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Tuesday Jul 17, 2018

Drawings From Detention: Assisting Asylum Seekers

I recently joined the Immigration Justice Campaign's(www.immigrationjustice.us) Dilley Pro Bono Project to assist asylum seekers at the South Texas Family Residential Center (STFRC), which is the largest family detention center in the United States.

As a family doctor who does medical affidavits for people seeking asylum and runs a clinic for people who have experienced sexual violence and human rights-related abuses, I know the process of seeking asylum is a traumatizing, years-long endeavor, during which many experience homelessness, food insecurity and, unfortunately, even death. Working at STFRC shined a light on the beginnings of my patients' journeys in the United States.

Although I'm still processing my experience, I wanted to share with you a few moments that stand out in my mind.

The Basics

People are eligible for asylum in the United States if they have suffered persecution or fear of persecution due to race, religion, nationality, membership in a particular social group or political opinion. Family detention holds primarily mothers and their children who are fleeing persecution in their home country. STFRC holds only mothers and their children. Most of the mothers being held in Dilley are from the "Northern Triangle" -- Guatemala, El Salvador and Honduras, where gang violence and lethal domestic violence are rampant. To call these mothers and children "illegal" is incorrect -- they are legally seeking asylum in the United States.

The vast majority of the mothers in family detention are awaiting a credible fear interview(www.uscis.gov) (CFI). Meeting a credible fear standard means there is at least a 10 percent possibility that the person could establish eligibility for asylum. A "positive" CFI result means the person can go on to apply for the years-long asylum process. A "negative" result means deportation. It should be noted that the detention of asylum seekers is not legally mandated. They could be released to their sponsor in the community (such as a family member or social worker at a community-based organization) with instructions to appear for their scheduled interview. But instead, the United States is choosing to detain mothers and children awaiting CFIs.

The Moments

Located in Dilley, Texas, the STFRC compound is a network of trailers: a mix of housing units, courts, medical and legal areas. For one week, our 18-member team worked within the confines of a trailer to provide legal care for asylum-seeking mothers and their children. The atmosphere fluctuated between an emergency room and a pediatric ward: Critical life and death issues were being managed, the need outnumbered the staff, time was short and stakes were high. At the same time, intermittent sightings of white, pink and blue blankets(www.npr.org) -- a staple of nurseries that here have been repurposed as shields for mothers to protect their young ones from the surrounding chaos -- were reminders that I was in a detention center, not a hospital.

Our team conducted CFI preps every two hours. We began each session with a "know your rights" presentation to a new group of mothers and children. Dressed in detention-issued uniforms of jeans, sneakers and solid color tops to identify their housing units (not unlike jail), women sat listening in a circle, clutching their children in one hand and a manila envelope containing their papers in the other. In direct competition with their efforts to hear and understand the session's essential information was a relentless soundtrack of childrens' coughs, cries and a loud television blaring the voices of carefree animated characters. It is a truly super-heroic effort to witness.

Bordering the common space where the rights presentations occur are private rooms where we met with clients for their CFI prep. To determine the grounds for asylum that may be most appropriate for a client's circumstances, mothers are asked to recount the details of violence that led them to seek safety in the United States. At the same time, women are tasked with soothing screaming toddlers, attempting to mask their own tears from their all-too-aware children, and trying to process the potentially life-saving legal information offered by the team, while being acutely aware of the clock ticking toward their interview time. The process can take hours.

After CFI prep, mothers await their CFI. An informal parking lot of empty strollers forms outside the trailer where court is held. Inside, the women (sometimes with their children), sit anxiously in a waiting room as they listen for their name to be called by the asylum officer. The atmosphere is thick with anxiety, and glazed with a superficial layer of distraction offered by Ice Age 2 playing on a television. Each time an asylum officer appears at the doorway, the women do a quick study of the officer's face. Will this person be kind? Will they be patient? Because their lives hinge on what transpires in the next 90 minutes with this stranger.

For those mothers and children who are released from detention, it's difficult to fathom that this is only the beginning. Awaiting them are years of repeating their story to prove their credibility while combatting family poverty, homelessness, illness, hunger and the ongoing threat of being separated from their children. My time in clinic has taught me that our systems are least kind to desperate mothers.

The Advocacy

My time in Dilley also forced me to reflect on my role as a physician-advocate.

I am part of a multidisciplinary team that came together last year to address the intersection of health, law and family detention, a collaboration that resulted in the adoption of a family detention-related resolution by the AMA House of Delegates(www.ama-assn.org). More recently, our team members' alarm regarding the increasing trend of detaining pregnant women led the AAFP, in a joint effort with the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, to issue a letter(2 page PDF) to U.S. Immigration and Customs Enforcement outlining the health harms of this practice.

But Dilley appears to be impenetrable to advocacy efforts on behalf of asylum-seeking mothers and children. (I was naively shocked when my first CFI prep was with a detained pregnant mother.) Health and human rights work requires highlighting the word "human." Unlike law, which affords the convenience of the term "alien" when attempting to distance oneself from the humanity of another person, medicine does not have such a lexicon. Even our most distancing term, "patient," still implies a human being. Although resolutions and statements are critical, they are not enough to link people to those perceived as "others."

So how else can we, as family physicians, harness our critical understanding of the nexus of physical, mental and maternal-child health to improve the care of detained families? For now, our best chance may be to amplify the basic human instincts we share with the people we serve: fear, safety, resilience and love.

Anita Ravi, M.D., M.P.H., M.S.H.P., is the founder and medical director of the PurpLE Clinic at the Institute for Family Health in New York City. She is not an artist, but enjoys using stick figures to promote health and gender equity. You can follow her on Twitter @anitafamilydoc.(twitter.com)

Posted at 03:21PM Jul 17, 2018 by Anita Ravi, M.D., M.P.H., M.S.H.P.

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