Archive for the 'Immigration & Refugees' Category
Add a comment March 7th, 2009 by Matthew Anderson
HealthRight International (formerly Doctors of the World-USA) – https://www.healthright.org/ – offers Human Rights Clinic training sessions for licensed physicians and mental health professionals interested in evaluating torture survivors. The sessions provide volunteers with an understanding of the asylum process in the United States, prepare them to evaluate the effects of torture on survivors, and address the importance of writing effective affidavits. The next session is on Saturday, March 14, 2009 from 8:30 to 1PM. For further information or to register, please contact Lisa Matos Jimenez at lisa.matos@healthright.org or 212-584-4866. The training will take place at HealthRight, 80 Maiden Lane, 6th Fl, NY, NY 10038.
These sessions are offered periodically and interested professionals should consult the HealthRight Interntional website for the most current events -https://www.healthright.org/jobs/volunteers-nyarea.
Commentary:
HealthRight International collaborates with the Human Rights Clinic at the Montefiore Comprehensive Health Care Center. Their evaluation protocols are quite detailed and adopt a holistic approach, evaluating both physical and psychological sequelae of torture. This is excellent training for individuals who work with refugees.
posted by Matt Anderson, MD
2 Comments February 6th, 2009 by Matthew Anderson
The Youth Leadership Project organizers
There has been snow continuously on the ground in New York since before New Year, a somewhat rare occurrence in these days of global warming. And saturday, January 31st was a particularly cold night. As one approached the basement of the St. Nicholas Tolentine church, a few brave souls stood outside smoking cigarettes and talking on cell phones.
Inside was the first annual fund-raising dinner of the Youth Leadership Project, a South East Asian community group. A dozen or so large round tables were spread around a long white room. At the tables was a happy crowd made up mainly of Cambodian immigrants. The room was filled with the sounds of people greeting friends. They saluted each other by putting their hands together as if in prayer and making a slight bow. Little kids zoomed in and out from a neighboring “children’s” room, mingling briefly with the adults and then returning. A small bar in the corner did a brisk business while people waited for the evening to start.
Chhaya and Khamarin, two of the YLP organizers, started the evening with a brief introduction to the Youth Leadership Project and appeals for help with two current projects. One is the Justice is Healing project (covered in detail in our blog of October 15, 2008); the other is a planned community center (more details below). They spoke in English and then Chhaya’s mother Ousara Phok, got up and translated their speech, a “translation” that involved copious thanks to many of the people sitting in the room.
The speeches were accompanied by a three course meal from Huynh Catering Services. The Huynh family, originally from Cambodia, has a long tradition of catering and Victor, we were informed, “does all the Cambodian weddings.”
With the speeches over, the very serious business of dancing began. Monorom, “one of the best Cambodian bands”, had been invited from Philadelphia and clearly knew what music the audience wanted to hear. Very quickly the dance floor was full. There were several different types of dances. Madison looked something like a line dance and can be seen at this link. Next came the circle dance (ramvong) a slow dance in which the dancers made elaborate movements with their hands as their hips swung slowly from right to left and back. Genders alternated in the circle. It was explained that in the old times unmarried people were not allowed to touch as they danced, thus the physical separation created by the circle. Finally, the Saravan dance which seemed to draw the most enthusiastic crowd.
We found a few minutes to catch up with Khamarin, one of the YLP leaders. He is a 20 year old student at New York College of Technology with plans to become a X-ray technician. He was born in the US and wasn’t entirely sure where in Cambodia his parents were born. His mother, he thought, came from Battambang and his father from a very small village.
Khamarin’s first experience in organizing came in 1999 when his aunt, a YLP
Chhaya and Khamarin
organizer had been campaigning against the welfare reforms of the Guliani administration. (This campaign was the subject of a film “Eating Welfare” made by CAAV: Organizing Asian Communities, the parent of YLP). Khamarin was quite young at the time but could not help being impressed by the fact that his aunt had brought people to the community to help. Thinking back now, he remembers how his elderly grandmother had started doing piecework about the time of the welfare cuts. She sewed small hair bands (scrunchies) in her apartment. He thought she was doing it as a hobby, but later he realized how many women in the community were doing this kind of piece work. “They would do the sewing and then the kids would cut the bands apart and sort them into piles.”
