McQuaide et al present a different kind of global health case report: when global health reaches our backyard. Immigration health has always been a concern but more so in the recent years in which we have seen huge movement of populations, be it South American migration to the USA and Europe as presented in this case report, or the Syrian refugees. This case report sheds light on some points which cannot be overlooked: the limitation in the application of diagnostic criteria – DSMV 5 – for more complex disorders which have not yet been included in the manual. Secondly, the need for a patient who has been persecuted for their ideals, and expressed thoughts to start trusting a foreign entity and divulging what is most profoundly painful to them. Thirdly, the lack of a common language and the need for cultural sensitivity.
These must be considerations when approaching such a situation.
As healthcare givers we will increasingly be exposed to such a population, be it for physical or psychological care. This case report brings together the importance of looking at the entire experience the patients has had prior to the meeting: pre immigration, the process of immigrating, post immigration and integration in the new country. Trauma, psychological and physical, often do occur in all three of these stages.
McQuaide and all presented the limitations of using only one diagnostic tool in order to evaluate this patient. Many of these patient’s are complex and do not fit in some of our developed country guidelines. One of the take home messages here is taking in the breadth of the human experience and being in front of us, not limiting ourselves to one or two tools. One must reach out and incorporate what is needed to diagnose and treat complex ills.
Furthermore understanding triggers, that the patient as is expressed here, has lost trust in the healthcare givers in their home countries, as the personnel serves as an extension of the government informants. How do we rebuild that trust?
This case report is of profound importance for the way in which it is so personal and applicable to so many physicians around the world who work with this population.
Chloe Pinto M.D.