Moving Should Not Be an Obstacle to Good Health

By Ned Calonge, MD, MPH

The U.S. is home to more than 40 million immigrants. Many of them move for economic opportunity, and many face health risks particular to the stress of uprooting themselves or being uprooted.

Moving should not be an obstacle to good health, according to the Migrant Clinicians Network, which serves the country’s mobile poor by supporting the health care professionals that serve them, including by providing technical assistance, education and advocacy.

Deliana Garcia, the Network’s director of international projects, research and development, recently described this work in a talk that will be viewed and discussed in groups statewide as part of The Colorado Trust’s Health Equity Learning Series.

The work has taken on new urgency at a time when the national political dialogue leading up to the election has amplified anti-immigration rhetoric.

“Stigma is only increasing,” said Garcia. “This is an area where we feel we are losing ground.”

Stigma can prevent migrants from seeking services they need—even when they are willing and able to pay for them. It may prevent them, for instance, from seeking out medical treatment provided by government agencies, out of fear of being incarcerated, deported or both.

However intense these barriers may be right now, many of the central challenges facing migrants are not new. Garcia gave the example of Luis, a 36-year-old migrant from Guatemala who was diagnosed with pulmonary tuberculosis. He moved four times during the course of a nine-month treatment, and the Migrant Clinicians Network was able to support each of his clinicians along the way to assure completion of therapy.

“If we can reduce his vulnerability to illness, we know we’ve done a good job,” said Garcia.

The ethos that drives the work of the Migrant Clinicians Network is to treat patients the way they—the patients—would like to be treated. That means taking the time to ask questions, listen fully to the answers, and try to provide the kind of support that the patients themselves most need.

Without this deeper engagement from clinicians, crucial clues can be missed. In one instance, said Garcia, a pregnant woman wasn’t eating well and kept missing appointments. In the words of her clinician, she was non-compliant.

What the woman really needed was a willingness to understand the complexity of her life: in point of fact, she had recently lost her 14-year-old daughter, left behind in Central America, to suicide.

“We have someone who doesn’t want to stay pregnant,” said Garcia. “She doesn’t want to stay alive.” An intervention by the Migrant Clinicians Network kept the woman in prenatal care until the delivery of her baby, and connected her with a therapist.

The network does more than provide direct support to clinicians. It also advocates for policy changes that would serve migrant health by, for instance, protecting them from the threat of incarceration and deportation.

Undocumented immigrants were explicitly excluded from the health care reforms of the Affordable Care Act (ACA). In Garcia’s view, the ACA advances came at the expense of people who needed its reforms the most.

“For me, it was difficult to do the great ‘hallelujah,’” she said.

The need of health care practitioners—along with policymakers, regulators, and institutions and individuals of all kinds—to work to build equity in a multicultural setting is only growing, said Garcia.

For all of our institutions, she said, this means valuing diversity, conducting honest self-assessments and managing the dynamics of difference. For individuals, it means being present, taking risks, lowering our defenses and being curious, open-minded and willing to accept alternative views.

“Globalization is going to increase the occasions in which we need to interact with people different from ourselves,” said Garcia. “We will no longer be able to channel our efforts only in the area we feel comfortable.”

The next iteration of the Health Equity Learning Series will take place Nov. 10, 2016. Please visit our website for information on the speaker, venue and time as it becomes available.