War Serves as Training Ground for Psychiatrist

By Amer Smajkic, MD

Twelve people sat in the large living room. They gathered on the floor around a few oil lamps. A doctor was checking their blood pressure, talking about what I know now to be immunization, sanitation, food preparation and storage, preventive medicine and healthy living. My father — a physician and professor of public health in Bosnia and Herzegovina — was doing his work. He was educating people and giving the villagers lifesaving information they lacked, as they had also lacked electricity and indoor plumbing. Some of them had not seen a physician more than once or twice in their lives.

I often think of experiences like these when I think of my early exposure to medicine and caretaking. My father’s dedication was demonstrated by a meticulous attention to careful listening and understanding his patients. This was my guiding example. I decided to study medicine because of these experiences.

After graduation, I began work as a general practitioner and continued research and teaching activities in pharmacology. Then the war in Bosnia and Herzegovina began. There was war in my country, in my city and in my clinic. I was assigned to a vascular surgery residency program to serve my country. My first day in the surgery clinic was in the middle of a battle. I treated people on the front line, in the hospital, assisting in hundreds of surgical procedures — how many I cannot remember — while in constant risk of death by bullets, bombs, hunger or thirst.

For months, we sewed vessels, reconstructed arteries and saved lives, often by candlelight, with no electricity or water. War conditions at least tripled the number of patients needing care. I did not have time to be tired and lived my life between the operating room and patients’ rooms. During this time I learned how satisfying it was to treat people with war injuries. Importantly, I learned that healing comes not only from surgeries, but also from long conversations with patients during many nights listening together to explosions in our city. Healing requires care, sensitivity, warmth and understanding of injured patients’ feelings.

Working under these conditions was exhausting and enormously stressful. My work not only deprived me of basic needs such as sleep and nourishment, but also of a sense of safety. I lived with the constant fear of being killed. To rescue myself from further deterioration and to save my life, I decided to leave.

I arrived in Chicago as a refugee of war sponsored by St. Luke’s Episcopal Church in March 1994. In the beginning, I simply had to survive. Rather than enduring war, I was trying to live through its consequences. I arrived the day after a group of nine severely wounded people also came to Chicago from Sarajevo. Under the auspices of the church, I volunteered to translate for the injured. For the first few months, I also helped them and their families establish themselves in Chicago, drove them to medical appointments, assisted with advice and emotional and social support. I found work at odd jobs, unloading trucks or painting houses, in order to survive.

In June of 1994, I turned my outreach work into a profession by becoming the first mental health counselor in a newly formed Refugee Mental Health program for Bosnians. Again, I found myself in the familiar professional role of healer. However, this time I was not working with surgical instruments. My work was listening to, talking with, and supporting my clients.

Since then, I have been fortunate to be able to create a unique professional setting for myself that has eventually led me on a path to rejoin the medical profession. At last, my work as a mental health counselor and my research and educational activities have begun to fit together with my family background, war and life experience, and personal talent. I evolved a profound natural commitment to practice as a psychiatrist and child psychiatrist dedicated to researching the effects of violence and healing, understanding and treating survivors, and educating fellow professionals.

Amer Smajkic, MD, is a psychiatrist at Rush University Medical Center.

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