Giving Immigrants and Asylum Seekers a Voice for Human Rights

Intro Melody

Juan Carlos: And welcome to the Baylor College of Medicine Resonance podcast, I am one of your hosts, Juan Carlos Ramirez. 

Trung: Yeah, and my name is Trung. I'm the lead writer for this episode, and I am very excited for you to get to know Dr. Boyd. 

Juan Carlos: And speaking of Dr. Boyd, in today's episode, Dr. Wesley Boyd will talk about the milestones in his career that have accumulated into his current work and professional interests. We will spend some time learning about what led him to co-found the Human Rights and Asylum Clinic at Cambridge Health Alliance. And from there, we will discuss his continuous involvement in the advocacy of asylum seekers and the impact of his work on this population in the US. 

Trung: All right! And uhm… 

Juan Carlos: And so, who’s Dr. Boyd for our audience that may not know him? 

Trung: Yes I will quickly just walk you through his accomplishments and his career interests basically before we dive into the contents of our podcast today. 

Juan Carlos: Yeah! 

Trung: So Dr. Boyd is a professor of psychiatry and medical ethics at Baylor College of Medicine. But before he was here, he obtained an MA in philosophy and a Ph.D. in religion and culture (along with) his medical degree at UNC Chapel Hill. He completed psychiatry residency at Cambridge Hospital and fellowship in medical ethics at Harvard Medical School. And then he also used to be on the faculty at the Center of Bioethics and an associate professor of psychiatry at Harvard. Additionally, he was a staff psychiatrist at Cambridge Health Alliance and is the co-founder of the Human Rights and Asylum Clinic just as Juan Carlos just told you. And he has taught extensively in humanities, bioethics, human rights and psychiatry. His areas of interest include social justice, access to care, human rights, asylum and immigration, humanistic aspects of medicine, physician health and well-being, the pharmaceutical industry, mass incarceration, substance use, among his other vast interests. He also writes for both academic and lay audiences in all of these areas. 

Juan Carlos: Wow. He wears many hats and I'm actually pretty interested to hear what, you know, what let him down this route, and I'm also curious if he teaches at Baylor although I've never come across his coursework. How did you hear about Dr. Boyd?

Trung: So the reason I (heard) about Dr. Boyd is because he gives, and I'm not sure if he gives this annually, but he gives a talk on immigration and the myths that America has about immigrants in general through the Doctors for Change group. And he was very open; he gave his contacts at the end, and he stayed for a very long time even after the Zoom was done to talk to students, and I was very engaged with him. And yeah, I just emailed him, and he said he would be more than happy to do the podcast with Resonance. 

Juan Carlos: I as well! I'm happy and excited to hear his story. And I guess, without any further delay, let’s talk to Dr. Boyd!

Trung: Yeah, let's get into it. 

Juan Carlos: All right. Sweet! 

Interlude Melody

Juan Carlos: So, welcome, Dr. Boyd! It’s a pleasure to have you on the Resonance podcast here at Baylor College of Medicine. I want to start off by asking a little bit about your background, where you're from, where you did your training, how your career brought you to the Baylor College of Medicine? 

Dr. Boyd: Well, I'm originally from Louisiana but spent most of my childhood in Florida and went from public schools there to Yale University. At Yale, I studied philosophy and actually wanted to be a philosophy professor. So I went to graduate school in philosophy at UNC Chapel Hill. While I was getting the master's degree, I realized it was a bad fitting program. And so I started looking around for other things to do, and two things happened. One, I started doing the pre-med courses that I had not done in college for the purpose of going to med school to be a psychiatrist. And I also met two professors in religion who are doing the kind of work I wanted to do in philosophy. And so I ended up switching, and after the master degree in philosophy, I ended up getting a Ph.D. in religion with them in the subfield of psychology of religion. So I finished medical school, or did medical school. I started the Ph.D. program a year before medical school and ended up staying at UNC Chapel Hill for medical school, and finished a Ph.D. and M.D. four years after starting med school. So I was in graduate school (for a) total of seven years (and) went from there up to Cambridge, Massachusetts for psychiatry residency. The reason I went into Cambridge is I was told it was the best place you could learn to do psychotherapy as a psychiatrist. 

