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For asylum seekers, life hangs on a doctor’s note

Dr. Richard Kovar, sitting in the Country Doctor Community Clinic, has been providing asylee exams for nearly 20 years. Credit: Matt Mills McKnight/KCTS9

Dr. Richard Kovar answered the phone; an attorney friend was on the line. A man named Phillips sat jailed in the Northwest Detention Center in Tacoma, the attorney explained, picked up for a routine traffic stop. He’d fled to the United States after men back home in Liberia beat him and left him in a ditch to die. Now facing deportation, Phillips was seeking asylum, fearing if he returned home, he would not survive.

But he had no proof. Could Kovar, the attorney asked, physically examine Phillips in order to strengthen his claim?

Kovar works as the medical director of the Country Doctor Community Clinic in Seattle, a cramped space on the northern edge of Capitol Hill near where the Kingfish used to serve étouffée. Nearby development with glass exteriors dwarfs the squat, humble clinic, which is starting to look dated. Still, the clinic’s French windows and corner street entrance welcome a mostly low-income clientely into a low-ceilinged waiting room.

Kovar’s glasses rest low on his nose. Deep creases cut from the corner of his eyes to his jawline. He buzzes with energy but when he switches from small talk to the harrowing world of asylum, his voice drops an octave and his intonation flattens.

After receiving that phone call from his attorney friend, Kovar agreed to see Phillips. Two guards escorted the Liberian man in through a back entrance to a small clinical room with a paper-covered exam table. He was shackled and dressed in an orange jumpsuit. Kovar had never done this kind of fact-checking exam before so he improvised. Were Phillips’ joints swollen? Could he lift his arms above his head? Were his eardrums damaged?

In the end, Kovar found enough in the way of scarring and permanent damage to later testify to the court that Phillips’ story was true.

Immigration authorities granted Phillips asylum. The year was 1998.

Nearly twenty years later, Kovar, working in that same Country Doctor office, now fields three emails in just one morning from attorneys and immigration advocates seeking similar medical exams for other asylum seekers. His exams have helped hundreds. “This is life and death,” Kovar says.

 

People who seek asylum say they have been or will be persecuted if they return home: Physical torture, rape, genital mutilation, starvation, death.  Journalists from Rwanda, LGBTQ people from the Gambia, opponents of the Mungiki in Kenya, the Yazidi minority from Iraq and Syria. As drug wars have flared up in Central America, immigration courts in Seattle have processed more people from Honduras and El Salvador. Toward the end of the Iraq war, around 2009, there were more Iraqi asylees. As the terrorist group Al Shabaab upended parts of East Africa over the last several years, more Somalis.

Asylum seekers sort into three camps: people who’ve overstayed their tourist or work visas; people who have entered the country illegally and file a claim; and those who reach the U.S. border and declare themselves asylees. This last group is shipped to an immigration detention facility.

Under United Nation rules, the United States is obligated to at least provide consideration to those who are deemed to have “credible fear” of persecution. Federal agents interview asylees and if they pass, their asylum proceedings can begin.

Since 2011, the U.S. has seen an enormous increase in people seeking asylum, all of whom have been funneled into an increasingly crowded and onerous immigration system. In 2011, there were 297,000 immigration cases pending review; at last check, that number was up to 542,000.  During that same period, the average time for a case to proceed through immigration court nationwide has jumped from 489 days to 687. Asylum cases move through immigration courts in Seattle and in Tacoma at a faster pace: an average of 409 days. Still, that’s nearly double the wait time from 2011.

It used to be that federal agents would book asylum seekers but then release them on parole, sparing them from being locked up. But parole began to disappear as an option during the later years of the Obama administration and detention facilities like the Northwest Detention Center have filled to capacity and beyond.

 

In 2011, The New Yorker published an article called “The Asylum Seeker.” It was about a Central African immigrant who freely admitted to the author that she was exaggerating her story — telling authorities in New York that she’d been raped when she had not. “That story did a lot of damage,” says Dr. Alexandra Molnar, a primary care physician in Seattle who, like Kovar, provides corroborating asylee exams. Molnar, who completes a handful of exams each month, says “99 percent” of the stories she hears check out. Still, for all the anti-immigrant rhetoric, without proof, it’s easy to pass an asylum seeker’s story off as an attempt to slip into the country through a backdoor. Stories like the New Yorker’s provide tinder for that narrative.

But when an asylee’s claims are backed by medical exams, Kovar estimates the odds of getting asylum jump from perhaps 20 percent to 85 percent.

Maggie Cheng, a staff attorney with the Northwest Immigrant Rights Project (NWIRP), agrees. “Those medical and psychological evaluations are very important to prove an asylum seeker’s claim,” she says. “Under U.S. asylum law, it’s [the asylee’s] burden to prove the torture, but being able to retell the perfect story is unrealistic.”

Getting someone through the asylum process is a three-pronged effort. NWIRP provides legal aid. Lutheran Community Services Northwest helps applicants transition to this country with English classes or housing connections or behavioral health services. And Kovar, Molnar and a network of two dozen other doctors across the region, provide medical exams. They do the medical work for free.

Molnar works as a primary care physician in Seattle. She has a kind of outdoorsy crunchiness about her and waxes nostalgic for traveling abroad. She and her husband recently went to see the band Galactic, a sort-of New Orleans-version of the Grateful Dead.

