to get a ticket as a visitor or managed to come in illegally. Many had relatives who are doctors or psychiatrists. There were lot of solicitors "specialising" in asylum cases. All coached their relatives/clients what to say in an interview. Many got drunk and their friends/relatives burnt them with hot iron, slashed parts of the body to substantiate their claim. some doctors gave local anaesthetics and inflicted injuries. Almost ALL claim that their life is in danger if they are returned to their country. However, once they are given refugee status or allowed to stay in this country, the first foreign visit they make would be to their home country!

    Even now I have patients who were perfectly alright until their asylum claim is refused. Suddenly they have sleep disturbances and the solicitors say they have PTSD. They want reports to say that their mental health will be seriously affected if they were deported. They want referral to the mental health team!

    Some specialist psychiatrists are available to give reports supporting the mental problems for which they charge £1200.00!

    Though the idea of a service for the torture victims is honourable and commendable, I hope wrong type of people are not benefited by their services.

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  • Dear Anonymous,
    I am very interested and concerned to hear about doctors deliberately inflicting wounds to simulate torture evidence- do you have any direct evidence for this? Please contact me if you can discuss this further.
    My email is jcohenmf@yahoo.co.uk

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  • Response from Freedom from Torture's Director of National Clinical Services, Andrew Keefe:

    Anonymous,

    I write as Director of National Clinical Services for Freedom from Torture to correct any misinformation you may hold about the people who access our clinical services.

    As Dr Burnett has described, Freedom from Torture has an extremely skilled clinical team experienced in documenting the medical evidence of a person’s physical and psychological torture in accordance with their duties as independent witnesses to the court and the standards set out in the UN Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (known as the Istanbul Protocol) for the provision of medico legal reports documenting torture. We have robust intake processes and all our medico legal reports are subject to independent medical review.

    In contrast with your allegations of false claims, survivors of torture often experience real difficulties in accessing protection under the UK asylum determination system. Insufficient attention continues to be given to the impact of trauma on the disclosure and testimony of torture within the asylum process and many of our clients are initially refused asylum, living in poverty or destitution until their claim is finally determined. Our clients may also experience discrimination in accessing services in the UK, an issue exacerbated by myths about asylum applicants and the asylum process. You may not be aware, for example, that return to the country of origin following a grant of Refugee Status would lead to an active review of that leave affecting an applicant’s future leave.

    We were disappointed to read your generalised comments in relation to solicitors, doctors and other professionals and would encourage you to report any actual evidence of unprofessional conduct to the relevant professional regulatory bodies.

    Yours, Andrew Keefe.

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