Clinical Director Carol Gomez and two patient advocates from the Program for Torture Victims (PTV) are at Los Angeles County USC Medical Center with one mission – to save a man’s leg.
They aren’t in the operating room. Instead, early on a Wednesday morning in April, they are in the crowded waiting room with their client, a 26-year-old Ugandan man who has osteomyelitis, a severe bacterial infection affecting his shin bone.
“It has been a long haul since he has been hospitalized with the wound opening in January,” said Gomez, vividly recalling the day earlier this year when they discovered the infection.
Their client came to America in 2016. He fled the central African country where he was violently attacked and tortured for being gay. He left everything behind – including his family – to seek asylum in the United States. He asked that we not reveal his name to protect family members in Uganda.
“If I was in Africa, they would cut off my leg,” he said, struggling slightly to speak English. “Or die because I’m running away from people who might want to kill me. So I’m here now, safe.”
Sitting in the waiting room of the biggest hospital in California, his biggest fear this day is losing his right leg. “[He] was attacked by a mob in 2014 and he had a traumatic break of his leg,” said PTV volunteer Robin Schoenfeld, who has worked as a nurse. His broken bone was treated but bacteria and dirt found its way into the wound. Now, four years later, the infection threatens his leg.
While his leg gets X-rayed and Gomez and the other advocates talk to nurses and social workers, a doctor tells him that a series of surgeries can save the leg.
“It feels like we went to war,” said Gomez. “We have to keep vigilant with him. But we see the light at the end of the tunnel.”
Days like this are typical for Gomez and her colleagues at the Program for Torture Victims. The nine staff members and four therapists focus on the rehabilitation of survivors. Their work day starts whenever they are needed. Whether it is accompanying clients to the hospital, or helping them find legal aid, or just going to the grocery store, their work is all about helping their clients survive a new world after already surviving trauma.
PTV helped more than 300 clients in Southern California last year, many just like the young man in the hospital, and nearly all of them are also applying for asylum.
There are two kinds of asylum seekers: Defensive asylum seekers are people who request asylum as a defense during deportation hearings. Affirmative asylum-seekers come to the United States under any visa or immigration status seeking protection because they have suffered persecution, or fear that they will suffer persecution, due to race, religion, nationality, membership in a particular social group, or political opinion. In 2017, 140,000 people applied for affirmative asylum, and 15,665 were granted, according to U.S. Citizenship and Immigration Services (CIS).
A cacophony of languages resonates through the hallways of PTV’s Koreatown office.
"Our clients come from whatever area in the world that is still practicing torture, which can be Russia, Syria, various countries in Africa such as Uganda, Democratic Republic of the Congo,” said therapist Rose Marie Durocher. In her 20 years of working with the organization, she has seen the ebb and flow of fleeing asylum seekers from around the world.
"Cameroon, Nigeria, we have some from Armenia, India, Pakistan.” She continues listing the countries and diverse reasons why clients fled, for many a matter of life and death.
Last year 33 percent of PTV clients were survivors of torture or persecution because they identified as LGBT. The only other group larger were those fleeing war-torn countries.
The majority of PTV clients, including the young man in the hospital, are affirmative asylum seekers who will eventually have a hearing with a CIS officer, which has grown more daunting.
“I’d say the last year has been catastrophic for asylum seekers,” said Judy London, directing attorney of the Immigrants’ Rights Project of Public Counsel, a nonprofit law firm. “There are many, many aspects of this system that need to be fixed.”
Many survivors have been waiting three to four years for an asylum interview. But the Trump administration early this year imposed a “last-in, first-out” policy giving the newest affirmative asylum applicants just 21 days to prepare their case before their interview.
According to CIS the change was made both for efficiency and to deter fraudulent asylum claims by immigrants who know that an applicant waiting for an interview can get a work permit. But attorneys for applicants think the speedup unjustly denies asylum-seekers the time they need to find a lawyer and collect needed documents. Advocates and applicants agree that the asylum process is virtually impossible to navigate without a lawyer, but many asylum-seekers cannot find or afford an attorney in the shorter time frame.
“It is targeting the most vulnerable,” said Sabrina Damast, an immigration attorney in Los Angeles. “It is not doing a better job of getting more meritorious claims resolved faster.”
Last week Attorney General Jeff Sessions announced that asylum would not be granted for victims of domestic abuse or gang violence. Sessions defended his strict interpretation as implementation of laws already in place.
Durocher, the PTV therapist, said it can takes months of getting to know a survivor, evaluating for symptoms of PTSD, to write a psychological assessment that will strengthen the asylum case. “Right now, you got to get the client in every day until you finish it, and you’ve got to get the report in a week before, and it is a lot of pressure,” she said.