In 2001, 2002 the YLP organized ACE gatherings: Arts, Community, Empowerment. “We would be broken up into little groups and have to cook an entire Asian meal right there,” he said, “You would interact with people who you wouldn’t normally meet.” He learned about “the whole other side of the world.” This led him to training in community organizing and in 2006 he participated in the community health survey that was part of the “Justice is Health” campaign. He would knock on doors and ask questions about health problems and experiences with the medical system. health. He remembered one elderly woman. “My Khmer is not all that good, but it was enough to understand her.” She told him that it had been 5 or 6 years since she had seen a doctor. She had complaints. Back pains, leg pains and recurrent nightmares going back to the war. But it was too much trouble to go to the clinic and have no one there who would understand you. And if she had to take the children to translate, they would miss school.
We discussed YLP’s vision of a community center. The YLP house at 2473 Valentine Ave now serves as an unofficial community center and people gather there for holidays. But it is small for the group’s ambitions. They hope to create a Mekong Center that will serve local southeast Asians, not just Cambodians. It would be place to teach cooking, sewing, gardening, art, and dance. “These are our people’s skills, even though here they are not looked on as skills.” A group of urban planning students from Hunter College had helped them out. As a school project the students had created plans for rebuilding the current house into a real community center. Estimated cost: $2 million. Now it was YLP’s job to figure out what they would do with the plans.
Khamarin said that he had never been to Cambodia. He is afraid of flying. What he knew of Cambodian history he had learned from YLP. His schooling had not taught him much about his parent’s native country.
The Cambodian community in the Bronx has suffered multiple traumas. But this was not in evidence last Saturday night.
posted by Matt Anderson, MD
1 Comment January 7th, 2009 by Matthew Anderson
As a follow-up to our October 15, 2008 posting on the South-East Asian Community in the Bronx: Justice is Healing, we wanted to share this invitation from the Youth Leadership Project. They will be holding a fund-raising benefit on 1/31/09 at St. Nicholas Tolentine 2345 University Avenue at Fordham Road, Bronx, N.Y. 10468 from 6PM to 1AM. They are hoping to raise money to support a community center.
Support a Vision and Help Build the Southeast Asian Community in the Bronx.
We believe in the healing and building of the Southeast Asian Community in the Bronx- that we will heal and build through the understanding and compassion we show to each other. Build a community center that will link the generations together; it will be a home away from home, a place of knowledge, strength and power.
We believe in the legacy of struggle, strength and resiliency of people– that the community’s history is important in building toward our future. We can share and learn from our history; pass it down through dance, art and activism. And that the young and the old will rebuild and build a sustainable Southeast Asian community.
We believe in changing the conditions and lives of our community with other communities in the Bronx-
With 10,000 Southeast Asian in the Bronx and a borough with so many different cultures and ethnicity we see our vision for change as part of the struggle to all who want to live free of violence. We are committed to building alliance and coalitions.
posted by Matt Anderson
1 Comment December 15th, 2008 by Matthew Anderson
Girls are not for sale
On Tuesday, December 9th, 2008 Ms. Lori Cohen, a lawyer from Sanctuary for Families spoke at Social Medicine Rounds on “Understanding Human Trafficking.”
Sanctuary for Families is the largest New York State non-profit “dedicated exclusively to serving domestic violence victims and their children.” However, over the past 20 years Sanctuary’s work in domestic violence has led the organization to become increasingly involved in issues of trafficking. DV victims are not uncommonly also victims of trafficking.
And, as Ms. Cohen pointed out, they often first come to the notice of health professionals who see them for the sequelae of their abuse. Clinicians, therefore, can play an important role in identifying and referring victims. A website (http://www.humantraffickinged.com/) has been set up to alert Emergency physicians to the problems of trafficking. This very simple, but quite useful site, is a joint effort by the (NY) Mount Sinai Department of Emergency Medicine, the American Osler Society, AMSA and Brown Medical School.
