Migrants have been crossing the border between Mexico and the United States in record numbers this year, and many are unaccompanied children. Once they make it to the U.S., what happens when they need health care?
On the latest episode of The Dose podcast, Carrie Byington, M.D., executive vice president of University of California Health, explains. Byington, who also serves on the Commonwealth Fund’s board of directors, draws on her expertise as a pediatrician and infectious disease specialist, as well as her personal experience treating immigrants and their families.
The pandemic highlights the urgent public health need for getting immigrants care, says Byington, noting that “people may choose to forgo testing, or choose to postpone vaccination if they’re afraid to sign up for a vaccine.”
SHANOOR SEERVAI: The U.S. has more immigrants than any other country in the world: 40 million people who live here were born in a different country. Around a third of them are undocumented, and almost half don’t have health coverage. At present, we are seeing record numbers of people at the southern border, and many of them are children. I’m Shanoor Seervai, and on today’s episode, I want to talk about what happens to these immigrants once they make it into the U.S., or if they’ve been here for a long time, when they need health care.
My guest, Carrie Byington, is executive vice president of University of California Health. She’s also a pediatrician, an expert in infectious diseases, and has firsthand experience as a clinician caring for undocumented families from Mexico and Central America.
Carrie, welcome to the show.
CARRIE BYINGTON: Thank you, Shanoor. It’s a pleasure to be with you.
SHANOOR SEERVAI: So let’s get started with the crisis at the border between the U.S. and Mexico. In the first three months of 2021, U.S. Border Patrol encountered more than 350,000 migrants at the border, and that’s three times the number of people from the same time period in 2020. Almost 34,000 of these people were unaccompanied minors. Given your experience as a pediatrician, what can you tell us about the health concerns for these children?
CARRIE BYINGTON: We have real concerns for these unaccompanied minors, many of whom are younger than five years of age. These children have been traveling through perilous conditions. They may have had limited health care prior to their journeys, and probably little to no health care during their journey. And now during this year, the pandemic heightens our fears for their health even more.
SHANOOR SEERVAI: When you mention the pandemic, I can’t help but thinking about how many countries have closed their borders this year, even to visitors and legal immigrants. Could you talk about what the pandemic has been like for immigrants in the U.S., the unaccompanied minors you referred to, but also those who have made it across the border and are undocumented? I mean, when we think about a virus, of course it doesn’t see who’s undocumented or who’s a U.S. citizen, but how does this discrepancy play out when it comes to things like getting tested or getting care if you fall sick?
CARRIE BYINGTON: Right, the virus doesn’t respect borders, and the virus looks for a susceptible host, no matter where they might be. So for our families that we see that are immigrant families, many times they are part of what we call a mixed-status family, where some individuals are U.S. citizens and some are not, and they may be on different paths towards citizenship or documenting their ability to be in the United States. When we have mixed-status families, there is always a desire to protect the most vulnerable and to not engage in activities that might draw attention to those whose legal status is less well-defined. And so this may prevent even U.S. citizens from seeking health care or from applying for health benefits for children or others.
SHANOOR SEERVAI: Specifically because one person in their home might be undocumented and they don’t want to come in contact with the system, what they regard as the authorities?
CARRIE BYINGTON: That’s correct, there’s a sense of needing to protect their family and to not draw attention. And so when we have people living like this, in the shadows, especially in the midst of a pandemic, it inhibits activities that may be for the best for public health. So people may choose to forgo testing, or choose to postpone vaccination if they’re afraid to sign up for a vaccine.
SHANOOR SEERVAI: Mm-hmm. So I want to talk about vaccinations later, but for now, can we go back in time and talk a little bit about your personal story? I know that you grew up in a Mexican American family in South Texas, and wanted to be a doctor from a very young age. Can you tell me more about that?
CARRIE BYINGTON: Thank you for asking about that, yes. I grew up with a very large extended family in South Texas, in a small rural community, and I was witnessing what I know now are health disparities. And so I saw people that I loved with health conditions that were not being adequately treated, and individuals who died at ages that were probably too young, and it really propelled me, seeing this need. I wanted to help, I wanted to be able to treat the conditions that I was seeing. And so at a young age, I think I began to notice these issues, and this was one of the biggest factors in me wanting to become a physician.
SHANOOR SEERVAI: And can you say why you chose to become a pediatrician and work with children?
