While the debate rages on whether children should be separated from their parents if they entered the United States illegally, the fact remains that these children need healthcare. As doctors, there is no controversy whether or not we treat these children if they need healthcare; we took an oath! It doesn’t matter where our politics lie—when it comes to our chosen profession, if a child needs medical care, we are going to provide it.
As a doctor who practices in a safe harbor state and in an area where there is a high population of recent immigrants from Latin America, as well as many other parts around the world, I see many of these children. Most come speaking not a word of English to live with relatives who already live in this state, and they are all scared of what the future will bring. Many of them suffered great trauma to join their families here. But despite what they endured, most hold onto hope that their future in the US will be better than in would be in their birth nation.
The unique healthcare needs of children who recently immigrated to the US and how to address them:
- Vaccination status: Many bring vaccine records in their own language. These need to be translated by an official translator. We cannot guess what these records state, because we may be wrong and guessing puts the child at risk for fatal infectious diseases. The healthcare systems of other countries do not necessarily follow the same vaccine schedule as in the US. The schedule we follow is well studied, with a mountain of evidence showing it works. We need to give these kids the vaccines they need to catch them up on the schedule we use here in the US (produced by the CDC and recognized by all US institutions and societies). If we fail to do this, we leave these kids at risk for devastating infectious diseases.
- PPD status: In order to enter school, children in the US need to receive a purified protein derivative (PPD) skin test to show that they are free from tuberculosis. Most of these children have received a tuberculosis vaccine (which is not FDA approved in the US because there is no evidence supporting its efficacy) and will have positive PPDs and need chest x-rays. I have petitioned my local school unsuccessfully \ to skip the PPD in children who have been vaccinated, because we know it will be positive and it can sometimes cause uncomfortable skin reactions. The school will not accept the Quantiferon TB Gold blood test instead, an approved test to screen for TB.
- Insurance status: Most of these kids are uninsured. In my area, uninsured children can receive free vaccines from the health department. We should know the services that are available where we practice to serve these children.
- Malnourishment: Many of these children are underweight. We need to assess their nutritional status and know if they are getting enough food.
- Abuse: Many of these kids suffered unthinkable abuse in their home countries and/or on their journey to the US. We need to examine them for any signs of physical or sexual abuse as well as question them regarding psychological abuse. I ha one patient who escaped to the US only to be sexually abused by a neighbor, and she held her tongue out of fear. In her home country, people did not talk about these things. Here in the US, we follow the appropriate channels to help kids who are abused and prevent it from happening again.
- Mental health: Most of these kids suffered some psychological trauma to varying amounts in their young lives. They are more at risk for suffering from a whole host of mental health issues. The sooner we refer them to mental health specialists, the faster will be their road to recovery. When this psychological trauma happens at very young ages while the brain is still developing, it can cause permanent adverse consequences.
- Language barriers: We need to have appropriate translators available when we treat these children. The family who accompanies them may not be the best option. There may be issues that they don’t want anyone to know about because they are afraid of immigration officials. My staff speaks Portuguese and Spanish (as well as Arabic since we have many patients who have emigrated from Middle Eastern countries). They will tell me if something is mis-translated. I try to reassure them that I am a doctor, not Immigration and Customs Enforcement, and that whatever they tell me is confidential. Often, they are so afraid that it doesn’t always work. I use my own translators.
- Culture shock: These kids grew up in a different culture. Often, they are coming from countries that have been ravished by war and with collapsing economies. However, they will still need to start school in the US. Many times, they will be put in a grade behind the one they were in their own country, just because of the language barrier. In my school district, they are well-trained in teaching English as a second language, which many kids need to complete until they can start actual classes. Know who they can contact at your local school, and have your staff give them the phone number.
- Laugh with them: Most of these kids have been traumatized in some way and can be quite devastated to find themselves in the US. No matter where they came from, they are still children. Talk to them like you would any other pediatric patient in your practice. I tell them they are not allowed to leave my office unless they give me one smile. And they usually do.
While we may disagree with immigration policies or that these kids should be allowed in the US, the fact remains that they are still children. They like to play games, they want to feel safe and loved, and they need to have their healthcare needs met. As doctors, we need to remember our calling. We need to stop thinking of these youngest patients as “immigrant children” or “border children,” because at the end of the day, they are just kids the same as yours and mine. The day we lose empathy for traumatized children is the day our profession is lost.