The reason I ended up staying at Cambridge Hospital, whose name is now Cambridge Health Alliance, the reason I ended up staying there over the years is because it is a large safety net hospital. It works with poor and indigent people. We saw tons of people who lacked health insurance. Uhm, there also is a lot of ethnic and racial diversity in the patient population. And so Cambridge actually, as a safety net hospital, had linguistic clinics in neighborhoods around Cambridge to serve the local community. So we had a clinic in the portion of Cambridge that was largely Haitian Creole and had services that were offered in Haitian Creole to Haitians in that community. We had another clinic in East Cambridge, one that I actually worked in as a resident, that was Portuguese speaking. And so East Cambridge is heavily Portuguese and Brazilian but Portuguese speakers, and so we had a clinic in that neighborhood as well and then another one in a more Latino community where, of course, Spanish was the predominant language. 

And so really, (I) was being part of that hospital for many many years, which laid the groundwork for a lot of what I've done since, including working with immigrants (and) working with asylum seekers. I started doing that work specifically about 15 years ago, plus or minus. And working with asylum seekers has really become a large part of both my professional work and also my professional and personal identity.

The reason…how I got from Cambridge to Baylor…So my wife is also a physician. We actually went up to the Boston area together for training back in 1992. I went to Cambridge hospital, as I said, for psychiatry residency. She's a pathologist specializing in pediatric and perinatal pathology and got a fellowship position at Children's Hospital in Boston and also Brigham and Women's. And so she trained there and ended up working at Children's Hospital, well in Brigham as well. And she was running anatomy and pathology at Children's for about a decade. 

She came down here to give grand rounds at Baylor, I think about 9 years ago, and after giving (the) grand round, she was heavily recruited to Baylor at that time and was offered a job at Texas Children's Hospital. And I came down and, (for) a number of days, and looked for jobs here. And I didn't find one that was as appealing to me as the job that she was being offered. So she ended up saying “no.” There was also a lot going on in our family at the time. Our old, sorry, our youngest son was still in high school and we would have had to uproot him. My mother who lived with us for two decades was still alive. She would have had to move with us. So there (were) other reasons besides just jobs. We ended up saying “no,” but my wife saw that very same job, saw that very same job, that she had refused years earlier was available a couple of years ago. And our son’s out of the house; my mother has passed on. And so it's just the two of us. And we were ready for a change. And so she put her name in the hat at Texas Children's knowing that if she did, she was going to be offered the job. 

And I came down, literally the day before Baylor shut down due to COVID and did not allow anyone to come in from outside. It literally was like March 10/11/12 two years ago when I came here and was offered a job at Baylor psychiatry and then also offered a job here at the VA. And I ended up accepting the job at the VA. We started working here about a year and a half ago, right in the middle of the pandemic. And at this point, I run the ethics or co-chair the Ethics Committee at the VA. And I'm the director of the Substance Use Disorders Program here at the VA as well. So that's what I'm doing. And in addition to that, I have a faculty appointment at Baylor in the Center for Medical Ethics and Health Policy. And currently, I'm teaching a third-year elective in health policy. And starting this August, I'm going to take over running the first-year health policy elective that runs in August. 

Trung: So evidently you have a lot of interests, and your interests range anywhere from healthcare to inmates to substance use to asylum seekers. But I do see a common theme. You really love the humanitarian aspects of things, and so I just want to know, what draws you into, you know, such aspect of healthcare. 

Dr. Boyd: You're asking a great question, and I do think that there is a common theme to where I direct my professional efforts. And I think that is working with people who are vulnerable, who are disenfranchised, and who might lack a voice. And I don't want to speak for people; I would never want to do that. But I certainly want to do everything I can to help vulnerable populations. 

And so, you know, you touched upon some of the groups of people I work with. First of all, just going into psychiatry, I think unfortunately there's still a lot of stigma around psychiatry, and I will do what I can to try to destigmatize mental illness. Even within psychiatry, there's a hierarchy of patients, and I think folks with substance use disorders are actually frequently looked down upon and, yet, the evidence is quite clear that there is a heavy genetic predisposition towards substance use disorders. And also, many people who end up misusing substances have had significant amounts of trauma in their lives. Working with this population is another aspect of the kind of work I do, where I feel like I'm working with people who are disenfranchised and having a hard time. The same holds true (for) some of the other areas I'm interested in. I've done a lot of work with doctors who have substance use disorders, and doctors, who end up being referred into physician health programs. They also are (a) pretty vulnerable population. Once you get referred into those programs, you often have very little choice but to do exactly what you're told if you want to continue being able to practice medicine. So I've done a lot of work with physicians who have substance use disorders, who have been identified as having some kind of mental health issue, and then get referred to programs. 

