Monday, May 16, 2016

Undocumented Immigrants

Matthew Gartland, MD
Resident in Medicine and Pediatrics at Massachusetts General Hospital

There are many stories of migration in Chiapas, Mexico. The state sits on the southern border with Guatemala and is a major crossing for nearly all undocumented Central American immigrants to the US, including those riding ‘La Bestia,’ a cargo train crossing the border estimated to carry a half a million migrants each year.

"Health is a human right. The care we offer is completely free we do not
 discriminate  based on country, community, type of insurance, or gender."
The region itself is also the starting point for many immigrants to the United States. Chiapas is the poorest state in Mexico with an estimated poverty rate of 76.2% in 2014. Despite being the most southern state in the country, it supplied the highest proportion of migrants to the US of any state in Mexico as recently as 2008. During my time in Chiapas I encountered many personal stories of families with relatives living in the US, as well as people whom had returned to the Chiapas after spending years working in the US.

One of my motivations for traveling to Mexico was the opportunity to view the issue of immigration to the US from another perspective. This is particularly important to me as I see many undocumented Central American immigrants in my clinic at MGH Revere, some of who passed through Chiapas on their journey.

During my time in Mexico I also came to understand the struggle of undocumented immigrants living in Chiapas. This group of migrants represents one of the more marginalized populations in the region having fled poverty and violence in Guatemala only to arrive in a new community with few social and economic resources.
For example, In the clinic in Salvador Urbina we met a Guatemalan woman who was 36 weeks pregnant and seeking prenatal care for the first time. She had tried to enroll in Seguro Popular, a public insurance program in Mexico for the poor. She was told she was not eligible because she lacked immigration documents. As a result, she had delayed presenting for care and was planning on a home birth with a local birth attendant.

Another Guatemalan patient we saw spoke only Mam, an indigenous Mayan language shared by almost a half a million people spanning the border. He was coming to the clinic for chronic shortness of breath and we suspected COPD. The likely cause of his chronic dyspnea was not tobacco smoke, but indoor air pollution from a wood-burning stove. We spent 10 minutes teaching the man to use two types of inhalers, but this was struggle given the language barrier and his low health literacy.

 We used a color/pictorial guide to convey the complicated schedule of medicines. We also used an empty water bottle to rig up a “spacer” to help improve delivery of the inhaled medicine.
In many ways these stories of the challenges of delivering healthcare were not unique to immigrants, but are more broadly challenges of poverty. Still, undocumented immigrants are among the most vulnerable patients owing to language, ethnicity, and poor literacy as well as lack social support structures, discrimination, and disenfranchisement. These challenges represent an opportunity for additional research, advocacy, and tailored programs.

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