What it’s really like to be a doctor on the border

The clinic intake form we used had a space for an asylum number. The number assigned when people first presented to the border requesting asylum. It’s not a tattoo, yet.

Refugee Health Alliance (where I worked for much of July 2019) provides care for asylees, refugees, and deportees just across the border from San Diego in Tijuana. On Saturdays, RHA volunteers roll bulging suitcases filled with supplies to migrant’s shelters to see patients. That’s where I first started doing “tent visits” rather than my usual U.S. home visits.

In July, Nadia Murad, a Nobel Peace Prize Winner, and a group of religiously persecuted refugees were invited to the White House. During a photo op with the president, she described how her mother and brothers were massacred in Iraq. She spoke those words into his ear. Seconds later, our president asked, “Where were they now?” Was he not listening?

Every day in Tijuana, I heard stories like Nadia’s. And I couldn’t have not heard. One parent’s son murdered. A nearly due pregnant woman whose husband had been burned up in Guatemala. A mother leaving six children in Cameroon as she fled for her life. A deportee’s spouse who had to choose between going with her husband or staying in the U.S. with her infant. Children separated from family during the long journey through the jungle.

I heard a lot. A man came to the clinic with complaints of blurred vision after sustaining a head injury in Cameroon. At age 53, it was simply presbyopia, and a pair of reading glasses solved his problem. From him, though, I learned about why his country was targeting the 20% Anglophile population. Another man, also from Cameroon, beaten to unconsciousness, managed to escape via the sea. A woman described her long trek through the jungles. She sought care at the clinic because her periods had stopped. Another woman presented late in the day uncontrollably sobbing as she feared she was pregnant.

Every day was eye-opening, but one Sunday’s events stood out. On a road parallel to the border. In an Uber driven by Jorge. Seated to my right in the cramped back seat — a scared mother from Venezuela cradling her desperately ill two-year-old. To my left — the ugly steel slatted wall. Taking the half-hour journey from the little boy’s folded blanket to Tijuana General Hospital, I recalled my distress when I once rushed my own daughter to the ER. Fear, confusion, and sickness filled the air while I struggled not to smother it with tears further.

Earlier at the shelter, there had been a heated discussion about the baby going to hospital. Loud voices. Distress. Interrupting the Sunday morning meal preparations. People coming. A crowd formed. Crying. And I could not understand why it was so hard to decide. The child was very sick — everyone agreed. But all these vulnerable people, some family, some not, were worried that going to the hospital would result in separation. Because the mother didn’t have her papers. They were lost during a trek thru the jungle. Imagine overcoming so many barriers to medical treatment — language, fear of deportation, incarceration. All at the age of sixteen with a child whose temperature was 104 degrees. Fleeing from a collapsing country. According to the U.N., more than 3 million people have left Venezuela since the economic crisis began in 2014. Impossible.

Another Saturday at a shelter with many children, I was helping a nurse at the medication table. She was counting out pills for a patient. The space was very crowded with tents used for living quarters taking up much of the room and a couple folding tables serving as our medical clinic. The kids were all around. Playing, laughing, putting stickers on, poking, and prodding. They were acting like children penned up all day in an enclosed and hot building. Finally escaping some of the angst of their situation. A young girl suddenly reached for the pills, and I grabbed her arm. Not hard or forcefully but emphatically. The feel of her skinny wrist lingers in my memory.

People who have migrated need gentleness. They need respect. They don’t need an emphatic white hand grabbing them, no matter how chaotic things become. More resources are needed at the border. To handle all the needs of thousands of asylum seekers who continue to suffer from “community trauma.”

A lawyer from San Diego came through the clinic and was wearing a heavy down jacket. He explained that while accompanying a client, there is a good chance both will be detained in “las hieleras,” the “icebox” where temps are kept at 50 degrees. No cell phones, no medicines, no mattresses. Just cold concrete. I wrote a few official doctor letters for refugees stating that they could not be without their medicine while in this holding tank for days. I went to the shelter for unaccompanied minors and wrote such a letter for a 16-year-old. She couldn’t interrupt her medicines nor lay flat on a concrete slab. Sadly her nine-month-old infant wouldn’t qualify for an exemption.

Since my return from Tijuana, I continue to see and hear things. And much of what I observe does not correlate with news on the radio. Incongruent. A few people suggest immigrants are immoral. They will use fake children to get into the U.S. faster. Requesting DNA samples to prove that groupings of humans who have endured unspeakable conditions in their home country, unjust treatment on their journey and intolerable delays at the border are biologically related. Yet, the worry on parent’s faces in Tijuana could not have been contrived.

Some anti-immigration proponents legislate as if migrants were immortal from denying vaccinations in detention camps, to penalizing legal immigrants for using resources to keep from starving, to simply denying adequate medical care at the borders.

Of all the people I have told about the medical clinic in Tijuana, not one has said, “You should not have helped.” But that is what our government is saying when they prosecute “border angels” who leave bottles of water in the desert.

The people I talk to in the U.S. ask, “How can I help?” Send toothbrushes and soap, toy cars and shipping container-sized loads of supplies.

One Tuesday, two young men came to the Tijuana clinic with big backpacks. They asked if we had any vitamins. Maybe some Gatorade? They planned to cross into the U.S. by foot somewhere along the desert. I hesitated and wondered if it was moral to assist someone who was choosing a course of action that could very likely lead to death. In the end, we loaded them with liter bottles of Pedialyte. Heavy, cumbersome bottles strapped to their packs. To survive, hydration trumps weight.

Did they make it? Did we short-change a baby needing oral rehydration?

If only there was more care for traumatized migrants than what can be provided with donated supplies and kind-hearted volunteers working to compensate for their government’s inhumanity.

Ann Colbert is a family physician.

Image credit: Shutterstock.com

View 2 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories