greetings I’m a primary care doctor for
adults and I’m going to talk today about
why welcome refugees into our community
about ten years ago our practice in the
suburbs closed and I moved down to the
inner-city clinic and I was amazed by
the number of refugees that we took care
of in the office and I realized I didn’t
know much of anything about refugees and
I was teaching medical students and
young doctors to care for them and I had
a lot to learn and it really was
stimulating to me in my career to work
with them at first informed the question
was what is a refugee so I’m not going
to assume that you know what a refugee
is a refugee is part of that big
umbrella of immigration and they are
legal residents that come to the United
States as part of our humanitarian
effort refugees cannot return to their
country of origin for legitimate fear of
persecution or death and that’s as
determined by the United Nations High
Commissioners on refugee the only
difference as you see here on the slide
between refugee and asylum seekers is
where they are when they apply to come
into the United States if they come to
the United States they’re here and they
apply they’re seeking asylum if they’re
outside the United States applying to
come into the United States they’re
refugees and the UN estimates that there
are about 17 million people of refugee
status in our globe today if you combine
that with the
people that are forcibly displaced from
their homes but still within their
country of war usually there’s about 65
million people more then since World War
two so what’s the process when they come
when they come here we do a physical
exam and that’s where I first meet them
and the purpose of the physical exam
obviously is to check for any illnesses
that need some treatment but it’s also
to make sure that they’re fit for work
because refugees receive public
assistance temporarily until they’re
quote economically self-sufficient
within a few months and if they’re not
then their job coach gives them a piece
of paper sends them to me to assess
their functional limitations now there
are challenges with refugees obviously
with language barriers there are
challenges with them trying to navigate
our complex medical system but
disability is one of those challenges
that is really quite frustrating and
I’ve been practicing for 30 years and
have actually never had a formal course
in disability determination so well it’s
not something most doctors really work
to do or like to do and it’s quite
cumbersome with the paperwork even for
people that have an obvious physical
impairment like somebody with an
amputation or refugee that’s had a bomb
blast but it’s really a challenge for
the refugees that often have
post-traumatic stress disorders because
just like our veterans of war
post-traumatic stress disorder is very
common in refugees but in medicine we
call it the great masquerader
because it doesn’t present with somebody
coming in saying I’m having nightmares
and I’m worried and I’m depressed they
come in suffering from
physical often pain or problems and I do
my exam and I do my tests and it often
doesn’t find something objective and
tangible and I certainly often don’t
have something that is a quick fix and
that can be very frustrating for the
refugee and it’s often frustrating for
the provider and my frustration reached
a peak several years ago
and I was at home and I received in this
invitation in the mail to the annual
benefit dinner for one of our
resettlement agencies here in our
community interfaith works and I saw
that they were honoring some refugees
but it was a weeknight I really did not
want to go and I recycled it into our
bin at home and my wife says to me but
wait a minute you got a goal you know
all these refugees I pulled it back out
and I looked at the picture and realized
I don’t know any of these people these
were people that were leaders in our
community and I wasn’t familiar with
them at all these are not the people I’m
seeing in the office and the light bulb
went on because I wondered are these
exceptional people the exception or are
the people that I’m seeing suffering in
the office are they the exception and my
bias possibly is fake news so I started
to research it and look and there wasn’t
really anything in our books about
disability with refugees so we studied
it and the details of our study are in
the Journal of immigration and minority
health but to summarize yes we showed
definitely pts we screened refugees when
they first came into the country
and emotional distress PTSD very common
one in three adults immigrating refugees
suffer from PTSD but it didn’t predict
that they would then be seeking
disability in fact the vast majority of
them were working and I learned from
that they yes emotional distress is
common in refugees and what do they do
about it they work through it they
literally work through it and then we
looked at well what is the true
prevalence of disability in the refugees
at that time of the study the US Census
data said that for adults at US citizens
aged 18 to 64 10.5% of them one in ten
claimed that they were disabled from
unlimited duty what did we find the
prevalence for refugees to be 11 percent
one in ten the same as our fellow
Americans so I concluded from that that
our refugees in our community are doing
Winston Churchill said that greatness
comes with responsibility and a buddy of
mine fellow physician we had talked
about this and I told him the results of
