Treating, not listening

Past failures are leading to innovative hospital programs for refugees.

Arnold Zable's new short story, 'The Ancient Mariner, is described as the ''strange and terrible story of Amal Basry, who survived the sinking of the SIEV X by clinging to the corpse of a fellow passenger''. Amal died of breast cancer in 2006 after entrusting her story to Zable. I can't stop thinking about how Amal related her story, because I know a good part of what Amal Basry might have said about her scarring and ultimately fatal battle with breast cancer. I was one of her doctors.

My introduction to Amal was short. A senior doctor said, ''She is crazy. I'm not seeing her.'' I was in my late 20s, just six months into oncology training, feeling vulnerable and inept. Patients, however, are a pretty forgiving lot and in a teaching hospital they put themselves up for all kinds of learning experiments. Many would smile encouragingly.

Amal was nothing like them. I encountered a woman in traditional garb who wailed loudly once she saw me. ''I am the doctor, Mrs Basry,'' I stammered. She sobbed louder, beating her chest. I ran out of the room and into a nurse. ''Don't you know?'' she said. ''Amal was on that boat that sank.'' I went back in. Desperate to help, I said gently, ''Mrs Basry, tell me about yourself.'' Haltingly, crying more than talking, she sketched the scenes of fleeing Iraq, capsizing in the SIEV X, and clinging to a corpse for 20 hours before she and a son were rescued. She jerked violently when I moved to examine her breast. She began to cry, screaming her disbelief that she could be rescued from drowning only to be condemned to a fate too shameful to even mouth. I listened helplessly until she said: ''Just leave me alone.'' Against my better judgment, but with palpable relief, I did.

For a while, Amal became my regular clinic patient since no one else felt like dealing with her host of problems. One day she hated needles, the next her doctors. One day she would curse Allah, the next day her fate. What Amal really needed was a multidisciplinary team to address her bewilderingly complex medical, social and emotional issues. But at least during those crucial early days, there was no concerted plan to remedy Amal, the whole person.

In my opinion, the crux of the problem was that, at the time, the air was thick with uncertainty about refugees, particularly those from the SIEV X. Who were these people and what did they want? Did they seriously throw their children overboard? With the volume on the refugee problem turned so high, it is no wonder that the breathless media, politicians, and shock jocks allowed the wider community to convert uncertainty into suspicion, followed by disengagement.

But hang on, you say. Surely given their education and focus on caring, doctors think differently. Surely they are above this prejudice. The problem is that one person's prejudice is another's opinion. To think that all doctors are immune to sound bites, fanciful headlines, and shock-jock tactics is to delude oneself. This does not imply that doctors are uncaring - but when there is no community consensus on how to care about refugees, we cannot exempt doctors from this community.

As a trainee, I volunteered at the Asylum Seeker Resource Centre at a time when refugees were denied access even to basic medical care and were routinely turned away from hospitals. I was frequently reminded by my bosses that I needed to do something more meaningful with my career.

Fast forward a decade and ironically, I am working in Australia's most culturally and linguistically diverse region. More than half of Dandenong's population comprises migrants and refugees. Burma, Vietnam, Iraq, Eritrea, Afghanistan, Sudan, Sri Lanka, Burundi, Serbia, the list goes on. Access to Medicare has improved and our public hospitals regularly see refugees now. Most have had inadequate medical care and have no notion of preventive health. When we admit them for a visible illness, we always uncover dormant ones. In our quest to fix them, we ask impossible questions. How can an illiterate, scared woman from Afghanistan remember a tetanus shot? Which devout Muslim woman will talk to the white male intern about noticing a breast lump? Which Sudanese adolescent will confess to the harried emergency doctor that he drinks too much to stifle the image of his father killed by a machete?

Doctors usually obtain their world view from the same place as everybody else. Should they be more deeply aware of the strong cultural, religious and philosophical attributes of their patients? Yes. Does their education and training in any way prepare them for it? No.

Healthcare spending is a bottomless pit. But the measure of a humane society is how it treats its weakest and most vulnerable, and no one is weaker or more vulnerable than the Amal Basrys of this world. Hospitals still cater poorly to the needs of refugees, but innovative programs such as the Dandenong Hospital Refugee Health Clinic are a start. The appointments are longer, and interpreters, social workers and skilled nurses back specialist doctors. These teams have an interest in more than just the presenting illness.

When I think about the spirited and sometimes obstinate Amal Basry, now immortalised by Zable, I regret that we treated the patient but failed the person. I like to think that her story will be a reminder of how to do things better.

Dr Ranjana Srivastava is a Melbourne oncologist and the author of Tell Me the Truth: Conversations with My Patients about Life and Death.