During the past 4 years, Central America has experienced a humanitarian crisis that has received global attention. Extreme violence, poverty, political instability, environmental degradation, and persecution are plaguing those living in Central America, resulting in staggering numbers of children and adults from such places as Guatemala, Honduras, and El Salvador seeking asylum in the United States.1,2
These regions, known as the Northern Triangle of Central America, consistently rank among the most violent countries in the world, forcing desperate families to flee with children, some of whom are only infants.2,3 Because gang violence exceeds the law enforcement and governmental capacity, there is little governmental protection, so families take a chance on immigration to protect themselves and their children.2 In some cases, children make this perilous journey alone.
According to US Customs and Border Protection, 59,692 unaccompanied children and 77,674 families sought asylum at the US border in 2016.4 These numbers have increased since then. From a healthcare perspective, the United Nations (UN) Office for the Coordination of Humanitarian Affairs reports that chronic malnutrition affects half of children under age 5 years in Guatemala, leading to irreversible mental, physical, and cognitive damage.5
HEALTH CONCERNS FOR IMMIGRANTS
Lack of healthcare services and limited resources can greatly affect the health of immigrant families and children. Many immigrants get sick during their long journey and are at increased risk of winter illnesses such as influenza. In addition, stress, lack of food, and sanitary conditions can add more stress for children and their parents. Refugees have noted that conditions at detention centers sometimes are more traumatizing than the journey. Some recount sleeping on cold cement floors in rooms kept at unbearably cold temperatures; the cold is considered a convenience for detention center employees to reduce the odor of immigrants who are unable to shower. Others have noted a lack of food, which often results in children being unable to eat. Given these examples, the deaths of two children in 2018, one from complications of influenza and the other from dehydration and shock, are not surprising. Since then, more children have tested positive for influenza and, although medication is prescribed, parents usually lack the money to purchase it. This poses a continued health issue because immigrant families typically are housed in close quarters and influenza is endemic in these conditions. Other common conditions treated include upper respiratory infections, otitis media, fevers, diarrhea, fungal infections, and wound care.
In an effort to combat these growing issues, teams of medical professionals in Arizona, including allopathic physicians, physician assistants, NPs, and nurses, are working together to provide medical care (Figure 1). Sometimes, team members use their own money to buy necessary medications and supplies. They also repeatedly request donations from the public and tirelessly devote their time to provide asylum-seeking immigrants much-needed healthcare. These volunteers recognize that the care they provide is often the only healthcare the immigrants will receive. Many of these passionate and dedicated providers deliver the highest quality healthcare they are capable of under the circumstances, and most express a feeling of personal fulfillment with being able to care for those most in need. But they too face many challenges.
Resources are limited in this nontraditional, makeshift clinic setting, which limits the healthcare services that can be provided. For instance, a majority of the immigrant children and families are taken from substandard conditions at detention centers and dropped off at churches that have makeshift volunteer-run clinics. Many immigrants arrive ill. Because of scarce resources, limited availability of medications and diagnostic testing, and at times a limited number of medical providers, treatment can sometimes fall below the standard level of care. Fortunately, these talented healthcare providers quickly adapt to the conditions and, through personal and professional resources, provide necessary treatments.
Many of the immigrants who arrive in the United States speak little or no Spanish; Guatemala, for example, has more than 20 dialects. Often, no translators are available, which complicates communication. Many immigrants do not know how to read or write, so they have even more difficulty understanding their health conditions and making appropriate decisions about treatment. Language barriers limit healthcare providers' ability to obtain past medical and vaccination history or a comprehensive health examination, complicating care and continuity of care.
Although migration is a determinant of health, many immigrants continue to experience the same health disparities they faced in their native country: hunger, cold temperatures, and lack of medical care. These issues can affect the overall physical, social, and mental well-being of this vulnerable population once families are released into the United States. In addition, follow-up or future care for immigrants will continue to be heavily reliant on volunteer-run free clinics because immigrants have no money or insurance coverage and are not eligible for public or government-funded healthcare programs. Because of lack of access to care, immigrants are more likely to rely on the ED for healthcare services.
Once released from detention centers to volunteer-run facilities, immigrants are relocated to various destinations throughout the United States to await the result of their asylum requests. Relocation makes follow-up healthcare services and quality of care difficult, if not impossible, to achieve.
Given the current global political situation, the number of asylum-seeking immigrants in the United States continues to rise. Many PAs are working to provide quality healthcare for these vulnerable groups while their asylum status is pending. But much work still needs to be done to determine the social and emotional effect of the journey and the subsequent effects migration has on children and families. Until those changes come about, we will proudly continue to provide humanitarian assistance to families in need and hope that more PAs will be inspired to work with these vulnerable populations.