We long for the moments in our life that justify our course, that illuminate the banalities of our daily routine, and that instill within us a mission that suddenly harmonizes all that you have done and all that you hope to do.
My first year as a physician-in-training consisted of an insurmountable study load, a constant quarrel with the torturous alliance of fatigue and self-doubt, and the simple reality being a 22-year old uncertain of himself and his future. When I was accepted into medical school, I committed myself to becoming a holistic, politically aware, and multifaceted physician advocate who is as proficient in the socioeconomic context of disease as he is in biochemistry and pathology.
With the obligation to stare at notes on my computer screen and find seemingly non-existent anatomical features in cadaver lab, this persona I strived to attain for so long had become an enigma that I was holding onto by a thread.
Then, I witnessed a silent, yet egregious injustice that turned this feeble thread into a strong grasp.
I had the privilege of assisting a lawyer, physician, and translator with a medical forensic evaluation on an asylum seeker detained in one of our country’s 300 privately contracted immigration detention facilities. This asylum seeker, Jemal, was also a physician but from Ethiopia, specializing in HIV/AIDS. He is an ethnic Oromo, a group in Ethiopia often persecuted by a government that seeks to admonish political dissent and free speech.
His work played an instrumental role in the lives of so many of his countrymen, yet he was imprisoned and tortured simply for holding different views from his government overseers. He escaped Ethiopia, arrived in the United States, expressed his desire to seek asylum, and was immediately detained. This man is not a criminal, yet the country that he sought as his protector from torture and persecution would be the arbiter of further injustice.
Jemal was transferred to the Immigration Center for America’s detention center in Farmville, Virginia. This is remote location is hours away from potential legal representation, medical care, immigration courts, and anyone who can provide this man with the slightest optimism and ease of mind. A significant number of immigration detention centers are intentionally placed in remote locations to distance themselves from legal and social assistance. Fortunately, for my team, this barrier did not stop us, and we embarked on a four-hour trip from Washington, D.C. to Farmville.
When we arrived, we checked in with the security personnel. Our visit had been authorized by the Immigration Detention Center days prior to our arrival, and my supervisor and I were ready to conduct the medical evaluation. We expected to simply fulfill our roles as health care professionals and provide this man with a service that he is entitled to. Instead, we were met with our second barriers: illogical and arbitrary policy, hostility, and broken promises. We were forbidden from conducting a medical evaluation, and our medical equipment, necessary documents and medical records, and even pens were confiscated.
In the face of arbitrary decisions made by those subverting government regulations and Jemal’s fundamental rights, we were motivated to find any way in. So, we improvised. We were now “visitors” desiring a simple conversation with Jemal. Finally, the prison staff budged and we were allowed to see Jemal empty-handed. When we were granted admission, we were confronted with our third and quite literally, our most palpable barrier, a 6-inch thick piece soundproof glass that separated us from Jemal. Still determined to conduct the evaluation, I witnessed one of the most skillful demonstrations of medicine I have ever seen. I witnessed my supervising physician conduct an entire medical evaluation where she documented Jemal’s physical and psychological sequelae of torture through a telephone and dirty piece of glass. When she was done, she affirmed that we will do everything in our power as health professionals to get him out of detention and get him the assistance he needs. Jemal’s look of relief unleashed a shiver within me that continues to resonate.
At the end of the day, I witnessed a sample of the greater injustice that is asylum seeker and refugee detainment. But, for me, the greater lesson is clear: the mission to improve the lives of those who have been victim to torture, persecution, and indignity does not end with an inspirational shiver. The practice of medicine goes hand in hand with the advancement of humanity. For every medical student or career physician struggling to find a purpose of their work, let us reaffirm our obligation to those who have been denied the right to pursue the greatest state of physical, social, and mental well being. Jemal’s story is unfortunately shared by too many in this world. For this medical student, the process of ameliorating each one of them begins with a call to action. This is a call to integrate the trials of my medical education with the goal of using these skills to stand with Jemal and those everywhere who need a voice and healing hand.
Kevin Diasti is a medical student.
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