our data and he says okay I know they
work but why here why bring them here we
don’t have any responsibility for what’s
going on over in Syria and I had to
argue back at that
because we invaded Iraq in 2003 and that
opened the floodgates for refugees in
the Middle East where do refugees flee
to they usually flee to the country next
door so in a two-year span
Syria next door to Iraq took in one and
a half million refugees from Iraq Jordan
took in a half a million by 2007 same
period the United States had taken in
less than 5,000 refugee Araki refugees
Jordan is the size of Connecticut Syria
is a little bigger than our state of New
York
imagine one and a half million people
flooding in from Canada with no
belongings and we taken them I’ve got to
believe that that has an impact on our
economy and particularly a Syrian
economy in their society and plays a
role in their current crisis and by 2011
they were in full-blown Civil War and
we’ve all heard that as much as a
million of the refugees fled across the
waters to Western Europe but it’s less
known that many just went next door
again and Turkey now hosts the most
refugees from Syria with three and a
half million Syrians in their country
and Lebanon the little town little
country of Lebanon has now host to 1
million Syrian refugees one in five
residents or people living in Lebanon or
Syrian refugees Lebanon is the size of
our community here in central New York
and they took in have taken in a million
refugees so we invaded Iraq it opened
the floodgates and and it really has
caused I think a crisis in the Middle
East and for years we did take some
refugees even though as a trickle but
President Trump now has really shut off
the tap and washed our hands of the
refugee crisis we’re starting our second
quarter here in 2018 and thus far we’ve
resettled 11 Syrian refugees now I must
say that this big global picture of
what’s going on is not what motivates me
to take care of refugees it does not get
me through my day what gets me through
my day is the opportunity to get to know
a refugee and it’s it’s it’s odd it’s
paradoxical because here I am taking
care of them trying to heal them and
what I find is that I receive a real
sense of belonging because of them and I
actually feel very much at home with
them and I think the best way to express
that is to share with you a phone call I
had with my mother when she was alive at
the end of the day I would call my mom
to check on her and I called her one
night in June and asked her how was your
and she said oh I had a wonderful day I
went up to your brother Dave’s head
dinner we set out on the back patio
overlooking his potato patch and she
described these lush green plants with
white blossoms on top
supported by rich dark soil piled
beneath them and there were no weeds in
the patch she said it was beautiful and
then there was a pause and she said I
just hope they’re not toppers and that
phrase I just hope they’re not toppers
flashed me back to the end of a potato
roll in June next to my dad leaning on a
hole saying I just hope they’re not
topless now for those of you that are
not potato farmers a topper is a root
plant like a potato that puts all its
energy up in the plant now when it comes
time for harvest there’s very and you
and you go go underground and get the
potatoes there’s very few potatoes and
that’s a big deal
for a dad who has to raise seven boys
and we had potatoes on the table every
night through the winter but I reassured
him I’m gonna take care of those
potatoes and they’re gonna be all right
but little did I know that June is about
as good as it gets for the potato plant
you get to the dog days of July and
August
and the ground gets hard and the cracks
you can hardly hold it and the weeds
start growing and you can’t keep up and
it seems like the harder you work the
worse those plants do and you begin to
until the fall and dad announces on a
Saturday morning that we’re going to go
harvest the potatoes and my brothers and
I go out to this field of just weeds and
you look for these little spindly
remnants of a plant and you start
digging and it was like digging for
treasures we would compete to see who
could find the hill with the most
potatoes the biggest potato the funniest
looking potatoes it was digging
treasures and as I reflected on that
after talking to my mom I thought taking
care of refugees is a lot like being a
potato farmer they come in and we’re all
excited and everything seems hopeful and
then as you work with them you find
there’s a lot of work and they have been
through a lot and they are suffering but
I also find that they are incredibly
resilient and very hopeful and our
differences really just melt away and
the only differences that I find is that
I was born and raised in a potato patch
and they were born and raised in a war
zone I was blessed with a healthy loving
family and many of them lost their
family I was raised in a community with
good public schools that allowed me to
live my dream of being a doctor and
their community blew up in her face I am
very privileged we as Americans are very
privileged in a lot of ways we’re like
that lush green potato plant with lots
of potential
but I just hope we’re not toppers it is
time to let the refugees and come in and
we have been vetting them very
successfully for decades and I assure
you that if we support them when they
come into our community
they will take root and they will grow
and they will not be Stoppers and we will all harvest treasures
