Handbook> Electives > Humanities in Medicine > Global Health:

Electives - Humanities and Ethics in Medicine

Global Health: Caring for Immigrants, Refugees & Asylum Applicants

Elective Number: 3526 (arranged)

Course Supervisor: Dr. Preston Reynolds

Evaluation should be given to: Dr. Reynolds

Duration: 2 weeks

Available: TBA

Report to: Dr. Reynolds

Time to Report: 1:00 pm

Place to Report: Center for Biomedical Ethics and Humanities, Barringer 5

Typical day: 1:00 pm - 3:00 pm

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 10

Course Description: Medical professionals with an interest in global health will encounter patients with a history of human rights violations whether working here or abroad. In addition, physicians working in urban areas with large immigrant populations and near INS Detention Centers including county prisons, often will provide care to individuals with a history of torture that often manifests as physical and/or mental health problems. This course will offer instruction on the legal process of refugee placement and application for asylum, and training in diagnosing and evaluating medical evidence of human rights violations. Emphasis will be given to conducting an appropriate history and physical examination with a patient with a history of torture, and a medical evaluation for asylum in the United States.

Didactic sessions will provide participants:

  1. an overview of international human rights covenants;
  2. knowledge of the legal and medical aspects of the asylum process;
  3. knowledge of the physical and psychological manifestation of torture;
  4. insight and instruction into conducting medical evaluations and interviews with patients who have experienced human rights violations;
  5. review of sample medical write-ups of individuals for use in asylum application;
  6. skills in maintaining well-being among physicians performing this work.

Readings will include literature on US military involvement in torture, physician complicity in torture, and a first-hand account of an individual with a history of torture and his effort to establish asylum status in the United States. Selected book chapters and articles will cover information on the mental and physical health consequences of INS detention in county prisons, and human rights violations abroad. Using standardized patients, participants will practice conducting an interview with an individual with a history of torture. They will spend a half-day session in the International Family Medicine Clinic assessing the extent of human rights violations among these refugees. The class will tour a legal advocacy center for torture survivors and a law school clinic devoted to assisting immigrants, refugees and asylum applicants here at UVA.

Objectives

Through the use of didactic discussion and simulated patients, participants will be able to:

  1. Describe common forms of physical and psychological torture as they present in immigrants, refugees and asylum applicants in the United States and in patients seen in many urban primary care clinics;
  2. Develop skills in conducting a history and physical examination in an individual with a history of human rights violations;
  3. Conduct a medical evaluation and complete the write-up for an individual applying for asylum in the United States; and
  4. Describe the process of obtaining refugee status and the benefit of a medical evaluation for asylum application.

This course will be taught by Dr. P. Preston Reynolds. Dr. Fern Hauck will give a lecture on immigrants and refugees in the Charlottesville community, describe the patients seen in the International Family Medicine Clinic, and discuss the problems these patients face integrating into US society. Dr. Reynolds will lead the other didactic sessions, teach skills in conducting a history and physical examination on an individual with a history of human rights violation, demonstrate how to write-up a history and physical examination for use in an asylum application, and make arrangements for a tour of human rights clinics involved in advocacy and care of torture survivors, immigrants and refugees here at UVA.

Syllabus:
Week 1: Class discussion – 3 hours per day + one-half day in IFMC

Day 1 – Global Health and Human Rights: History of Human Rights and the Epidmic of Torture

  • Health and Human Rights: Basic International Documents. 2nd Edition. Edited by Stephen Marks. Harvard University Press, 2006. Section 4: Protection of Life and Physical Integrity, pp. 109-161..

Day 2 and 3 – Torture and US Military Involvement (Select one of the following):

  • Tara McLelvey. Monstering: Inside America’s Policy of Secret Interrogation and Torture in the Terror War. Carroll and Graf Publishers, 2007.
  • Michael Otterman. American Torture: From the Cold War to Abu Ghraib and Beyond. Pluto Press, 2007.

Day 4 – Physician Complicity in Torture

  • Steven Miles. Oath Betrayed. Torture, Medical Complicity, and the War on Terror. Random House, 2006.

Day 5 – Medical Health and Physical Consequences of Torture and INS Detention

  • Physicians for Human Rights and the Bellevue/NYU Program for Survivors of Torture. From Persecution to Prison: the Health Consequences of Detention for Asylum Seekers, 2003.

Week 2: Class discussion – 3 hours per day + SP interview + write-up of interview of applicant for asylum + one-half day in IFMC + field trip to Washington, DC

Day 1 + 2 – Immigrants, Refugees, Asylum Applicants

  • Interviews with a torture survivor
  • Lecture by Dr. Fern Hauck

Day 1 + 2 – How to Conduct an Interview with an Asylum Applicant

  • Selected Readings and Book Chapters, See week 1, day 5 + sample medical write-ups of applicants for asylum
  • Physicians for Human Rights. Examining Asylum Seekers: A Health Professional’s Guide to Medical and Psychological Evaluations of Torture. Physicians for Human Rights, 2001.
  • Standardized Patient

Day 3 – Conducting an Interview with a Torture Survivor

  • Selected Readings and Book Chapters, See week 1, day 5 + sample medical write-ups of applicants for asylum
  • Physicians for Human Rights. Examining Asylum Seekers: A Health Professional’s Guide to Medical and Psychological Evaluations of Torture. Physicians for Human Rights, 2001.
  • Standardized Patient + presentation by students from day 2

Day 4 – Conducting an Interview with a Torture Survivor

  • Selected Readings and Book Chapters, See week 1, day 5 + sample medical write-ups of applicants for asylum
  • Physicians for Human Rights. Examining Asylum Seekers: A Health Professional’s Guide to Medical and Psychological Evaluations of Torture. Physicians for Human Rights, 2001
  • Standardized Patient + presentation by students from day 3

Day 5 – Tour of Human Rights Law Clinic for Immigrants and Refugees at UVA.

This description is a general overview. The instructor will establish the schedule and particular requirements at the time of the course.