Why many immigrants fear doctor visits could leave them vulnerable to deportation
But before that, as the days passed and the toe blackened, the family's urge to go to the hospital was outweighed by fear that immigration agents could be lurking there.
The man and his wife are Mexican immigrants without insurance or authorization to be in the
"That case sticks in my mind," said
Health care workers across
How often that fear translates into people actually forgoing care is unclear, and some providers with large immigrant patient populations say they haven't seen a change in the numbers of people seeking treatment.
Still, the impact of immigration fears are underappreciated, he said, and over the last year the hospital system has implemented a campaign to clarify, mostly through signage and brochures, that the hospital is not an extension of law enforcement and that it will take care of people regardless of their immigration background.
Other providers say the high-anxiety climate is not only discouraging some immigrants from seeking care, it's also affecting their health.
She sent an older woman with a bad hip injury to
Another patient, a young construction worker with poorly controlled diabetes, told Shaw he can't come in for regular visits because money has gotten tighter as employers have become more stringent in asking for documentation when hiring.
Shaw says people have broken down sobbing in her office because they are overwhelmed with worry about what might happen to them or family members. She's seen a rise in cases of insomnia, anxiety and reflux problems associated with heightened stress.
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"The way that it's affecting people is very hard to watch," Shaw said. "I'm astounded by people's strength even in the face of this."
The fears revolve not just around deportation, which has been expanded in the first year of the Trump administration to target many more people without criminal convictions, but also future immigration status. This month Reuters reported on draft rules being considered by the
As word spreads of the possible change, some worried patients are saying they want to disenroll from benefits such as food stamps and Medicaid, so that they won't be excluded from getting green cards in the future, said
"What I usually tell them is that the change hasn't happened yet," she said. "But you don't have control over anything, so you can't promise there won't be consequences."
Adults without legal status -- including those who have work permits through Deferred Action for Childhood Arrivals, a program for people brought to the
But even those who qualify for benefits are not signing up because of deportation concerns, some providers say.
Dentist
The factors behind the enrollment drop are complex. A recent change to how dentists can bill for Medicaid may be dissuading enrollment because of confusion about whether the in-school services will compromise visits to a community dentist, Valencia said. But parents also have expressed reluctance to enter their names or information into any system for fear it might get into the wrong hands, said
Commentary: Immigrants help America thrive. My story proves that. »
But when it comes to her own health,
"I live with the fear that they will come and they will take me," said
"It's not that I'm taking advantage, I use them for necessity to survive every day," she said. "It's not for oneself, it's for the kids. All of the services are for the kids."
At
But patients -- even those here legally -- are raising more concerns when asked to provide information for insurance enrollment, she said.
"We make sure that it is clear that we think it is critical for everyone to continue getting care," Valukas said.
At
Similarly, financial counselors have reported that immigrants are nervous about applying for charity care, a fund hospitals use to cover medical services for the poor, because it requires applicants to list their employers and other personal information, Stanley said.
While those concerns have always existed, "the current political climate has exacerbated that anxiety and apprehension," Stanley said.
Trump not expected to extend DACA deadline,
To address patient fears, the
That has not happened in
News of such enforcement actions often drives the fears that cause people to cancel medical appointments, Quinones said. When she is approached by worried immigrants, she reassures them that as long as they are honest -- that is, not using fraudulent names or
Avoiding care is just one outgrowth of heightened fear. Providers are also describing rising mental health issues as mixed-status families grapple with worries that they could be split apart. Some teenagers are being instructed on how to take care of their younger siblings if their parents don't come home, and "that's a public health concern because no teenager should be responsible for that," Quinones said.
At
To help provide counseling to immigrant families, the
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The project trained a dozen church parishioners in evidence-based tools that help combat anxiety, depression, post-traumatic stress and family conflict, conditions believed to be prevalent in a community highly stressed not only about immigration arrests but also violence, poverty, substance abuse and low-wage jobs. Those laypeople lead family support groups at the church, without any outside health professionals present, so that people can open up in an environment where they feel comfortable.
"We have noticed no reluctance to either come to the sessions or talk to people there," said project founder Dr.
Providing counseling -- sometimes culturally taboo in the community -- in a faith context helps families feel supported, said
One goal is to help families communicate, without anger, about what they will do if they are forced to leave the country.
"Some of the teens don't want to leave, they don't want to go to
Beyond the fears and stress, providers say the greatest challenge for immigrant patients, many of whom are uninsured, is affording care.
Cynthia Magellanes, a registered nurse and supervisor of community health at
But Vazquez, whose own family is in the country without legal permission, said the greatest challenge personally has been mental health. She has a DACA permit that expires next year, and as she completes her master's in social work "my immigration status is on my mind every day." Talking with peers in similar situations about how to cope with depression and anxiety helps.
Knowledge helps also. Vazquez said her parents aren't afraid to seek medical care. "I think it's because of the information that I bring," she said. "I'm able to connect them to trustworthy clinics or providers."
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