Skip to main content

“Bleeding Too Much” (In the Words of a Refugee)

  • Chapter
  • First Online:
  • 564 Accesses

Abstract

In this chapter, we will explore a case involving a refugee with irregular menses who experienced significant trauma before resettling in the United States. In addition to addressing a trauma-informed approach to healthcare, the case explores some of the challenges that new Americans may face during the resettlement process, including access to healthcare, communication, and social support. At the conclusion of the case discussion, learners will be able to recognize the complexity of the process refugees face when leaving their home country, identify health issues that refugees may experience, and develop strategies to overcome barriers to communication in a clinical setting.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. World Health Organization. Female genital mutilation [Internet]. Geneva: WHO; 2018 Jan 31 [cited 2018 Jul 5]. Available from: http://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation.

  2. United Nations Office on Drugs and Crime. Human trafficking [Internet]. Vienna: UNODC [cited 2018 5 Jul]. Available from: https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html.

  3. Ubuntu! Myths about sexual assault- rape myths [Internet]. Durham (NC). [cited 2018 Jul 5]. Available from: https://iambecauseweare.wordpress.com/myths-about-sexual-assault-rape-myths/.

  4. Mobini S. Psychology of medically unexplained symptoms: a practical review. Cogent Psychol. 2015;2:1.

    Article  Google Scholar 

  5. Page L, Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. J R Soc Med. 2003;96(5):223–7.

    Article  CAS  Google Scholar 

  6. The UN Refugee Agency. What is a refugee? [Internet]. Geneva: UNHCR [cited 2018 Jul 6]. Available from: https://www.unrefugees.org/refugee-facts/what-is-a-refugee/.

  7. United Nations Migrants and Refugees. Definitions [Internet]. UN. [cited 2018 Jul 6]. Available from: https://refugeesmigrants.un.org/definitions.

  8. The UN Refugee Agency. Figures at a glance [Internet]. Geneva: UNHCR. [cited 2018 Jul 6]. Available from: http://www.unhcr.org/en-us/figures-at-a-glance.html.

  9. Human Rights Watch. Rohingya crisis [Internet]. New York: Human Rights Watch. [cited 2018 Jul 10]. Available from: https://www.hrw.org/tag/rohingya-crisis.

  10. The UN Refugee Agency. Rohingya emergency [Internet]. Geneva: UNHCR. [cited 2018 Jul 10]. Available from: http://www.unhcr.org/en-us/rohingya-emergency.html.

  11. US Department of State Refugee Processing Center. Admissions and arrivals. Historical arrivals broken down by region (1975 – present) [Internet]. Arlington (VA): RPC. [cited 2018 Jul 12]. Available from: http://www.wrapsnet.org/admissions-and-arrivals/.

  12. Krogstad JM, Radford J. Key facts about refugees to the U.S. Pew Research Center, Facttank [Internet]. Washington, D.C.: Pew Research Center; 2017 Jan 30 [cited 2018 Jul 12]. Available from: http://www.pewresearch.org/fact-tank/2017/01/30/key-facts-about-refugees-to-the-u-s/.

  13. United Nations High Commissioner for Refugees. Statistical yearbook 2016. Table 26: indicators of host country capacity and contributions. Geneva: UNHCR; 2016 [cited 2018 July 30]. Available from: http://www.unhcr.org/en-us/statistics/country/5a8ee0387/unhcr-statistical-yearbook-2016-16th-edition.html.

  14. International Organization of Migration. About IOM [Internet]. Le Grand-Saconnex: IOM. [cited 2018 Jul 12]. Available from: https://www.iom.int/about-iom.

  15. US Department of Health and Human Services, Administration for Children and Families. Office of Refugee Resettlement. Washington, D.C.: ACF. [cited 12 Jul 2018]. Available from: https://www.acf.hhs.gov/office-of-refugee-resettlement.

  16. The UN Refugee Agency. US resettlement agencies [Internet]. Geneva: UNHCR. [cited 2018 Jul 6]. Available from: http://www.unhcr.org/en-us/us-resettlement-agencies.html.

  17. World Health Organization. Migration and health: key issues [Internet]. Geneva: WHO. [cited 2018 Jul 12]. Available from: http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/migrant-health-in-the-european-region/migration-and-health-key-issues.

  18. McNeely CA, Morland L. The health of the newest Americans: how US public health systems can support Syrian refugees. Am J Public Health. 2016;106(1):13–5.

    Article  Google Scholar 

  19. US Department of Health and Human Services, Administration for Children and Families. Office of Refugee Resettlement. Refugee health [Internet]. Washington, D.C.: ACF. [cited 2018 Jul 12]. Available from: https://www.acf.hhs.gov/orr/programs/refugee-health.

  20. Giacco D, Priebe S. WHO Europe Policy brief on migration and health: mental health care for refugees. Geneva: World Health Organization. [cited 2018 Jul 15] Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/293271/Policy-Brief-Migration-Health-Mental-Health-Care-Refugees.pdf.

  21. Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC. Healthcare barriers of refugees post-resettlement. J Community Health. 2009;34(6):529–38.

    Article  Google Scholar 

  22. Centers for Disease Control and Prevention. Refugee health guidance [Internet]. Atlanta (GA): CDC. [cited 2018 Jul 15]. Available from: https://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html.

