Physicians Volunteer to Care for Young and Old Crossing the Border
Cover Story — December 2014
Tex Med. 2014;110(12):16-20.
By Kara Nuzback
After traveling hundreds, sometimes thousands, of miles, Central American children poured into Texas this summer in search of a better way of life. Some were lucky enough to have a parent or older sibling with them; many made the journey alone.
Nearly 100,000 unaccompanied minors and families crossed into the United States from October 2013 to August 2014 — almost four times as many as from October 2012 to August 2013, according to the U.S. Border Patrol. Most of the immigrants came from El Salvador, Guatemala, and Honduras.
According to Human Rights Watch, Honduras had the highest murder rate in the world in 2013, and violence and extortion at the hands of powerful criminal organizations are rampant throughout Honduras, Guatemala, and El Salvador.
News outlets reported U.S. Border Patrol facilities were overwhelmed, and state officials expressed the fear of disease outbreaks along the border. But physicians who volunteered to help treat undocumented immigrants, including Edinburg pediatrician Martin Garza, MD, El Paso family physician David Palafox, MD, and El Paso infectious disease specialist Gilberto Handal, MD, say most of the travelers suffered little more than fatigue and mosquito bites.
Some doctors worry this is not the last time undocumented immigrants will flood the border, unless lawmakers do something to prevent recurrences.
According to the Border Patrol, about 50,000 unaccompanied children entered the United States through the Rio Grande Valley from October 2013 to August 2014. Border Patrol statistics show about 21,000 unaccompanied minors crossed the border through the Rio Grande Valley in all of 2013.
Eduardo Olivarez is chief administrative officer for Hidalgo County Health and Human Services in Edinburg. He says federal Border Patrol centers there housed unaccompanied minors and sent adults who traveled alone back to their home countries after brief immigration hearings.
Border agents in McAllen processed family units differently, he says, screening them in about 36 hours and sending them to the bus station, where they had just 72 hours to catch a ride to reach family members throughout the United States. After 72 hours, they would no longer be able to legally pass the immigration checkpoint located north of McAllen.
Unlike unaccompanied minors, the family units, which normally consisted of mothers and young children, had no health screening before Border Patrol sent them on their way, Mr. Olivarez says.
"Within 36 hours, we had all these people showing up to our bus station," he said. "They needed baths, they needed food, and they needed clothing."
A surge of volunteers rallied to help the hundreds of families, who often waited overnight to get on a bus heading out of the Rio Grande Valley. Mr. Olivarez says Dr. Garza and Sister Norma Pimentel of Sacred Heart Catholic Church in McAllen — with help from the City of McAllen, the county health department, local medical professionals, religious organizations, and concerned citizens — were pivotal in the massive volunteer effort to provide the immigrant families with showers, food, water, and medical attention.
"This was a federal jurisdiction operation that overflowed into our community," he said.
Mr. Olivarez says normally when a crisis strikes, relief efforts start at the local level and work their way up to the federal level.
"This started at the federal level, and it doesn't work down the pipeline," he said. "No federal or state money was given to this."
He says state and federal standards for emergency management relief require the county to spend millions of dollars before it is eligible for aid. Because volunteers provided the relief using donations, Mr. Olivarez said, "We didn't spend anywhere near that."
"We said heck with it … we're just going to take it on and do it on our own," he said. "It was amazing."
Dr. Garza, who normally works at his private pediatrics office in Edinburg, says he started volunteering in mid-June, after a friend who also volunteered reached out to him. He says when he arrived, the bus station in McAllen was overwhelmed.
Sacred Heart took many immigrants in and gave them food, shelter, and clothes; the city provided tents for some families to sleep in and facilities for them to shower. Nurses from a local home health center circled the parking lot to make sure the families received medical attention if they needed it.
Then what Dr. Garza calls "a blessing" happened. Raymond Sanchez, a businessman who owns a mobile vaccination clinic in the Rio Grande Valley, donated his mobile medical unit to the cause.
"The mobile unit was the exact perfect thing we needed," Dr. Garza said. "They moved it right into the parking lot [of Sacred Heart]."
For the rest of June through July, a rotating cycle of about 30 physicians and 20 nonphysician practitioners — all volunteers — saw 60 to 80 patients a day.
Thankfully, Dr. Garza says, it was summer — typically a slow time of year — and many physicians were on vacation and willing to offer help.
He says the typical patient was a mother in her 20s with an infant or toddler; patients commonly suffered skin infections, diarrhea, or constipation. He says he encountered two or three cases of chicken pox but "nothing more significant than that."
By August, the rush of patients started to taper. Dr. Garza says there's no longer a need for the mobile unit, and physicians who were still on call as of October, including him, now see patients in a room inside the parish hall.
Dr. Garza says he is impressed with the local medical community's willingness to volunteer their time and skills.
"They really stepped up," he said. "We set our political views aside. We were there because we saw the need."
Texas Medical Association President Austin King, MD, visited physicians volunteering at the mobile unit in McAllen in June. He says many of the families had no health screening before arriving at the mobile clinic.
"Most of them had been traveling for weeks," he said. "I was glad to see physicians and health care people in general step up to volunteer their services."
Christine Mann, spokesperson for the Texas Department of State Health Services (DSHS), also said family units are not sufficiently screened for infectious diseases at U.S. Immigration and Customs Enforcement (ICE) centers.
