Employer-funded clinic's easy access, low cost and on-point services include 'proactive wellness' programs
By LISA EISENHAUER
The Loyola Medicine Asylum Clinic that opened this spring is helping migrants who fear harm in their home country make their cases for legal, protective residency in the United States.
The clinic relies on doctors who volunteer their time and expertise to conduct forensic medical examinations. They document migrants' claims of persecution in their homelands, recording physical evidence the patient has been the victim of human trafficking,
torture, anti-LGBTQ violence, religion-related mistreatment, female genital mutilation, sexual and gender-based violence or injury by gang members. The findings of the examinations go into affidavits that become part of the migrants' asylum petitions,
which may also contain assessments of mental trauma.
Blair
The clinic is at MacNeal Hospital in the Chicago suburb of Berwyn. The hospital is part of Loyola Medicine, which is based in Maywood, another Chicago suburb. The hospital is a member system of Trinity Health. The hospital cares for a population that
includes many Hispanic residents and many undocumented migrants.
Castro-Caballero
The asylum clinic was founded by Dr. Yessenia Castro-Caballero and Dr. Amy Blair. Castro-Caballero is a pediatrician with Loyola Medicine and assistant professor at Loyola University Chicago Stritch School of Medicine. Blair is a family medicine physician
with Loyola Medicine and assistant dean for health advocacy and assistant director of the Center for Community and Global Health at Loyola University Chicago Stritch School of Medicine.
'A chance at the American dream'
Castro-Caballero says she started volunteering to do forensic examinations of immigrants after she learned in 2017 about the policy of separating children from their parents at the Mexican border under
the Trump administration. She and other physicians asked staff at the National Immigrant Justice Center how they could help those families. The Chicago-based nonprofit that provides legal
aid to migrants said there was a need for clinicians to conduct forensic examinations to assist asylum seekers in building their legal cases for protected immigration status.
Migrants are detained while being processed by U.S. Border Patrol officers before boarding a bus to a detention center in June in La Joya, Texas. Studies show that migrants who apply for asylum based on persecution stand a better chance if a medical
professional documents evidence of the mistreatment.
John Lamparski/Sipa USA via AP Images
"We went to them with the intention that we could do something at the border, but this kind of work can be done in our own hometown," Castro-Caballero explains.
Even though President Donald Trump ended the highly controversial family separation policy by executive order in June 2018, Castro-Caballero and the other doctors pressed on with their efforts to aid asylum seekers.
In 2019, they were part of the inaugural group of clinicians in the Midwest Human Rights Consortium, a network of providers from many specialties including obstetrics and gynecology, pediatrics
and mental health who are willing to perform trauma-informed examinations for asylum seekers.
The Loyola Medicine Asylum Clinic and counterparts at the University of Illinois — Chicago and the Ann & Robert H. Lurie Children's Hospital of Chicago are outgrowths of the consortium.
The consortium is under the umbrella of the Refugee Immigrant Child Health Initiative of the Illinois chapter of the American Academy of Pediatrics. That initiative started in 2017 with the
goal of improving the quality of health care for migrants.
Castro-Caballero also volunteers with the Refugee Immigrant Child Health Initiative. As a first generation American of Mexican and Colombian descent, she says she can relate to the challenges refugees face in building a new life in the United States.
"I wanted to give others a chance at the American dream and all the opportunities that this country has given me," she says.
Veteran examiner now trains
Blair has been doing forensic examinations of asylum seekers for 15 years with Physicians for Human Rights. She started just after completing her medical residency and spending several months in Southern
Africa, where her husband was doing refugee advocacy work.
"I was determined to continue to do something in the realm of human rights with my time and my talents," Blair says. "I felt a real call and a duty as a physician to volunteer my time toward the promotion of a new beginning for people coming from tragic
and violent places sometimes."
Blair got training on how to do forensic examinations through peer mentors. She now coaches other providers, who may be reluctant to jump into legal processes, and shows them how to document the findings of their forensic examinations.
"By and large, the providers do not need to be trained in the physical exam, they all were trained to do that," Blair says. "They just need to be trained in the process of converting those skills to an affidavit for a legal case."
The Loyola Medicine clinic provides only physical examinations. Mental health forensic exams are offered elsewhere.
Evidence bolsters cases
At the Loyola clinic, the providers start by asking the asylum seekers to describe the persecution they endured and then the examiners document any evidence they find of that torment. Blair says it could have
come in many forms, including beatings, genital mutilation and sexual abuse.
"These are difficult things to find and look for, but when it corroborates a story of past persecution and fear of future persecution then those are really powerful findings," Blair says.
In fact, a study published in November 2021 in the Journal of Forensic and Legal Medicine found that having forensic medical evidence can be a major boost
in asylum cases. Researchers analyzed 2,584 cases initiated by Physicians for Human Rights that included forensic medical evaluations. The researchers "found that 81.6% of applicants for various forms of immigration relief were granted relief, as
compared to the national asylum grant rate of 42.4%."
Blair and Castro-Caballero became acquainted through a colloquium held on a wintry Saturday in Chicago in 2019. The event was initiated by medical students and attracted more than 100 providers for forensic medical training.
When Castro-Caballero later did her first forensic exam, Blair was by her side.
"When Dr. Castro-Caballero and I spoke about our shared desire to do what we could for the refugee population and use our position as physicians to advocate, it sort of went from being a voluntary individual effort to a more collaborative, institutional
mission-based initiative," Blair says.
Blair credits Dr. Charles Bareis, chief medical officer at MacNeal Hospital, with shepherding the idea for the Loyola clinic through the lengthy administrative and regulatory approval process. She explains that any requested use of a clinical setting
gets intense scrutiny.
"I was just so impressed with Dr. Bareis' ability to get everybody in the room and get everybody onboard," Blair says. "Those pieces wouldn't have been easy at all for Dr. Castro-Caballero and I to move by ourselves. It would have been too big of a lift."
An early win
Providers do the examinations after hours in clinical space at the hospital. The evaluations are done without charge and are scheduled through the Midwest Human Rights Consortium at the request of immigration lawyers.
The clinic has a roster of providers with various expertise who can perform the exams. In its first few months, the clinic has done three.
Castro-Caballero conducted one of those first exams done at the Loyola clinic and she later learned that it led to an asylum grant for that person and their family. "It's an incredible feeling to know that your physical exam skills contributed to the
safety and the establishment of this well-deserving family here in our country and that they can move forward with their lives without living in fear," she says.
Blair says a majority of the cases she's been involved in over the years have gone in favor of asylum seekers. She believes Loyola's clinic has the capacity to provide more examinations and help more migrants become legal residents. However, a shortage
of lawyers willing to take on immigration cases, many of which are handled pro bono, and a backlog in the court system mean demand is relatively low.
Both Castro-Caballero and Blair say they are proud to have small roles in a wider effort to welcome to the United States people who have no safe option to live in their home countries. They also are grateful to have the backing of Loyola Medicine and
Trinity Health.
Blair sees the clinic as an extension of the organizations' Catholic mission and as in line with Catholic social teachings on the sanctity of every human life. "This is one way to engage in the immigration and migration crisis we're in in a way that lends
the expertise of health care providers," she says.
Copyright © 2022 by the Catholic Health Association of the United States
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