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Icahn School of Medicine at Mount Sinai
NEWSLETTER Issue 1
August 2017
A NOTE FROM OUR
DIRECTOR
Dr. Elizabeth Singer The world is in the midst of the largest refugee crisis since World War II, with over 65 million people worldwide forced to flee their homes due to conflict, persecution, and human rights abuses. Although the United States remains the second largest recipient of asylum applications, the landscape has changed drastically over the past year amidst much anti-immigration rhetoric, uncertainty about government policies, overcrowded immigration detention centers, and increased raids by Immigration and Customs Enforcement (ICE) to round up and deport immigrants and asylum seekers. As we embark on our second full year of student coleadership within the MSHRP we have a renewed sense of mission against this backdrop and a clarity of our vision: to train and educate h e a l t h c a re p ro f e s s i o n a l s a n d students about health and human rights, to provide medical and psychological evaluations for our clients, and to link asylum seekers to continuity care and ongoing social services. Over the past year, with the unwavering support of the Page 1 !
Image Credit: The Gay and Lesbian Coalition of Kenya
Department of Medical Education, our students have joined the program’s network of dedicated and compassionate clinical volunteers and have been mentored to engage in the work of evaluating clients, documenting human rights abuses and suffering, and drafting written testimony to be used in the legal immigration proceedings of asylum seekers. These efforts lead to over 90% asylum grant rates, nationally, compared with just under 50% grant rates for asylum seekers without a forensic medical evaluation. Just as important as the statistics, however, is the fact that our students and providers are able to give a voice to the stories of so many who have faced persecution and have been silenced: the mother and child who fled gang warfare in Honduras, the Tibetan man who was persecuted by Chinese authorities because of his religious beliefs, and the transgender woman who could no
longer live amidst the constant police-sanctioned physical and psychological persecution she faced in Jamaica. We have the privilege of having our clients share their narratives with us, teach us, and give of themselves as we listen and bear witness, both to the atrocities as well as to their humanity and astounding resilience. I am proud that we have such devoted providers and students who make it possible for our program to care for asylum seekers and grow in the process. I am encouraged that we continue to listen to stories that deserve to be told.
IN THIS ISSUE: About the MSHRP 2016-2017 Highlights The Clinic: By The Numbers Student Perspective
UPCOMING EVENTS: MSHRP Training: 10/14/17
Newsletter Issue 1
August 2017
ABOUT THE MSHRP Who we are The Mount Sinai Human Rights Program (MSHRP) is an Icahn School of Medicine at Mount Sinai (ISMMS) affiliated organization dedicated to assisting asylum seekers, our clients, who have experienced torture and human rights abuses in their countries of origin. Through a multi-pronged approach and working alongside human rights attorneys, the MSHRP provides pro-bono, forensic medical and psychological evaluations for asylum seekers and, where appropriate, medical affidavits to document human rights violations in U.S. immigration courts. The program focuses on providing unbiased evaluations while simultaneously Faculty Directors teaching current and future health care professionals about the intersection of health, human rights, and social justice.
89% GRANTED ASYLUM FOLLOWING MEDICAL EVALUATION VS. 37.5% NATIONAL AVERAGE
Student Advisory Board
A student-faculty hybrid model The MSHRP operates on a student-faculty hybrid model, combining student and faculty leadership to leverage the strengths of both groups. The hybrid model allows students to manage and motivate each other's programmatic efforts, and students are responsible for overseeing the management of the clinic, assisting in non-clinical operations, and linking clients to continuity care and additional resources as needed. Faculty mentors maintain oversight of the program’s mission and vision, aid students’ initiatives, and conduct forensic evaluations with student shadows, who play an active role. The MSHRP partners with volunteer ISMMS faculty and Mount Sinai clinicians to conduct the medical and psychological exams at no cost to the clients.
