I talk and teach a lot about “trauma-informed care”. Trauma-informed care basically means care (provided by anyone) informed by the knowledge of the science of what trauma does to the brain and body as well as the nuances of what this might look like emotionally and socially. This approach shifts away from the question of “What’s wrong with this person?” to a more holistic view of “What happened to this person?” A trauma-informed approach is the foundation on which to begin a healing and recovery process.
What does it mean to have a trauma-informed approach as a health care professional? I always give suggestions for what this can look like for others, but allow me to share examples of what this looks like in the work that I do.
“When we can see the image of God where we don’t want to see the image of God, then we see with eyes not our own.” Richard Rohr
During clinical encounters, I am aware that each patient I treat carries more pain than I may ever know and that each patient has built up thick walls of protection not only to guard against more hurt but also to keep the pain from erupting into uncontrollable emotion. I pray constantly and am acutely aware, even subconsciously, of ways I might connect with patients during such a brief encounter that lets them know that they are valued and that there are people who care about them. This takes intentionality and concentration.
When I’m treating a Thai women at an outreach center, I sit on a stool next to the couch and hold a clipboard so that I can be on her level. When an African woman is sitting on a mat on the floor of a day-school I get off of my chair and sit next to her to ask her medical history.
Sometimes I have to go out and look for a particular woman who is so traumatized by coming to the place of the clinic that I have to meet her on the street or accompany her back to the place and be with her as she processes through the acute hurt.
Going on outreach with organizations and getting on the ground into the nitty-gritty world of the sex trade gives me insight into their dark world. Going out to meet them on their starts to break down barriers to good health care – some trust is build up and they are more willing to accept help.
Trauma-Informed care is:
• Being very patient during clinical encounters. Some patients will dissociate during the encounter, others are high or drunk.
• Accepting them for who they are right then and there and receiving what they are offering of themselves to me at that moment.
• Taking extra time with a patient to listen to whatever they want to share with me – and it can be all sorts of things! I also take time to introduce myself, to explain what will happen during the encounter, and to make sure they understand about any test I do (especially an HIV test).
• Not showing disappointment or getting angry when they return to the street.
• Taking their health seriously and exploring new ways of health and taking care of themselves. For example, access to better contraception, or even start using contraception.
• Acknowledging the chronic pain some of them feel: “I wish that I could do more to relieve your pain.”
• Being open and friendly with the gregarious transgender woman, but knowing when to look her in the eyes and ask serious questions about her health.
Being trauma-informed also means that I’m in touch with my own vulnerabilities and hurts. I must grieve my own losses, but I also must allow myself to grieve the pain and losses experienced by my patients. I need to be aware of my vulnerability to secondary trauma and taking good self-care measures to prevent/mitigate it. I let my heart be broken for the people I serve, and deal with my broken heart appropriately so that my care for others is well-balanced and empathic. Someone once told me, “God is breaking your heart so that he can enlarge it.” I pray that this is true!
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