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Dr. Martina Scholtens Photo: Alex Walls/UBC

Refugee clinic doctor reveals our bumpy relationship with newcomers

In this interview, Dr. Martina Scholtens explores her 10 years at a Vancouver refugee clinic and her recent book, "Your Heart Is the Size of Your Fist."

By Pieta Woolley

Q You’re a physician. Why are you compelled to write?

A For the last decade, I’ve been writing regularly for my own benefit, my own pleasure and my own sanity. At the refugee clinic, so much that was moving or perplexing happened, and I didn’t want to forget it. So I’d take 10 or 15 minutes at the end of each day and write what had been memorable. I never thought I’d ever do anything with it. I just wrote to memorialize the patient and my own experience.

I was both horrified and fascinated by the passage where you describe, with compassion, your examination of a Chinese refugee for evidence of torture, to help assess his refugee claim. You report that your friends and acquaintances often want to hear the grisly details of your work.

To be honest, when I first started at the clinic, the first few times I heard these stories, I was fascinated by them. Voyeuristic, even. I couldn’t believe the details and the plot. That was my initial reaction. That passed quickly. Now, when people at dinner parties want to hear these awful stories, I get it, but it enrages me. It’s so upsetting to me. I don’t fault them for it. It’s their own naiveté that allows them to ask a question like that.

Q In the book, you’re careful to exclude details that would feed that voyeurism. Why are Canadians so interested in foreign gore?

A I think it’s because we’re fortunate — it’s removed from us, so we have the luxury of being titillated by it. I’ve met thousands of refugees who have told me in detail unimaginably gory things that happened to them, showed me pictures, told me stories I’ll never forget. So for me now, gore is not an abstract idea. I think of my patients.

Q Is there one who stands out for you?

I sent a patient to a lab for blood work around Halloween. As seasonal decorations, the staff had put all these plastic bloody handprints on the windows. The patient came back so stressed. He didn’t understand how someone could think it was funny. He had actually seen bloody handprints in his own home, and it meant that something horrible had happened to someone he loved.

Q I loved your story about the Vancouver family who rented a small apartment over their garage to a refugee family but were outraged when the newcomers asked if the host’s son could stop dunking basketballs against the side of the garage in the evening when they were putting the baby to bed. Because asking that seemed like they were ungrateful. What drives this kind of reaction?

A It came up so often that a refugee would do something the helpers didn’t think was appropriate — for a refugee. In the book, one newly arrived family didn’t want to buy their clothes second-hand, and their sponsors were annoyed by that. It’s the “beggars can’t be choosers” mentality. Or someone will give refugees a great deal on renting their basement suite, but they’re taken aback if the refugees advocate for tenant rights. It’s human nature — there’s an attraction to people being beholden to us.

Q In your book, you call out the “helpers” — those who dive in to help refugees, but the helping often comes with some ugly behaviours and expectations.

A When the helpers expect the helped to have a permanent attitude of gratitude, that’s a problem. I did mention the problematic helper dynamic in a workshop once with lots of church sponsors — and I felt quite bad for doing it! I was genuinely moved by how many people wanted to help the Syrians, and I didn’t want to dismiss that or be critical. I was surprised: it was the most well-received part of the whole presentation. They were really into the group discussion. There’s so much benefit in even having the helper-helped dynamic brought to your attention.

Q What’s been useful to you, in sorting out the helper role?

A I’ve been really wary of the accolades, of people being impressed by my working in refugee health. It’s not altruistic. There are all kinds of practical reasons why I did it. I was really aware of the benefits I was getting. So it’s not that I was giving to the refugees and not taking anything myself.

Q Something I admired in your book is your brave chapter about racism, including your own. You describe your shock at yourself for feeling invaded when an Iranian-Canadian neighbour moved into Deep Cove, your white, wealthy neighbourbood in North Vancouver. Why did you decide to include this story?

A I’m a medical practitioner working with refugees, so you’d think I’d be the least racist person out there. I tried to be truthful by telling this story, and I know I made myself vulnerable by including it. I think we like to have these ideas about ourselves and who we are, but when we have a gut reaction, it’s telling. I had this experience, and it was shocking to me. I spent so much time teasing it out. One thing I’ve learned over the years with writing is that if I share an uncomfortable experience, I’ll find I’m not the only one. I don’t mind embarrassing myself. When I had that reaction and then I had all that reflection around it, I think it was valuable.

Q Since you wrote this book, the clinic has shut down. The government funding ended. What’s been lost in the closure?

A It was the only refugee clinic in British Columbia. If I wanted to see refugees again, I’d barely be able to eke out a living because physicians are usually paid on a “fee for service” basis. For an adult, you get $31 per visit, whether they have one problem or 10, if they’re English language learners or fluent. The fee structure doesn’t reflect the complexity of the patient. That’s why we had the refugee clinic. I was paid for 3.5 hours whether I saw three patients or 25. It allowed me to take the time I needed with patients.

Q What is a helpful thing that people can do to promote greater support for refugees?

A One thing I saw so often in patients was loneliness. It’s heartbreaking. I wish the general public realized the huge power of just reaching out in small ways to people who are new to Canada in spite of the cultural barriers and the language barriers.

This interview has been edited and condensed.

Author's photo
Pieta Woolley is a writer in Powell River, B.C.
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