When she was a resident at Elmhurst Hospital Center in Queens, N.Y., Dinali Fernando, M.D., didn't always go home after her shift ended. Sometimes, she stayed on and wrote medical affidavits on torture victims who showed up in the emergency department.
A native of Sri Lanka, Fernando was especially interested in immigrant and refugee medicine. While she never faced political torture herself, she had friends who were killed in conflicts. Cousins and grandparents were forced to flee their homes permanently during the country's civil war, which began in the 1980s and lasted 25 years. So when two of Fernando's mentors at Elmhurst started a volunteer program to provide medical, mental-health and social assistance to torture victims who came through the ED, she immediately signed on.
The program trains staff and medical residents to identify victims of torture, a much-needed addition to the busy ED. Located in one of the country's most ethnically diverse zip-code areas, Elmhurst Hospital has a patient population that comprises primarily immigrants and refugees, many hailing from countries in political turmoil. And—according to results of an ED survey Fernando and others conducted from 2008 to 2009—between 6 and 8 percent of the ED patients fit the United Nations definition for victims of torture.
The ED is an important "port of entry" for these patients because many don't yet have political asylum and are uninsured, so they're unlikely to go to a primary care clinic for medical treatment, Fernando says. But ED doctors often lack the time and know-how to identify torture victims and give them the care they need—as well as the medical documentation necessary for political asylum.
Since patients often aren't forthcoming about their experiences, "it's on us to have the clinical acumen to see where they're coming from," Fernando says. "They are afraid we may not believe their stories because they may seem so unbelievable, or they may think their history is unrelated to the complaint their presenting for."
In 2009, a three-year federal grant from the Office of Refugee Resettlement formally helped to establish the Libertas Center for Human Rights, which operates out of clinic space at Elmhurst Hospital Center. The hospital is seeking additional funding to ensure the program continues to thrive. Fernando now runs the center and continues with her ED coverage. About 100 clients receive ongoing services, from long-term therapy to help with medications and finding housing, employment and food pantries. About 35 clients are from West Africa, 25 from South and Central America, and 25 from South Asia and the Middle East.
ED staff refer some clients, while community organizations and lawyers representing clients in asylum cases send others.
Kulsoom Hashimi's lawyer directed her to Libertas in November 2010 when she was seeking political asylum. The 28-year-old Hashimi had fled her native Afghanistan that February to escape an abusive cousin that she was being forced to marry because she had been "promised" to him at birth. When her cousin heard she had talked to a magazine reporter about her marital situation, he beat Hashimi to the point that she still suffers chronic knee and back pain. With the help of other family members, she fled Afghanistan and came to the United States.
At Libertas, doctors examined Hashimi and wrote her an affidavit that helped her gain asylum. They also referred her to a gynecologist for some other medical troubles that resulted in surgery, and provided her with a therapist and medications for the depression she experienced as a result of the trauma she suffered at home and coming alone to a new country.
"They were supportive and very caring, all without charge," says Hashimi, who now has a job as a receptionist and accounting assistant at an agency that provides housing for senior citizens.
"We want to do anything we can," she says. "Any small thing. They've been through hell and back, and their stories are so hopeful. I have a lot of respect for them."