"One gap [in health care services] identified is that family units that are apprehended and in Immigration and Customs Enforcement are not sufficiently screened for infectious disease before being released into the general public," Ms. Mann said. "The Department of State Health Services is encouraging ICE to develop procedures for family units that take public health into account."
The Kids Are All Right
During a conference call between DSHS and TMA on July 9, DSHS Commissioner David Lakey, MD, projected a total of 90,000 people would emigrate from Central America to the United States in 2014. In comparison, he says, in 2012 and 2013, about 12,000 and 26,000 Central Americans, respectively, immigrated into the United States.
The U.S. Border Patrol is responsible for handling immigrants and has processing centers in cities along the United States-Mexico border, including Del Rio, El Paso, Laredo, and McAllen.
"Facilities have been very overcrowded," Dr. Lakey said. "We've been pushing to really improve sanitation."
Other facilities opened their doors to help relieve crowding at Border Patrol centers, including Lackland Air Force Base in San Antonio, which held 1,200 beds, as well as facilities in Oklahoma and California.
Dr. Lakey says in these close quarters, DSHS worried infections like norovirus and H1N1 influenza could spread rapidly. According to Ms. Mann, DSHS knows of no disease outbreaks that occurred in any of the facilities.
Dr. Palafox, who regularly practices in El Paso, volunteered to screen patients at the ICE Processing Center in El Paso on July 21. He says he saw about 20 patients, and he did not spot any diseases among them. Mostly, he sprayed Benadryl on mosquito bites and handed out Tylenol.
"They were all hungry, tired, and thirsty," he said. "And they all said thank-you."
Dr. Palafox says the patients he treated appeared to be happy to be in the United States. Many asked to use the phone to reach out to relatives who were already in the country.
"It was a good experience; I wish more people would volunteer," he said. "Forget the politics; it was people in need."
Dr. Palafox is a member of the El Paso Border Regional Advisory Council (BorderRAC), which organized physician volunteers in conjunction with the El Paso County Medical Society to provide medical evaluations and treatment at processing centers during the immigration influx this summer. Wanda Helgesen, BorderRAC executive director, says the collaboration between the Border Patrol center in El Paso and the advisory council significantly decreased the number of immigrants who needed to be hospitalized.
Dr. Palafox says all the border agents he encountered spoke fluent Spanish, and the ICE facility was well-staffed, well-coordinated, and clean. Border agents separated immigrant men from women and children; Dr. Palafox treated only the women and children.
Dr. Handal says on the day he volunteered in July, a nurse performed preliminary screenings, and if a patient needed extra attention, the nurse sent the patient to him.
He encountered one young woman with tuberculosis; the other patients he saw carried only scabies or similar, easily treatable skin diseases. (See "After the Influx.")
Stemming the Tide
Dr. Handal says his greatest concern is that the surge of undocumented immigrants this summer is not an isolated incident.
"As the weather gets better and the rainy season stops, we will have again the same problem unless there is a policy of collaboration with Mexico," he said.
Dr. Handal attended the ninth annual Border Health Conference in Washington, D.C., in July.
"My impression was really our representatives are so partisan they don't think about things clearly," he said.
He says immigrants will continue to cross the border and put a strain on the country's resources if there is no repatriation process.
"The system the way it is, is not working," he said. "We need to accelerate the judicial process as well as to extend the regulations we have with Mexico and Canada of immediate repatriation when there is no case for a refugee status."
El Paso County Medical Society President Juan Escobar, MD, spoke about immigration at the Border Health Conference. He said the country needs a long-term fix.
"We need to have some leadership by our elected officials to try to stem the tide," he said. "It's a problem, and the elected officials don't want to do anything about it."
He says after the border crisis this summer, hundreds of thousands of Guatemalans, Hondurans, and Salvadorans got the message they can cross the border undocumented, and the United States will take them in.
Dr. Escobar says many physicians are happy to volunteer during an emergency, but the flood of immigrants could become a regular occurrence.
"Basically, it was the private sector that was handling all the medical issues," he said.
Kara Nuzback can be reached by telephone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.
After the Influx
The spread of infectious disease turned out to be an unfounded fear during this summer's massive inflow of undocumented immigrants, but stress, trauma, and mental illness remain a possibility for many children who made the journey without their parents.
During a conference call between the Texas Department of State Health Services (DSHS) and TMA on July 9, Brownsville pediatrician Marsha Griffin, MD, noted most children don't report violent events they've witnessed.
"It's an important thing to gently ask over time; they're not going to tell somebody the first time they see them," she said, adding that she alerts teachers and school staff of patients who have experienced traumatic events.
DSHS Commissioner David Lakey, MD, says the trauma for child immigrants can be twofold: events in their native countries that caused their parents to send them to the United States and the trauma they may have experienced on their journey.
"There's abuse of the girls — rape, etc. — that takes place," he said. "A lot of those things don't become obvious the first time you see individuals."
El Paso family physician David Palafox, MD, who volunteered his time this summer to screen women and children who crossed the border, says the trauma from the journey of unaccompanied minors might pale in comparison to the experiences they had in their home countries.
"I have no idea what they were dealing with where they came from," he said. They came to the United States for a better way of life, he adds.
"If I were living somewhere else, I'd come to the United States if I could," he said.
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