BEYOND BORDERS
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Becoming a Clinician-Evaluator
Many physicians are already skilled in trauma-informed interviewing and documentation of clinical findings – the basic skills necessary to conduct FMEs . The remaining task is to hone these skills toward forensic evaluations and develop experience , leading to expertise . To make this process more feasible for busy physicians , the Asylum Medicine Training Initiative ( AMTI ) was launched in 2022 . AMTI is a free , open-access and peer-reviewed virtual course that was developed collaboratively by a group of 80 experts working in more than 40 institutions across the U . S . 12 It provides best practices and guidelines based on international standards and has become the primary and most widely used resource for clinicians interested in contributing to asylum medicine no matter where they practice . The core modules in AMTI can be completed asynchronously and over a period of five to seven hours total .
Currently in Kentucky , only one physician with experience conducting FMEs for MPS has been identified . Due to the high volume of MPS in Kentucky 7 and the immense opportunity for clinicians to support this population , I founded the Kentucky Human Rights Collaborative ( KHRC ). KHRC is a growing network of clinicians , community stakeholders , legal professionals and trainees , working together to build capacity for providing pro-bono forensic medical evaluations across the state . I am grateful to be working with a talented group of students and faculty who are committed to the mission of KHRC and are passionate about galvanizing interest and care for vulnerable migrant populations . Members of KHRC are dedicated to developing its role as a convener for stakeholders and especially for physicians , whom we will support and connect with as they learn more about asylum medicine and translate their already existing relevant skills into practice .
Channeling Hope and Finding Courage
The rise of violence around the world is rooted in a multitude of inextricable factors . These include gender-based violence , intolerance based on social group and climate change , among others . All these factors are dramatically shaped and exacerbated by the lack of material safety among the working class , economic instability and political leadership fueled by hate . Every single day , people around the world make the painful decision to embark on a journey rife with uncertainty and danger to strive for a safer future for themselves and their children . The courage it takes to risk death and trek through treacherous places like the Darién Gap , a deadly jungle corridor situated between Panama and Colombia , is tremendous . Yet , the display of resilience emboldened by the most valuable human emotion – hope – is breathtaking .
As physicians , we see hope in patients and their families every day . We encourage it in others when appropriate and simultaneously work hard to find it within ourselves . While attending the North American Refugee Health Conference last year , I experienced hope in a new way , and it was electric . I was surrounded by more than a thousand people who care deeply for the vulnerable immigrants in their communities and work tirelessly to expand networks of support and find solutions . I left the conference feeling more excited than ever about the opportunities that have always been in front of me , just waiting for me to recognize that I have the power as a physician to fuel justice and propel social change . It took me a long time to understand that I can choose to be the people I admire and that it is a conscious decision requiring confidence and courage . If millions of people around the world can act courageously to find refuge for themselves and those they love , we as physicians can act courageously to support them when they arrive at the place that they have risked everything to get to .
References
1
American Immigration Council . An overview of U . S . refugee law and policy . American Immigration Council . Published September 17 , 2018 . https :// www . americanimmigrationcouncil . org / research / overview-us-refugee-law-and-policy
2
UNHCR . Global Trends report 2023 . UNHCR . Published 2023 . https :// www . unhcr . org / global-trends-report-2023
3
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 . Journal of Immigrant and Minority Health . 2007 ; 10 ( 1 ): 7-15 . doi : https :// doi . org / 10.1007 / s10903-007-9056-8
4
Saadi A , Taleghani S , Hampton K , Heisler M . Clinicians ’ Perspectives on the Impacts of Post-2016 Immigration Enforcement on Immigrant Health and Health Care Use . Journal of Health Care for the Poor and Underserved . 2021 ; 32 ( 4 ): 1778- 1797 . doi : https :// doi . org / 10.1353 / hpu . 2021.0166
5
Immigration can reverse rural population decline . FWD . us . Published August 22 , 2023 . https :// www . fwd . us / news / rural-decline /
6
Gorsick C . Refugees In Kentucky . Kentucky Office For Refugees . https :// www . kentuckyrefugees . org / refugees-in-kentucky /
7
Take a look : How immigrants drive the economy in Kentucky . American Immigration Council . Published 2020 . https :// map . americanimmigrationcouncil . org / locations / kentucky /#
8
Goodman S . Fewer doctors-in-training are applying to Kentucky programs , according to a new study . WKU Public Radio | The Public Radio Service of Western Kentucky University . Published May 15 , 2024 . Accessed November 29 , 2024 . https :// www . wkyufm . org / 2024-05-15 / fewer-doctors-in-training-areapplying-to-kentucky-programs-according-to-a-new-study
9
Elenga N , Krishnaswamy G . A new generation of physicians — The Generation Z . Are you ready to deal with it ? Frontiers in Public Health . 2023 ; 10 . doi : https :// doi . org / 10.3389 / fpubh . 2022.1015584
10
Ferdowsian H , McKenzie KC , Zeidan A . Asylum Medicine : Standard and Best Practices . PubMed . 2019 ; 21 ( 1 ): 215-225 .
11
Moreno A , Grodin M . Torture and its neurological sequelae . Spinal Cord . 2002 ; 40 ( 5 ): 213-223 . doi : https :// doi . org / 10.1038 / sj . sc . 3101284
12
Asylum Medicine Training Initiative . Asylum Medicine Training Initiative . Asylum Medicine Training Initiative . Published 2022 . Accessed November 20 , 2024 . https :// asylummedtraining . org /
Dr . Karim is a graduate of the University of Louisville School of Medicine . She is pursuing child neurology residency and is slated to begin training in July 2025 . Dr . Karim is also the founder and lead director of Kentucky Human Rights Collaborative ( KHRC ). Please contact her at admin @ kyhumanrights . org with any questions about KHRC .
Dr . Morgan is a child neurologist and Assistant Professor of Pediatrics at the University of Louisville School of Medicine .
22 LOUISVILLE MEDICINE