BEYOND BORDERS
group ( i . e ., sexual orientation or gender identity ) if they return to their countries of origin .
Other populations among MPS include victims of human trafficking , minors who have been abused or neglected by a parent , survivors of domestic violence , survivors of torture and victims of certain crimes . Vulnerable migrants who fall into any of these categories have stronger immigration cases when clinical evidence provided by FMEs supports the narratives of what they have endured . In fact , a 2007 study showed that 89 % of asylum cases with FMEs were successful , compared to 37.5 % of cases without FMEs . 3
Making the Case for Kentucky
Since the 2007 study was published , the field of asylum medicine has grown significantly . There has been a proliferation of medical student-run asylum clinics and the development of a clinician evaluator workforce . However , the growth of this field has mostly occurred in major cities . A 2021 study that evaluated the perspectives of physicians engaged in asylum medicine revealed that 75 % of respondents practiced in California , Boston and New York City . 4 This highlights a substantial gap in the asylum medicine workforce in the South and in rural areas where immigrants are building vibrant communities and filling gaps in the workforce , thereby boosting prosperity for everyone . 5 In 2023 , Kentucky ranked fourth in the country among top refugee-receiving states . 6 Although refugees are distinct from MPS , this ranking indicates the evolving disposition of communities in the Bluegrass State . It also underscores the pattern of immigrants who , regardless of status , often choose to settle down where people with shared heritage and / or similar lived experiences already live . These Kentucky communities deserve the same degree of care that people receive in major cities and coastal states with more robust systems of immigrant support . In considering the large numbers of immigrant families in our state , 7 a conscionable response from Kentucky physicians can be to identify small , yet powerful ways to leverage the respect and power inherent to our profession . Fortunately , asylum medicine offers physicians a small , specific and particularly impactful opportunity to help Kentucky ’ s MPS secure safety and access to basic rights including health .
Negative and inaccurate perceptions about Kentucky have shaped the state ’ s national image for decades . This has been exacerbated by political rhetoric that incorrectly blames people who live in rural communities or in the South for the national surge of hate , intolerance and overt violence towards immigrants and people of color . As a Kentuckian who was born in Southeast Asia but grew up in this state , I am never shocked , but increasingly insulted when I travel and meet people who have disparaging ideas about Kentucky . They have never seen the beauty of our rolling hills or existed in our communities of deeply caring and rooted people . I believe that strengthening care for vulnerable immigrants can help transform how Kentucky is perceived . It can show people , especially younger generations who prioritize diversity and tolerance in their communities , that Kentucky is a place where they can thrive and raise globally minded children . It can also help to retain medical talent in our state at a time when young physicians are leaving at alarmingly high rates . 8 Many young medical students and physicians-in-training value social change and desire medical careers that are fulfilling yet justice-oriented . 9 When students and trainees see their attending physicians galvanized into advocacy for the most vulnerable people in our communities , perhaps they will choose to stay in Kentucky and work alongside us .
The Nuts and Bolts of a Forensic Medical Evaluation
An FME is a trauma-informed interview and examination that elicits peoples ’ narratives of reported abuse or mistreatment and the accompanying physical or psychological symptoms . The goal is to assess consistency of the client ’ s reported mechanism of injury or account of traumatizing events with clinical findings . Examples of evidence collected during an FME may include scars from lacerations , incisions , abrasions or burns . Evidence may also consist of general ailments like arthralgias , myalgias or fractures that have resulted in abnormal healing or atypical exam findings . 10 Neurologic injury among MPS may include traumatic brain injury and related cognitive impairment . Peripheral neuropathy can be caused by axonal damage resulting from forced traction in the context of positional torture or mechanical compression of nerves from prolonged restraint . 11 Psychological impacts are far-reaching and common among MPS . Evidence may consist of general symptoms including anxiety , fear , sadness , social dysfunction and other symptoms that may match diagnostic criteria for a variety of psychiatric disorders . An important distinction between an FME and the clinical practice of physicians is that FMEs do not entail any symptom management or treatment – it is a one-time evaluation .
Depending on clients ’ experiences and mechanisms of trauma , there may be a need for a psychological evaluation , a physical evaluation , or both . Regardless of the type of evaluation , a focused exam collecting clinical evidence results in a medical affidavit . A medical affidavit is a detailed , persuasive and credible medico-legal document that reports five essential components : ( 1 ) credentials of the evaluating clinician , ( 2 ) the client ’ s history and background , ( 3 ) physical and / or psychological exam findings , ( 4 ) consistency of findings with client ’ s history , and ( 5 ) conclusions . Medical students and physicians-in-training can support busy clinicians in completing FMEs by helping with laborious tasks such as the drafting of medical affidavits and coordination of services for evaluations . Learner participation in these ways can cultivate a generation of physicians committed to advocacy and investment in asylum medicine . Given the high risk for vicarious trauma in those practicing asylum medicine , building a supportive community of clinicians and learners who prioritize lifelong learning and self-care can sustain interest in and impact of this field . For most physicians , it is difficult to imagine adding responsibilities to an already heavy load of professional duties and workdays marred with bureaucratic and administrative tasks . However , meaningful engagement through a practice like asylum medicine can help reinforce a sense of purpose and combat feelings of exhaustion . In other words , engaging in asylum medicine can be one potential antidote to physician burnout .
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