Child Immigration: A Mental Health Discussion

mexican girl

Written By Ivonne Sahagun-Carreon, MD, a pediatrician in Texas working with immigrant children

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It’s in the news every day. Unaccompanied minors from Central America and Mexico, crossing the borders into the USA in search of a better life.  They risk life and limb to escape the prospect of continuing to live in war-torn countries where children suffer from hunger, poverty and disease, and where they risk being used as cannon fodder or being sold into prostitution.

We look on nervously from the areas north of the Mexican border. As physicians, we took a vow to practice medicine to the best of our abilities regardless of race and creed.  No matter my opinion on the politics, the grim reality is there are tens of thousands of people who are in mental, physical and emotional limbo; and they need help.

A few weeks ago, an institution outside of San Antonio  asked if I “could help out.”  Several hundred children were arriving into the area. They had no idea what they would do for them medically… there was no plan in place.

These immigrant children don’t compare to the usually healthy US children who gather in gyms to do school physicals. This is not a quick project.  The logistics of taking medical care of these kids are not as easy as they make it seem (“come check them out, see what they need”). There are myriads of things to consider:

Malnourishment
First of all, most of these kids are malnourished from the long journey.  Will we do CBC’s and CMP’s on every one of those? What will we do with abnormal labs, of which there will be many? They’ll need at minimum multivitamins, and we’ll further need to coordinate with other agencies for nourishment. In more severe cases, we will need to provide appropriate specialty follow-up.

Infectious Disease
Second, they will carry communicable diseases. Given the fact that most of them possibly lived in crowded conditions back home, and on the cattle cars and buses that brought them up to the border, they would need at the very least a PPD or Quantiferon-TB to assess for tuberculosis, and flu test. What happens with the significant amount of kids who will be positive? We will need someone to provide chest x-rays, medications and follow-up. We will need to administer medication for most children for lice and scabies. And at the very least, a stool sample should be sent for ova and parasites- which will require more patient care. Some treatments – like for TB – take months to administer: how do we track these children as they hop from shelter to shelter or even state to state? What about other more rare diseases? We’ll have to hold our breaths… and see.

Developing Records of Basic Care
None of them, I surmise, will have shot records. At the very least, we will have to provide a basic panel of catch-up immunizations according to their age.  Every child will need a new shot record, inscribed with as much identification as possible (will the older siblings recall all the information accurately about their younger siblings?) and somehow make sure it makes it to their destination. We also need to put them in some sort of tracking system like Immtrack to make it easier for follow-up vaccinations to be given appropriately.  We need to keep careful records – preferably with photo identification – during exams.  School-aged children are easier to manage because local school systems already assist in tracking and administering vaccines.  Older teens, outside many school systems’ reach, have a higher chance of defaulting on their shots and bringing more disease into the community, weakening herd immunity.

Pregnancy
There will be a few females pregnant. They will need assessment by a physician and appropriate labs and imaging obtained, since the unborn children likely will be born on American soil.

Aside from front-line treatment, a host of other support and integration services are needed. Will the children be integrated into our already strained public school systems? Or will we provide teachers to teach them in their shelters? How will we locate and hire the teachers? Are there real public health concerns when we allow these children to integrate into classrooms? They will also most likely benefit from mental health services… a luxury that most Americans don’t have access to in this day and age.

I’m not saying we shouldn’t do those things. If these children will be integrated into our society eventually, we need to take appropriate measures to help them, and to protect our own. But can we? Do we have the resources? Politics to the side, can we make space at the dinner table for them?

Ivonne Sahagun-Carreon, MD

Ivonne Sahagun-Carreon, MD

Bio:

Dr. Ivonne Sahagun-Carreon attended the Instituto Tecnologico y de Estudios Superiores de Monterrey and did her residency in pediatrics at Baylor College of Medicine in Houston, Texas. She currently resides in New Braunfels, Texas, and lives with her twelve year old son and three dogs.

Comments

  1. Diane Eisman says

    Thank you so much for this well written discussion. Most of us are not aware of all that is happening and all the difficulties

  2. Forrest says

    Very good article, Ivonne.

    Actually, the medical aspects of this are quite straightforward compared with the political and social issues.
    You already know how to take care of these children – you do that everyday.
    Getting some funds for the vaccines and treatment of lice and worms will not be too hard. Mental health and quality education – not going to happen.

    Disposition is the kicker – integrate them into the welfare and foster care system, send them back to their country of origin, or establish refugee camps along our borders?

    I bet you can guess how that conversation will play out.

  3. Ivonne Sahagun-Carreon MD says

    I guess there is no good answer. It’s hard not to incorporate politics here. But the fact remains that many children are still being housed in crowded conditions and these infectious diseases will likely be passed on. As physicians our duty is twofold– treat whomever is in our jurisdiction regardless of their disposition, but also to protect those who are ALREADY in our jurisdiction. Throw a bunch of under-immunized kids with the population and we’ll see an uptick in preventable diseases.

  4. DA Rydland MD FACOG says

    This puts a whole different face on the problem of dealing with the children that are coming to America. Politicians are arguing about who is responsible – and not sending any money. You, who are “in the trenches” just know that there are a bunch of kids who need protection. Those who are coming and those who are already here.
    Great post!

  5. C Peterson MD says

    Very well-balanced discussion of the medical issues at hand in this situation. This is the first I’ve seen of a pediatrician’s perspective on the matter. Thanks for letting us see this issue from a practical perspective.

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