In this two-part series, 番茄社区 spoke with physicians providing care to migrants in border cities. This article documents the experiences of providers in San Diego. Another, focusing on El Paso, Texas, can be viewed here.
SAN DIEGO -- Julie Sierra, MD, was getting very frustrated, despite her usually upbeat attitude.
"I am literally sitting in the UCSD hospital room of an 18-year-old asylum seeker, calling every number I can find for ICE [Immigration and Customs Enforcement] to come remove his ankle monitor so that he can get an MRI of his brain," the University of California San Diego primary care physician wrote in an email to 番茄社区 several weeks ago.
The internist has been volunteering hours of her time every week to diagnose and treat asylum seekers whom ICE officials release from a detention center into San Diego streets -- ankle monitor and all -- to await their hearing date. Many, as it turns out, need screening for diseases or injuries, and many have conditions that turn out to be a lot more serious than originally suspected.
"No one answers the phone at any of the [ICE] offices. We have been trying for 24 hours," Sierra said. "I would be more than happy to tell you everything that is going on here with asylum seekers being denied care."
She added that she has heard many other stories like this one from other doctors taking care of asylum seekers, and urged more publicity about the problem. "People need to talk about this," she said.
In a series of conversations, some while sitting beside the young man in his hospital bed, Sierra explained he had come with his family from a city in Central Mexico. After spending two months in Tijuana shelters waiting to apply for asylum seeker status, they were held in what Sierra and others refer to as the "ICE box," the detention center at the San Diego/Mexico border.
But while he waited with his family, he developed a headache that would gradually develop into an inner ear infection.
He had complained to the detention center officer "that he had a headache. The officer said, 'Yeah, I have a headache too,'" Sierra said, indicating an 'I could care-less' attitude.
After three days, he was able to get some antibiotics, but "whoever they saw gave the wrong antibiotics, so he was just getting worse."
At one point, she said, immigration officials took away his antibiotics.
The infection "got worse and worse, and it got to the point where, once he got out, we started him on (a different course of) antibiotics but he wasn't getting any better."
"It turned out the infection had spread to the bones of his inner ear, like an abscess," she said.
Widespread Care Denials?
This sort of thing happens too often, she said. "I've seen little girls have their albuterol inhalers taken away, and I've seen people with high blood pressure. They've had those medications taken away."
Sierra said many asylum seekers tell stories like that. "They don't know the names of the people who take [their medication] away. They just make them surrender all their medications."
For reasons that remain unclear, the young man and his family were not returned to Mexico to wait for their hearing, as a new Trump administration policy set forth, but were cleared to come into the U.S. The family was told to contact a San Diego-based humanitarian organization, which called Sierra to examine him.
"By the time I saw him," Sierra said, "he had gotten progressively worse over the next two days, and that's probably why the abscess developed. He was vomiting, with a fever, and feeling horrible. So we brought him to the emergency room. We thought he might have meningitis."
It was a medical emergency. The young man needed an MRI. Sierra wondered what would happen to her if she just went ahead and cut it off herself.
The humanitarian organization that had picked him up talked with someone from the Bernie Sanders campaign, Sierra said. That individual contacted an official at ICE headquarters who basically said to "go ahead and cut off the ankle monitor," so UCSD could perform the MRI.
Sierra got some tools and cut it off herself so the young man could get into the magnet.
The imaging showed he needed surgery, which he got the next day. "They went in through his ear canal and drained a bunch of pus, so he got some relief from the pressure, but he still has an infection in the bones behind his inner ear," Sierra said.
Sierra declined to speak further about the case, saying she didn't want to jeopardize the man's asylum hearing. And, because federal detention officials denied the man care while he was in the ICE facility, he now has an attorney who is filing a lawsuit against the federal government for the harm that the delay in care may have caused.
It is unclear whether he will be among those in a alleging that ICE is purposefully denying care to tens of thousands of migrants in agency custody.
Mark Lane, founder of San Diego's Minority Humanitarian Foundation, helps asylum seekers find housing after they've been discharged from detention centers along the Southern California border. He said he knows denial of care in federal facilities has been a persistent problem.
