Physicians Caring for Migrants Are 'Screaming Into the Void'

Usha Lee McFarling, MA

December 02, 2019

Physicians Step Up and Speak Out

Physician organizations also are speaking out and promoting policies that incorporate their concerns. The AAP, the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Psychiatric Association have long protested conditions for migrants. The groups issued a powerful joint statement in August.

Some of the strongest language has come from the American Medical Association, which has repeatedly called on the Department of Homeland Security, CBP, the Department of Justice, and Congress to improve conditions.

"We are deeply committed to the health and safety of all individuals regardless of their immigration status," said Patrice Harris, MD, MA, the association's president. As a child psychiatrist who has long worked with children in Atlanta's foster care system, Harris is especially troubled by the separation of migrant children from their families. "We will continue to raise our voices and speak out as long as there are inhumane conditions," she said.

In the meantime, many physicians continue to step in as volunteers to help fill the need for care. The response by fellow physicians, says Harris, has been deeply inspiring. "I'm not surprised," she said. "Physicians don't run away from problems. We run toward them."

Some who have stepped up are local, adding volunteer work to already busy schedules. Others are spurred by pleas from medical societies, like one that came from the Texas Medical Association asking for help in El Paso. This spring, the New Mexico Department of Public Health put out an urgent call for medical help after the town of Las Cruces started receiving migrants because El Paso could handle no more. Physicians working near the border say volunteers are now urgently needed in Mexico.

Volunteering brings its own set of hassles, said Jessica Merlin, MD, PhD, MBA, a palliative care physician from Pittsburgh who has worked in Botswana and Vietnam. In order to help at a volunteer clinic in Laredo, she needed to get a Texas license and determine whether her malpractice insurance would cover that work. "It's very hard to figure this stuff out," Merlin said. "I hate to focus on liability when people need help, but it's a reality."

Some of the much-needed help is coming from retirees. Jaime Estrada, MD, MS, retired a few years ago and founded Texas Doctors for Social Responsibility, a group that works on a host of healthcare inequity issues and now the border crisis.

Physicians like Estrada, who have spent their careers working along and near the border, say the current problems are taxing a part of the country that's already deeply impoverished and medically underserved.

"I have patients who are so afraid to come in, they call me on the phone instead of coming in," said Rodolfo Urby, MD, a family physician in San Antonio who serves as president-elect of Texas Doctors for Social Responsibility. "I do what I can, but it's only so much."

The crisis at the border is "a big, crazy mess," says Urby. It has made many existing problems worse. But he does see one bright side. "Before, access to care on the border was always a silent problem," Urby said. "Now people are aware of it."

None of the physicians who work or volunteer along the border expect migration into the United States to stop. And many agree that providing the best healthcare possible, regardless of a patient's citizenship status, is an ethic deeply embedded into the vows they have taken as physicians. So, as long as new migrants need healthcare, many physicians say they will continue to be on the front lines to provide it. "It's not the Hippocratic oath," says Griffin, the pediatrician from Brownsville. "It's the human oath."

Usha Lee McFarling is an American science reporter who has written for the Los Angeles Times, Boston Globe, STAT News, and the Knight Ridder Washington Bureau. In 2007 she won a Pulitzer Prize for Explanatory Reporting. Follow her on Twitter

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