Much Ms. Cohen’s talk was devoted to sex trafficking, and particularly sex trafficking among minors. About 450,000 children run away from home each year. One out of three are estimated to be lured into prostitution within 48 hours. This may explain why the average age at which prostitution begins is 13. Ms. Cohen showed the beginning of a film (which is currently being aired on Showtime) entitled “Very Young Girls” about tween and teenage prostitutes. This was not a very easy film to watch. However – in a section of the movie we did not see – it traced how Rachel Lloyd, “a survivor of commercial sexual exploitation and trafficking” established GEMS – Girls Education & Mentoring Services – to help young women who are victims of trafficking and to end commercial sexual exploitation of children. The bracelet pictured in this post is sold by GEMS to raise money.
Whereas most human trafficking is within the United States (state to state and within states) New York City has a large population of immigrant victims of trafficking. Trafficking into the United States comes from Southeast Asia (China, Thailand, Vietnam), followed by Eastern Europe (Russia, Ukraine, Czech Republic), and finally Latin America. As Ms. Cohen noted, whenever there is an important military conflict affecting civilian populations, trafficking from that area increases. She discussed clients of hers from Russia, Venezuela, the Ukraine, Korea and Sri Lanka, as well as locally trafficked victims of abuse. Sometimes women are brought in by organized crime rings, other times by “Mom and Pop” or family operations, such as the infamous Carreto family in New York.
Ms. Cohen emphasized that recognizing that a woman was a victim of trafficking is often difficult. Women are distrustful of government agencies. They often times do not have identification papers and believe that they have committed crimes. Their stories are programmed by the trafficker. Denial or minimization is common, as is shame. Language poses a barrier with abusers often serving as “interpreters.” The Human Trafficking ED site offers recommendations for providers seeing patients who they suspect are victims of trafficking.
The take home message is that clinicians should be aware of this problem, maintain an index of suspicion for abuse and trafficking, know how to sensitively interview a patient and have access to referral sources, such as Sanctuary for Families.
Posted by Matt Anderson, MD
2 Comments November 20th, 2008 by Matthew Anderson
US Incarceration Rates Stratified by Race
Each October our Residency Program in Social Medicine does something rather unusual. We take our interns off the hospital wards to participate in “Orientation Month.” For four weeks they learn about social medicine and the Bronx, the place in which they are practicing medicine. They are introduced to the philosophy, theoretical framework, and practice of Social Medicine through a curriculum of didactic and experiential learning. The month emphasizes a biopsychosocial perspective that integrates patients, their communities, and the medical system into a holistic view of health problems. At the conclusion of the month residents present a synopsis of the clinical problem they have studied and develop a proposal to address its social determinants.
This year the overall theme of the Orientation month was The Impact of Violence on Clinical Practice. We explored this through three cases: one involved a patient who had been incarcerated, the second a case of domestic violence and the third an immigrant. These cases were tightly integrated into a series of activities that included visits to prisons (Riker’s Island and Sing Sing), community organizations, community centers (e.g. the Bronx Community Pride Center), local businesses (such as botanicas) and Bronx institutions such as the Botanical Gardens and the Bronx Museum. The interns also learned practical skills such as how to perform a medical evaluation of an ayslum seeker and how to do community organizing (a workshop taught by Steve Max of the Midwest Academy).
On Tuesday, November 18th the interns presented their work as part of our regularly scheduled Social Medicine Rounds. A standing room only crowd listened as they shared what they had learned and made a a variety of project proposals. Their presentation can be downloaded as a Powerpoint. While the Powerpoint does not capture the richness of their actual presentation, it suggests the themes they explored and learned about.
Posted by Matt Anderson, MD
2 Comments October 15th, 2008 by Matthew Anderson
Event Organizers: Chhaya Chhoum , Joyce Wong, and Ousara Phok
On Friday, September 19, 2008 we had the opportunity to attend a community health forum organized by the Southeast Asian community of the North West Bronx. The forum, entitled “Justice is Healing,” was the work of a local community group, the Youth Leadership Project (YLP).
