A Medical Doctor Reflects on the Treatment and Healing of Torture Survivors

by Jason Dzubow on November 16, 2016

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.

Dr. Sugarman running from one appointment to the next.

Dr. Sugarman running from one appointment to the next.

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.

{ 25 comments… read them below or add one }

Maribel Martinez March 10, 2017 at 1:08 pm

Hey Jason, Keep doing the good work you are doing. Your blog is a blessing for people like us. My question is i have pending asylum case never qualified for any public assistance. But i still get my health coverage from Obama care. This time something new happened that my children who are my dependents qualified for Medicaid. Can i keep it or deny it. Will it hurt my case?

Reply

Jason Dzubow March 10, 2017 at 4:55 pm

I do not see how your children getting Medicaid will affect your asylum case. Take care, Jason

Reply

Jyoti BISBEY February 18, 2017 at 2:17 pm

Kate, I am so proud of you. Wish there were more of you. Keep on running and inspiring.

Reply

African February 2, 2017 at 11:08 am

I am trying to help a former kidnap victim in Sudan who is still unsettled after four years and is currently in Kenya with no status. I’m a bit at a loss in how to proceed. He is very traumatized and feeling unsafe in Kenya. I am helping him financially but this is not sustainable. Jason, can I tell you more about him and can you offer any guidance by email or phone?
Do you know of any medical facility or person that he maybe able to approach in Kenya?
Thank you

Reply

Jason Dzubow February 3, 2017 at 5:57 pm

Sorry, it is not something I know about. Perhaps this place may be able to point you in the right direction: http://stars-egypt.org/. Take care, Jason

Reply

Elizabeth November 28, 2016 at 12:33 am

Dear Jason.
Thank you for been a blessing. I need help to reach out to Dr Kate Sugarman, am applying for asylum for myself and son.my son is 6 years old,he suffered Extensive damage to both eyes from my home country and blind.
May God reward you all.

Reply

Jason Dzubow November 28, 2016 at 7:40 am

Send me an email ([email protected]) and I will pass it along to her. Take care, Jason

Reply

Elizabeth November 29, 2016 at 3:00 am

THanks so much Jason.I sent you an email
Grateful.

Reply

A Khan November 18, 2016 at 7:56 pm

Hi Jason,

I heard about premium processing, please help to understand, if a person is waiting for her / his decision or approval ,in this case he /she can apply for it.

if yes, please let me know about the steps for applying and how we can apply?

Reply

Jason Dzubow November 20, 2016 at 11:13 am

There is no premium processing for asylum. I wrote a blog post proposing that once, but it has never been implemented. Take care, Jason

Reply

A Khan November 20, 2016 at 2:00 pm

thanks Jason for quick response.

Reply

mark November 18, 2016 at 6:53 pm

Hi, and many many thank you and all your help
I am trying to expedite my case do you think its best to do it just me or with the help of senator.
thank you so much

Reply

Jason Dzubow November 20, 2016 at 11:44 am

The senator will not be much help. Usually, you need to show that you or a family member has a health problem that will be helped if your case is granted, or that you have immediate family members overseas who are in danger. You can contact the local asylum office to ask about the expedite process. You can find contact info for the asylum office if you follow the link at right called Asylum Office Locator. Take care, Jason

Reply

Benedicta November 17, 2016 at 1:58 pm

Thank you Dr. Kate Sugarman for your invaluable assistance. Please, how do I contact you Dr.? Thank you to Attorney Jason Dzubow also for your all-important legal tips for asylum-seekers. Blessings to both of you!

Reply

Jason Dzubow November 17, 2016 at 5:33 pm

I forwarded your email address to her. Take care, Jason

Reply

Izzac November 16, 2016 at 10:26 pm

Dear jason
Am a granted asylum and i applied to my wife and 2 kids since septmber and i didnt get the approval from them yet , so mr donald trump can stop them from coming here ? Am muslim???how long it will take to get approval for my I 730 ? Is there anyway to make it faster ?

Reply

Jason Dzubow November 17, 2016 at 7:19 am

The I-730 process is usually pretty fast. Usually it takes between 1 to 3 months. After that is the consular processing, which varies depending on the consulate. Unfortunately, I think the Trump Administration could make it more difficult for relatives to come here. I am not sure that they will target family members of asylees, but it is a concern. As for making it faster, there is probably not much you can do, since you only just filed in September, but you could maybe send them a letter and explain the urgency. If you family members have health issues or are living in unsafe conditions, you can mention that and provide some evidence (likes a doctor’s note). Like I say, I do not know that that will make much difference, but you can try. Good luck, Jason

Reply

Amit November 16, 2016 at 3:48 pm

I am too waiting for my interview result for 2 months. My interview was expedited as I have PTSD and become suicidal when stress occurs. But these trends are horrible if the AOs are trying to please the incoming govt with their actions and policy change.

Reply

Jason Dzubow November 16, 2016 at 5:59 pm

My guess is that most AOs are not happy with the incoming Administration, and I highly doubt your delay is related to that. Post-interview delay is very common, unfortunately, and some people wait many months or years for a decision. You can inquire with the asylum office about the progress of your case. You can find their contact info if you follow the link at right called Asylum Office Locator. Also, you can contact the USCIS Ombudsman (a link is also at right) and maybe they can help. Take care, Jason

Reply

kate sugarman November 16, 2016 at 11:22 pm

be sure to get help for your symptoms of PTSD

Reply

Amit November 17, 2016 at 5:13 pm

Thanks Dr Sugarman, I am seeing a psychiatrist and a psychologist regularly but meds don’t seem to work much because of the predisposing factors and stress.

Reply

Amit December 8, 2016 at 9:10 pm

Jason, Dr Sugarman
Since I have second interview coming up, can I have contact details of Dr Sugarman please. I am having psychiatric help for my PTSD as well but I need to get my injury and surgery scars marked and certified, if Dr Sugarman can help me with this.
Regards
Amit

Reply

Jason Dzubow December 9, 2016 at 10:25 am

I will forward your request to Dr. Sugarman. Take care, Jason

Reply

[email protected] November 16, 2016 at 3:40 pm

Things are not looking good here although people are saying that policy changes are going to take time but politics is in for sure. My asylum interview was expedited on request of a democrat by AO, I got interviewed awaiting decision now since the dems lost, the same office is not even replying to status enquiry by same office sent 21 days back. Your comments Jason.

Reply

Jason Dzubow November 16, 2016 at 5:57 pm

It is possible to expedite a case prior to the interview, but it is very difficult to expedite a case after the decision, since it depends on (among other things) the security background check, which is not within the control of the asylum office. So my only real comment is that your case sounds very similar to many other cases I have seen. Hopefully, you will get a good decision soon. Take care, Jason

Reply

Leave a Comment

Previous post:

Next post: