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  (PDF). and algorithm  (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.