adults and I’m going to talk today about
why welcome refugees into our community
about ten years ago our practice in the
suburbs closed and I moved down to the
inner-city clinic and I was amazed by
the number of refugees that we took care
of in the office and I realized I didn’t
know much of anything about refugees and
I was teaching medical students and
young doctors to care for them and I had
a lot to learn and it really was
stimulating to me in my career to work
with them at first informed the question
was what is a refugee so I’m not going
to assume that you know what a refugee
is a refugee is part of that big
umbrella of immigration and they are
legal residents that come to the United
States as part of our humanitarian
effort refugees cannot return to their
country of origin for legitimate fear of
persecution or death and that’s as
determined by the United Nations High
Commissioners on refugee the only
difference as you see here on the slide
between refugee and asylum seekers is
where they are when they apply to come
into the United States if they come to
the United States they’re here and they
apply they’re seeking asylum if they’re
outside the United States applying to
come into the United States they’re
refugees and the UN estimates that there
are about 17 million people of refugee
status in our globe today if you combine
that with the
people that are forcibly displaced from
their homes but still within their
country of war usually there’s about 65
million people more then since World War
two so what’s the process when they come
when they come here we do a physical
exam and that’s where I first meet them
and the purpose of the physical exam
obviously is to check for any illnesses
that need some treatment but it’s also
to make sure that they’re fit for work
because refugees receive public
assistance temporarily until they’re
quote economically self-sufficient
within a few months and if they’re not
then their job coach gives them a piece
of paper sends them to me to assess
their functional limitations now there
are challenges with refugees obviously
with language barriers there are
challenges with them trying to navigate
our complex medical system but
disability is one of those challenges
that is really quite frustrating and
I’ve been practicing for 30 years and
have actually never had a formal course
in disability determination so well it’s
not something most doctors really work
to do or like to do and it’s quite
cumbersome with the paperwork even for
people that have an obvious physical
impairment like somebody with an
amputation or refugee that’s had a bomb
blast but it’s really a challenge for
the refugees that often have
post-traumatic stress disorders because
just like our veterans of war
post-traumatic stress disorder is very
common in refugees but in medicine we
call it the great masquerader
because it doesn’t present with somebody
coming in saying I’m having nightmares
and I’m worried and I’m depressed they
come in suffering from
physical often pain or problems and I do
my exam and I do my tests and it often
doesn’t find something objective and
tangible and I certainly often don’t
have something that is a quick fix and
that can be very frustrating for the
refugee and it’s often frustrating for
the provider and my frustration reached
a peak several years ago
and I was at home and I received in this
invitation in the mail to the annual
benefit dinner for one of our
resettlement agencies here in our
community interfaith works and I saw
that they were honoring some refugees
but it was a weeknight I really did not
want to go and I recycled it into our
bin at home and my wife says to me but
wait a minute you got a goal you know
all these refugees I pulled it back out
and I looked at the picture and realized
I don’t know any of these people these
were people that were leaders in our
community and I wasn’t familiar with
them at all these are not the people I’m
seeing in the office and the light bulb
went on because I wondered are these
exceptional people the exception or are
the people that I’m seeing suffering in
the office are they the exception and my
bias possibly is fake news so I started
to research it and look and there wasn’t
really anything in our books about
disability with refugees so we studied
it and the details of our study are in
the Journal of immigration and minority
health but to summarize yes we showed
definitely pts we screened refugees when
they first came into the country
and emotional distress PTSD very common
one in three adults immigrating refugees
suffer from PTSD but it didn’t predict
that they would then be seeking
disability in fact the vast majority of
them were working and I learned from
that they yes emotional distress is
common in refugees and what do they do
about it they work through it they
literally work through it and then we
looked at well what is the true
prevalence of disability in the refugees
at that time of the study the US Census
data said that for adults at US citizens
aged 18 to 64 10.5% of them one in ten
claimed that they were disabled from
unlimited duty what did we find the
prevalence for refugees to be 11 percent
one in ten the same as our fellow
Americans so I concluded from that that
our refugees in our community are doing
Winston Churchill said that greatness
comes with responsibility and a buddy of
mine fellow physician we had talked
about this and I told him the results of
our data and he says okay I know they
work but why here why bring them here we
