Doctors practicing asylum medicine look for scars of persecution

This is the story that Paulin Kalonji, once the owner of a small business in Africa, told Dr. Katherine McKenzie at the Yale School of Medicine when he applied for asylum in the United States:

One evening in February of 2013, three soldiers from the Democratic Republic of Congo entered Kalonji’s home and dragged him to a waiting car. They took him to a building that had been converted into a makeshift prison, and he was thrown into a small room with about 15 other people. The room was hot and infested with ants. During his two weeks there, soldiers would come and take people out in the middle of the night. Those who left the room at night never returned.

Occasionally, Kalonji was taken to an interrogation room and told to take off all his clothing. He was asked about statements he made in opposition to the Congolese government. The soldiers told him he was going to die. And then they tortured him.

For almost a decade, McKenzie, an internist the Yale School of Medicine, has conducted forensic evaluations of claims like those made by Kalonji, a practice called asylum medicine. Asylum status can be granted to people who have been persecuted or have a well-founded fear of being persecuted if they return to their own countries. Asylum seekers come from countries where domestic abuse goes unpunished, gang warfare is rampant, genital mutilation is practiced, and people are tortured because of their race, religion, or sexual preference.

Although physical abuse is not a condition of being granted asylum, applicants who have physical signs of torture and who undergo a forensic medical evaluation have a better chance of being one of approximately 20,000 people granted asylum each year.

McKenzie noted an ugly scar on Kalonji’s lower right leg, consistent with his claim that a soldier had cut him with a bayonet. There was a similar oval-shaped scar on his left buttock, also cut with a bayonet, he had reported. Kalonji also said that his captors had let melting plastic drip on his foot. McKenzie noted a raised scar on his foot, consistent with burning.

In her report, McKenzie noted that Kalonji’s insomnia and anxiety supported a diagnosis of post-traumatic stress disorder. Kalonji, now 47, was granted asylum a few days before Christmas, 2013.

“The stories are powerful,” said McKenzie, who has practiced general medicine at Yale since 1995. “These people are living in countries that consistently violate the human rights of their own citizens. The ability to help them is very meaningful.’’

As director of the Yale Center for Asylum Medicine, McKenzie and colleagues have seen about 55 such asylum-seekers. She saw her first case in 2006 — a woman from the Congo who was referred by lawyers at the Yale Law School Immigration Legal Services. The woman said she was detained for her political beliefs, and then raped, beaten by batons, and burned by her guards.

McKenzie says her job is not to determine the veracity of claims like these, but to use her medical training to assess whether the physical and mental findings are consistent with the story that is told by the asylum-seeker. She finds most of these stories compelling.

“By the time these cases are referred to me, they have been well vetted by the attorneys who request an evaluation,” she said.

McKenzie plans to take a sabbatical this year and conduct research in asylum medicine. The goal, she said, is to create a standard of practice for a growing field. This spring Yale hosted a national conference on asylum medicine that drew more than 100 people. In addition, many Yale students, residents, and fellows have a keen interest in the field, and are offered the opportunity to observe evaluations of asylum-seekers.

She is also acutely aware that she is only seeing those lucky few among the millions of asylum seekers who managed to flee persecution and abuse to reach the United States.

“It is a privilege to provide care to patients in my internal medicine practice, but performing these forensic evaluations has provided me with an opportunity to use my medical training in uniquely challenging intellectual way,” McKenzie said. “I realize that the asylum seekers I see are some of the most vulnerable people in the world and am grateful to do something that helps them.”

Kaljoni is grateful to McKenzie. His wife and seven children have joined him in his home in Bridgeport. He has good job in the Naugatuck Valley transporting surgical equipment.

“As soon as my five-year waiting period is over, I plan to apply for citizenship,” he said through an interpreter.