Last December, a friend asked for assistance bringing a meal to a house in Tucson. It was temporary housing for families from Central America who had sought asylum and were released by U.S. Immigration and Customs Enforcement (ICE) officials pending asylum proceedings.
Three families of mothers and children were eating quietly at a table when we arrived. They were awaiting a ride to the bus station, where they would continue their journey to their sponsor's town. A father sat in the living room, trying to comfort his sobbing child, a hefty three-year-old with no muscle tone, whom the father had carried all the way from Guatemala. No other health care providers were available—it was late afternoon on New Year's Eve—and I realized the congested, febrile child who was unable to cough up secretions needed additional assessment. We took him to the ED for an X-ray and influenza test, which was negative. As a nurse and community member, I recognized how much there was to do here—and how valuable nursing knowledge was to these efforts.
LIFE ALONG THE BORDER
As a fierce debate rages on the national stage about border walls, immigration policy, and DACA (Deferred Action for Childhood Arrivals), a closer look at two communities close to the U.S.–Mexico border presents a different picture. At the border crossings close to Tucson, Arizona, and San Diego, California, thousands arrive from Mexico every day. Most come from nearby towns to do business or visit family, but thousands of others come from further away in Mexico or from Central America, seeking more permanent entry into the United States. They are fleeing violence and poverty or looking for a better life for their families.
The majority of migrants who arrive at the border are families made up of one or two parents and children. Many voluntarily surrender to U.S. Customs and Border Protection agents, either at official ports of entry or after crossing the border. They are then held in detention centers run by ICE while their applications for asylum are assessed. This includes determining if the migrants have family members or a friend willing to sponsor them and pay for a bus or airplane ticket to the sponsor's locale.
In recent months, the number of migrant families crossing the U.S.–Mexico border has risen, despite current U.S. policies emphasizing prosecution, detention, and limits on asylum. (Of note, according to a recent Pew Research Center report, the number of people apprehended at the border today is still less than it was in the 1980s, 1990s, and 2000s, when approximately 1 million people were apprehended annually.) Although ICE used to provide transportation and other assistance to migrants who were allowed to stay in the country pending completion of their asylum proceedings, the agency stopped doing so last fall.
FILLING A LOCAL NEED
Those following national news reports are likely unaware of what happens after a migrant family is released from ICE custody. Instead of being left on their own to make their way to their U.S. sponsors—ICE officials often drop off migrants at local bus stations, parks, or fast-food restaurants—migrant families are frequently released to local churches and community organizations that house them in empty schools and houses owned by nongovernmental organizations. These facilities have been converted into temporary but welcoming shelters, and many have been set up with just a few hours’ notice. The network of volunteers in border towns such as Tucson and San Diego have been mostly organized through their churches and local Catholic community organizations; in recent months, volunteer efforts have expanded to include other organizations and friends of friends, as word of local needs has spread.
Tucson. Volunteers in Tucson originally worked with a disseminated network of house and church shelters, each capable of working with two to three families. There were also intermittent emergency responses, in which two motels were utilized to house migrants. However, in recent months, there was recognition that a larger response was necessary. After a developer offered the local Catholic Community Services agency temporary use of an abandoned monastery, the agency opened a shelter there in January that houses 120 people; approximately 100 more people can be accommodated on cots in the old chapel. Here, families are registered, screened for communicable diseases, and provided with food, showers, clean clothes, and a place to sleep. Through a collaboration with the Pima County Health Department, flu vaccination is offered. In my work helping to administer this vaccine, I've observed that more than 1,000 doses have been provided so far.
Volunteers help migrants contact their sponsors and navigate the purchase of bus or (rarely) plane tickets to the towns where they live. They pack bags of snacks and sandwiches for their trips. For the long bus ride ahead, families may be provided with a travel bag that contains hygiene supplies and age-appropriate distractions for children. Volunteers drive migrants to the bus station or airport, pick up the tickets, and explain the process of transportation transfers, waiting to see that the families safely board a departing bus or plane.