You mentioned jails. I have written about mass incarceration and some of the difficulties that people have when they're incarcerated

And then I've also done, as I said, a lot of work with asylum seekers. A portion of asylum seekers end up in immigration detention. And immigration detention sounds nice, but basically, it is jail. And so I've been in jails and prisons (a) handful of times to meet with and do evaluations of asylum seekers who are incarcerated to try to help them both get asylum and also get released from jail or prison. You probably know especially during the pandemic that in jails and prisons, COVID has really run rampant. In most jails and prisons, there’s no ability to socially distance. There's frequently not any kind of PPE, hygiene is often lacking, and on, and on and on. So, not surprisingly, whether it's immigration detention or in jails and prisons otherwise, the dangers of COVID are dramatically higher for people who are incarcerated. And that's all on top of the fact that being incarcerated in the first place, irrespective of COVID, being incarcerated increases your health risks basically across the board. You know, cardiovascular, mental health, you name it. Almost all medical and mental health conditions get worse when people are incarcerated; they don't get better. 

Trung: I think you also wrote an article regarding the COVID situation (and) how it impacts detention centers, called “When the Treatment is Torture.” And I think, in addition to all the things, the comorbidities, cardiovascular risk, and lack of PPE and things that you mentioned in the detention centers, there are also other things that asylum seekers are subjected to in these centers including, like, isolation. Like back in the days when they still had very rudimentary understanding of how to do social distancing and things like that. So could you help us to, like, enlighten us a little bit more about that issue? 

Dr. Boyd: Yeah, and that article “When the Treatment is Torture” really refers to the notion that, or the fact that, it really refers to the fact that, in incarceration settings, in general, and an immigration detention in particular, people are being, individuals are being placed into solitary confinement, supposedly for their own good. In some cases, they'll be put in solitary confinement if they are diagnosed with COVID, and, in other instances, they'll be put in solitary confinement to keep them away from people who might have COVID. In either instance, you're being placed in solitary confinement. And I have another article that says, very clearly that solitary confinement is tantamount to torture. To my mind, the use of solitary confinement is entirely and totally punitive, no matter even if they say it's for your health or is to try to protect you from COVID. It is entirely and totally punitive. For anyone who has a mental health condition already, solitary confinement almost definitely is going to make it worse, if not dramatically worse. For individuals who don't have any mental health issues prior to incarceration, being placed in solitary confinement can cause depression, anxiety, suicidal thoughts and a condition that otherwise would be considered delirium, you know. So solitary confinement generally makes everything worse, and the thought that prisons are using solitary confinement in reaction to COVID is unconscionable. 

Trung: Yeah, I think, for me, when you mentioned in the talk a while back (that) I attended with the Students for Human Rights, I thought it was very refreshing. I never thought of COVID in that angle, like in my mind, social isolation, that's always like, that’s the way to go. But there's always a context, like, everything can be taken to extremes and like, in the context of asylum seekers and solitary confinement, social isolation, yeah, it's a form of torture. 

Dr. Boyd: And just to piggyback on that, overwhelmingly people who are put in immigration detention who are seeking asylum, the vast majority of them have not committed crimes. It is not a crime to seek asylum according to either international law or U.S. law. So despite what you have heard in the political rhetoric over the years, it is not a crime to come into this country and ask for asylum. And in fact, the way asylum law is written here in this country, as well as in other countries: if someone is seeking asylum and they're a member of a particular group, (which) could be a political group or religious group, (whether) you're gay or lesbian coming from a country where being gay or lesbian is is is going to get you either, you know, beaten or killed, and a number of other groups, if you are a member of those groups you come into this country, and you say “I fear for my life if I am sent home, I want asylum,” you are supposed to be given a hearing and (have) your case heard. And if you have credible fear, you ought to be granted asylum according to the law. 

