From the temporarily delayed Senate Bill 4, which cracks down on "sanctuary cities," to the decision to wind down a program that gives work permits to young people living in the country illegally, undocumented families in Texas are on edge.
They’re afraid of getting deported, and that fear has kept many from feeling safe outside their homes. For some, that means skipping out on doctor’s appointments and forgoing necessary medical care.
The recent wave of state and federal policies cracking down on illegal immigration and the swirl of what’s perceived as anti-immigrant rhetoric over the past year have turned anxiety about deportation into a real fear for many undocumented families.
And that fear has become toxic, Juan Carlos Cerda says.
Under stress, health falls by the wayside
Cerda is a "Dreamer" – undocumented and a recipient of the Deferred Action for Childhood Arrivals program, known as DACA. His parents brought him to the U.S. illegally when he was just 7 years old, and for the past 17 years they’ve called Dallas home. He's now an immigration campaign organizer at the Texas Organizing Project.
“A lot of people in the community are just worried about going out into the streets and coming in contact with a raid or just seeing ICE officers, so there’s a lot of fear, a lot of threats coming from a lot different places,” Cerda said.
He said his greatest fear is losing family – and many like him are willing to risk a lot to stay together – even their own health.
“Sometimes when we're under a lot of stress, we forget about basic things like breathing. We put our health on hold. We lose sleep, we don’t drink enough water, and we don’t eat healthy things,” Cerda said. “It can be really hard to talk to people even about what we’re feeling – why we miss an appointment, why we’re acting a certain way, why we’re shying away from things. We just want to protect ourselves.”
Higher no-show rates
It isn’t just happening in North Texas. It’s widespread, according to Karen Mountain, who is the CEO of the Migrant Clinicians Network. The Austin-based nonprofit provides training and support to 10,000 federally qualified health centers around the country. Last year, they served 24 million people – many of them are undocumented.
“What we’re finding and hearing from all over the country is a huge concern around whether or not seeking routine care and preventative care as well as care for their children, who may be documented, is going to put those families in jeopardy of deportation,” Mountain said.
In a recent Migrant Clinicians survey, two-thirds of the clinics that responded said their immigrant patients have been reluctant to seek health care.
“What we heard was a real significant uptick in the no-show rates. Parents are unwilling to take their kids to the doctor because even though the children may be documented, the parent may not be,” she said. “And they’re also concerned about buying insurance for their kids because that would necessitate them specifying where they live and being able to have their economics tagged.”
Some clinics from the survey report their patients are worried about providing personal information – wary of where it would go and how it might be used against them. Some are also trying to save money in case loved ones are detained. Mountain said opting out of doctor's visits, though, can be harmful.
“We are looking at immunizations for infectious disease, delaying or preventing very costly care at the end stage of diabetes or hypertension, multiple hospitalizations for children with asthma because they are in poor control because their parents are afraid to bring them into care,” she said.
This all comes amid a heightened anxiety among Americans about the future of the Affordable Care Act, and rising medical costs and insurance premiums. Many wonder why citizens, who can barely afford their own health care, should support those living here illegally. One health provider that was surveyed said that they had been receiving animosity from the local non-immigrant community for serving migrant workers and possible undocumented immigrants.
“It’s not our job as clinicians to police people. It’s not our job as clinicians to deny people care,” Mountain said. “When that happens, we all suffer because it is more costly to the healthcare delivery system to treat end-stage disease than to catch it early.”
Mountain said it only takes one story about an immigration raid or deportation to scare a family away. For instance, in April, 75 undocumented immigrants were arrested in North Texas in a federal immigration operation – and a third didn’t have criminal histories. Mountain said it’s up to doctors to placate those fears and support those communities in the few ways they can.
Calming the community
The Los Barrios Unidos Community Clinic in West Dallas released a video on its Facebook page earlier this year to address concerns from its patients, the majority of whom are Latino and uninsured. The video clarifies why they ask for certain pieces of information, it promises confidentiality and expresses solidarity with their undocumented patients during what they call "uncertain times."
A clinic spokesperson said this trepidation is nothing new; in fact, they began fielding questions from patients before the presidential election in November.
Doctors and social workers at community clinics are relying on technology like the Los Barrios Unidos video to provide the best possible care for undocumented patients. They’re turning to methods like texting appointment reminders and consulting via telemedicine – anything that can effectively reach out to under-served populations and ensure some degree of privacy.
At Jefferson Dental Clinic, they’ve deployed a social media campaign and a Spanish website called Estamos Contigo, which translates to “We are with you.” The network of dental clinics has served low-income, multicultural communities across Dallas-Fort Worth for half a century.
Earlier this year, the clinic hosted a “Know Your Rights” panel with Telemundo, civil rights lawyers and the Mexican Consulate. They livestreamed the event on Facebook for those who were uncomfortable leaving home.
Dr. Renee Townsend is the regional dental director of Jefferson Dental. She said several of their clinics have noticed a downturn in appointments and emptier waiting rooms. It’s hard to quantify, she said, but the fear is undeniable.
“We have to constantly assure our patients that we will give them good care in a very private setting,” Townsend said. “I can’t think of one single time that we’ve ever had an immigration officer come into our offices. So we give constant assurance that at least in our office, they are safe.”
For the medical community, treating undocumented patients isn’t just about addressing their physical ailments. It’s about understanding and accommodating what patients experience outside the clinic doors.