Survivors of torture in a general medical setting: how often havepatients been tortured, and how often is it missed?

Abstract

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?ABSTRACT ⅷ Objectives To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. ⅷ Design Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. ⅷ Setting The internal medicine clinic of a large, urban medical center. ⅷ Participants A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. ⅷ Interventions All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. ⅷ Main outcome measures Self-reported history of torture. The awareness of primary care physicians of this history. ⅷ Results Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. ⅷ Conclusions Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients.

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

“…However, it has previously been found that general practitioners are unaware of the implications of patients having a refugee background and that they often refrain from enquiring further about the refugee situation [24]. In addition, there is also evidence that indicates that torture and other traumatic incidents experienced by the patients may be missed by the general practitioners [22,23]. Contrary to these findings, some of the health professionals in our study expressed that they are aware of the importance of considering a traumatic background in regards to their refugee patients.…”

“…Survivors of torture may not easily share their stories on their own initiative [21]. Furthermore, several studies show that general practitioners are uncertain whether a refugee background is of importance in relation to the health of their patients [22-24] and that they are reluctant to initiate conversations about traumatic experiences in relation to the situation in their home countries, their escape and their life in exile [24]. …”

Special Considerations for the Treatment of Pain from Torture and War

“…The first task is to recognize the torture survivor: we know that most go unrecognized [4, 5]. It is often estimated that at least 30 % of refugees have been subject to torture or organized violence, yet refugees are rarely asked about experiencing violence.…”

Teaching Residents to Work with Torture Survivors: Experiences from the Bronx Human Rights Clinic

“…[3][4][5] In the United States, there are over 500,000 foreign-born torture survivors, and about 20 percent of these live in New York City's metropolitan area. 3 Torture, in the human right context, is defined as acts that cause intense physical or psychological pain, are volitional, are done to punish or coerce, and are sanctioned actively or passively by governments or their agents. Although 5-11% of foreign-born patients at US urban medical centers are torture survivors, doctors often are unaware of this medically relevant information.…”