If I hadn’t heard her sob, I might not have looked up. I was so immersed in her story, and so fixated on my own studious note-taking, that I didn’t doubt the steady rhythm of her voice until I heard it break. Huda’s (name changed) eyes were filling with tears, and I quickly handed over the tissue box, feeling that its trifling weight was an apt metaphor for how little I could do to help her.
Huda and her husband were Afghan refugees — and while she had been in the States for over a year, her husband remained stranded in Turkey, unable to join her as approval for his resettlement remained pending, possibly accumulating dust in a bureaucratic office somewhere. As she sat across from me in the psychiatric clinic, I couldn’t help thinking that her problems cut deeper than her depression — that many of her circumstances were the result of systemic injustices, ones that warranted systemic corrections.
I developed an interest in refugee issues during my first year of medical school, as a result of informative lunch lectures that were wisely scheduled right after anatomy lab. As a result, I kept an ear out for refugee issues, and subsequently, I planned to address refugee health access in Houston over the course of a year-long service project. I started with optimistic goals: to collect health provider information, organize it into an electronic resource, and distribute it to refugee agencies. It was clear and simple enough to pitch. My imagination cast a sunny light on the prospects of aiding refugee health.
The first blow to my naivete came swiftly. I had just begun my service project; I had started by shadowing caseworkers as they addressed refugee needs. That morning, the objective was to help an elderly refugee with a limp to obtain disability benefits. This, as the caseworker warned me before beginning our expedition, would prove to be a difficult task. I dismissed this concern — surely she simply meant that the line would be long at the Social Security Office and the forms would be tedious.
Haven’t we all suffered the “slings and arrows of outrageous fortune” at the local DPS when getting our driver licenses renewed? Upon arriving, we waited for four hours in an over-crowded waiting room. The applicant, Sara, offered her seat to me repeatedly although she was the one with a limp. When we stepped up to the window at last, the officer informed me and Sara’s son that we were not allowed to accompany her as we crowded up the window. We explained that she needed accompaniment because she did not speak English yet, and asked politely to be allowed to stay.
The officer next suggested that, since she was unlikely to be approved for disability benefits, perhaps she should consider not applying at all. Hearing this, I started to lose my temper. I raised my voice a notch and, keeping my eyes fixed on the officers’, stated that we were not leaving without completing the forms and sending in the application, and I would stand by to assist and move out of the way of the window as needed. The officer didn’t raise any more objections, and we continued with the application. This experience stands out in my memory as the first time I was genuinely angry about the injustices refugees undergo in the system. I had been annoyed and disquieted, many times, by their sufferings, but this was the first time I felt anger, and the first time I acted out of anger to advocate for them.
Two months later, at a family medicine clinic, I saw an Iraqi refugee, Asad, nominally for hypertension, but his history was notable for substance abuse and addiction. His story was an interesting one — he had served the U.S. Army as a translator, and afterwards was granted refugee status for his service.
However, despite his dreams about coming to America, he was sorely disappointed. After his arrival, he felt he had been abandoned by the system. He was repeatedly unsuccessful in finding a job and struggled to maintain his basic expenses. Despite his hardships here, he did not even have the option of returning to his native country of Iraq, since he had previously helped the U.S. military there. He hated living here and had thought repeatedly of ending his life. This was the second time I felt the same acute indignation, and my anger welled up. I must have done a poor job of hiding it, because my attending remarked to me that I seemed restless the rest of the day.
After finishing my stint at the clinic, I worked on my project, the electronic health directory, for three days straight, once coding overnight, driven mostly by the remembrance of these helpless situations. That year, I also helped to organize four local refugee health fairs and volunteered at several others. Ultimately, it was my anger, rather than my empathy or sensibility, that spurred me. Anger is the result of feeling passionate about an issue, and passion is how ideas are pushed to tangible strides. It’s understandable how, over time, our compassion is worn down when we see case after hopeless case. But if we can hold onto those times when our sense of injustice was pricked, those times when we felt anger on behalf of our patients, I think we can continue to advocate with passion and purpose. There is still much work ahead to be done for them.
Weijie Violet Lin is a medical student.
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