And so I guess the reason I went on that tangent is that overwhelmingly the people in immigration detention have not committed any crime whatsoever, including asking for asylum, which I just said, is not a crime. And yet, they are being placed in solitary confinement, sometimes for very, very, very minor offenses. So, apart from COVID, solitary confinement is frequently used in immigration detention as punishment for in some cases, very minor infractions. You know, you back talk to guards and they're going to put you in solitary confinement. You are put into solitary confinement; you start pounding on the wall because solitary confinement is making you crazy, or anxious, or depressed, or suicidal, and they just lengthen your sentence in solitary confinement. So, it's used in very, very punitive ways for people who are, you know, who's quote-unquote “crime” is that they were trying to seek asylum here in the United States. One of the co-authors on one of the papers that you mentioned, herself, was a federal whistleblower because she was reading reports of individuals in immigration detention who are being placed in solitary confinement. And she's one of the people who first brought this to our attention and has really, as a whistleblower, gone public to try to get the practice stopped. 

Juan Carlos: So, it seems like there's just a lot to unpack there and that you clearly you…I guess what I'm wondering: is this sort of…their basic care? Right? So, where do asylum seekers or inmates, like, where do they get their care? 

Dr. Boyd: Believe it or not, the only group of individuals in the United States who are constitutionally guaranteed the right to healthcare are people who are incarcerated. And so you asked a very good question. Where do people who are incarcerated get their care? They get it generally from within jails or prisons. And if there is, you know, (a) serious enough need or an emergent need that can't be handled on prison grounds or within the jails, they will get transported to hospital facilities nearby ideally, right? 

The medical care inside jails is generally less robust than it is in prisons. So if you're just taking your average jail or your average prison, the care in prisons is going to be generally better, but again the…

Juan Carlos:…that, yeah, go ahead. 

Dr. Boyd: The conditions within prisons are not conducive to health. In fact, as I said, they make conditions worse, almost all the time. For example, I mean, and here. Here's some of the reasons. The food is not as nutritious as it should be, right? And so you're eating, you know, higher fat food, or calorie rich food, that might be, you know, be less healthy for you. Often, your ability to walk around and or get exercise is curtailed, right? And again, this is probably more true in jails across the country than it is in prisons. And, you know, those two facts alone plus you're in a very stressful environment, and we all know stress has both physical and mental health ramifications, so there are all kinds of reasons why being incarcerated isn't good for your health. 

And there are all kinds of reasons why being incarcerated is not good for your health. To answer your question though, where should healthcare be delivered for people who are incarcerated? It should happen right there in jails and prisons. 

Juan Carlos: It's very interesting and, you know, I guess history tends to repeat itself, but at a certain point it ought not to. Right? And what do you think is the greatest disconnect between helping us break that cycle? 

Dr. Boyd: Yeah, thank you for asking the question. This is…what I'm about to say are points that I very frequently make. And in fact, one of my colleagues, former colleagues, (who)'s up at Harvard, used to say, “oh, Wes always wants to make sure he adds the following.” And here's what I always add because it's absolutely true. And, by the way, I try not to say things that are not true, and even though I have strong opinions on things, I try to base them in facts. And I am open to being corrected, you know, if I am wrong on facts. But here's what the facts are: Immigrants and asylum seekers are far less likely to commit crimes here in the United States than native-born Americans (and) are less likely to commit murders than native-born Americans. They don't end up costing our healthcare system lots and lots of dollars. 

So, you know, one argument against immigrants that, (which) turns out doesn't hold water, is so if we just let everyone come in, they're going to take, take, take, and it's going to, for example, use up all our health care resources. I had a colleague at Cambridge Hospital. Going back up, I had a colleague (at) Cambridge Health Alliance. Her name is Leia Solomon and she documented extensively the ways in which immigrants actually bolster our healthcare system. She documented that immigrants put far more money into Medicare than they ever take out in terms of accessing medical care. 

