Dr. Martina Scholtens holding her book “Your Heart is the Size of Your Fist.”

Q&A: Dr. Scholtens on her new book and working with refugees

Bridge Clinic may have closed, but Dr. Martina Scholtens’ new book “Your Heart is the Size of Your Fist” describes her experiences working as a physician there with refugees. The release of the book has already received attention: CBC wrote an article, and local film production company Jenkinson/Goode have optioned the rights, and are working to develop it for the screen.

We sat with Dr. Scholtens for a chat about her book.

VCH News: Why is the title of the book “Your Heart is the Size of Your Fist?”

Dr. Scholtens: It’s anatomically true, and I liked the connotations. A fist is a sign of aggression but it’s also one of strength, and it seemed appropriate as a metaphor for the journey of refugees.

The book follows an Iraqi family during their first year in Canada. The end of the book describes a birthday party for the mother, who’s holding her baby whose fist is curled up next to his face. To me, it was a symbol – I hoped the baby would have the same strength as his parents. That’s what the book is about. It’s not about the awful things people endured. It’s hopeful.

VCH News: Did you see patients on a recurring basis?

Dr. Scholtens: At the clinic, we would see refugees during their first year in Canada. You got to know the families well over the year. You would get to see the entire family. It was really quite fun and rewarding to see people get launched in the first year. The kids would start off knowing virtually no English. Then they’d go to school, and 3-4 months later, they’d have adopted the language and customs. The parents were very keen to work. Lots of them from the beginning were trying to find employment to contribute and support themselves.

(After a year) and once they settled in, we would connect them to a family doctor in their community. It was hard to see them go. Patients would become quite attached as we would often meet them in their first week in the country.

VCH News: Any memorable experiences?

Dr. Scholtens: I did a lot of prenatal care, and “well woman care”: family planning, pap tests, mammography. I would meet with women one-on-one in my office, repeating the same information. Many patients were quiet and deferential when they saw me; they’d nod and agree with everything I said.

One day, I thought, “This is so inefficient. We should tell this information to 20 women at a time.” So the nurse and I organized a women’s health group visit. For our first group visit, we had 12-15 Karen women from Myanmar. They all came in on the bus, and spent the whole morning with us. We provided hot drinks and snacks.

The nurse gave a presentation on family planning, and I talked about pap tests and mammography. It was interesting what happened in this group setting: the women were different. They were engaged, sharing stories. They told us about this bark from a tree in the jungle that had medicinal properties. They told us that at the refugee camp, someone had handed out brightly-coloured condoms, and that they thought the condoms were candy.

In this group setting, the women felt freer to share, discuss, joke. It made me feel like the odd one out, and that I was the guest. It flipped the usual doctor-patient relationship.

After the workshop, we offered pap tests. Every woman wanted it done. Also, later, when I saw these women one-on-one in my office, the interaction was strengthened. I appreciated the opportunity to do things differently.

VCH News: Any advice for staff working with refugees?

The value of humility. I prefer the term cultural humility rather than cultural competence. I was meeting people from other parts of the world about which I knew nothing. There was great value in recognizing my own limitations, and being curious and respectful. A sense of humour is helpful. I made cultural faux-pas, but my patients never held it against me. They were forgiving because they recognized that I came from a place of goodwill.

Dr. Martina Scholtens is a family physician, and a clinical instructor at UBC. She’s also a fourth year public health resident at UBC. She continues to write. Her book “Your Heart is the Size of Your Fist” is available from major book sellers. 

VCH refugee health care services

If you’re interested in learning more about current services that VCH offers, visit the refugee health care services page on VCH.ca.