Asylum Medicine: A Clinician’s Guide

Book Title: Asylum Medicine: A Clinician’s Guide

Editor: Katherine C. McKenzie

Publication Details: Cham, Switzerland, Springer Nature, 2022. 249 pp., $119, e-book, $160, hardcover

When I first received this book for review, not seeing the subtitle, I thought I was going to be reading a historical account of the “bad old days” gone by. Instead, it is a very contemporary, practical manual for those involved with the bad days of the present, which results in patients arriving on our shores, fleeing horrendous circumstances, seeking safety. Its focus is not the care of refugees—though that is an essential component of it—but rather the assessment of asylum applicants. The book is very well organized. While it is eminently readable cover-to-cover as an introduction to the discipline, it also serves well as a convenient, point-of-care quick reference resource.

The volume begins with a historical account of asylum seeking. While describing the history of the phenomenon, the authors remind the reader that even the Pilgrims of 1620 arrived in this country seeking asylum. Throughout the centuries, the need for asylum has continued unabated. In addition to the historical perspective, a very clear overview of legal issues and requirements for asylum seekers is presented. There are specific criteria that define asylees. Free from cumbersome legalese, a clear explanation is provided on who qualifies for asylum and who does not. Although asylum status is legally determined, the medical data that physicians provide give valuable insight that guides decision makers.

After laying this foundation, the book becomes very practical. The next section focuses on how to prepare for and perform thorough evaluations. It offers an approach to each session of the evaluation, and it touches on training for not only the physicians but the interpreters and asylum seekers as well. The authors also cover the logistics of conducting an evaluation, when to seek legal advice, and how to advocate for asylum seekers. Lastly, they give a brief overview of the elements of the medical and psychiatric evaluations, which are fleshed out in greater detail in later chapters.

Needless to say, asylum evaluations involve copious paperwork. Guidance is provided on documentation of the evaluation, writing an effective report, and preparing and delivering testimony on behalf of potential asylees. The authors provide excellent examples of the different forms involved. The text also includes lots of excellent illustrations, diagrams, and tables to aid in each aspect of the evaluation. A very useful atlas of physical findings is incorporated as an appendix. These resources are great aids in conducting efficient and effective evaluations.

The authors devote a section to special populations and their needs. These include pediatric asylees, those seeking asylum based on sexual or gender-based threats, and the LGBTQ population. Guidance is also provided for providing evaluation in special settings, such as detention centers, with valuable insight into the confounding effect of these settings on the evaluation. Remote, virtual evaluations are covered, and the potential advantages and the pitfalls of this method of assessment are clearly delineated.

To round out the completeness of this work, the authors include a section on how to teach asylum medicine. Inspiring and preparing the next generation of physicians to perform this service is an important part of the work to be done, as is raising advocates for this population on a broader scale. The well-being of physician evaluators and the implementation of strategies to minimize the impact of secondary trauma on those who evaluate individuals who have suffered unspeakable maltreatment is also effectively addressed.

Overall, this is an important contribution to the resources for individuals involved in the care of such patients. It is very accessible in terms of the writing style and organization. It will be a valuable addition to the library of any physician who works with immigrants, refugees, and asylum seekers.