Right? Why would immigrants put more money into Medicare ultimately and boost the holdings of the Medicare, the trust fund for Medicare. Why would they do that? Because they tend to be younger and healthier than native-born Americans. So, they're working jobs; they're putting money into Medicare through their employment, and then they might leave the country before they ever even, you know, access Medicare. But so Leia Solomon and colleagues at Harvard documented the fact that immigrants put more money into Medicare than they ever take out. They also do the same thing for the private insurance pools. So they are working jobs, putting money into private insurance and not using proportionate amounts of care. And so, as a result, they end up putting more money into Medicare, and it’s the private insurance pools than they never use. 

Immigrants also tend to be…I'll just leave it at that. I mean those are the big ones. So immigrants are not more likely to commit crimes, they're not more likely to commit murders, and they put far more money into this economy than they ever take out. There was a study that was commissioned by the federal government and ultimately never released because the presidential administration at the time didn't want it released, that showed that immigrants, I think it was over a decade, ended up putting something to the tune of $60 billion more into the economy than they ever take out. So it's not, you know, when I say that immigrants are actually good for the economy, it's not just in the healthcare sector. It is across the board. 

In fact, there is a New York Times op-ed a few years ago that said, “Let the Mass Deportations Begin.” I think that was the title of it, and you read the fine print and basically, he was saying, and as far as I can tell, the author is a white male. The author was saying that because immigrants are so good for the United States, we ought to start mass deportations of native-born Americans, get them out of the country, and then our country will be better off as a result. I mean he was being tongue-in-cheek, but his basic point, and he's just, his essay is filled with facts about the ways in which immigrants make this country a better place. 

The other thing (that’s) just completely hypocritical is that our whole country was founded by immigrants, right? There are no native born Americans if you go far enough back except the Native Americans, right? Not people like me. And so, for people to say, you know, to point their fingers at this latest round of immigrants and say, you know, they don't belong or we want them out of the country, historically, it's just dead wrong. I mean, the other part of this country is that, if you go back to 1790, there was a lot of anti-immigrant sentiment. And so, you know, and each sort of generation would have its own group of immigrants who were particularly despised, you know. It's the Germans at one point, the Irish, and the Chinese, and now it's, you know, I mean, just take your pick over the years. 

So this is, you know, if I sort of step back a little bit, I can at least appreciate it in the context of history that there's a long tradition of anti-immigrant sentiment that is just as wrong today as it was 50 years ago and as it was a hundred years ago, much less 200 years ago. 

Trung: So we talked a lot about, especially when you mentioned about misconceptions when it comes to asylum seekers. You said earlier that seeking asylum is not a crime, and these people are being put into basically jails although they did not commit any crime. I'm sure that's not the only misconception that the public has about asylum seekers and immigrants in general. And I've already read your article on “Who Seeks Asylum in the U.S. and Why” and you expressed a lot of…uhm…you basically explained away these misconceptions, and I have a list of them listed here. But if you want to go through, like, if you can just shed a light for us, you know, for us, the general public to kinda understand asylum seekers in their perspectives, instead of what’s being fed to us. 

Dr. Boyd: I think it's a great question and I just think it's easier to look outside of ourselves and cast blame outside of ourselves as opposed to looking inside ourselves and saying, oh wow, you know what, it's not immigrants who are the problem, it's not immigrants for the reason I don't have a job or I'm being threatened with getting kicked out of my apartment, or I can't maintain romantic relationships, or whatever. It's really me. 

Juan Carlos: I can see how that’s tough to chew and even harder to swallow as a society. 

Dr. Boyd: Yeah, I mean, think about the things that are the most likely to kill us. Number one is tobacco. Number two is heart disease, which can come about by way of bad diet or exercise, etc. Number three is alcohol and all of the alcohol-related ramifications that can kill us. Those are the big three killers in our country. All three of those things are things that we have the ability to make changes ourselves to try to improve our odds, right? 

Juan Carlos: I think (what) I remember when I was doing my internal medicine rotation is, this is sort of a related to diabetes and diet and exercise, is someone, one of the attendings, said that behavioral changes are going to be the toughest thing you can try to get someone to do to better their health. And I think since then it's, you know, I couldn't agree more on, that it's these behaviors that could have the biggest impact.

