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.

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