  23. The UN Refugee Agency. Sexual and gender-based violence [Internet]. Geneva: UNHCR. [cited 2018 Jul 12]. Available from: http://www.unhcr.org/en-us/sexual-and-gender-based-violence.html.

  24. The US Agency for International Development. Preventing and responding to gender-based violence. [Internet]. Washington, D.C.: USAID. [cited 2018 Jul 12]. Available from: https://www.usaid.gov/gbv.

  25. United Nations Women. Facts and figures: ending violence against women [Internet]. New York: UN Women [cited 2018 Jul 15]. Available from: http://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures.

  26. United Nations Population Fund. FGM dashboard [Internet]. New York: UNFPA. [cited 2018 Jul 17]. Available from: https://www.unfpa.org/data/dashboard/fgm.

  27. Smith SG, Zhang X, Basile KC, Merrick MT, Wang J, Kresnow, et al. National intimate partner and sexual violence survey: data brief [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2014 Nov [cited 2018 Jul 17]. Available from: https://www.cdc.gov/violenceprevention/pdf/2015-data-brief.pdf.

  28. Centers for Disease Control and Prevention. ACEs definitions. Data and statistics. [Internet]. Atlanta (GA): CDC; 2016 Jun [cited 2018 Jul 5]. Available from: https://www.cdc.gov/violenceprevention/acestudy/about.html.

  29. Felitti V. Adverse childhood experiences and adult health. Acad Pediatr. 2009;9:131–2.

    Article  Google Scholar 

  30. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–58.

    Article  CAS  Google Scholar 

  31. Centers for Disease Control and Prevention. Adverse childhood experiences (ACEs) [Internet]. Atlanta (GA): CDC; 2016 [cited 2018 Aug 22]. Available from: https://www.cdc.gov/violenceprevention/acestudy/index.html.

  32. Substance Abuse and Mental Health Services Administration. Trauma informed approach and trauma specific interventions [Internet]. Rockville (MD): SAMHSA. [cited 2018 Jul 17]. Available from: https://www.samhsa.gov/nctic/trauma-interventions.

  33. Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J, Holland A, St. Clair J, SooHoo J. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202–9.

    Article  Google Scholar 

  34. Kirmayer L, Narasiah L, Munoz M, Rashid M, Ryder A, Guzder J, Hassan G, Rousseau C, Pottie K. Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ. 2011;183(12):E959–67.

    Article  Google Scholar 

  35. Centers for Medicare & Medicaid Services. Strategic language access plan (lap) to improve access to CMS federally conducted activities by persons with limited English proficiency (lep). Baltimore (MD): CMS; 2014 Feb 28 [cited 2018 Jul 15]. Available from: https://www.cms.gov/About-CMS/Agency-Information/OEOCRInfo/Downloads/StrategicLanguageAccessPlan.pdf.

  36. Figley CR. Compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Routledge; 2013.

    Book  Google Scholar 

  37. Ansari A. Battling biases with the 5 Rs of cultural humility. The Hospitalist [Internet]. Philadelphia (PA); 2017 [cited 2018 Jul 12]. Available from: https://www.the-hospitalist.org/hospitalist/article/136529/leadership-training/battling-biases-5-rs-cultural-humility.

  38. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25.

    Article  CAS  Google Scholar 

  39. Fadiman A. The spirit catches you and you fall down: a Hmong child, her American doctors and the collision165413 of two cultures. New York: Farrar, Straus and Giroux; 1997.

    Google Scholar 

  40. Centers for Medicare & Medicaid Services. Accountable Health Communities Model [Internet]. Baltimore (MD): CMS. [cited 2018 Jul 12]. Available from: https://innovation.cms.gov/initiatives/ahcm/.

  41. Cruess RL, Cruess SR. Expectations and obligations: professionalism and medicine's social contract with society. Perspect Biol Med. 2008;51(4):579–98.

    Article  Google Scholar 

  42. Cruess SR, Cruess RL. Professionalism and medicine's social contract with society. Virtual Mentor. 2004;6(4):185–88.

    Google Scholar 

Further Reading on This Topic

  • Beah I. A long way gone: memoirs of a boy soldier. New York: Sarah Crichton Books; 2007.

    Google Scholar 

  • Korn F, Eichhorst S. Born in the big rains: a memoir of Somalia and survival. New York: The Feminist Press at CUNY; 2008.

    Google Scholar 

  • Mire S. The girl with three legs: a memoir. Chicago (IL): Lawrence Hill Books; 2011.

    Google Scholar 

  • Rawlence B. City of thorns: nine lives in the world’s largest refugee camp. New York: Picador; 2016.

    Google Scholar 

  • Wamariya C, Weil E. The girl who smiled beads: a story of war and what comes after. New York: Crown Publishing Group; 2018.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrea V. Shaw .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shaw, A.V. (2019). “Bleeding Too Much” (In the Words of a Refugee). In: Caruso Brown, A., Hobart, T., Morrow, C. (eds) Bioethics, Public Health, and the Social Sciences for the Medical Professions. Springer, Cham. https://doi.org/10.1007/978-3-030-03544-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-03544-0_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03543-3

  • Online ISBN: 978-3-030-03544-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics