Detention and Abuse

Asylum and Migration, Persecution of Health Workers, Stopping Torture

Creating the University of Miami Human Rights Clinic

An interview with Natasha Chida.

What inspired the asylum clinic?

A combination of things led us to create our human rights clinic in Miami. I had worked with the Asylum Network on a few projects while serving on the PHR Student Advisory Board during medical school and had been speaking with Jenni Balde (the then Asylum Network Director) about doing a training in Miami in 2009.  We then heard about Albert Einstein´s Human Rights Clinic and thought that a similar project may be needed in Miami (in addition to a one-time training). Miami has a large asylum-seeking population but at that time did not have a group of professionals who were consistently documenting, so the need was great.

At the same time that these things were occurring, Dr. Stephen Symes (program director of Jackson Memorial Hospital´s Internal Medicine Residency and also the director of the J Weiss Residency in Social Medicine and Global Health Equity) had been asked by local legal professionals in Miami to evaluate several immigrants who had been detained and were in need of medical care.  Evaluations were thus being done prior to the creation of the HRC.

At this time (fall of 2009) we began speaking with PHR at the University of Miami Miller School of Medicine about starting a clinic; we essentially formed a coalition of students, residents, and faculty to work on the project.  We then contacted the associated program directors of Albert Einstein’s program and they were kind enough to provide us with information about how the clinic is set up and run, etc.  We then began contacting people in Miami who we thought would like to be involved.

What resources did you need to have?

Support from a key faculty member who was willing to serve as medical director (Dr. Symes), support from key medical school faculty, partnerships with local community organizations who deal with these issues, and a group of faculty, residents, and students who were willing to interview and document.  We also made use of PHR´s sample affidavits and the training packet we received during the Miami Asylum Network Training. Lastly, we contacted other similar clinics in the country and obtained information from them. Dr. Ramin Asgary of the Mt. Sinai School of Medicine was particularly helpful.  Based on all of this information we created the structure [1] (PDF). and algorithm [2] (PDF). of our clinic.

What is the first thing you should do when creating a system to provide evaluations for asylum seekers?

Always research what resources are already available to asylum seekers in your community.  It is always a good idea to keep from replicating activities that already exist. In addition, it is preferable to partner with organizations who are already involved in the work you want to do.  Have a good sense of what your community needs before starting a project (essentially, perform a needs assessment).

How much time did it take to start the clinic?  What is the time commitment now?

In the beginning it probably took about 5 hours per week for a few months.  This mainly involved contacting people, communicating (conference calls), meeting with people, creating documents for the clinic, etc.  Now it really depends on how many evaluations we have.  If there are none, then less than an hour a week on average.  If there are, it is a bit different. Each eval takes at least 8 hours in total (including the interview, examination, and then writing the affidavit later) so the time commitment is variable. This is divided amongst members, however, so it isn´t too bad.

How do asylum seekers find your clinic?

Dr. Symes had already formed good relationships with local community organizations such as the Florida Immigrant Advocacy Coalition and Catholic Charities prior to the creation of the HRC.  Both of these organizations have legal wings that serve asylum seeking clients. These organizations contact Dr. Symes directly to ask for evaluations. In addition, we also had pre-existing connections with PHR, through which we are also referred clients. Lastly, we did some research (via the internet and phone calls) on organizations in the state of Florida who serve asylum seekers; we have contacted them and they will also send us clients in the future.

How do you cover your costs?

At this time we do not have costs, but in the future we may apply for grant funding if necessary.

How do you recruit new MDs and med students?  What skills do they need to have?

The student Chapter of PHR officially runs the clinic. We recruited residents through the J Weiss Residency. Once we have more clients we may open it up to other residents, but for now we are focusing on the Social Medicine Residents. In terms of attendings, we have a group of core faculty. We essentially knew people who would be interested and contacted them personally. UM as a human rights community is pretty close-knit so we already had relationships with people who we knew would be interested.

When we need more attendings in the future we´ll send out emails to other people who we know are interested in these issues but also ask our existing members to contact people directly.  In terms of skills, students and residents need commitment and an interest in this type of work. Attendings need to be able to perform a thorough history and physical/psychological exam.  It isn’t absolutely necessary for students/residents/attendings to have attended a PHR Asylum Network Training, but it is very helpful. Everyone should at least read PHR’s handbook on documenting for asylum seekers.  People really become experts at doing the evaluations with practice.

It was a bit easier for us to find faculty to be involved because we already knew several people who would be interested because we’ve been involved with Miami’s human rights community for some time. If students who are new to a med school are seeking faculty, the best thing to do is always meet with a few key players on campus and get names of people who have an interest in human rights.  Once you have the names you can directly contact them.

Host a discussion: Case studies of asylum seekers

To help people develop an understanding of the range of reasons that asylum seekers request sanctuary in the U.S., you may host a discussion these case studies. Participants may wish to read these cases ahead of time, or the discussion facilitator may read the profiles one at a time.

Politically persecuted, detained and tortured

This case is for a man in his 30s from Cameroon. The client is seeking a physical and psychological evaluation. In Cameroon, he was arrested and detained on three occasions for his political opinion and association with the Southern Cameroons National Council and human rights activities. His reported physical scars include scars on his head, as well as on his legs and feet from beatings in detention. In addition, he has reported difficulty sleeping, nightmares, nervousness/anxiety, and headaches. He speaks English. The attorney is seeking a completed affidavit by December and will also be requesting oral testimony in January.

Subjected to FGC, forced into marriage, and abused

This case is for a woman in her 20s from Burkina Faso. The client is seeking a psychological evaluation. She is seeking asylum because she was subjected to FGC when she was 5 years old and still suffers from physical pain and emotional trauma from the procedure. When she was 20 she was forced into a marriage by her stepfather, during which she was systematically raped. She is now legally married in the US and has a baby, but fears that if she returns to Burkina Faso she will be forced to return to her marriage, where she will once again be raped. She also fears her daughter will have to undergo FGC.

Gay, HIV positive, and threatened

This case is for a man in his 40s from Jamaica. The client is seeking a psychological evaluation. In Jamaica, his life was threatened because of his sexual orientation and HIV positive status. He and his friends were attacked for being gay. He was forced to be closeted his entire life, and was also in an abusive relationship. His attorney also believes he suffers other non-obvious psychological issues, including extreme anxiety, shyness and panic attacks.

Fleeing domestic violence

This case is for a woman in her late 20s from El Salvador. The client is seeking a psychological evaluation. She has suffered extreme abuse by her common law husband and father of her two children. Since becoming pregnant with her first child, she was subjected to beatings and rapes. He threatened her and told her if she ever left him that he would kill her, also threatening to take away her children. He took one daughter from her and did not return her until the client agreed to go back to him. He was an alcoholic and a drug abuser and would hurt her often when he was drunk or high. The client fled to the US after he beat her one night in front of his friends. She left her children with her mother in El Salvador.

Seeking treatment and dignity

This case is for a woman in her 30s from Nepal. The client suffers from a rare and deadly skin disease, which renders her unable to tolerate sunlight. She suffers from chronic tumors, which are surgically removed on a monthly basis, resulting in massive scarring and the complete loss of her nose. As a result of cultural stigma associated with disability, she was denied schooling at an early age, and she and her siblings (also afflicted) were victims of ridicule and violence. Due to a lack of sophisticated medical care in Nepal, she has only received effective care in the U.S. She has lost one brother to depression, and fears she will fall victim to the same fate is she is returned to Nepal. She speaks Nepali and some Hindi.