Physicians Caring for Migrants Are 'Screaming Into the Void'

Usha Lee McFarling, MA

December 02, 2019

Wait in Mexico

More recently, apprehensions at the border have decreased, likely linked to a "wait in Mexico" policy that requires that recently arrived immigrants wait for their immigration hearings across the border in Mexico.

Shelter housing migrants awaiting immigration hearing; Mexicali, Mexico

Pediatrician Marsha Griffin, MD, used to see hundreds of migrants a day stream through the local respite center in Brownsville. She saw children so traumatized by their journey and detention that they were breaking down, cutting themselves, and even contemplating suicide.

Now that they've stopped coming, she's even more worried.

Many immigrants in Mexico are sleeping under bridges or whatever shelter they can find, with little sanitation, food, or healthcare, she said. "They don't have a place to shower. They're in tents or under tarps. And half of them are kids," said Griffin.

As bad as things were in detention centers, conditions appear to be worse in Mexico, she said. "There are thousands of people massed at the border. They are being kidnapped, they are being extorted, they are being raped," she said. "Some of these families have spent their life savings to get to the border and it's all for naught."

The current lull in the numbers of migrants attempting to cross the US border may be only temporary; recent data suggest that the numbers are likely to rise again. And immigration policy changes have resulted in migrants taking increasingly dangerous journeys to cross the border—a so-called "funnel effect"—and then rapidly dispersing across the nation. Physicians throughout the country are beginning to see that "the border" has a long reach.

The Border Is Everywhere

Ben McVane, MD's ED at Elmhurst Hospital in Queens, New York, is some 2000 miles from the Texas-Mexico border. So when a woman arrived with extensive abrasions to her feet, border crossing wasn't the first thing that came to mind. The 24-year-old Spanish-speaking patient was reluctant to provide details. "Her feet were mangled and inflamed well beyond the story she was giving us," McVane said.

To hear an 8-year-old tell you what it's like to be separated from her father, who was taken away right in front of her, is traumatizing.

Given the extent of injury, he ordered a series of lab tests, which revealed a markedly elevated creatinine kinase level. The patient had rhabdomyolysis and was dehydrated.

She only later told hospital staff that she had recently crossed the border. Her 7-day trip included walking through the desert and then being driven north for several days with almost no water. The combined conditions of extreme heat, prolonged physical exertion, and hypovolemia can lead to exertional rhabdomyolysis and acute kidney injury.

Such injuries, known as "border-crossers' nephropathy," are not new to physicians at the southern border. But now they are seen as far away as New York.

Many areas not traditionally considered major destinations for migrants are now home to new populations, sometimes in large numbers. New Orleans is one example, where unaccompanied minors began arriving to join adult relatives who had come to help rebuild the city after Hurricane Katrina. What in past years was a few children entering the city has now turned into hundreds of children each year.

A team working with pediatrician Kim Mukerjee attends to the unaccompanied minors entering New Orleans, some of whom have never had medical care. "The things we see are astounding. Whether they are 2 years old or 12 years old, we might be the first pediatrician they have ever seen," she said. "These kids are coming to us sicker than I've ever seen, with more trauma than I've ever seen before."

Mukerjee's is a world of 3-hour workups and struggles to get uninsured kids with seizure disorder or other neurologic issues into MRI machines. Her clinic days are packed with newly arrived migrants; her waitlist is months long.

"We were already under pressure to provide healthcare in a region with incredible health disparities, let alone handle a new humanitarian crisis," Mukerjee said. The workload can feel impossible. "We're a very small team trying to take on a very large problem," Mukerjee said. "Someone said we were trying to confront a tidal wave with a bucket."

The work takes a psychological toll on providers. "To hear an 8-year-old tell you what it's like to be separated from her father, who was taken away right in front of her and deported... It's traumatizing," Mukerjee said. Her team has had to remember to actively take time for themselves, to address their own needs and to prevent burnout.

Immersed as she is in the issue, Mukerjee is surprised to find many of her fellow physicians unaware of the large population of unaccompanied minors living among them. She has recently been traveling the state of Louisiana, giving grand rounds about her work. "People come up to me after I give a talk and say they're stunned," she said. "They had no idea this was happening."