Georgetown Physicians, Students Grow Network to Help Asylum Seekers

APRIL 8, 2015— It was a “patient” list like no other.

On this day, Georgetown family medicine physician Ranit Mishori, MD, MHS , wasn’t reviewing her patient load for a day at MedStar Health at the Spring Valley clinic where she practices. No, this patient list included 16 men and women from Ethiopia, El Salvador, Rwanda, the Democratic Republic of Congo, Cameroon and other countries, all of whom were in the greater D.C. metropolitan area seeking asylum.

Each story is tragic — tales of humans tortured with machetes, whips, rubber tubing, and batons. One 29-year-old man from Eritrea was hung upside down, the bottoms of his feet were beaten and he was then forced to walk across sharp rocks. Most of the applicants were persecuted because of their political beliefs, but some sought asylum because of sexual abuse or assaults based on sexual orientation.

Mishori, director of global health initiatives in the family medicine department at Georgetown University School of Medicine , is one of three Georgetown family medicine physicians who work with Physicians for Human Rights (PHR) Asylum Network, conducting forensic evaluations on a pro bono basis. Colleagues Christina Gillespie, MD, MPH , and Sarah Kureshi, MD, MPH , are also a part of the PHR network of volunteers.

They are among 350 members nationwide who handle about 500 physical and psychological evaluations each year — looking for signs of abuse, torture or trauma.

“These asylum evaluations can be very, very tough. You sit for hours hearing the most horrific stories of what happened to people and what human beings are capable of inflicting upon other people,” says Mishori, who has been conducting these evaluations for about 10 years.

“But it also reveals the resilience of the human body and the human spirit. As awful and as heartbreaking at it can be, it is also sometimes exhilarating — the notion that you are helping afford somebody so in need a second chance in another country.”

Students Stepping Up

Mishori, Gillespie and Kureshi have taught evaluation techniques to roughly half of family medicine residents over the years. Mishori and Kureshi also offer workshops and co-teach a medical school elective on health and human rights.

“Our goal is to have every Georgetown medical student aware of this network, and knowledgeable about the effect of abuse on lifelong health,” says Mishori.

Their efforts are beginning to pay off. In 2014, a small group of Georgetown medical students established a student-run Asylum Clinic here.

Only a few medical schools have established such a center, Mishori says.

“These students are very committed and they will be taking the initiative to link physicians with asylum seekers, while learning the skills and bringing in other medical students,” she notes.

Last fall, the students organized a daylong, PHR-run training session for medical students from Georgetown and George Washington universities, as well as local physicians who wished to participate in evaluations. More than 50 people attended.

Kelly DiLorenzo (M’15) initiated the project along with fellow students Nathan Praschan (M’17) and Nicholas Stukel (M’17).

DiLorenzo says she first learned about human torture and how human rights intersect with health in Mishori’s health and human rights elective.

The subject piqued her interest in learning more about PHR and what she could do to help as a medical student.

“This is an important opportunity for physicians with an interest in human rights — we are hoping Georgetown physicians will attend training to become an evaluator and join the network,” DiLorenzo says. “You don’t need an extensive background in this, and it’s not a huge time commitment; you can do as many or as few evaluations as your schedule allows.”

DiLorenzo, who graduates this spring, and her classmates hope the Georgetown Asylum Clinic will serve as a hub to get students more interested and involved, and to engage more physicians in the area.

“Through our connection with PHR, we can send a notice to all our physicians who have been trained when an asylee needs an evaluation,” she says.

Teaching Universal Skills

Kureshi, who has been a member of PHR since medical school at Mayo Clinic, says her work for the Asylum Network has made her much more sensitive to signs of abuse in her own patients.

“I am more intuitive. I can recognize signs of trauma in some of my clinic patients. My training taught me how to dig deeper, asking questions that do not revictimize these individuals,” she says.

“I think this is a skill all physicians, especially those in family medicine, should learn. When we know what our patients are facing, we can recommend counseling, ask for help from social workers and ensure they have a safe place to live.”

Gillespie concurs, noting that physicians bring a unique skill set to human rights issues.

“It is very meaningful to use your skills in a way that not everyone can, helping in a way that is profound,” she says.

‘In Your Own Backyard’

The majority of evaluations performed across the country — around 92 percent — lead to the granting of asylum, according to Jillian Tuck, JD, asylum program manager with PHR.

She stresses that the D.C. area, in particular, is in need of trained evaluators, especially psychiatrists, psychologists and licensed social workers who can conduct psychological examinations.

“Torture techniques have grown more complex and sophisticated,” Tuck says. “In many cases, the new techniques cause no visible physical markings but do leave a variety of serious mental health problems.”

Tuck and the Georgetown Asylum organizers hope to dispel the notion that international human rights work has to take place in war-ravaged countries halfway around the world.

“People think you need to go to places like the Congo or Burma in order to do human rights work, but this is a way to engage in this work in your own backyard. Asylum seekers are living in your neighborhoods, in your cities,” Tuck says.

While medical students are not able to perform evaluations on their own, all agree that exposing them early on, not only to the need but to the interview and examination techniques, is incredibly important.

“This is the next generation of human rights physicians,” Tuck says.

Note: In the December issue of the Journal of Immigrant Minority Health , Mishori, Kureshi and colleagues published results from a survey that asked participants to qualitatively reflect on their experience and motivation for participating in asylum evaluations.

For more information on Georgetown’s Asylum Clinic, contact Ranit Mishori at mishorir@georgetown.edu.

By Renee Twombly and Lauren Wolkoff
GUMC Communications