The setting for the forum was the beautiful new Bronx Library Center off of Fordham Road. In a large meeting space below the entrance, mothers tended to noisy toddlers and infants in strollers. Hot Cambodian and Vietnamese food was served on long tables alongside literature about various immigration related campaigns. Inside the Library’s auditorium some 200 participants listened to a full evening’s worth of speakers. Most were southeast Asian immigrants from community. However, it was heartening to see faces of all complexions amongst the public. The presentations were translated into three languages: Khmer, Vietnamese, and English. Despite this often laborious process interest remained high throughout the 3 hour program and people left energized.
YLP, established in 1996 by the CAAAV: Organizing Asian Communities (aka the Committee Against Anti-Asian Violence), has been working for several years to address the needs of several thousand primarily Vietnamese and Cambodian refugees. (See our posting on Agent Orange.) These refugees were settled in our part of the Bronx is the early 1980′s. Many had suffered tremendous losses in their home countries. In some cases, their entire family had been killed. They had spent years living in refugee camps. Now they found themselves in some of the most troubled areas of the Bronx, not speaking English (or Spanish!) and with limited social services. Many suffered from post-traumatic stress disorder, a problem aggravated by neighborhood violence. In one, very public case, a young Cambodian, Kim Hong Tim, was murdered as he drove his taxi in the spring of 2000.
Local organizations reached out to help. The Montefiore Family Health Center – a federally funded Community Health Center – established an Indochinese Mental Health Program in collaboration with the Montefiore Department of Psychiatry. This Program became a lifeline for many patients. Providing much more than simply mental health, workers in the program coordinated care with the clinic’s physicians and hooked people into community resources. CAAV organized the YLP to address the damage caused by “welfare reform” in the mid-90′s. As part of this effort, YLP produced a film – Eating Welfare – which chronicles the situation in the community at the time.
Over the past two years, YLP has partnered with the NYU Center for the Study of Asian American Health to examine the health problems of local South East Asians. In 2007 YLP interviewed and surveyed 150 residents, asking them about their major health problems and their concerns regarding health care. The results of this survey can be found at the following sites:
Cambodian Community: http://www.med.nyu.edu/csaah/research/ethnic.html#cambodian_chnra
Vietnamese Community: http://www.med.nyu.edu/csaah/research/ethnic.html#vietnamese_chnra
As a result of this survey YLP made five key recommendations:
1. Improved language access and translation services.
2. Availability of complementary and alternative treatments.
3. Outreach and education programs linking trauma and diabetes.
4. Workforce development (i.e. hiring and training of southeast Asian community members).
5. Integration of health and social services
Many community members spoke at the event, detailing their experiences with healthcare in the Bronx. A common theme was difficulties with translation. In some cases children were used as translators. This is highly problematic because children should not be involved in certain health care discussions. Children may not know their parent’s language sufficiently well to function as medical translators. Using phone translators is also problematic because they are often not skilled in specific medical terms nor do they know the context of a conversation.
In the long term, the YLP would like to see a comprehensive war survivors clinic, a resource that would be of value to many communities in the Bronx. The demands of the YLP are very much in agreement with the vision of community health. The responsibility of health professionals extends beyond simply treating disease when it shows up in the office. The job of a community health center is to reach out to the surrounding community and particularly to the most vulnerable parts of the community. It addresses not just medical problems but also the multiple social and health issues of its community.
For additional coverage of this event, see the 10/2/2008 article in the Norwood News by Rebecca Chao. You can also listen to a radio report entitled Welcome to the Health Forum made by Radio Rootz.
2 Comments September 29th, 2008 by Matthew Anderson
Nestled amidst the McDonalds, Duncan Donuts and various Latin eateries of Jerome Avenue in the Bronx, sits the World of Taste Deli/Restaurant (formerly the Phung Hung Market), a cheery Vietnamese restaurant serving authentic sandwiches and various noodle soups. It is one of many signs of our local Vietnamese community.
