Juan came to see me for a follow-up visit about a rash. I entered the room anticipating he would be pleased that the steroid cream I prescribed had helped, and that we'd have a quick and easy visit.
"So how is your rash?" I asked.
Juan replied that his skin had not improved and admitted that he hadn't even taken the medicine. He hadn't had a chance.
My patient had been imprisoned for more than a month by Immigration and Customs Enforcement (ICE). We were back where we had started two months earlier, except now he was living in constant fear of deportation.
U.S. Immigration and Customs Enforcement photo
A U.S. Immigration and Customs Enforcement agent makes an arrest.
Regardless of our political views, this story -- which is not new -- makes a number of issues clear: The recent increased crackdown on undocumented immigrants is affecting many things, including their health, and the unintended consequences of that crackdown may affect the health of U.S. citizens, as well.
I see many patients from Mexico and Central America who are undocumented, and in the past few months, they have been bearing the weight of fear and uncertainty about their future. When it was announced that ICE was going to become more active, one patient told me, "I didn't leave my house for two days."
She avoided the usual stores where many Latinos do their day-to-day shopping out of fear that these areas would be prime targets. Now every time she and her husband see a police officer, they panic.
"My legs get warm and my heart starts palpating; I start sweating," she said. Although she's lived, worked and paid taxes in the United States for more than a decade, she and millions of others like her now have a heightened level of anxiety that few U.S. citizens have ever experienced.
This fear could prevent undocumented immigrants from seeking care, which poses a public health risk to the general population if, for example, these patients aren't vaccinated or treated for communicable diseases.
Having been born in the United States, it's difficult for me to put myself in these patients' shoes. I simply can't imagine the fear and stress they are going through. But I do understand how fear and stress lead to things like high blood pressure, increased blood glucose, anxiety, depression, panic disorder, insomnia and a whole host of other medical conditions.
Some might argue that this is simply the natural consequence of these patients' decisions to come into the country illegally or to overstay their visas. Certainly there are arguments to be made on both sides of this issue, but as physicians, I believe we need to consider how the changes in enforcement of immigration statutes will affect not only our undocumented patients, but also the rest of our patients.
Consider this: We all encourage our patients to eat more fruits and vegetables, and across the country, the majority of agricultural labor is performed by undocumented immigrants. According to researchers at the University of California, Davis, approximately 70 percent of all farm labor contractor employees in Central California, a region that supplies a significant percentage of U.S. produce, live in the United States illegally.
But migrant farm workers are now fearful of ICE showing up in the fields or orchards and taking them away. What would happen if those workers suddenly disappeared? Would native-born U.S. citizens fill the gap? Unlikely. Despite farm wages in my home state of Pennsylvania in the range of $14 to $20 per hour, Americans just don't seem interested.
It seems clear that without those workers, healthy foods would become more scarce and more expensive. Farmers across the country would struggle more than they already do to find adequate labor, and the health and wallets of everyone would suffer.
Working in a federally qualified health center, I can see how difficult it is for many of my patients to get fresh fruits and vegetables. If the potential downstream consequences of greater enforcement of immigration laws become reality, getting my patients to eat healthy will be even more challenging.
There is another element to this situation that makes me empathic toward my patients who are affected by the immigration crackdown, and that's the racism they've experienced since Jan. 20. One of my patients told me that she's had more overt racist remarks thrown at her in the past few months than ever before in the many years she has lived here. She said that during a recent trip to a local department store, an employee refused to provide her service because she had an accent. Another patient shared that a co-worker insulted her by mixing her name with scatological terms simply because the name sounded foreign. I could go on.
Being treated in these ways undoubtedly adds to the anxiety, fear, depression and stress that these patients are enduring.
So why is all this important for us as physicians? We need to recognize that immigration is not just a political issue, but one that deeply and directly affects the lives of millions of people, and that it has the potential to affect all of us in significant ways.
The AAFP is working to address this situation for physicians and patients. During the recent National Conference of Constituency Leaders, delegates adopted four resolutions or substitute resolutions aimed at protecting the health of immigrants. (When a resolution is adopted by the NCCL it is referred to the appropriate AAFP commission or the Academy EVP for further consideration. The commission or EVP will develop a recommendation to the Board of Directors, which makes the final determination on the outcome of the resolution.)
The Academy already has policies that promote the concept of health care for all, regardless of immigration status, and support for migrant health centers. The Academy also recently stood up for international medical graduates and others who could be affected by the administration's proposed immigration restrictions.
This issue directly affects our immigrant patient's health, especially their mental well-being. As professionals who strive to provide high-quality, compassionate care for our patients, we must detach ourselves from our personal biases when treating undocumented patients and recognize how the past few months have been incredibly difficult for them.
Luis Garcia, M.D., is a family physician in York, Pa., working at Family First Health, a federally qualified health center. He focuses on caring for the Spanish-speaking community and is an avid photographer.