don’t have any responsibility for what’s
going on over in Syria and I had to
argue back at that
because we invaded Iraq in 2003 and that
opened the floodgates for refugees in
the Middle East where do refugees flee
to they usually flee to the country next
door so in a two-year span
Syria next door to Iraq took in one and
a half million refugees from Iraq Jordan
took in a half a million by 2007 same
period the United States had taken in
less than 5,000 refugee Araki refugees
Jordan is the size of Connecticut Syria
is a little bigger than our state of New
York
imagine one and a half million people
flooding in from Canada with no
belongings and we taken them I’ve got to
believe that that has an impact on our
economy and particularly a Syrian
economy in their society and plays a
role in their current crisis and by 2011
they were in full-blown Civil War and
we’ve all heard that as much as a
million of the refugees fled across the
waters to Western Europe but it’s less
known that many just went next door
again and Turkey now hosts the most
refugees from Syria with three and a
half million Syrians in their country
and Lebanon the little town little
country of Lebanon has now host to 1
million Syrian refugees one in five
residents or people living in Lebanon or
Syrian refugees Lebanon is the size of
our community here in central New York
and they took in have taken in a million
refugees so we invaded Iraq it opened
the floodgates and and it really has
caused I think a crisis in the Middle
East and for years we did take some
refugees even though as a trickle but
President Trump now has really shut off
the tap and washed our hands of the
refugee crisis we’re starting our second
quarter here in 2018 and thus far we’ve
resettled 11 Syrian refugees now I must
say that this big global picture of
what’s going on is not what motivates me
to take care of refugees it does not get
me through my day what gets me through
my day is the opportunity to get to know
a refugee and it’s it’s it’s odd it’s
paradoxical because here I am taking
care of them trying to heal them and
what I find is that I receive a real
sense of belonging because of them and I
actually feel very much at home with
them and I think the best way to express
that is to share with you a phone call I
had with my mother when she was alive at
the end of the day I would call my mom
to check on her and I called her one
night in June and asked her how was your
and she said oh I had a wonderful day I
went up to your brother Dave’s head
dinner we set out on the back patio
overlooking his potato patch and she
described these lush green plants with
white blossoms on top
supported by rich dark soil piled
beneath them and there were no weeds in
the patch she said it was beautiful and
then there was a pause and she said I
just hope they’re not toppers and that
phrase I just hope they’re not toppers
flashed me back to the end of a potato
roll in June next to my dad leaning on a
hole saying I just hope they’re not
topless now for those of you that are
not potato farmers a topper is a root
plant like a potato that puts all its
energy up in the plant now when it comes
time for harvest there’s very and you
and you go go underground and get the
potatoes there’s very few potatoes and
that’s a big deal
for a dad who has to raise seven boys
and we had potatoes on the table every
night through the winter but I reassured
him I’m gonna take care of those
potatoes and they’re gonna be all right
but little did I know that June is about
as good as it gets for the potato plant
you get to the dog days of July and
August
and the ground gets hard and the cracks
you can hardly hold it and the weeds
start growing and you can’t keep up and
it seems like the harder you work the
worse those plants do and you begin to
until the fall and dad announces on a
Saturday morning that we’re going to go
harvest the potatoes and my brothers and
I go out to this field of just weeds and
you look for these little spindly
remnants of a plant and you start
digging and it was like digging for
treasures we would compete to see who
could find the hill with the most
potatoes the biggest potato the funniest
looking potatoes it was digging
treasures and as I reflected on that
after talking to my mom I thought taking
care of refugees is a lot like being a
potato farmer they come in and we’re all
excited and everything seems hopeful and
then as you work with them you find
there’s a lot of work and they have been
through a lot and they are suffering but
I also find that they are incredibly
resilient and very hopeful and our
differences really just melt away and
the only differences that I find is that
I was born and raised in a potato patch
and they were born and raised in a war
zone I was blessed with a healthy loving
family and many of them lost their
family I was raised in a community with
good public schools that allowed me to
live my dream of being a doctor and
their community blew up in her face I am
very privileged we as Americans are very
privileged in a lot of ways we’re like
that lush green potato plant with lots
of potential
but I just hope we’re not toppers it is
time to let the refugees and come in and
we have been vetting them very
successfully for decades and I assure
you that if we support them when they
come into our community
they will take root and they will grow
and they will not be Stoppers and we will all harvest treasures
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