Local nurses, physicians, health students, and retired health professionals conduct initial screenings for obvious medical issues (such as fever or diarrhea) and for contagious conditions, such as varicella, scabies, and lice. We ask migrants about any medicines they may have been taking or lost during their journey. After this initial screening, we address a myriad of minor problems, like coughs, sore feet, and dry skin.
San Diego. An interesting contrast to Tucson is San Diego, where I visited a shelter for newly arrived migrants last spring. At the shelter, I noticed the noise of generators, tarps shielding fencing from view, and the two armed guards at the gate. (Recent demonstrations nearby necessitated increased security measures.) The shelter housed migrants who'd sought asylum, were processed by ICE, and were then released to travel to their final U.S. destinations. They needed assistance in making contact with their sponsors and completing arrangements for travel. With a capacity of 120 people per night, all housed in one large room, the building was owned by the Catholic Charities Diocese of San Diego and operated by the San Diego Rapid Response Network, a coalition of organizations, community leaders, and attorneys, including the American Civil Liberties Union of San Diego and the Jewish Family Service of San Diego. The population turns over every 24 hours. (Editor's note: This temporary migrant shelter was subsequently relocated to an unused courthouse in downtown San Diego. The San Diego Rapid Response Network continues to operate the shelter, which now serves up to 200 migrants daily.)
The medical response in San Diego is highly organized. In conversations with volunteers and a professor at the University of California San Diego, I learned that the Department of Homeland Security requested that the county provide health screenings before admitting migrants into shelters. As a result, the county's board of supervisors helps to fund screenings performed by physicians from University of California San Diego Health, a local health care system. Additionally, nurses from the county's public health department are available for support and screening assistance. Three mobile clinic vans (two from local health centers and one from the health department) and a trailer with three shower units—for those treated for scabies or head lice—are on site.
CHANNELING FLORENCE NIGHTINGALE
In both Tucson and San Diego, it's difficult to ensure that adequate numbers of volunteers and staff are present when migrant families arrive at a shelter. The anticipated number of families, and the times at which ICE brings them to a shelter, are estimates at best and often leave volunteers and staff sitting around to wait. Families are sometimes dropped off three, four, or five hours later than expected.
A mostly volunteer social safety net has been created along the border to care for these families. What's lacking is a sustainable infrastructure in which staff are paid to coordinate volunteers, set policies, purchase supplies, and respond to problems. In its absence, nurses and other volunteers continue to provide health care. Working as a nurse in one of these shelters is a reminder of Florence Nightingale's principles: we provide medical triage while offering water and fresh fruit, decide how best to disinfect the room of a child with chickenpox (there's no housekeeping services to provide assistance, so we wipe down surfaces with bleach and leave windows open to air out rooms overnight), ensure an adult who has had surgery receives food, and organize the administration of the flu vaccine. We rely on commonsense nursing principles daily, looking at the entire picture and figuring out what's needed.
The Registered Nurse Response Network has provided nursing support to local volunteer efforts in Tucson. This disaster relief project sponsored by the California Nurses Foundation and National Nurses United has sent teams of volunteer nurses on weekends to Tucson since February. These nurses help local volunteers, providing basic health care services to migrant families. The organization offers opportunities for nurses who don't live near the border to contribute to this humanitarian effort through financial support or short-term volunteer commitments. For more information, visit www.nationalnursesunited.org/rnrn-deployments.
Nurses interested in learning more about volunteering with local groups that provide assistance to migrants in Tucson and San Diego can contact Catholic Community Services of Southern Arizona (www.ccs-soaz.org/services/detail/migration-and-refugee-services), Catholic Charities Diocese of San Diego (www.immigrationadvocates.org/nonprofit/legaldirectory/organization.392617-Catholic_Charities_Diocese_of_San_Diego_Immigration_Services_San_Diego_Off), or San Diego Rapid Response Network (www.rapidresponsesd.org ). —Patricia J. Kelly, PhD, MPH, APRN