CARRIE BYINGTON: I was particularly attracted to pediatrics because of the potential for change. I’m driven by potential. One of the things that bothers me the most is seeing unrealized potential, potential that is wasted, and I saw with children so much potential to impact their entire lives, their future and therefore our future, by giving them a healthy start, by making sure that pregnant women receive prenatal care and they had the healthiest babies they possibly could, and that those infants had good health after they were born. And so I became very attracted to pediatrics because of the potential to influence health for the entire life.
SHANOOR SEERVAI: Mm-hmm. So you were born in Texas and you currently live in California, and I wanted to ask how living and working in medicine in these two border states has informed your views about the health care that immigrants receive in the U.S.?
CARRIE BYINGTON: Yes, I’ve always lived and worked in the southwestern part of the United States, and so immigrant health care has always been something that I’ve encountered, in every facility where I’ve worked, in every hospital, in every clinic. And when you encounter people at times of hardship, they’re facing an illness, and they’re also potentially facing an issue with immigration, you really see the vulnerabilities of them as human beings, and you see the gaps that we have in a nation trying to address these very personal issues one-on-one.
SHANOOR SEERVAI: Can you talk about your work before you were in Texas and California when you ran a clinic in Utah?
CARRIE BYINGTON: Sure. So, immigrant health care touches us everywhere, and people may not think about Utah, which is 700 miles from the Mexican border, as a state with a large immigrant population, but we actually saw in Utah a very rapidly growing Latino population that was emigrating from Mexico and Central America. And so I, with a partner, started a clinic at the University of Utah for these patients, and we cared for these individuals, I cared for these individuals, for 21 years.
SHANOOR SEERVAI: Can you tell a story about one family, I’m sure you have many, but something that’s really stayed with you?
CARRIE BYINGTON: There are so many stories that I have. One in particular stays with me. A young boy from Mexico who walked across the border with his family from Mexico to Utah, and he had had a neurosurgical procedure in Mexico prior to his journey, and he was not healed from that procedure as he walked across Mexico and the United States, and he arrived in my clinic at about 5:00 P.M. on a Friday afternoon, and I had to arrange for him emergency neurosurgery that evening, because not only his wound, but his brain had become infected during this trip. That’s the type of tragedy that we see day in and day out when we’re encountering people during their migrations, and the very serious and even life-threatening conditions that may impact them during their travels.
SHANOOR SEERVAI: How did you build trust with families, children, mothers, who might’ve been afraid to come because they were undocumented or from mixed-status homes? How did you get them to come to your clinic?
CARRIE BYINGTON: Building trust is the most important thing, and one of the messages I give to my trainees is that you just have to keep showing up. You can’t just open the doors and expect to be part of the community. You have to show your commitment and your willingness to stay, and to be there every day. So some things will help to bring people in, having services that they need clustered together is very useful, having people who can speak Spanish or other languages. We spoke 16, 17, 18 different languages in our clinic. So having people who can speak your language offers such a sense of relief and an ability to express your needs that’s very important. But really I think it’s about being part of the community and being there consistently. We’ve seen that through the pandemic.
We have relied on relationships that faculty members have built at the University of California through decades, and connections with community stakeholders. We’ve relied on those connections to bring testing to the communities, to bring vaccines to the communities, and to have that sense of trust that we’re bringing something that is important for the community and that will help the community.
SHANOOR SEERVAI: Can you talk a little bit about specific ways in which the University of California is able to provide care for undocumented people?
CARRIE BYINGTON: Well, a good example today is the care that we’re providing for unaccompanied minors at the border, and so three of our institutions, the University of California, San Diego, is providing care for unaccompanied minors in San Diego, and then in Long Beach, the University of California, Los Angeles, and the University of California, Irvine, have collaborated together to provide care for minors in Long Beach. And so we draw on our faculty and staff, on our stakeholders and others that invest in the University of California, we draw on those resources to allow us to reach out to communities in need.
So, caring for the unaccompanied minors at the border is just one of the things that we’ve done recently. Throughout the pandemic, we have used our resources to go into communities at the border, in the Central Valley, in the San Joaquin Valley, in Northern California. We’ve taken mobile vans, we’ve worked with other stakeholder community groups to go to churches, to go to places of work, to go to the fields in the agricultural areas, to take testing, to take vaccines, to take our students so that they can share their knowledge. We rely on these different networks and connections to reach these communities.
SHANOOR SEERVAI: Mm-hmm. So, I just want to play devil’s advocate a little. We often hear the argument that undocumented immigrants don’t pay taxes and they place an undue burden on our health care system. Is that true?