Molnar’s own family history is similar to some of the asylum seekers she examines. Her family fled Hungary to the United States during World War II. And yet, that story isn’t what led her to this work. “I’m not a surgeon so I don’t have the feeling of saving a life,” she says about her daily work doing primary care and routine physicals. But someone seeking asylum — that’s “life and death,” she says. When she saw a flier at her office asking for volunteer doctors to do exams, she signed up.

At her house in Seattle’s Maple Leaf neighborhood, Molnar’s son is in one room watching Inside Out, the Pixar movie. She’s in another room, cradling her infant child and talking about her work: genital mutilation and torture. Molnar says traveling the world doesn’t interest her like it used to. The stories she’s heard over the years from asylees make her better appreciate the United States and its human rights protections.

But as passionate as Kovar and Molnar are about doing the exams, they must complete them with as much objectivity as possible. Because the moment a doctor’s stenography is seen as advocacy, the legitimacy of the exam and therefore the story could be questioned by the court. A three-inch binder of training materials for doing these exams instructs doctors to see asylees as “clients,” not “patients.” “Clients should not be given the misimpression that they are going to receive treatment or therapy,” the materials read.

This flies in the face of the standard patient-doctor relationship. “I’m usually the advocate,” Molnar says. But for these exams “I always tell them, ‘This is not your doctor’s visit.’ We’re not meeting patients where they’re at.”

So doctors treat their clients as if they are mannequins, mannequins alleging horrific abuse.

The questions are probing, searching out specifics: Was there a knife used? How long was it? What angle did it enter? Was it rusty? Did the asylee attempt to suture his own wounds? Doctors are warned of abusers savvy enough to use instruments that leave fewer marks. So there’s additional detective work: look deeper for proof of internal bleeding, fractured bones or swelling. If a client’s story includes being forced into a certain position for long periods of time — bound or forced to stand —joint pain, limited range of motion, poor blood circulation could be clues as to what happened. If electricity was used, a client may react to touch more sensitively. And if there was sexual abuse, as is often the case, there should be signs of internal lacerations, pelvic pain and long term psychological damage.

The exams can take an hour or more.

 

Trump has aggravated an already complicated immigration system, heightening the anxiety for asylees and their advocates. Beth Farmer, director of refugee and asylum services at Lutheran Community Services, says she’s heard some “weird stuff” recently — cases getting denied that she thought were slam dunks. Recently, two clients applied for asylum on behalf of family members, but their materials were returned without any comment. Tim Warden Hertz with NWIRP says no asylees held in detention have been released on parole in the last month. NWIRP’s Maggie Cheng says her organization has seen some “concerning denials” being ruled in Seattle Immigration Court.

Trump’s recent immigration order sets higher bars for credible fear at the border and immigrant rights organizations that are worried asylum seekers will be driven underground. What worries advocates the most is a proposal to keep people in Mexico who declare asylum at the U.S.-Mexico border, rather than transporting them to a facility in the United States, which is what happens now. There are obvious questions surrounding whether Mexico would accommodate this. But if asylum seekers are denied access to in-person counsel and a medical examination, it would essentially mean their chance of being granted a stay in this country would drop dramatically.

A less penetrable Mexico border would impact not only Mexican or Central American asylees. Take, for example, the case of one man from Somalia. According to his affidavit, the man’s father preached openly against Al Shabaab and had also worked for the U.S. military, a combination that put the entire family in danger. The man’s father and brother were shot dead in the head; the man said he had been kidnapped, starved and beaten over the course of a month before escaping. Using a smuggler, the man traveled for 45 days from Kenya to Turkey to Brazil and then north to the U.S.-Mexican border where he requested asylum and was shipped to the Northwest Detention Facility in Tacoma for adjudication.

In the end, Kovar examined him and corroborated the man’s accounts. He was granted asylum. But were he held in Mexico, none of that would have happened.

“The Trump threats are very frightening and he does seem intent on keeping people at the border,” Kovar says. “I was in Tijuana not long ago and saw a large number of probably African men huddled up on one block, probably figuring out how they would get across the San Isidro crossing. They are likely to be kept out.”

 

The training materials for asylee exams include an entire chapter on physician self-care. “Secondary trauma is a big deal,” Kovar says.

After an exam, Kovar typically shuts down. “I walk out of here and I just turn off. Does it trickle into other parts of my personal life? I think it probably does. I’ve had to acknowledge that lately,” he says.

But his work as a doctor juggling both patients and clients requires he compartmentalize. “These are the worst stories you could possibly hear. But I can’t be shortchanging the next person because I’m having a breakdown.” Kovar exercises regularly, eats healthy, drinks a single malt whiskey on occasion to stay sane.

As Kovar talks about his work in the context of Trump and his leviathan wall with its proposed 10,000 new border guards, not to mention his threats on Seattle because it’s a sanctuary city — the act of completing hour-long exams in the Country Doctor clinic can feel, well, minuscule. But Kovar forges on.

“I believe fiercely in the right of asylum,” he says. “There’s a due process that needs to happen that can’t happen with just a lawyer.” People like him are part of an infrastructure that needs to stay steady and strong on behalf of the most vulnerable, he says. Even in the face of so much change.

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