El Paso, TX, United States (KaiserHealth) – It wasn’t the rash covering Meliza’s feet and legs that worried Dr. José Manuel de la Rosa. What concerned him were the deep bruises beneath. They were a sign she could be experiencing something far more serious than an allergic reaction.
Meliza’s mom, Magdalena, told the doctor it started with one little bump. Then two. In no time, the 5-year-old’s legs were swollen and red from the knees down.
De la Rosa noticed a bandage-covered cotton ball in the crook of Meliza’s elbow, a remnant of having blood drawn. During their time at the Immigration and Customs Enforcement detention facility, Meliza had been sent to a hospital, Magdalena explained, cradling the child with her 5-foot frame. They had run tests, but she had no way to get the results. Through tears, she begged for help. “My daughter is my life,” she told him in Spanish.
The doctor would see nearly a dozen patients that March evening at his makeshift clinic inside a warehouse near the El Paso airport. That week, similar ad hoc community clinics would treat hundreds of people, some with routine colds and viruses, others with upper-respiratory infections or gaping wounds. Like Meliza, all were migrants, mostly from Central America, a river of families arriving each day, many frightened and exhausted after days spent in government detention.
De la Rosa, an El Paso pediatrician, is one of dozens of doctors volunteering on the U.S.-Mexico border as the flow of migrants crossing without papers and asking for asylum climbs to a six-year high. Unlike previous waves of immigration, these are not single men from Mexico looking to blend in and find work. Most are families, fleeing gang violence, political instability or dire poverty.
President Donald Trump has declared a national emergency on the southern border to free up billions of dollars in funding to construct a wall as a means of stemming the tide of asylum seekers. He was expected to make an appearance in Calexico, Calif., on Friday to tour a 30-foot section of fence that was rebuilt last year.
But the federal government isn’t covering the cost of the humanitarian crisis unfolding in border communities like El Paso.
In the absence of a coordinated federal response, nonprofit organizations across the 1,900-mile stretch have stepped in to provide food, shelter and medical care. Border cities like El Paso, San Diego and McAllen, Texas, are used to relying on local charities for some level of migrant care. But not in the massive numbers and sustained duration they’re seeing now. As the months drag on, the work is taking a financial and emotional toll. Nonprofit operators are drawing on donations, financial reserves and the generosity of medical volunteers to meet demand. Some worry this “new normal” is simply not sustainable.
“The care we are providing we could never have foreseen, or imagined spending what we are spending,” said Ana Melgoza, vice president of external affairs for San Ysidro Health, a community health system providing care for migrants crossing into San Diego. She said her clinic has spent nearly $250,000 on such care since November.
More than two dozen people have died while in immigration custody under the Trump administration, according to a recent NBC News analysis. The government says it added nurses and doctors to its facilities after two children died in December. Immigration authorities are now taking 60 children a day to the hospital and doing medical screens for every child under 18, U.S. Customs and Border Patrol Commissioner Kevin McAleenan said during a March news conference.
But many people still have serious needs upon release. When Gutierrez and his colleagues started these clinics, they were meant to temporarily fill a gap caused by the change in government policy. Asked if he thinks the volunteer work is sustainable, he shook his head and sighed. “I’m so tired.”
The financial model – relying on donations and volunteers – also has its limits. Asylum seekers generally don’t qualify for social services, including Medicaid, before they have been granted asylum. In California, negotiations are underway to make some of the $5 million in emergency funds the state is spending at the border available to reimburse clinics for care, according to the office of state Sen. Toni Atkins. Physicians in Texas and Arizona were not aware of similar conversations in their states.
Dr. Blanca Garcia, another El Paso pediatrician, has been volunteering a few days a week since October. Like many of the doctors, she cites a moral and financial argument for providing care to the migrants, who are in the country legally once they apply for asylum. These are vulnerable people who might not otherwise seek care, and for every diagnosis of strep throat, she is likely preventing an expensive emergency room visit, she said.
Still, there are limitations to what they can provide.
Cristian, 21, and his 5-month-old baby, Gretel, arrived at an El Paso shelter in a former assisted living facility early one afternoon. He’d never been alone this long with his daughter, he said. His wife – a minor – had been separated from them at the border, put in the custody of the Department of Health and Human Services. Cristian didn’t know when she might be released.
While in detention, he had spent several nights with Gretel on a concrete floor in a room with more than a hundred other men, he said. He asked a guard for a better sleeping situation. Instead of receiving help, he said, he was punished by being forced to sit and stare at a wall for over an hour as Gretel cried in his arms.
Still breastfeeding before she was separated from her mother, she would suck on his nose and at his shirt. He was worried that she wasn’t getting enough to eat, and that the formula he was giving her wasn’t as good for her as breast milk. Dr. Garcia told him the baby looked healthy.
Still, Cristian was anxious, and grew increasingly distressed as he recounted their history.
“Will the baby be OK?” he asked in Spanish.
She assured the young father he was doing everything he could.
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