Alumni profile: Cynthia Willard
Treating the tortured
An alum launches a clinic for torture survivors in (of all places) Utah
By KATHARINE MILLER
Cynthia Willard, MD, cares for patients who’ve been beaten with
bats and whips, raped with foreign objects, suspended by their wrists
or ankles, burned with hot cigarettes or irons and shocked with electric
probes. Their heads have been submerged in blood or excrement, and the
soles of their feet have been beaten. They have chronic headaches, pelvic
pain, torn ligaments, post-traumatic stress disorder and an inability
to trust.
With such clientele, you’d expect to hear that Willard, class of
1994, works in Kosovo or Rwanda, but the clinic she started in 2003, the
Utah Health and Human Rights Project, is located in Salt Lake City. More
than 30,000 refugees settled in the Salt Lake Valley in the last 10 years,
and about 30 percent are likely torture survivors, says Willard.
“This isn’t a shady, marginalized thing that happens only
to political activists,” she says. “The problem is widespread,
and it happens to ordinary people — bakers, candy-factory workers,
dentists, stay-at-home moms, short-order cooks and silver miners.”
Starting a clinic for torture survivors is a daunting task, says Willard’s
medical school classmate Erika Schillinger, MD, ’94, now a clinical
assistant professor of family medicine at Stanford. “But it’s
not at all surprising that Cindy did it. It’s just the sort of thing
she would do. Issues of social justice have been important to her for
a long time.”
Still, Willard says, “Opening this clinic is not necessarily where
I saw my career going.” She had cared for refugees in Kenya and
Kosovo and had expected to work with underserved populations overseas.
Getting domestic
But when she married a U.S.-bound academic who took a job in Salt Lake
City, she put on hold her plans for international medical work and resigned
herself to a traditional family practice. Then, much to her surprise,
Willard started seeing refugee patients come through her office. A light
went on: perhaps here was an opportunity to pursue the dream of international
human rights work without leaving home.
Willard decided she wanted to create an organization that would not only
treat torture survivors but also teach Utah’s health-care providers
to care for such refugees.
During the next year (her husband’s sabbatical), Willard armed
herself with the skills she’d need to create such an organization
by getting her master’s of public health at UC-Berkeley. She then
began planning the project with a two-year grant from Echoing Green Foundation,
an organization that provides start-up funds for ventures promoting social
change. She developed an advisory board, created a budget, rented a space
and prepared a work plan. “For a long time it was a one-person operation,”
she says. But gradually she recruited supporters and volunteers.
Willard knew that it wouldn’t be enough to hang up a sign. Indeed,
when the clinic opened in 2003, one of her first goals was to generate
interest among the physicians who care for the refugee population. “There
is very little awareness in the medical community that torture is an issue,”
she says. So she began educating local health-care professionals about
the prevalence of torture survivors in Utah and how best to handle these
patients’ medical needs. As a result, the clinic staff today can
evaluate refugees’ medical, mental health and social needs, and
then refer them to medical professionals they’ve trained.
Willard last summer left Utah for Irvine, Calif., but she still spends
about 30 hours a week helping the clinic there. The organization is going
strong — it recently received a $150,000 grant from the federal
government.
The problem is certainly not unique to Utah, and Willard believes that
physicians everywhere should have baseline knowledge about torture: “Know
this is an issue with specific health consequences, and then ask about
it.” Torture survivors won’t volunteer information because
their stories are usually horrific, embarrassing and unbelievable, she
says. But a series of simple questions, asked with empathy, can lead to
explanations for a wide range of physical and emotional symptoms.
During a client interview, Willard first makes it clear that she knows
of abuse by the police and military in the refugee’s home country.
“That way they’ll see that I won’t be freaked out when
they describe what they’ve been through,” she says. Willard
recommends going through a list of questions, but the wording isn’t
important as long as the questions are asked with sympathy, she says.
“I understand you’re a refugee,” she’ll say.
“I understand you’ve been through a war.” And then she
goes through a list of non-threatening questions. “I’ll ask:
‘Have you ever been imprisoned? Were you ever in a concentration
camp? Have you lost any immediate family members? Have you ever been abused
or beaten by military and police? Have you been deprived of food or shelter?’
These are reasonable questions to ask.”
Healing words
Knowing about a patient’s torture experiences allows her to help
patients more fully, says Willard. One patient complained of chronic headaches,
yet his CT scan was normal. When he told Willard he had suffered repeated
beatings while in a Serbian concentration camp, she could reassure him
that he had not been permanently damaged and successfully treat him for
post-trauma chronic pain.
A female patient feared breast cancer because one breast drooped. Her
mammogram was normal, but Willard learned that she had been tied to a
tree by Serbian militants and beaten over her breast. The patient was
certain the soldiers had brought on breast cancer. Willard could explain
that her breast drooped because the soldiers had damaged her connective
tissue — not because she had cancer.
Torture survivors also suffer a unique kind of psychological trauma.
Willard defines torture as the deliberate, systematic infliction of physical
and/or mental pain on an individual or group by an agent of a state. “It’s
different from war trauma,” she says. “It has that added personal
note.” Survivors often lose their ability to trust others —
even their own family members. Treating torture survivors means helping
them learn to trust again. And that starts with developing trust between
the patient and the doctor.
Work with torture survivors takes its toll on physicians, says Willard.
“It’s very painful to hear these stories,” she says.
That’s one reason her clinic makes referrals to a network of volunteers,
each of whom handles, at most, four to five clients.
Willard admits the work has changed her in some ways. “I like to
think people are kind and gentle and good, but I’m not sure I really
believe that anymore.” And she’s upset by the U.S. government’s
complacency, she says. “When I see things occur like the abuses
at Abu Ghraib, or when I hear the White House talk about the Geneva Conventions
as ‘quaint and obsolete,’ it makes me feel cynical.”
Still, the work is gratifying, says Willard. In almost every case, clients
get better — they become less socially isolated and enjoy their
families more. A Bosnian woman who had been repeatedly raped and lost
an eye was having a hard time relating to her own children. “She
has blossomed,” says Willard. She got a part-time job, gets her
hair done and comes to the clinic with cakes for everyone. And she has
opened up more to her children. “Small victories like that are very
rewarding,” says Willard. “We get to see these incredibly
damaged people evolve into happier, more fulfilled people.”
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