1. A Student-Run Asylum Program: Service, Capacity Building, and Education.
Ranit Mishori, MD, MHS, FAAFP
Georgetown University School of Medicine, Department of Family Medicine
Nathan Praschan, Nicholas Stukel, Kevin Diasti
GUSOM PHR Leadership Team

2. Objectives Describe N. American Trends
Describe Rationale for GUSOM program
Discuss activities, barriers

3. Disclosures
I am a paid consultant for Physicians for Human Rights (Program on Sexual Violence in Program Zones; MediCapt project. NOT ASYLUM PROGRAM)
I received funding related to this work from the Josiah Macy Jr. Foundation
I received funding for some of this work from the Dr. Scholl Foundation

4. U.S. Asylum Standard
The US, at its discretion, may grant asylum to an individual who meets the definition of “refugee” under US Law.
Refugee: unwilling or unable to return to home country due to past persecutions, or well-founded fear of future persecution.
Burden of proof is on the applicant.

5. Asylum Seeker
A person who has left his/her country of origin and applied for recognition as a refugee in another country, but is still awaiting a decision on his/her application. 
Meet definition of refugee: has experienced past persecution or has a well-founded fear of future persecution based on one of the five protected grounds – race, religion, nationality, political opinion, or membership in a particular social group.

6. Asylum Trends: North America
173,100 new asylum applications 2014
An increase of 42% vs 2013
Canada: up 1/3
US: approx 121,200 claims, 36,800 claims more than in (+44%)
UNHCR Asylum Trends 2014

7. The Need Hundreds of thousands flee their homelands yearly.
Tens of thousands seek refuge in the United States through legal asylum.
Only 38% are granted asylum.*
PHR and the GUSOM Asylum Clinic work to raise this number by providing asylum evaluations!
*Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health 2008;7:7-15.
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

8. Asylum Evaluations
Legal
Medical
Psychiatric
Reported Shortages

9. Medical Asylum Evaluations
89% were granted asylum, compared to the national average of 37.5% among US asylum seekers who did not receive PHR evaluations.
Lustig et al. J Immigr Minor Health Feb;10(1):7-15.

10. Process Referral through: Lawyer, Law School clinic, Asylum network
Review any other clinical supporting documents
Conduct the evaluation
Write Affidavit with input from the legal team
Testify as expert witness (sometimes)

11. History at GUSOM 2004 Dept of Family Medicine PHR Georgetown Law
Resident Education
Health and Human Rights Course

12. Unique Opportunity
HOYA Clinic  opportunities to learn about urban and minority health
GUSOM Asylum Clinic  opportunities to learn about
Refugee health
Global health
Human rights
Asylum law in the US
Physical diagnosis
Empathy and compassion
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

13. Partnership with Physicians for Human Rights

14. Mission
The Georgetown University School of Medicine’s Asylum Clinic seeks to improve the quality of life for victims of torture and persecution by:
bolstering their efforts to obtain legal asylum,
connecting them with vital healthcare and living services, and
spurring interest and investment in refugee health among burgeoning healthcare professionals.
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

16. Operations TASSC Leadership team CALS PHR Asylum Seekers Referral
Scheduling Coordinators
Continuing Care/ Development Coordinators
Education Coordinators
PHR
Advisory Board
Referral
Client Representative
Correspondence and organization
Asylum Seekers
Student Volunteers
Clinician Volunteers
TASSC, HOYA Clinic, Unity Clinic
Programming Educational Oversight
Asylum Evaluation
Follow-up care
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

17. SOURCES FOR ASYLUM CASES
PHR - Physicians for Human Rights
Contact: Jennine Sawwan
TASSC - Torture Abolition and Survivors Support Coalition
Contact: Dr. Kate Sugarman
Georgetown CALS - Center for Applied Legal Studies
Contact: Philip G. Schrag <

18. Scheduling Coordinator:
Clinician Scheduling
Maintain a list of clinicians detailing
Training status
Availability
Specialty
Contact physicians and determine availability to evaluate within the month
Establish date with lawyer, client, and clinician
Scheduling Coordinator:
Daisy Kim (M2)
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

19. Scheduling Coordinator:
Student Scheduling
Maintain a rotating list of students
Established dates sent to on- deck students who can volunteer based on availability
Gaps filled by leadership team
Scheduling Coordinator:
Hayley O’Brian (M2)
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

20. Evaluation and Affidavit
Locations
Department of Psychiatry
Department of Family Medicine
Family Medicine Residency Site
Community-based
Debriefing
Drafting affidavit and send to preceptor
Record experience in the Standard Medical Evaluation Form online
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

21. Continuing Care/Development
Continuing care is vital to the mission of the asylum clinic
We are not a point of care
Refer clients to available clinics (partnering with HOYA Clinic for Resource Specialist training)
Follow clients longitudinally throughout process
Continuing Care Coordinator:
Kevin Diasti (M2)
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

22. TASKS AND RESPONSIBILITIES
Educational Model
TASKS AND RESPONSIBILITIES
EDUCATIONAL
GOALS
POTENTIAL
OUTCOMES
Research the context prior to asylum evaluation
Develop understanding of current events and refugee issues
Improved knowledge and understanding of global health and human rights issues
Attend training and participate in human rights curriculum
Attend and assist with the asylum evaluation
Recognize signs of torture and learn the basics of forensic documentation
Improved history taking and physical diagnosis skills
Appreciate the mental health burden of torture and refugee/asylee status
Enhanced empathy and compassion and increased recognition of the role of mental and behavioral health
Write a medical-legal affidavit
Appreciate the legal structure involved in obtaining asylum status
Improved interdisciplinary and interprofessional collaboration
Follow-up with asylum-seeker periodically
Appreciate the ethical and cultural issues in the care of refugees and asylum seekers
Understand the importance of follow-up care and barriers to integration and acculturation
NOTE: Each of these tasks also has practical utility for clinic operations.
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

23. Human Rights Curriculum
Didactic
(e.g. Torture and Art, ID’ing scars, etc.)
Experiential
(asylum clinic participation and follow-up)
Advocacy
(participation in PHR advocacy days and letter writing)
Educational Goals and Outcomes
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

24. Education HHR course Holocaust Museum University Events
Community Based events
Guest Speakers
Local Conferences

26. Advocacy

27. Scholarship PHR Annual Student Conference
Article for Journal of Student Run Clinics
CENTILE Colloquium
22nd National Conference on African Refugees and Immigrants

28. Student Advising Cornell >> GU GU >> SLU GU >> UNC
GU >> HU, GWU

29. Advising

30. Stumbling Blocks Risk management Student turnover Faculty recruitment
Funding (program; faculty time)

31. Future Directions
Expand capacity for evaluations with trained clinicians
Identify and build more relationships community partners for continuing care
Legal partnerships
Apply for a grant to provide trainings free of charge
Need
Mission
Opportunity
Operations
Clinician Scheduling
Student Scheduling
Evaluation
Care
Curriculum
Future

32. Acknowledgements Drs. Kureshi, Gillespie Ferdowsian PHR; TASSC
Psych, FM departments

34. Acknowledgement
This presentation was made possible, in part, by a President’s Grant from the Josiah Macy Jr. Foundation
For questions:

35. Questions?