Student Directors
Communications
Initiatives
Fundraising
Advocacy Research Education
Public Relations Website & Social Clinic
Forensic Evaluations ACCESS Provider Recruitment
WHAT IS THE DIFFERENCE BETWEEN A REFUGEE AND AN ASYLUM SEEKER? A REFUGEE is a person who seeks protection in a foreign country owing to a well-founded fear of being persecuted on account of race, religion, nationality, membership of a particular social group, or political opinion, and includes persons who have fled war or other violence in their home country. Refugees request protection while still overseas, and are given permission to enter the U.S. An ASYLUM SEEKER is a person who meets the definition of refugee, is already present in the United States or is seeking admission at a port of entry, and whose request for sanctuary has yet to be processed. Page 2 !
Newsletter Issue 1
August 2017
2016-2017 TEAM HIGHLIGHTS
ACCESS
Recruitment
Advocacy
The ACCESS team facilitates continuity of care, assistance with social services and job placement, and empowerment of clients. We have worked with 25 clients since December 2017, providing continuing support and referrals as needed.
The number of providers qualified to complete forensic evaluations more than quadrupled since the start of 2017. To date, there are 13 mental health evaluators and 17 medical evaluators, 7 of whom are also qualified to complete gynecologic exams and 2 of whom are qualified to complete pediatric evaluations.
The advocacy arm works to disseminate information about the clinic's activities to a variety of audiences. Work is ongoing for an opinion piece looking at the changing origin of the clinic's clients.
Student Abstracts and Publications Gus Ruchman, MD 2020 Publication: “Whom We Miss” Narrative Reflection accepted by the Annals of Emergency Medicine Hazel Lever, MD 2019 Oral Presentation: “Mental Health Sequelae and Histories of Violence Among Women Asylum Seekers Who Have Undergone FGM/C: A Retrospective Study” Presented at the North American Refugee Health Conference in Toronto, June 2017 Syed Haider, MD 2019 Oral Presentation: “The Mount Sinai Human Rights Program: Experiences From the Organization of a Faculty-Student Model of Healthcare.” Presented at the North American Refugee Health Conference in Toronto, June 2017
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Newsletter Issue 1
August 2017
THE CLINIC: BY THE NUMBERS Since 2013, the MSHRP clinic has served 189
clients seeking asylum from 41 countries.
5% Europe & Central Asia
1 in 3 originate from Honduras or El Salvador
1.5% Middle East & North Africa
5% South Asia
73%
WOMEN 2.5% East Asia & Pacific
52% Latin America & Caribbean
50% 34% Sub-Saharan Africa
Our clients seek asylum in the United States due to fear of persecution for one or more of the following reason: 93% Membership in a social group
AGE 25 - 36
HUMAN RIGHTS ABUSES MOST COMMONLY REPORTED BY CLIENTS
Gang Violence 20%
52% Political beliefs 12% Religion
Domestic Violence
7% Race <5% Nationality
54% Sexual Violence
Physical 30%
Gynecologic 19%
LGBTQ Persecution 10%
EVALUATIONS
Priority exam type requested by clients’ attorneys
Psychological 51% Page 4 !
43%
Female Genital Mutilation 22% 8 out of 10 subjected to psychological threats 7 out 10 experienced beatings/blunt trauma
Newsletter Issue 1
August 2017
STUD ENT PERSPECTIVE
SYED HAIDER | STUDENT ADVISORY BOARD | MD 2019 How did you first learn about the MSHRP? Newsletter issue N°1
I first learned about the MSHRP as a junior clinician at the East Harlem Health Outreach Partnership (EHHOP). While taking a patient’s social history, he revealed that he had recently immigrated to the United States and was seeking asylum from persecution he faced in [country] as a member of the LGBTQ community. With his permission, I reached out to Dr. Holly Atkinson, the program director at the time, and she helped arrange a forensic medical examination with one of the clinic’s trained volunteer providers. Although brief, I felt empowered and inspired, and I wanted to know how I could contribute to the MSHRP as a medical student. What have you been involved in since joining the program? When I joined in 2016, the MSHRP was not part of an official student organization, so much of my work as a first-year student focused on helping to design and implement the student leadership structure. As a second-year, I had the opportunity to shadow physical and psychological evaluations with providers who were not only excellent clinicians but educators, as well. I learned to administer the clinic’s social services needs assessment survey during the exams, and helped draft the medical affidavits afterwards. Have you had any particularly rewarding or memorable experiences? I recently shadowed a physical evaluation with Dr. Singer for a client who, after experiencing government persecution due to his religious background, was deported from his native [country] and detained in [country]. As he recounted his experiences, I couldn’t help but admire his resilience. Despite his arduous journey to the U.S., in which he endured severe physical and mental abuse by security forces, he remained hopeful for a brighter future. In immigration court 15 days later, the client was granted asylum and I learned that the Page 5 !
medical affidavit I helped write played a critical part in the August 7, 2017 judge’s decision. It was inspirational to have contributed a small part in helping the client move forward. How has the MSHRP contributed to your experience at ISMMS? As a future physician with a strong interest in human rights, social justice, and clinical medicine, I am continuously fascinated by the breadth and depth of issues I have been able to engage with as a MSHRP member. The leadership and shadowing experiences have allowed me to stay engaged with local and global politics while giving me access to top experts in the field. Working with my equally motivated peers has provided me with a skill set and knowledge about the U.S. asylum application process, the role of healthcare practitioners in documenting human rights abuses, and experience in advocating on behalf of a vulnerable patient population. Moreover, despite a hectic weekly medical school schedule, my contributions to the program are personally fulfilling. I am incredibly thankful to Dr. Singer and all the MSHRP faculty who have mentored and supported me in all my endeavors.
“As a future physician with a strong interest in human rights, social justice, and clinical medicine, I am continuously fascinated by the breadth and depth of issues I have been able to engage with as a MSHRP student member.”
Syed Haider, MD 2019
Newsletter Issue 1
August 2017
UP COMING EVENTS The NYC Refugee and Asylee Health Coalition Grand Rounds Panel: "Asylum Seekers in Immigration Detention" Friday, September 8, 2017 | Annenberg Building, Room 12-06, 12 - 2 PM Join Dr. Craig Katz and colleagues for this panel discussion about working with asylum seekers in detention across the U.S. as they undergo the asylum process. Center-Wide Ethics Luncheon: “Coming to America: Ethical Considerations of Working in the Immigration Detention System Thursday, September 14, 2017 | Hatch Auditorium, Guggenheim Pavillion, 2nd Floor, 12 - 1 PM Drs. Elizabeth Singer and Mary White present ethical issues physicians encounter while conducting forensic evaluations for asylum seekers detained in U.S. detention centers at the Medical Student Ethics Organization (MESO) sponsored luncheon. Lunch will be provided. Asylum Evaluation Forensic Training with the Weill Cornell Center for Human Rights Saturday, September 16, 2017 | Weill Auditorium, 1300 York Ave., 9 AM - 3:30 PM This session is open to any clinician or student interested in performing forensic evaluations of asylum seekers. RSVP at: https://goo.gl/forms/mzlBmCofvo9Xt0Uo1 MSHRP Asylum Evaluation Forensic Training: “The Forensic Evaluation of Asylum Seekers and Documentation of Human Rights Abuses” Saturday, October 14, 2017 | Annenberg Building, Room 12-01, 9 AM - 4:30 PM This on-site training is open to all students, physicians, clinical psychologists, NPs, and LCSWs. Breakfast and lunch will be provided. Register by Wednesday, October 4th at: http://bit.ly/2wm5XQd
CONTACT: MOUNTSINAIHRC@ICAHN.MSSM.EDU
TO DONATE TO THE MSHRP: HTTPS://WWW.GOFUNDME.COM/MOUNT-SINAI-HUMAN-RIGHTS-PROGRAM OR HTTPS://PHILANTHROPY.MOUNTSINAI.ORG/DONATE
OUR MISSION THE MOUNT SINAI HUMAN RIGHTS PROGRAM’S
DUAL MISSION OF SERVICE AND
SCHOLARSHIP IS DEDICATED TO PROVIDING FORENSIC MEDICAL EVALUATIONS TO SURVIVORS OF PERSECUTION WHO SEEK ASYLUM IN THE
UNITED STATES,
AND TO
ADVANCING HEALTH, DIGNITY, AND JUSTICE BY INSPIRING AND EDUCATING HEALTHCARE STUDENTS AND PROFESSIONALS TO PROTECT, PROMOTE, AND FULFILL HUMAN RIGHTS.
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