Groundbreaking Achievements in Asylum Medicine

Katherine McKenzie, MD, FACP, assistant professor of medicine (general medicine), has recently achieved two milestones as the director of the Yale Center for Asylum Medicine (YCAM). In 2021, she founded the Society of Asylum Medicine, whose mission is to support the field by promoting collaboration, providing mentorship, and sharing resources with the community. In January 2022, she published Asylum Medicine: A Clinician’s Guide, the first comprehensive text in the field, with contributions from experts across the country.

“Both the society and the book are first-of-their kind endeavors in asylum medicine, and position Yale as the leader in the field,” said McKenzie.

As director of YCAM, McKenzie has performed forensic medical evaluations of asylum seekers for nearly two decades, gathering objective evidence that can help attorneys and human rights groups build a legal case for individuals coming to the United States seeking protection from serious human rights violations in another country.

The Center’s broader mission includes educating trainees; advocating for asylum in general through media campaigns and opinion pieces; and contributing to the scholarly body of asylum medicine through research, review papers, and clinical case studies.

McKenzie started the Society of Asylum Medicine (SAM) with three peer-institution colleagues - Hope Ferdowsian, MD, (University of New Mexico), Amy Zeidan, MD, (Emory University), and Shawn Sidhu, MD, (University of California, San Diego) - to create the first professional organization dedicated specifically to asylum medicine, and to provide a space for member-driven collaboration between physicians, mental health providers, clinicians, and human rights professionals.

The SAM website provides a resource page that offers a library of asylum medicine literature, legal and historical documents, reports and annual statistics, perspective and opinion essays, advocacy tools, training videos, and more. Members of the society also have access to a listserv that encourages communication and exchange of ideas within the community.

Siddhi Nadkarni, a medical student at Yale School of Medicine and the current student leader of YCAM, said that she frequently uses the Society website’s resources to improve her evaluations and to guide YCAM trainees on affidavit writing. “Something I find especially helpful on the website is the set of body diagrams, which we use for all of our evaluations. They allow you to really accurately depict where someone’s injuries are because you can physically draw on the diagram and submit that as part of your affidavit.”

The body diagrams were created for YCAM by Anne Marie Boustani, MD, assistant professor of radiology and biomedical imaging at YSM. This contribution from Boustani illustrates the interdisciplinary collaborations that occur between YCAM and departments at the medical school, Yale College, and other Yale professional schools.

In the future, McKenzie hopes for the society to offer educational resources such as podcasts and webinars. She is also interested in eventually creating a journal and an independent conference for the Society of Asylum Medicine. Currently, the SAM conference occurs in collaboration with the Society of Refugee Healthcare Providers annual meeting.

McKenzie said she initially became interested in publishing a clinician’s guide after writing a chapter on asylum medicine for a book written by one of her colleagues, Aniyizhai Annamalai, MBBS, MD, director of the adult refugee clinic at Yale School of Medicine. Recognizing that there was no clinician’s guide dedicated specifically to asylum medicine, McKenzie decided to take the initiative herself.

“I’d never written a book before, but the endeavor was satisfying,” said McKenzie. “I loved the process. I reached out to contributors and, as the editor, I was responsible for bringing it all together, as well as writing two chapters on my own.”

Nadkarni said that this book has also proved to be a valuable point of reference for her work as the student leader for YCAM. “As a part of a refugee conference that we just attended, I had the opportunity to make a presentation that we sent to everyone as a resource on self-care during evaluations. I drew heavily from a chapter in this book to create that presentation,” she said.

Both the Society of Asylum Medicine and Asylum Medicine: A Clinician’s Guide reflect the remarkable contributions that McKenzie has made to the field of asylum medicine over the past 20 years. In alignment with YCAM’s mission to support the growth of the field and educate the next generation of medical professionals, McKenzie intends for the Society and the Clinician's Guide to not only be useful resources for current clinicians, but to serve as educational tools for students and trainees interested in joining the field.

“The workforce for this field is chronically under-subscribed,” said McKenzie. “We always have more asylum seekers / evaluators, so we need to train the next generation to bolster the workforce. If people are trained at Siddhi's level, they learn a lot about trauma-informed care, and that is a skill that can be used for this population as well as for all patients who are cared for by doctors and other clinicians. So it's an important skill that they should have, regardless of whether they become asylum evaluators or not. And what a trainee brings to the field is the antidote for our cynicism or our burnout. I’ve been doing this for 20 years, so when I see a young, uncynical trainee, it can certainly be enriching. The benefits go both ways.”