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Crossing into a Deeper Understanding of Care for Immigrant ​Patients

 
Marsha Griffin, MD, FAAP, and Julie M. Linton, MD FAAP

August 22, 2016​

 

In every encounter with a child, whether in the clinic or in the hospital, pediatricians seek to uncover how the child’s history may impact his or her health. For those of us who care for vulnerable immigrant children – those who flee their homelands in search of safe haven in the United States – the medical history we elicit must include their journey. Often, this journey includes trauma and persecution that threatens their health and safety.

 

Earlier this month, an American Academy of Pediatrics delegation ventured to the Texas Rio Grande Valley, on the Texas-Mexico border. Our goal was to better understand what happens to immigrant children when they first cross into the United States and become the responsibility of American authorities. Top national and state AAP officials, along with members of the academy’s Immigrant Health Special Interest Group, met with government officials and local leaders along this southernmost border, including fellow AAP pediatricians, immigration attorneys, Office of Refugee Resettlement (ORR) staff and volunteers.​

 

On our first evening in the region, we visited the infamous border wall, which for many children from Central America and Mexico represents the final hurdle in an arduous journey to the United States. The 18-foot high barrier would loom over the many immigrant children who, immediately after crossing the wall, turn themselves over to Custom and Border Protection (CPB) agents. We met with several of these officers during our visit. As we entered the room, armed agents in intimidating uniforms awaited us. For many of us, despite our status as U.S. Citizens and pediatricians representing the American Academy of Pediatrics, we felt a palpable anxiety. However, we imagined that our anxiety could not even begin to approach that of the children we represent. 


​ ​"During our conversations with the border patrol agents, we realized that immigrant children and families are trapped in a process built for adults."​

 


During our conversations with the border patrol agents, we realized that immigrant children and families are trapped in a process built for adults. The CBP officers are charged with a mission to protect our border; yet, they have been increasingly tasked with the care of traumatized children and families seeking safe haven. CBP agents are not trained, nor equipped, to provide compassionate, comprehensive care for children, and would prefer to focus on their job as law enforcement officers. We agreed with them, and believe children should not be subjected to the conditions in the CBP processing centers.

Once processed, Customs and Border Protection agents transport unaccompanied children to the Office of Refugee Resettlement (ORR) shelters, where the environment is more child-friendly. At two of these facilities we visited, we were inspired by the efforts made by ORR to provide comprehensive care for children crossing the border without the protection and comfort of their families. The children giggled as they peered out of their classrooms. They calmly greeted us as they awaited medical screening evaluations. They comfortably and respectfully interacted with the ORR facility staff. The staff members with whom we interacted clearly were mission-oriented and dedicated to the welfare of the children in their charge.

Families with children crossing the border are first processed by CBP, and if not deported or detained, are then transported to the McAllen bus station. There, they are met by Catholic Charities volunteers, who offer to provide their most pressing, basic needs at a Catholic Church nearby. The weary families arriving at the Church are welcomed with applause upon crossing the threshold. We spent an afternoon with the volunteers at Sacred Heart Catholic Church, while they provided nourishing food, fresh clothing, showers and a safe and loving place to rest as the children and families prepared to embark on long bus trips to reunite with families across the country. Witnessing this, our emotions ranged from sadness about the need for these children to flee; to outrage regarding the treatment they receive during their journeys; and then to gratitude for our partners along the border who treat these children with dignity and compassion. As our AAP leaders collected clean underwear and socks for tired, scared and travel-worn children, their tentative smiles moved our hearts and once again connected us with our vision – for each child to have a future of optimal health and well-being.


"Witnessing this, our emotions ranged from sadness about the need for these children to flee; to outrage regarding the treatment they receive during their journeys; and then to gratitude for our partners along the border who treat these children with dignity and compassion.​"

Without legal help for children crossing the border, whether in families or alone, hopes for care and protection may not last. The AAP advocates for legal representation for all immigrant children, because children without counsel are far more likely to be deported, regardless of the merits of their case or the dangers to which they would be returned. We met with attorneys from the South Texas Pro Bono Asylum Representation Project, which provides “Know Your Rights” presentations to unaccompanied children in ORR shelters and tries to connect unaccompanied immigrant children with legal services after they are released to rejoin their families, wherever they might be across the nation. Attorneys representing immigrant children value the opportunity to partner with pediatricians who can uncover and document crucial information supporting the children’s cases in immigration courts, and who can provide comprehensive care in the aftermath of the disclosure of traumatic histories. Unfortunately, most communities lack sufficient legal services or coordinated medical-legal partnerships to serve the legal needs of immigrant children who have been previously detained. We explored opportunities for the AAP to build these partnerships and to support our legal colleagues in our shared mission on behalf of the well-being of immigrant children.

As members of the Immigrant Child Health Special Interest Group and fellows of the AAP, we are overwhelmingly proud to be part of a professional organization that cares deeply about all children in the U.S. and publicly demonstrates a firm commitment to this vision. We are grateful for leaders who took the time to witness with their own eyes this leg of the children’s journey, and who seek to know the conditions in which immigrant children are held within the United States. We honor the efforts of so many fellow pediatricians across the country who care for immigrant children. 

We got a glimpse into these children’s histories and experiences upon entering our country. For those of us privileged to be on this trip, we may have only been able to offer the children clean clothes and a warm smile; but tomorrow we promise to continue the struggle to give all children hope for health and well-being.​

​​Ab​out the ​​Authors

 

​Marsha Griffin, MD, FAAP, and Julie M. Linton, MD, FAAP, co-chair the American Academy of Pediatrics Immigrant Health Special Interest Group. Dr. Griffin is a pediatrician practicing on the Texas/Mexico border. Dr. Linton serves on the Executive Committee of the AAP Council on Community Pediatrics and practices in Winston-Salem, NC, where she cares for immigrant children on a daily basis.

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