Dr. Boyd: Oh, sure. And, you know, I can't tell you how many times over the years I've counseled people to exercise. I can probably tell you the number of times people have actually taken me up on it. Right. So I mean I'm personally a big believer in regular exercise. I think it's really good, not only for my body, but definitely for my mind and so as a psychiatrist, I frequently would tell people, “hey is there any way we can just get you, you know, walk 30 minutes a day or anything?” And it's a really, really sliver teeny tiny minority of people who actually took me up on it. Do I think it would be helpful? Absolutely. Am I that surprised that so few people would start exercising based on my counsel? Unfortunately, I'm not that surprised for the reasons you just said. 

Trung: I feel like we talked a lot about asylum seekers, their perspectives and challenges that they face, but I think one thing that, surprisingly, we haven’t touched on is, how YOU are doing to, like, in this whole process…like, what is your, I guess, what is your role in advocating for the asylum seekers? I think our listeners would also want to learn a little bit about your job and, specifically, (is there) anything you find extraordinary, things that you found out that you didn't know before since you started your job and start to become more involved with asylum seekers? 

Dr. Boyd: So, I'll tell you what I do specifically with asylum seekers. If someone comes to me because they know the kind of work I do, and say, “hey Wes, I got this patient who wants to seek asylum. Can you do an evaluation of them to help?” The first thing that I say is they need a lawyer first. So if you're seeking asylum, you need legal representation because for anyone who's not a lawyer, a courtroom or a courtroom-type setting is a strange place with its own set of rules. And if we're all medical people on this call and we walk into a (courtroom), (although) we speak the language, you know, we are still going to be in a strange setting and the odds are going to be stacked against us. 

Imagine if English not only isn't your first language but you don't speak English AND you don't know the rules, the odds are completely stacked against you if you go into an asylum hearing without legal representation. So step number one has to be to get legal representation. Once you have legal representation, that's where I can come in or someone like me can come and help. So what I do in the asylum process is I will perform a psychological evaluation of the asylum seeker in order to support their claim for asylum. The way that a psychological evaluation can help an asylum claim is to corroborate the story that the person's telling, right because often, you know, you don't have pictures. You don't have video evidence of what happened in your home country, what you're trying to escape from. And so that's where a person like me can come in, meet with someone, hear the story and say, you know what, I think they're telling the truth. 

How can I say that? Because I've interviewed in my regular job as a psychiatrist thousands of people at this point and, although I'm sure I have been fooled on some occasions, I now, more or less, can assess pretty accurately if people are telling the truth. I can also document if there's any kind of mental health conditions, such as depression or post-traumatic stress, that has arisen as a result of what they suffered in their home country, what they're fleeing from. I can document that. And I can also state that if they were to be made to return to their home country, the very thing they're fleeing, that mental health condition could get worse. 

I also realized one thing I didn't say (or) I haven't said yet is of the people I've seen who have been seeking asylum here in the United States, overwhelmingly, they face death if they're forced to go back to their home country. If you are, for example, gay or lesbian from Uganda, and I've seen gays and lesbians from Uganda in asylum settings, and you're forced to go home, that could easily be a death sentence for you. If you're gay in Brazil, which, ironically, Brazil has had gay marriage on the books nationally for a long time, but the reality on the street for gays in Brazil is that you can be beaten and or killed if people realize you’re gay. And I've been told for example, if you're in Brazil and being assaulted as a result of your sexual identity, if a police person were to be walking by, they will either just keep walking or might join in in the abuse. And also, if you're from Central America in Honduras, El Salvador and to some extent Guatemala, and you're fleeing gang violence, yeah, they've been extorting you because you have a small business and every week they come by and they want rent money, right, or you're a teenage girl and they ask you to be the gang girlfriend, which is a euphemism for sex slave, right, and you refused, they're going to kill you. Or if you're a young boy and they want you to start running drugs for them and you refuse and you consistently refuse, ultimately, you're going to get killed. And so, when people are fleeing, you know, gang violence in Central America, (when) they're fleeing political persecution because they're a member of an opposition party in many countries, in all of these situations people face, I doubt that they go back to their home country. 