The increase in caseload for PTV’s small staff has been incremental, but the pace of writing reports has greatly increased. Durocher reflects on how hearing and documenting grim stories every day can take a toll.
“It does at first and when you first start this work, if you’re not prepared, if you’re not trained, it can wear you out ‘cause you have a sense of almost helplessness because there isn’t much you can do to really help, considering the political climate we have right now and the long waits these people have for getting asylum hearings.”
The recent policy change in interview priorities has only made things worse for those who have been in limbo for years, separated from family, home, and country. As of March 2018, there were 318,624 pending asylum cases according to CIS, and the backlog has grown more than 1,750 percent over the last five years with a growing rate of new asylum applications.
Asylum-seekers awaiting an interview do not get any benefits from the state but are eligible for a work permit six months after their initial application.
“The big challenge was to wait – the waiting time to have the work authorization – because when you don’t work, you know you have to pay bills,” said Ben, 45, who travels an hour by bus to work. He’s very aware that if he could afford a car, it would knock 40 minutes off his commute.
He jokes about his first time on the bus when he had no idea how to let the driver know his stop. Eventually he realized there was a button. “Ah okay, so I can press the button... it was funny.”
One young man from Nigeria had his asylum interview in May 2018. He, too, was fleeing his country after suffering torture and physical violence for his sexual orientation. Because he has not told his strict Muslim family in the United States that he is gay, he asked that we not use his name.
“It’s against the law in my country,” he explained nervously at the PTV offices, and groups seek out gay people to brutalize. He says he was beaten, violated, and shown videos of others who were tortured as an example of what could happen to him. “I was seriously injured and I couldn’t tell my family what really happened because I’ve been hiding my sexuality.” He finds life in America liberating but can’t completely shake the fear of persecution.
“Being in an environment where you can be free and be the kind of person you are was a lot different for me because I couldn’t. It was kind of difficult for me in the sense that I was afraid of still being attacked.”
Documenting such fears is a way PTV can help.
“It’s harder if you don’t have the scars,” said PTV medical director Kendra Gorlitsky. “That’s why they want the medical doctor’s testimony. But the psychologists are very skillful at extracting the history as well. So there are some signs that people have that are psychological as well.”
In her career, she has seen the distinguishing marks of every kind of human abuse, from boot heels and electrical cords, to cigarette burn scars and female genital mutilation.
PTV therapists and doctors write in-depth forensic evaluations for their clients as part of their jobs and have decades of experience recognizing the imposter from the true victims. The emotional scars coupled with the physical ones are what distinguishes fact from fiction.
Originally from Cameroon, Ben escaped after being persecuted for his gender identity. He used to be a civil engineer in the West African nation of Burkina Faso. Now, he works as a security guard at a medical center in Sylmar. The pay is low but he has freedom he would not have otherwise had in his homeland.
“For me America is a place of freedom, safety, a place where I can express myself as who I am,” said Ben.
He applied for asylum in 2015 and has been waiting ever since.
Ben lives in a modest North Hollywood studio. His tiny space contains a bed, a kitchenette and a large television – his only luxury. Blaring news about the latest moves by the Trump administration, the Middle East, and immigration fills the modest room with tension as he itemizes his monthly budget out loud. Ben wants a car, but he’s barely been able to save $300 dollars a month so far after paying $1,150 in rent. Although taking the bus is inconvenient, balancing a household budget is the kind of problem that he willingly tackles in his new life.
“The best feeling in the world, get up every day, go to work, come back, take care of myself, pay my bills. You know, live a normal life,” said Ben.
“They’re not couch potato people,” said Schoenfeld. PTV members are aware of increasing anti-immigrant sentiment, but for each of the survivors that enters their office, the goal is survival, not trying to take advantage of the system. “It’s like, ‘No. I want to contribute, I want to do something for this country that’s opened up a place for me.’”
Back at the PTV office, the hall is filled with activity. Laughter fills the kitchen as new clients arrive to share meals and meet up with other survivors. Theater and art workshops help clients express themselves and feel connected to a community again.
“We are rebuilding their lives,” said Durocher.
She, like so many other people who do this work, takes inspiration from the clients.
“I’m constantly amazed just by the resilience.” said London. “It seems like it would be really depressing work, but it is incredibly uplifting to work with someone who has lost everything, but has this amazing ability to move forward.”
“If you’re only seeing your lawyer and your doctor and your therapist, that isn’t happening so a lot of this is in the groups creating relationships and friendships and trust,” said volunteer and workshop coordinator Diane Lefer. “Because we’re really focused on the whole person. And the trauma was terrible but it can’t define you.”