This case study looks at a community-based presentation for a refugee with post-traumatic stress…

This case study looks at a community-based presentation for a refugee with post-traumatic stress
Jamilla is a 32-year-old woman who has presented to a community health clinic with her husband. You have
seen her before, several months ago. She speaks good English and an interpreter is not required and her
husband is happy to wait in the waiting room… She appears to be anxious and withdrawn and she reports
that she has not been able to sleep for the past 3 months. However, she also states that she is constantly
fatigued, irritable and finds it difficult to get out of bed. You take a set of observations: Temp: 37.5 OC, Pulse:
113 bpm, BP 140/90, RR: 21. Her height is 155cm and her weight is 77gs (an increase of 5kg from 4 months
ago). Her BMI is 32.
Jamilla is dressed modestly in a long black dress and a grey head scarf. She is clean and tidy and wears no
makeup or jewellery. She has clear olive skin but looks like she is mid 40s in age. She is sitting still and
quietly with her hands in her lap and looking downcast. She is responsive and her speech is normal rate. She
gets teary talking about the past, and situations which are currently difficult. She makes appropriate eye
contact and she is oriented to time and place.
Jamilla was born in Afghanistan. Her parents were farmers and she grew up in a rural area. She was exposed
to violence and conflict from a very young age. There were even times when she was a girl and there was not
enough food to eat. During the conflicts, several of her family members have been killed, and some have
disappeared. She married when she was 16 years old, had her first child (Mohammad) when she was 17,
and a second child (Mahir) when she was 19; both boys. She fled Afghanistan with her husband and children
seven years ago due to increasing violence, and they ended up in a refugee camp in Pakistan where they
stayed for four years. The camp was very crowded and dirty, and she never felt that her family was safe. She
and her family eventually settled in Australia three years ago and now have permanent residency.
Jamilla states that she is finding it difficult to cope. Since arriving in Australia her husband has not been able
to find a job; he has stopped looking for work and spends most of his days at home. She reports that their
relationship can be difficult because he is always home, and he gets in the way of her housework and her
cooking. She is worried about the type of life she can provide for her children as they live in a small 2-
bedroom unit which faces a busy road, and they have difficulties paying the bills. She is unhappy with her
living arrangements as her two sons do not have any room for study.
She wants to save some money just in case of an emergency and to help with her children’s education. She
does not know how to get a job or what she could do because she didn’t have any formal education. She
practices her English by watching English speaking television shows, and by practicing with her sons.
Jamilla smiles when she talks about her children and states that they were the reason they left Afghanistan
in the first place – back home there was too much violence and poverty. When the boys were young, they
were easy to control, but now they are older, 15 and 13, there is more conflict at home. She would like her
boys to ‘fit-in’ with the Australian way of life but believes the boys do not show enough respect or
appreciation for their Afghan culture. She has no family or friends and feels very isolated. She has tried to
make friends in the past, but she finds it difficult to trust people, and she is shy in social situations. She
attended a refugee women’s group when she first arrived in Australia but the experience triggered painful
memories and she felt guilty for surviving when so many had died, so she stopped going. Her Islamic faith is
important to her, but she has recently stopped praying.
Jamilla worries about the future. She has been having difficulty concentrating, is irritable at times but also
easily startled. She is unable to sleep because she has terrible nightmares about the past, and she will wake
up in a sweaty panic. Lately, there have been times where she has been very fearful about leaving the house,
so her husband and/or her sons accompany her on her errands to provide support.