Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
When I was a second-year family medicine resident at Georgetown University an encounter with a young man from Rwanda changed my professional life forever.
The man had faced a horrific journey. In escaping the Rwandan genocide, he had walked across several African countries, been recruited as a child soldier, stowed away aboard a ship to Latin America, found his way to Mexico, and finally made it across the U.S.-Mexico border to safety and the prospects of a new life.
I had volunteered, under the supervision of a faculty advisor, to perform a forensic medical evaluation, usually an hours-long encounter to assess an asylum-seeker’s claims of torture, ill treatment, or other form of persecution. Much of the process was oral — a history — as we slowly guided him to reveal his story in excruciating detail. There was a physical component too as we assessed and documented the scars he bore. Some of his scars, we noted, were psychological.
Although this encounter happened nearly 15 years ago, I still think about this man. I was aware that our assessment and report could help change his life. What I didn’t know was that it would change mine as well.
There, in that exam room, my two worlds merged: once a journalist covering war and conflict, now a physician in training, I realized that some of the people I had covered as a journalist, I could now help in much more direct ways.
I had volunteered, under the supervision of a faculty advisor, to perform a forensic medical examination, usually an hours-long encounter to assess an asylum-seeker’s claims of torture, ill treatment, or other form of persecution.
Eventually, I moved from student to teacher, and I have now trained hundreds of medical professionals on four continents in this practice through Physicians for Human Rights (PHR), one of the main organizations that works on asylum issues, and on my own. I always highlight its potential impact. Research shows that a medical evaluation more than doubles the odds of a person being granted asylum.
In the process, I have come to believe in the tremendous value for medical students and residents of involvement in these evaluations.
Certainly, the need for this service is great. In 2018, the United States received 254,300 new applications from asylum-seekers, and tens of thousands of others have been waiting years to have their asylum requests reviewed. The current migrant crisis at the U.S.-Mexico border has highlighted the enormous medical and legal needs of asylum-seekers. It has also inspired involvement from health professionals who may have been unaware of these issues previously.
Although more needs to be done, the medical community is stepping up. PHR now has grown its asylum network to more than 1,500 health professionals. In addition, we have seen a significant growth in the number of pro bono asylum programs established at medical schools in recent years. The number of student-led programs that PHR has helped establish has grown from 6 to nearly 20. At Georgetown University School of Medicine’s student-run asylum program, for example, we have trained hundreds of clinicians, residents, and medical students in the past five years.
Our family medicine residents are required to complete at least one supervised asylum evaluation during their training. Many find the experience so meaningful that they ask to do more.
Why involve residents and medical students? Beyond expanding the much-needed future pool of asylum evaluators, these assessments offer incredible educational opportunities.
As my co-authors and I argued in a recent article, participation is an experiential way to learn about human rights principles and the links between human rights violations and health. Participants get the opportunity to hone their physical examination skills, particularly the skin exam, and to engage in cross-cultural communication. They also participate in interprofessional education with behavioral health and legal professionals and develop leadership, patient advocacy, and operations management skills.
Students play many key roles in our program, including scheduling sessions and helping write affidavits. They also organize our trainings for health professionals — daylong events that focus on how to use clinical and medical expertise to assess claims of torture and ill treatment and document findings in a systematic way. In addition, in my department, our family medicine residents are required to complete at least one supervised asylum evaluation during their training. Many find the experience so meaningful that they ask to do more.
Our trainees are not alone in finding this service meaningful. In a 2015 survey we found that clinicians’ experiences performing these evaluations were overwhelmingly positive. As one participant wrote, “I am humbled and grateful to people who put themselves in my hands. I am privileged to meet these brave people who are trying to find a better life against great odds. I cannot imagine doing what they do.”
As one participant wrote, 'I am humbled and grateful to people who put themselves in my hands. I am privileged to meet these brave people who are trying to find a better life against great odds.'
Of course, hearing stories of terrible trauma can be difficult. But more than anything, students and residents benefit from these experiences because asylum-seekers’ stories are about the strength of the human spirit. I’ve seen it time and again.
I remember that from my own first encounter with that young man years ago. Retelling what happened was painful for him. Hearing what happened was tough for us. But it was also uplifting. His courage, his resilience, his hopefulness despite the great trauma he had suffered were incredibly inspiring. And the moment we learned that his application was granted was profoundly satisfying. Now in his mid-30s, I hope he is doing well out there and enjoying life in America.
Ranit Mishori, MD, MHS, is professor of family medicine at the Georgetown University School of Medicine and the faculty leader of Georgetown’s Asylum Clinic. She is also senior medical advisor at Physicians for Human Rights.