Asylum seekers get help from physicians

Washington, D.C., internist and geriatrician Katalin Eve Roth, MD, remembers a Burmese woman seeking asylum who cut off her waist-length hair because prison guards had grabbed her hair to hurl her against the wall during beatings.

Horrific accounts from a woman from Sub-Saharan Africa stay with Hope Ferdowsian, MD, MPH, also an internist in Washington, D.C. The African woman was tortured, raped and infected with HIV. After being granted asylum in the United States, she hugged Dr. Ferdowsian on the courthouse steps and whispered, "I'm free. I'm finally free."

Katalin Eve Roth, MD

Dr. Ferdowsian, director of research policy for the Physicians Committee for Responsible Medicine, a Washington, D.C.-based nonprofit organization, said she's "impressed by the level of resilience and forgiveness people demonstrate and their willingness to move on."

Drs. Roth and Ferdowsian devote time each month listening to stories of torture and documenting the scars, poorly healed bones and mutilations. They are among hundreds of physicians, psychologists and social workers throughout the country who volunteer to perform medical evaluations of asylum seekers and draft affidavits of their findings.

"We cannot help everyone, but we can make a difference," said Dr. Roth, an associate professor at George Washington University Medical Center who practices at George Washington University Medical Faculty Associates. She sees asylum seekers at Bread for the City, a nonprofit organization where she is a board member.

The evidence physicians gather often helps convince a judge to grant asylum.

A study published February 2008 in the Journal of Immigrant and Minority Health found that of 746 cases examined, 89% of asylum seekers who received medical evaluations were granted asylum compared with 37.5% who did not receive evaluations. "Medical evaluations may be critical in the adjudications of asylum cases when maltreatment is alleged," researchers concluded.

Satisfying work

Although the stories they hear are wrenching, physicians say such work is gratifying.

Coleen Kivlahan, MD

"I've done lots of things in my 26 years of family medicine, and this is by far the most rewarding. Nothing even comes close," said Coleen Kivlahan, MD, MSPH, chief medical officer of Aetna's Medicaid division.

She works in a small clinic in Herndon, Va., treating immigrant workers who have diabetes, and conducts physical exams for asylum seekers in Arizona detention centers and elsewhere.

"You use your ability to listen, your ability to do a physical exam, your ability to write in a coherent way. And if you do it well, then someone can get citizenship, be safe and not die," Dr. Kivlahan said.

Bread for the City, which provides food, clothes and legal advice to poor and homeless persons in Washington, D.C., started offering exams to asylum seekers in May 2009. Attorneys, who also work for free on the asylum cases, refer clients for evaluation and provide interpreters. The clinic at Bread for the City sees several asylum seekers each month.

"It's hard and sad," said Randi Abramson, MD, medical director of Bread for the City. "It's unbelievable what people can do to other people."

Dr. Abramson was alerted to the need by Physicians for Human Rights, a Cambridge, Mass.-based group that formed an asylum program 18 years ago. The program connects those seeking admittance to the U.S. with health care professionals, and offers training for physicians and others interested in providing the physical exams. HealthRight International has a similar program.

Lawyers sometimes contact the physicians to let them know of their clients' success -- most of the people they help are granted asylum, doctors said.

"Over the years, after doing many evaluations, the spirit of humanity and the ability to survive incredible things is extremely inspiring," Dr. Kivlahan said.

The time required is manageable, doctors said. A physical evaluation requires about two hours and it takes another two or three hours to write the affidavit. Physicians rarely go to court when a case is heard.

"It's a great volunteer opportunity," Dr. Abramson said. "Unlike other primary care or specialty care activities where you do follow-up, this is a one-time thing. After the visit, you go back and forth with the attorney to make sure the paperwork is in order. It's not a long-term commitment."

New York City internist and epidemiologist Mary White, MD, conducts examinations at detention centers, primarily in Elizabeth, N.J. She has done more than 40 evaluations over the last five years.

"The first couple of times I had a little trouble keeping my emotions in check," she said. "You have to learn to keep the medical affidavit clinical. You can't advocate for anything or include opinions."

Some doctors say they receive cards of thanks. Such notes of appreciation help them remember they are making a difference.

"When doctors do an evaluation, the person seeking asylum has a much better chance of getting asylum," Dr. Roth said. "It's personally fulfilling for the physician to be able to help someone so directly."