Health Care for Hell’s Refugees

Michael Grodin discusses his work treating torture survivors at the Complementary and Alternative Medicine Refugee Health Clinic at Boston Medical Center. Photos by Max Esposito (COM ’10)

This week, BU Today presents “Reaching Out,” a five-part series on the many ways that the Boston University community works to ease the hardships of immigrants and refugees in the Boston area.

Tap tap. Acupuncturist Ellen Silver Highfield’s finger gently nudges the tiny needles out of their tubes and into the mocha skin of Maryan Abdi. Color-coded by size, the metal quills protrude from the 73-year-old Somali woman’s feet and legs as she reclines on the examination table, her ankle-length floral dress a splash of color in the sterile room at Boston Medical Center.

Abdi tells a translator of swarming bullets fired by warring militia clans that have plunged her native Somalia into unrelenting turmoil since 1991. She speaks of family members who have been killed: her husband and two children. The trauma of it all left her unable to sleep until she was prescribed antidepressants. As Abdi talks, Highfield rests her hand on her patient’s fingers. “I’m so sorry,” she murmurs. She asks the translator, Mohamed A. Warfa, to “please tell her that this point here”—she indicates a needle she’s placed in the forehead—“this is to help quiet the mind.”

Warfa has heard stories like these before.

“I asked one woman, ‘Is your family here with you?’ She said, ‘No children—eh-eh-eh-eh-eh,’” mimicking a machine gun.

The exam room is one of four at the one-year-old Complementary and Alternative Medicine Refugee Health Clinic (CAM), staffed by Highfield and Michael Grodin, a psychiatrist and a BU School of Public Health professor of health law, bioethics, and human rights. Every hospital harbors the suffering, but most CAM patients have lived through a particular hell: they are torture survivors, having endured personal abuse or watched loved ones suffer through it. Two-thirds of the patients—CAM has treated about 50—fled war-shredded sub-Saharan Africa, their psyches haunted by memories of family murdered or left behind.

“It’s not like a single trauma, like a hurricane,” says Grodin. “These people are trapped, imprisoned, and they can’t escape.”

Grodin began his career three decades ago working mainly with Holocaust victims. He wondered why some torture victims were more resilient than others. In 1998, he helped found with several BU faculty members the Boston Center for Refugee Health and Human Rights, based at BMC, and worked extensively with Tibetan Buddhist monks tortured by Chinese authorities.

Grodin started CAM as an outgrowth of his work at the Boston center because he believes that to best diagnose and treat patients from other countries, physicians must understand their religious and cultural background. The clinic, which sees patients for four hours every Friday morning, gets financial support from BU, the UN’s Voluntary Fund for Torture Survivors, and the federal Office of Refugee Resettlement, as well as private donations from organizations like the Tides Foundation.

“A lot of my patients have ‘heartache,’” Grodin says. “They’re not talking about chest pain. They’re talking about homesickness—sadness. In many cultures, people don’t talk about mental health, depression. They manifest it as back pain or chronic body pain.”

He is convinced that psychotherapy—talk—often doesn’t help such survivors. Some don’t trust doctors, who were their tormentors back home. Others, he says, used disassociation to survive the physical agony of torture. “They were sitting in their mind” during the painful events, he says. “They were separate from their body.”  Grodin uses Chinese movement exercises to bring those people back into their bodies.

“Good chi flow,” he says while examining a Liberian patient. The woman has complained that her knees hurt, but when asked the cause, she says she doesn’t know. Grodin has some clues. He knows that the woman has been beaten, raped, and forced to walk on gravel on her knees, and he also knows that memory loss is a coping mechanism used by many survivors. He asks if her pain has improved from his treatments. “Little by little,” she tells him in accented English.

“OK, let’s get to work,” the doctor says, proceeding to array the areas around her knees and some other spots with acupuncture needles. He also proposes to cup her, referring to a traditional Chinese pain remedy that places upside down cups on afflicted parts of the body.

“I don’t want cups today,”  she tells him.

“You’re the boss,” Grodin replies, inserting the green-tipped needles into her skin. The predominance of female patients is not coincidence. “Mainly we’ll see women,” says Grodin. “The men are arrested and tortured and often killed or imprisoned.”

Movement, acupuncture, cupping, chanting: alternative medicine to Westerners, these are conventional treatments to CAM patients. “We don’t see what we do as alternative,” says Grodin. “We see it as integrative. We work together with the primary care doc.” That, he says, is because much of Western medicine, such as pain-killing drugs, works quite well. Grodin says he uses the complementary medicine to decrease the dose of narcotics that patients need.

CAM is currently collecting data to measure the effectiveness of its treatments. Grodin’s Liberian patient and Abdi have both reported that their pain had at least somewhat diminished after their visits. Elsewhere, researchers are investigating why acupuncture works with some forms of pain and not others.

“I’m less concerned about the science than I am about people getting better,” Grodin says. He believes that a review of his efforts will find that CAM is cost-effective, he adds, reducing the number of expensive trips to the ER in a fruitless quest for pain relief.

Grodin tries to reassure patients that their trauma is a normal response to the horrors they’ve survived. He offers Africans an analogy: “If they’re in the bush and they see a tiger, what happens? You get scared, and you run. That’s the normal response. But if you go to the zoo and see the tiger behind the cage, how do you feel? Safe.”

“They’re reacting here as if the tiger’s still out,” he says. “What we have to do is build the cage.”

Tomorrow, part two reports on the Haitian Earthquake Long-term Pediatric Support (HELPS) team, a multipronged effort by professionals at the BU School of Medicine and Boston Medical Center to offer social and legal services to Haitians who have fled the devastation of last year’s earthquake.

Rich Barlow can be reached at barlowr@bu.edu. Devin Hahn can be reached at dhahn@bu.edu.