"We pick up people throughout the week, and a lot of the time they're sick with respiratory issues, and sometimes they're sicker," he said. "Sometimes they've gone into detention with medications on them for different illnesses, and those meds are taken away from them. Sometimes they get sick while they're in there, and they're ignored."
Or, he said, "the treatment is drink a lot more water and take some Tylenol."
He knows of two young women or girls who miscarried in the detention center. "One was denied treatment and she miscarried, and the other one, they finally took her to the hospital. She said they gave her an IV and she was unconscious. When she woke up they told her she didn't have a baby anymore."
In a former courthouse building in downtown San Diego, the non-profit Jewish Family Service (JFS) organization has attended to the needs of some 15,000 asylum seekers -- in families where at least one member is younger than 18 -- who arrive here in an effort to escape violence or political turmoil in their homelands, not knowing what will come next.
After going through the detention center for processing, they are released onto the streets of San Diego to await a hearing on whether they will be allowed to stay in the U.S. With no money or resources, many of them are driven by van to the JFS facility and dropped off, usually in the afternoon or early evening.
Humanitarian Org Fills the Gap
Earlier this month, the Supreme Court allowed the Trump Administration to bar large numbers of migrants from obtaining asylum status -- those from Central America -- unless they have applied for asylum and been denied in a country they had to pass through on their way to the U.S. It's unclear what impact this will have on the thousands of migrants who are waiting in Mexico, as numerous other court cases on the issue are still underway.
The high court's decision is unlikely, however, to affect those migrants from Mexico who are seeking asylum status because they do not have to pass through another country to get to the U.S. border.
These days, since the Trump Administration's so-called "Remain in Mexico" policy, the center is receiving far fewer migrants than it was months ago, when as many as 270 people would come in on one day. Now, it averages about 21 people a day, but that's still a lot of people.
The facility puts them up for one or two nights on green cots set up in an open area of a large room. They get food, counseling, and social services support through a combination of funding sources that include San Diego County, UCSD, and the JFS.
For some of the migrants, emotions run high for a variety of reasons, fear of what will come next to concern about those left behind. In a small stairwell, a female guest sobbed on a staff member's shoulder. Charts on the wall show travel times and temperatures of distant cities, where relatives that sponsored them await their arrival.
Lucy Horton, MD, an infectious disease specialist at UCSD, is one of a core group of about 25 physicians who receive a salary to screen, treat, and if necessary, refer these asylum seekers for more acute services.
Horton said the team there sees conditions that aren't those typical of an outpatient setting in the U.S., "like scabies and lice." Many of the guests -- they're called guests rather than patients -- have wounds or skin conditions from injuries during their travels or during their wait south of the border. And a few have incurred electrical burns, she said during an interview that was monitored by a public relations representative. She often doesn't know where the injuries occurred but they can be serious.
And, of course, they bring no medical records to help with a diagnosis.
Many of the migrants with symptoms are referred to local emergency rooms, especially given their exposure to infections and other hazardous conditions.
"It's a really high-risk population, and we have to bear in mind what they have recently been going through and the fact that they have had very little access to care," Horton said. "We might have a bit of a lower threshold to refer to an emergency room, or to a higher level of care."
According to statistics released by one large San Diego health system, Scripps Health, one Scripps facility in Chula Vista, near the Mexican border, treated 1,732 patients who were in federal immigration agency custody since Jan. 1, 2017. Another San Diego health system, Sharp HealthCare, recorded 1,808 discharges of people who were in U.S. Border Patrol custody from July 2018 to the end of June 2019.
For Horton, one recent patient sticks out. A man in his 30s developed a skin infection while he was in Tijuana waiting for his number to be called.
A clinic there diagnosed him with cellulitis. He was given some antibiotics, but it turned out to be far more serious: a case of necrotizing fasciitis.
"By the time he actually crossed the border after his number was called, he was critically ill," she said.
When the severity of his condition was finally recognized, he was sent to a San Diego hospital where he underwent four major surgeries to remove infected skin and muscle, Horton said. "It was in his chest wall and came close to reaching some of his internal organs."
Horton said he spent several weeks in intensive care, complicated by several bouts of C. difficile, but finally pulled through. "He ended up getting skin grafts because so much of the skin and muscle had been removed from his chest wall that they couldn't actually close the wounds anymore."