So what I can do is I can, as I said, corroborate the story. I can document mental illness if it has arisen as a result of the torture, and I can state that, “I think their mental health condition will deteriorate if they're forced to go back to their own country.” I then, after meeting with the client and performing an evaluation, getting the history, etc., I write up an affidavit. Usually they're a minor, about five to seven single-spaced pages all together. I will send it to the attorney. We sometimes go back and forth a few times to get the report as up to (indiscernible) as possible. And then if testimony is required, when they get to their asylum hearing I will testify in court if necessary. It is a tiny minority of cases where I actually have to testify. I don't like going into court. I don't like testifying at all, but given the stakes that asylum seekers face that I just was speaking about, I will gladly testify if it means there's a greater chance that someone is not going to be deported to their own country. Psychological evaluations definitely make cases stronger. The lawyers I have worked most closely with will not go to court unless they have a psychological evaluation to support their claim. 

The only data we have about the effectiveness of psychological evaluations is from around 2004 or 2005, so I'm going to quote variable data. But back then, if you were seeking asylum and did not have a psychological evaluation to support your claim, the grant rate was about 30%. So about 30% of the time people would be granted asylum. If you had a psychological evaluation to support your claim for asylum, the grant rate went up to about 90%. So that is evidence that psychological evaluations are dramatically helpful for asylum claims. And if I were seeking asylum myself, I would get a lawyer, like hands down, no matter what, however I needed to. And I would make sure that I had, you know, medical documentation from someone like me. Or if there (are) physical scars and things like that, evaluation from a doctor who does physical medicine would also be important. 

And oh, and you asked what else I do? And so that's what I do in terms of actual evaluations of asylum seekers, but in addition to that, as you already discussed, I do writings about asylum and immigration issues and I do a lot of teaching about it. So I will teach medical students and, in fact, trainees of all disciplines have sat in on the evaluations with me. So I've done didactic teaching, but I also have, at this point, I usually have trainees who are sitting in on the evaluation with me while I'm meeting with clients. 

Trung: And thank you for all of your good work. Honestly, I think, wow, whatever you’re doing, all the jobs, all the teachings, and all the advocacy, they are all amazing. And it’s something that you know, the general public, don't really think about. There (are) a lot of things…there (is) a lot that goes into helping asylum seekers, like complete foreigners in our country. And yeah, it's more than just like food, shelter and water. Yeah, so thank you. And we’re approaching the end, but like, I don't want to run out of time for the podcast and not talk about the world that we can that we live in. So, recently, like there (have) been a lot of world changing events. And even (during) the last time you gave us a talk, it was right after the whole Afghanistan crisis and the U.S. troops pulling and things like that. And now that we have the war that is happening in Europe, (I) just want to know your perspective on…like, because of those events, has there been any change in the work that you do, the people that you meet? 

Dr. Boyd: It's a great question. The war in Ukraine has not directly affected anything that I see or do on a daily basis. I'm working at the VA and I do think, despite what I just said, because I work at the VA, I know that, you know, the scenes from (the) war are going to be triggering for a number of veterans. I haven't had any (veteran) come directly in to tell me that but some of the folks who work under me here at the VA have mentioned that and see that, and so I am aware of that. But here's what I want to say about the war in Ukraine: the pictures and videos that we're seeing on television and elsewhere are absolutely horrific. And I would wager that nobody with half a brain would blame Ukrainians for immigrating, getting out of Ukraine as quickly as possible and seeking asylum, or at a minimum seeking shelter in another country, right? So I would wager that everyone listening to this podcast, who's had any exposure to the news whatsoever would say, anyone fleeing Ukraine right now ought to be helped as much as possible. 

The people who are seeking asylum in our country, and I'm not talking, when I talk about asylum seekers I'm not talking about people who are coming across our Southern border to get work, right, I'm talking about people who are fleeing violence and fleeing threats of death. The people coming into our country who are seeking asylum, overwhelmingly, in their own lives are in war-like situations. 

So I don't want to draw direct analogies to having Russian shells come down in an apartment building, but if you're in Central America and you've had one or two family members murdered in front of you by gang members, and you finally secured the means to get out and to come seek asylum, it’s as bad for you in your home country as anywhere on Earth. And so I can’t draw a perfect analogy but I'm just telling you that it is absolute terror that people flee from. And so, you know, when I'm meeting with asylum seekers and when I'm hearing their stories, I want to do everything I can to try to keep them safe and to not have them go back to their countries, where they overwhelmingly face death. 

