title: A refugee's perspective on their neurosurgical care in North America.
abstract: BACKGROUND
  There is a growing population of refugees within North America and an increasing awareness of their unique medical requirements. These requirements include both a well-recognized need to understand the different pathologies that can present in these patients as well as the rarely described need to understand their unique perspective and how this can impact their medical care, especially for routine neurosurgical conditions. This paper highlights a refugee's perspective toward the medical system in North America and documents how several aspects of this unique perspective hindered or delayed the care for the management of this patient with a cervical cord tumor.
  
  
  METHODS
  A 34-year-old female Somalian refugee presented with an ependymoma to Vancouver General Hospital 3 days after arriving in North America. The tumor was removed through a standard posterior cervical laminectomy approach. The patient and her care workers were interviewed 6 months postoperatively to determine if any aspects of care were negatively impacted by her refugee status. Problems related to communication, medical history, mistrust of care workers, familial support, and access to follow-up care were recognized and recommendations for improvements provided.
  
  
  CONCLUSIONS
  It is well known that the North American physicians must be familiar with the unique spectrum of medical conditions within the refugee community. This paper highlights that physicians must also be aware that refugees may have a unique perspective on our health care system that can negatively influence their care for even routine neurosurgical conditions.
authors.affiliation: Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Honey
authors.affiliation: Division of Neurosurgery, The University of British Columbia, Vancouver, BC V5Z 4E3, Canada, USA.
authors.forename: Anujan
authors.initials: A
authors.lastname: Poologaindran
authors.affiliation: School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Mayhew
authors.affiliation: Neuroscience Social Work, The University of British Columbia, Vancouver, BC V5Z 4E3, Canada, USA.
authors.forename: Laura Vander
authors.initials: LV
authors.lastname: Steen
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA.
authors.forename: Christopher Charles
authors.initials: CC
authors.lastname: Gillis
keywords: Neurosurgery; refugee care; spinal cord tumor