CARRIE BYINGTON: Undocumented immigrants do pay taxes in a variety of ways, and there are a number of studies that demonstrate that. Even though they pay taxes, they may not be eligible for those tax-supported benefits. I think it’s imperative and to the benefit of all, if we want a healthy population, to ensure that all people residing in the United States have access to health care.
SHANOOR SEERVAI: What are some of the other reasons for that?
CARRIE BYINGTON: Well, certainly infectious diseases is one reason that shows how we are all connected, because we’re all susceptible to certain infections, and if we have untreated infectious diseases, we can expect to see outbreaks, and we’ve seen outbreaks in this country not only of COVID-19, but of measles, of whooping cough, and others. We’re fortunate that scourges like tuberculosis and polio are under control, but that is always at risk if we have large pockets of unvaccinated people or individuals who aren’t able to receive health care.
SHANOOR SEERVAI: Is there an economic argument for undocumented immigrants to have health care?
CARRIE BYINGTON: So in our country we rely on immigrant labor to fill many jobs that may not be filled by U.S. citizens. We rely on the strength of this workforce, especially in the areas of agriculture and food production. And these individuals, as they pay their taxes, contribute to the economic base that supports Social Security and those who receive Social Security benefits.
SHANOOR SEERVAI: We’ve talked a lot about how this pandemic has been very difficult for immigrants, and one of the questions on my mind is, are undocumented immigrants getting vaccinated? Do they know that they can?
CARRIE BYINGTON: We’re working to make sure that everyone knows that they can be vaccinated, and that vaccines are free of charge. The Department of Homeland Security issued a statement in February of 2021 trying to reassure all immigrants that vaccines were available and that they could receive vaccination regardless of their immigration status. That’s a message that needs to be widely disseminated, and something that we are working on throughout the communities in California where we are engaged.
SHANOOR SEERVAI: So, we’ve talked a lot about immigrants receiving health care. I want to pivot now to immigrants who work in health care. There are lots of these, but there’s one specific group, young people on DACA, or Deferred Action for Childhood Arrivals. Now, this program would grant a pathway to citizenship for child migrants, but it’s just been hotly contested for so long in Congress. Can you tell me why programs like DACA are so important to strengthening our health care system?
CARRIE BYINGTON: I believe DACA is really important for strengthening our health care system, and the University of California took a strong advocacy position at the Supreme Court to support the rights of DACA enrollees. What we see in health care is that we benefit, our patients benefit, and the classes of students that we’re teaching benefit, by having very diverse members in our health workforce. Individuals who may be bicultural, who understand the communities that we’re serving, who understand their cultural norms, the beliefs that they may have about health care, the medications that they use in their homes. And so having this knowledge strengthens us as health care providers, and allows us to provide better health care for those that we encounter.
SHANOOR SEERVAI: Can you talk about your own experience being a bicultural and bilingual provider?
CARRIE BYINGTON: Being able to communicate directly in Spanish to patients has been an important part of my practice. I can describe a single case where I think being able to come and provide consultation made a real difference to a family. There was a young boy and his mother who were at the emergency room at a children’s hospital, and the diagnosis was thought to be leukemia with a secondary infection of the hip. But when the usual tests were done, the doctors found out that the boy did not have leukemia, and so I was consulted to see if perhaps this infection had resulted in these changes in the blood cells.
I went and I interviewed the mother, and I talked with her and asked her what medication she had been giving her child for the fever that he was experiencing from the infection, and she let me know that she was giving a medication called Neo-Melubrina. Neo-Melubrina is a medication that was banned in the United States in the 1970s but is still commonly used to reduce fever in Latin America. My colleagues had never encountered that medication and were unaware of it. It was the medication itself that was causing the damage to the blood system that we were seeing with the child. It was not leukemia, but actually a reaction to the medication that he was taking, and that none of the English-speaking providers had been able to get that history.
SHANOOR SEERVAI: Thank you so much for joining us today, Carrie.
CARRIE BYINGTON: Thank you for having me.
SHANOOR SEERVAI: The Dose is hosted by me, Shanoor Seervai. I produce this show for the Commonwealth Fund along with Andrea Muraskin, Naomi Leibowitz, and Joshua Tallman. Special thanks to Barry Scholl for editorial support, Jen Wilson and Rose Wong for our art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions, with additional music from Podington Bear. Our website is thedose.show. There you’ll find show notes and other resources. That’s it for The Dose. Thanks for listening.