One of the health concerns of the Vietnamese patients who visit our clinic has been the possible health sequelae of the use of Agent Orange by US forces during the Vietnam War. On Friday, September 19, 2008 we had the pleasure of meeting Mr. Ngô Thanh Nhàn, a Vietnamese activist in the Agent Orange campaign. He spoke at a forum organized by the South East Asian community in the Bronx entitled “Justice is Healing.” [We will be discussing this forum in a future post.]. Mr. Nhàn’s presentation follows that of Dr. Nguyen Thi Ngoc Phuong, one of the leading Vietnamese obstetrician-gynecologists, who spoke at our Social Medicine Rounds in November of 2007. Both are members of the Vietnam Agent Orange Relief & Responsibility Campaign. This campaign is a joint initiative by US veterans and Vietnamese living in the US.
Agent Orange was one of several defoliants sprayed by the US Army during the Vietnam War. Defoliants kill plants and were intended to deprive guerilla fighters of hiding places and destroy crops that might feed them. In addition, the Army sought to make entire regions “uninhabitable” forcing their population into controlled villages (called strategic hamlets).
These defoliants were contaminated with dioxin, considered one of the most toxic substances known to man. The health impacts of dioxin were succinctly summarized in a 2007 American Public Health Association statement on Agent Orange:
“Dioxins are known to be risk factors for cancer, immune deficiency, reproductive and developmental disorders, and central nervous system and peripheral nervous system effects.
Studies conducted by the international scientific community have shown the association between exposure to the herbicides and health outcomes, including cancer, reproductive illnesses, immune deficiency, endocrine deficiencies, nervous system damage, and other ill effects and possible developmental disabilities and emotional problems in children.
Those negatively affected may include children born to parents who were sprayed directly. Current conditions recognized by the US Veterans Administration as service connected to Agent Orange exposure include the following: soft tissue sarcoma, chloracne, Hodgkins Disease, multiple myeloma, non-Hodgkin’s lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, chronic lymphocytic leukemia, diabetes (type 2), and spina bifida in the children of veterans.”
About 1/10th of Vietnam is estimated to have been sprayed with some 20 million gallons of Agent Orange. Dioxin hot spots remain today around US air bases. Upwards of 2.1 million people may have been exposed to Agent Orange.
There is a strong case that the use of Agent Orange and other herbicides is illegal under various international agreements. In addition, there is evidence that the US military knew that Agent Orange was contaminated with dioxin.
In September of 2004 a group of Vietnamese filed a law suit in New York Federal Court against 36 chemical companies. The suit sought to hold the companies “accountable for their actions when they knew they were providing a poison in orangebanded barrels to the United States government which was to be sprayed on millions of people and vast areas of land in South Viet Nam.” The suit was thrown out of court by Judge Jack Weinstein. The judge’s decision stated in part: “Defendants moved in those cases for summary judgment based on the government contractor defense-in essence, the claim that the government told us to do it and knew at least as much as we did about the dangers. The court granted defendants’ motion to dismiss those tort-based claims on the grounds that the contractor defense applied.” This lawsuit has been appealed.
There is a need to clean up the dioxin that remains in Vietnam and to care for and compensate the victims of this toxin. There is also an interest in doing a comprehensive survey of the effects of Agent Orange in the Vietnamese community in the US. Agent Orange-related damage is also an ongoing problem for US Veterans. The Veterans’ Administration has lots of information on Agent Orange, sprayed “to remove unwanted plant life and leaves which otherwise provided cover for enemy forces during the Vietnam Conflict.”
Sadly, we are likely witnessing a replay of this story today in Iraq. Please see our September 12, 2008 posting on the impact of the war on health conditions in Fallujah.
