The man from Somalia sat nervously in an examining room at Hennepin County Medical Center, gingerly brushing his fingertips against the left side of his head.
"You're having surgery to remove shrapnel from your skull," Dr. Steven Hillson told him, pausing to let a Somali interpreter dressed in a black head scarf and a floor-length skirt translate.
The patient, Abdulqadir Jiirow, 31, nodded and explained that the shrapnel had been there since 1991, when he was 14 and civil war broke out in Somalia and an artillery shell smashed into his home. It had not bothered him much until recently, when he began to work at a meat-packing plant and the helmet and goggles needed for the job pressed on it painfully.
Mr. Jiirow said he worked in a small town several hours away and shared an apartment with other Somalis, while his wife and child lived in Minneapolis. He saw them on weekends.
"It's still astonishing," the doctor, shaking his head, said after Mr. Jiirow left. " 'Someone sent artillery into my home.' But it's common."
Hennepin County Medical Center, a sprawling complex in downtown Minneapolis near the Metrodome, offers an extraordinary vantage point on the ways immigrants are testing the American medical establishment. The new arrivals — many fleeing repression, war, genocide or grinding poverty — bring distinctive patterns of illness and injury and cultural beliefs about life, death, sickness and health.
In a city where Swedes and Norwegians once had separate hospitals, Hennepin spends $3 million a year on interpreters fluent in 50 languages to communicate effectively with its foreign-born patients.
Many arrive with health problems seldom seen in this country — vitamin deficiencies, intestinal parasites and infectious diseases like tuberculosis, for instance — and unusually high levels of emotional trauma and stress. Over time, as they pick up Western habits, some develop Western ailments, too, like obesity, diabetes and heart disease, and yet they often question the unfamiliar lifelong treatments these chronic diseases need.
Some also resist conventional medical wisdom or practices, forcing change on the hospital. The objections of Somali women to having babies delivered by male doctors has led Hennepin, gradually, to develop an obstetrical staff made up almost entirely of women.
Doctors here say that for many of these newcomers, the most common health problems, and the hardest to treat, lie at the blurry line between body and mind, where emotional scars from troubled pasts may surface as physical illness, pain and depression.
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