In 1989, the king of Bhutan proclaimed its “One Nation, One People” policy. Under law, all citizens of Bhutan, regardless of cultural background or geographic location, were required to dress only in traditional Northern Bhutanese garb and only learn the Northern Bhutanese language of Dzongkha. In the 1990s, hundreds of thousands of ethnically Nepali Southern Bhutanese led public demonstrations against this policy, leading to participants being branded as anti-nationals. Thousands were imprisoned and tortured without formal charges or trial, and many more fled to refugee camps in India and Nepal, with UNHCR camps in Southeast Nepal hosting over 80,000 refugees at times. These individuals, formerly successful farmers and merchants, then lived in these makeshift camps through several unsuccessful repatriation negotiations between Nepal and Bhutan. After decades, they began to resettle in foreign lands, with many moving to the US and thousands settling in Philadelphia, where I have had the privilege of working with them.
I remember reading as much as I could about their shared experience and about common health conditions I may come across before walking into my first clinical encounter with a Bhutanese refugee. Technically, I was a medical student, but considering classes were yet to begin, I soon realized that I had no idea what I was doing. My very first patient walked in with a productive cough, congested lungs, and a history of treated tuberculosis. That patient looked at me like I was a doctor, while I fumbled incompetently with the sphygmomanometer trying to take my very first blood pressure, and I remember being beyond surprised at my patient’s, well…patience. I realized then that medicine in low-resource settings is much messier in practicality than it is in any book I could read.
In books, patients come in with their medication lists. In clinic, they come in unable to explain the purpose of their medications. In books, impartial interpreters act as well-translated subtitles for the doctor and patient. In clinic, ad hoc community members who know some English have conversations with the patient that the doctor may not completely understand. In books, patient rooms are sterile environments with proper tables and all the tools necessary for through examination. In reality, free clinics for refugees take place in community center multipurpose rooms in which both the patient and doctor can hear loud music from nearby social events. In the US, illnesses like tuberculosis are now just case studies. But for my patients, they are part of a very real medical history.
Working with the members of Philadelphia’s refugee community has taught me that the best attribute I can have as a clinician is flexibility. With this, I have learned to see my patients as part of a greater system. Seven months later, I’ve learned to talk Bollywood with the schoolchildren, play peekaboo with little girls dressed in “Nepali boys’ clothes,” and chant prayers with community members at a homum. And now, when I have the honor and privilege of volunteering at a clinic, instead of reaching my hand out for a handshake, I put my open palms together, bow slightly, and say “Namaste Ji, mero nam Pavitra ho.”
In books, patients come in with their medication lists. In clinic, they come in unable to explain the purpose of their medications. In books, impartial interpreters act as well-translated subtitles for the doctor and patient. In clinic, ad hoc community members who know some English have conversations with the patient that the doctor may not completely understand. In books, patient rooms are sterile environments with proper tables and all the tools necessary for through examination. In reality, free clinics for refugees take place in community center multipurpose rooms in which both the patient and doctor can hear loud music from nearby social events. In the US, illnesses like tuberculosis are now just case studies. But for my patients, they are part of a very real medical history.
Working with the members of Philadelphia’s refugee community has taught me that the best attribute I can have as a clinician is flexibility. With this, I have learned to see my patients as part of a greater system. Seven months later, I’ve learned to talk Bollywood with the schoolchildren, play peekaboo with little girls dressed in “Nepali boys’ clothes,” and chant prayers with community members at a homum. And now, when I have the honor and privilege of volunteering at a clinic, instead of reaching my hand out for a handshake, I put my open palms together, bow slightly, and say “Namaste Ji, mero nam Pavitra ho.”