Posted by Matt Anderson, MD
Add a comment July 17th, 2008 by Matthew Anderson
We have just published Volume 3, Number 2 of Social Medicine. The full table of contents in available on line. Here is some information about the articles:
Earlier this year we invited Asa Cristina Laurell, a prominent Mexican public health activist to prepare a special issue on progressive health reforms in Latin America. Dr. Laurell was the head of the Mexico City Health Department from 2000-2006 and – had the Mexican elections not been stolen by the right – she would currently be Mexico’s Minister of Health. She contributed a paper describing the Health Department’s experience with providing free medicines and medical care to people who did not qualify for coverage under Mexico’s employment-based Social Security System. Other papers examine Brazil’s Unified Health System, the SUS, which is one of the world’s largest public health systems; the Venezuelan attempts to provide free health to the all citizens with assistance from the Cubans; Uruguay’s moves to a public-private system that will guarantee the right to health; and finally Bogota’s experience with providing poor communities with access to health care through the Health at Home program.
American readers may be particularly interested in the article by Razel Remen and Lillian Holloway, two US students studying medicine at the ELAM school in Havana Cuba.
We publish two articles of original research. A Hong Kong team reports on public attitudes during the SARS epidemic in 2003, while Dr. Paula Acevedo presents data on reproductive patterns among Latin American immigrants in Spain.
Sadly, we publish the last article written by Edmundo Granda, one of the founders of ALAMES, the Latin American Social Medicine Association. He passed away in April of this year. He approved the final galleys of the Spanish version of his paper via blackberry from the hospital on the week he died. His paper considers the historical trajectory of ALAMES and where Latin American Social Medicine may be heading.
Finally, Dr. Lanny Smith interviews Chilean activist Victor Toro, a political refugee from Pinochet’s Chile, who is now facing deportation from the US, his home of nearly 2 decades. Ironically, he has been a immigrant rights activist (and patient of Dr. Smith) in the Bronx, New York, for most of these years. His account of becoming ill in an ICE detention facility mirrors the concerns discussed in our July 10th posting about Dr. Homer Venters.
Posted by Matt Anderson
3 Comments July 10th, 2008 by Matthew Anderson
What do Social Medicine doctors do?
Dr. Homer Venters, a 2007 RSPM Internal Medicine Graduate, is currently working as an Attending Physician at the Bellevue/NYU Program for Survivors of Torture and is a Public Health Fellow, New York University. During his residency at Montefiore, Dr. Venters worked with Bronx Defenders, a legal aid organization in the Bronx, helping to get people involved in the criminal justice system into primary care. This work resulted in the publication of an article about the tragic case of Scott Ortiz in the Harm Reduction Journal. His work as a resident was awarded the Dan Leight Social Medicine Award.
On June 4 2008, Dr. Venters testified in front of the House Judiciary Committee’s Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law. He discussed problems with the medical care provided to Immigration and Customs Enforcement (ICE) detainees. It is clear to people working in the field that ICE detainees are not accorded the same medical care provided to other US prisoners. Dr. Venters outlined some of the reasons why. Specifically he pointed out that the ICE medical system is designed to care for acute problems; it is not set up for persons with chronic medical issues. To quote from his testimony:
“This institutional aversion to caring for detainees with chronic disease is evidenced in recent detainee deaths. One year ago, a 23 year old transgender woman, Victoria Arellano was detained by ICE. Ms. Arellano had AIDS and was taking a life saving medicine to prevent opportunistic infections that could quickly cause pneumonia and death were she to stop. These medicines are essential for people with AIDS and even a brief interruption risks sickness and death for a patient. Despite reporting her medical history and her medication when detained (and throughout her detention), Ms. Arellano was refused her medicine. Over the following weeks, Ms. Arellano developed a cough and fever, which should have prompted hospitalization and evaluation. Instead, Ms. Arellano was given an inappropriate antibiotic by the detention center medical staff, was still refused her needed medication, and returned to her cell. By the time Ms. Arellano’s cellmates staged a protest to draw attention to her deteriorating condition, she had become very ill and died soon thereafter, comatose and shackled to her bed. Faced with a common chronic disease, ICE medical staff withheld the correct medicines, gave inappropriate medicines and failed to seek more competent care for Ms. Arellano. The care that Ms. Arellano required would be routine in almost any medical clinic or hospital in the United States.”
The full testimony is available here.
Posted by Matt Anderson
