Give me your tired, your poor, your huddled masses, and your illegal border crossers…

26 May

With this post, I am bringing back into focus one of the key themes of this blog: exploring new professional practice. Although I have written posts on learning the logistics of travel PT, this is my first to catalog new perspectives I’ve gained from my clinical/professional experiences. Although this post focuses on my experiences with healthcare and illegal border crossers, I love my work and I respect those I provide my services to– regardless of their circumstances, social status, origin, etc.

Despite my years living in central Texas, my first professional exposure to the issues of the U.S.-Mexico border has been here in Tucson. Seeing the dark green clad Border Patrol trolling the hallways and parked beside hospital beds has become nothing out of the ordinary. But with growing experiences and conversations, I feel more and more like a five year old whose reply to every statement is, “But why?” On any given day, the glaring perplexity makes me want to give America an open-palmed slap on the forehead and say, “Are you for real?! This is crazy!”

So let’s get a few things straight about the lingo. When I interviewed for my travel assignment, I was delicately told I would work with a significant population of “undocumented immigrants” to primarily assist with discharge planning. Okay, an interesting choice of nomenclature, I thought. Up on the hospital floors, you hear “border crossers” mostly. Without sounding too insensitive, I don’t understand why we must mince words. These folks are illegal immigrants. (As a side note: Not all border crossers are Mexican. People from many countries attempt to use the U.S.-Mexico border as an illegal gateway.) They are crossing the border with no respect for a (failing) immigration system or the laws/regulations of our society. Although my opinion is a common one, the public’s opinion is quite varied. There is a mix of distain (of the “free ride”), frustration (with a flawed U.S. system), and sympathy (for those who “surely are fleeing a place where they can’t get the care they need—how sad!”). I can understand and have personally experienced each of these feelings during my time here. But, instead, let’s look more closely at the ass backward approach to healthcare for those injured during their ill-fated border cross.

While attempting to cross the border, many get injured. Most often these injuries occur by trying to scale the fence (I mean, really, how likely is that plan to be successful anyway?) or when running away from Border Patrol. Frequently we see spiral fractures of the tibia, trimalleolar fractures, etc. So these folks are brought to our hospital and receive all kinds of diagnostic testing and medical consults for their injury. They occupy our hospital rooms, watch cable, and receive good care. Then they get orthopedic surgery. Some with external fixators placed, some with internal fixation, almost all with a weight bearing restriction. Who pays for these services? America does. Then comes the “PT eval and treat” order. We provide our skilled services for evaluation, assessment, patient education and discharge recommendations for durable medical equipment. Who pays for these services? America does. We communicate with the physician, the case manager, the social worker. They want to know our recommendations for mobility to be able to cross back to Mexico. But in the next breath we are told, “Well, they are a border crosser, no funding, so we can’t get them anything.” Crutches are usually the only guarantee. They want to know what type of vehicle they can mobilize into for transport back to the border, and if they can safely walk (or hop) back into Mexico’s custody since U.S.’s Border Patrol cannot physically cross the border with them to assist. The orthopedic surgeon gives the patient discharge instructions. Some state a follow up is required in a few weeks—a follow up for which some patients have in fact attempted to re-cross the border. It’s a bitch when this time your external fixator gets caught in the fence (true story). This last bit makes me want to slap some ortho docs in the forehead. Where is the awareness to their patient’s situation? Where is the responsibility to the patient to make reasonable recommendations for follow up? Where is the social responsibility to the U.S. to not encourage abuse of our systems?

Given this scenario, the greatest frustration amongst the physical therapists I work with is this: Why is it that a U.S. and/or hospital system will pay for thousands of dollars of medical and surgical care for illegal immigrant (who choose to climb the fence, who are running away from being caught for something illegal) but then refuses to see it through and provide assistive devices that cost less than $100 to ensure their safe mobility?

I, along with many of my PT colleagues, will tell you that it doesn’t take an Oprah “a-ha!” moment to see that this is a ridiculous system and misappropriation of U.S. / healthcare dollars, physical resources, and clinician time. A fellow PT posed a novel concept: As military personnel are frequently trained in medical care and triaging, why isn’t Border Patrol utilizing a medical triage where these injured folks can be stabilized with essential care and returned to their country of origin for further medical intervention? We can provide care to meet the emergent, basic needs all humans deserve. But must we provide medical care that many of our own American citizens cannot afford or do not receive?

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2 Responses to “Give me your tired, your poor, your huddled masses, and your illegal border crossers…”

  1. Cindy Brown May 26, 2012 at 9:37 pm #

    I agree with everything you’ve said. You are so articulate. I think you should send this to not only Gov. Jan Brewer but all Arizona congressman, Pres. Obama and every US congressman. Go Jen!!!!

    • workingonwanderlust May 26, 2012 at 9:58 pm #

      Wow, thanks! 🙂 It’s definitely frustrating as an American and as a PT. I also have a colleague that tells me of the royal pain it is as a non-American here who follows all the rules, works and contributes to society. So backward, it makes me sick.

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