Kate Sugarman is a medical doctor at Unity Health Care in Washington, DC, a public community health clinic. She works with people who have survived abuse and trauma, including many refugees. As a family physician, she is qualified to make medical diagnoses and prescribe treatments. She has particular experience in diagnosing and treating post-traumatic stress disorder through her family medicine training program and her clinical practice, which focuses on minority and immigrant patients, many of whom suffer from physical and mental disorders. She is also an adjunct faculty member at the Georgetown University Law School Center for Applied Legal Studies (the Law Clinic) in support of their asylum work. Here, she discusses her work, and the new reality of a Trump Administration:
The morning after the election felt like day zero of the apocalypse.
Like most of us, I learned that night that Trump had won. But I knew I could not stay up too late to mourn. I had to meet a patient at 7:30 AM for a forensic evaluation.
Just to explain: When I say a forensic evaluation, what I mean is a medical examination that is part of an asylum seeker’s evidence in his or her quest for asylum. I do not perform psychological forensic evaluations, which would mean psychological evidence of the effects of being tortured, such as anxiety, depression or PTSD. Those exams are most often conducted by mental health professionals. I conduct medical forensic evaluations. Most of the effects of torture that I document are visible scarring on the skin from beatings, stabbings, burning, etc. I also document any other visible medical signs of the effects of being tortured, like swelling, hearing loss, damage to bones and joints, etc. I never charge the asylum seekers for these examinations.
I conduct the examination in the following way. First, I read the patient’s personal statement–which explains why that person fears persecution in the home country–so I have a basic idea of what happened. Then I gently interview the patient, always trying my best not to retraumatize the person. The focus of my interview is the physical violence that has left visible scarring and other signs of torture on the person’s body. Then I examine the patient, looking for scarring and other signs of abuse. Since I have performed these examinations for so many years on so many people, I have a sense of whether scarring is consistent with the stated explanation of how it happened.
The 7:30 AM patient had approached me the previous week. He told me that his asylum case had been denied, but he found a lawyer who had agreed to try to reopen the case. He asked me whether I could document his scars. I told him yes, as long as he could bring me his personal statement. The interview and examination were straight forward. As often happens, he only reported one scar to me. I had him get partially undressed at which point, I discovered more scars that he had forgotten to describe to his lawyer or me. Because asylum applicants often fail to remember all their old injuries, I always try to do a “head to toe” examination whenever possible.
After we finished, I rushed off to clinic where I had another asylum seeker waiting for me. This person had no visible scarring, but had been seeing me for some time in clinic to be treated for depression and insomnia due to the torture. His lawyer wanted a summary of my clinic notes describing the emotional distress that this person had been experiencing.
Both patients were extremely grateful for my services.
According to a study from Physicians for Human Rights, forensic reports from physicians can make a big difference in the outcome of an asylum seeker’s application. I choose to do this work because I find it enormously rewarding. I have heard so many times from attorneys that judges and Asylum Officers comment on my reports, saying that the evidence I documented was very helpful in evaluating the applicant’s claim.
I have discovered over the years, in addition, that just the fact of the client presenting their story to me, and my active and compassionate listening, seems to have a therapeutic value to the client. Clients sometimes seem a little less burdened after I have finished listening to them and documenting their scars. Of course, there is no greater gift than when someone comes running into clinic to hug me, and tell me that they were just granted asylum. Twice in the past few weeks, people came up to me, thanking me for my detailed and kind forensic evaluations, which they said were very helpful in their receiving asylum. I had examined each of these people more than five years ago, but they apparently never forgot me.
But now–with the election of Donald Trump–asylum seekers may be feeling more fearful. So what would I tell a Trump supporter? That is a difficult question, but I suppose if Mr. Trump wants to make America great again, we should help wonderful and deserving people be granted asylum. If my grandparents had not been allowed into the United States, then they would have been killed by Hitler, and I would not be here in the U.S. doing this important work.
I cannot undo Trump’s victory, but I am determined to do everything in my power to help as many asylum seekers as possible.