Lauren Jepson, Kim Griswold and Sarah Riley.

Medical students Lauren Jepson (left), and Sarah Riley (far right), are co-founders of the Human Rights Initiative at UB, which collaborates with Kim Griswold, MD, MPH. 

Students Assisting in Forensic Exams of Political Asylum Seekers

Published April 12, 2016

story by dirk hoffman

Through a unique intersection of medicine, the justice system and the human rights field, medical students are advancing their training by assisting survivors of torture and political violence seeking asylum in the United States.

The students take careful notes during both the history and physical examination portions of the evaluation, noting vitals, then measuring and photographing each scar.
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Working in conjunction with the Western New York Center for Survivors of Torture, the student-run Human Rights Initiative at the University at Buffalo enables students to facilitate and assist in forensic evaluations that can ultimately substantiate claims for asylum.

Playing Vital Role in Forensic Evaluations

Students first became involved with the center in 2014 through the school’s summer research internships. After the internships ended, the Human Rights Initiative was formed to allow students to continue the collaboration.

Students worked up a protocol for conducting forensic exams and play a vital role — acting as scribes — during the evaluations. Students are also involved with scheduling physicians and interpreters, working with attorneys and making sure the clients have adequate means to get to appointments.  

Fourth-year students Lauren Jepson and Sarah Riley co-founded the initiative with third-year student Kathleen Soltis.

Jepson and Riley were both on the executive board of the student chapter of Physicians for Human Rights (PHR), sparking their initial interest in student-run asylum entities.

Creating Draft Affidavits for Use in Asylum Petitions

About 70 students have been trained as scribes by either PHR or HealthRight International on the proper way to record the forensic evaluation information.

The students take careful notes during both the history and physical examination portions of the evaluation, noting vitals, then measuring and photographing each scar.

After the evaluations, the students type their notes in the form of a draft affidavit, which is first sent to the attending physician for editing and the addition of an assessment section and then forwarded to the client’s attorney.  

“It can be nerve-wracking at first, but what we do is pair an inexperienced scribe with someone who has been through the process before — so that is really helpful,” says second-year student Rachel Engelberg.  

Students are debriefed after sitting in on evaluations to make sure they are coping well after often hearing horrific stories of abuse.

Although the subject matter discussed in a forensic examination can be heavy and deeply disturbing, more often than not Riley says she leaves the evaluations feeling inspired and uplifted by the individuals she has just met.

“We have been allowed to bear witness to the tremendous resilience of the human spirit, and it is a privilege to be invited to hear our clients’ deeply personal stories,” she says. “We have had opportunities to meet some outstanding people who have survived the absolute worst of conditions and are still able to persevere, even with a smile. It is humbling.”

Contributing to Successful Outcomes in Court

Many of the forensic evaluations are conducted by the center’s medical director, Kim Griswold, MD, MPH, associate professor of family medicine and psychiatry.

Department of Psychiatry faculty Dori R. Marshall, MD, clinical assistant professor; Peter S. Martin, MD, MPH, clinical assistant professor; and Cynthia A. Pristach, MD, clinical professor; conduct psychiatric examinations for the center.

Two of the center’s clients have successfully been granted asylum status, and Griswold says the reason success is not more immediate is that it can sometimes take years for the process to make its way through the courts.

“The first one was amazing because the judge found against the individual,” Griswold says. “I testified, Dr. Marshall testified and the judge said he didn’t believe us.”

“The appeals panel found against the judge with some tough words. This individual had visible scars from the torture,” she says.

Funding Raised for Training, to Spread Awareness

Students have obtained funding for training and other endeavors through the Medical Alumni Association and the Parents’ Council.

Some of the initiative’s accomplishments thus far:

  • facilitating 19 psychological evaluations and 18 medical evaluations 
  • sending 22 students to Yale University for PHR training in April 2015
  • Jepson and Riley presented a poster about the initiative at the North American Refugee Health Conference in Toronto in June 2015
  • presenting Grand Rounds in obstetrics and gynecology, medicine and psychiatry
  • becoming an officially recognized Polity (medical student government) club
  • hosting an informational dinner to educate physicians in the community on its mission

Third-year students Chris Manschreck and Brian Quaranto, along with Engelberg, later joined the initial executive board of Jepson, Riley and Soltis. First-year students Brittany Cesar and Caroline Gorka and second-year students Sarah-Grace Carbrey and Laura Easton were later added in an effort to provide capable leadership across all four class years.

Inspiring Experience Affects Career Choices

The experience of working with asylum seekers has impacted students’ career choices and future goals. 

“I hope to continue working with refugee and asylum-seeking populations domestically as a physician, but I also hope to broaden my understanding of health care — and human rights abuses in general — in international settings, especially in places of conflict,” says Jepson, who plans to enter a pediatrics residency.

Riley says she was deciding between two specialties she loved and ultimately applied for a residency in psychiatry because she feels it will allow her to continue this type of work and help fill a huge need. 

“Meeting survivors of torture who have the strength and courage to not only survive horrific and unthinkable abuses, but also to relocate to the United States and undergo the tedious and lengthy asylum application process, has completely changed my outlook and shaped my envisioned career,” she says.

Students say mentors played key roles throughout the experience and left a profound impact on them.

“It has been so rewarding to work with mentors like Dr. Griswold, whose dedication to serving the most vulnerable of the community and ever-optimistic attitude are so admirable,” Jepson says.

And from Riley: “Her dedication to this work, her compassion, approachability, patience and support of both medical students and our clients is inspiring.”

Developing the Art of Real Communication

For her part, Griswold says she is confident that even if students don’t necessarily go on to continue working with refugee populations, they will take with them new skills they have learned.

“It is real communication. They are developing the art of listening,” she says. “When these refugees come in for an exam, the stories come out, and to be able to listen and direct the person or encourage that person to be able to share their story — that is a skill, and they learn that.

“They are learning much more than medicine, and I think it takes much more than great medicine to make a new doctor,” Griswold says.

Global Mission to Assist Victims of Torture

The WNY Center for Survivors of Torture is a program of Jewish Family Service in collaboration with the Department of Family Medicine and Journey’s End Refugee Services.

It was founded in 2014 through a state Health Foundation grant and is currently funded under the federal Office of Refugee Resettlement.

Although the center is mostly seeing asylum seekers from countries such as Democratic Republic of Congo, Nigeria, Ethiopia and Eritrea, as part of its mission it will take care of anyone who has had a history of torture, including Holocaust survivors.