And, you know, I mean, some people have asked me over the years, like, you know, how do you take care of yourself with this work, right? You must hear some pretty bad stories. And I already mentioned I try to exercise basically every day. I think that helps. My wife is also a physician; she and I talked a lot and we debriefed a lot. I think that helps. That said, there are some stories I've heard from asylum seekers that I won't even share with her. And she's a pathologist; she does autopsy. I mean, she sees a lot, right? But some of the stories I've heard from asylum seekers are so traumatic, I won't even share them with her. 

Juan Carlos: You know what one, I guess perhaps, positive thing that that could…has come about in recent weeks: perhaps, you know, it has sort of opened our eyes, the entire world, you know. Everyone, many countries, and everyone we kind of feel for the Ukrainian citizens. And absolutely, you know, there's no question that, you know, they have every right to be seeking asylum. Perhaps this could be like a turn, not like, you know, turning a new, you know, (a) stone, or something. But perhaps it is giving us, you know, the society, better understanding of, like, what asylum seekers go through, you know. We are seeing it develop. I mean, I don't know how many people that, you know, keep up with the news in Central America or Brazil or stuff like that. So I think this has really put front stage, you know, that many asylum seekers are seeking, you know, very legitimate threats and so, perhaps, this could help us as a society, sort of, move forward and also advocate for asylum seekers and help you in this fight.

Dr. Boyd: I completely agree. I mean, you know, my heart goes out to the Ukrainians. I can't imagine being on the receiving end of that kind of Russian aggression at the hands of Vladimir Putin, who, you know, as far as we can tell is not even getting accurate reports from his own people because they're all scared to tell him the truth. So who knows how long it's going to go on, but it does hearten me somewhat to hear stories, for example, that people here in the United States are willing to pay more for goods and services in order to support the Ukrainians And so wow, here in America, we're willing to literally pay a price for people in a country where 95% of folks in the U.S. didn't even know where Ukraine was two months ago, right? And now we're all willing to pay a price for them. If we can garner that kind of empathy and sentiment for others and for strangers who don't speak our language, you know, I wish we could do the same for asylum seekers. 

But you're absolutely right, there's no one in the world, I think, (who) would say that Ukrainians fleeing that war don't deserve asylum. And just you know, to put a coat on it, to repeat, seeking asylum is fully legal according to both U.S. law and international law. It is considered a fundamental human right. There's a document that was foundational to the creation of the UN the Universal Declaration of Human Rights (UDHR). It was published in 1948. It arose…the UN arose and this document arose out of the horrors perpetrated on the world by the Nazis in World War II. And in that document, it guarantees the right to seek asylum for anybody. 

Trung: Thank you so much. Yeah, that was very inspiring. And I never thought of it that way. Like, if we can, you know, exert the same amount of empathy and willingness to help like we are right now for Ukrainians to anyone who needs help, in dire needs, if we can extend the same empathy, like, how much better the society we live in will be?

And with that do you have any, like, closing remarks for us, you know, budding physicians? A lot of your listeners are going to be involved in healthcare, and they probably will be providing care for asylum seekers, for immigrants at one point or another. Do you have any closing remarks, any advice you would have for us moving forward? 

Dr. Boyd: Yeah, not so much advice but definitely some closing remarks. I feel very fortunate to be where I am currently. I feel like, as a medical professional, I have a voice that at least some people are willing to listen to. And given that the kinds of things that affect our health and well-being go far beyond the medical exam room into the world at large, I feel like if there are ways that we can be advocates for our patients, we have a duty to do that. I feel…I mean I… working with immigrants and asylum seekers is a large part of my identity as I said, and I am a better person for doing the work. Even though it can be painful, the stories can be incredibly distressing, working with asylum seekers, doing advocacy work on their behalf and in other arenas, it makes me a better person. What else could I want? 

Trung: Thank you so much sir, as always. Uhm, yeah, you left us with a lot of food for thought, a lot of a lot of thought provoking ideas and conversations. And yeah, thank you so much for your time. 

Dr. Boyd: Well, thank you for having me. It's been a pleasure

Juan Carlos: Absolutely. And I think one final thing that we can take away from this is hope. Yeah, that the difference is being made. So thank you very much for your time and we look forward to hearing more about your work. And thank you so much.

Dr. Boyd: You can't see me, but I'm nodding my head right now. Thank you. Take care.

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