All the chairs in the waiting room were filled by dozens of newly arrived migrants waiting to be seen by a Cook County health worker at a clinic in Chicago. Julio Figuera, 43, was among them.
He didn\u2019t want to talk much about traveling to Chicago from Venezuela, where a social, political and economic crisis has pushed millions into poverty and led 7 million to flee, Figuera and three of his kids included.
But somewhere along the way, he\u2019d gotten pneumonia.
Figuera, who was living with hundreds of other asylum-seekers at O\u2019Hare International Airport while waiting for more permanent shelter, returned for follow-up care at the county clinic. The stubborn cough came back, so he did, too. The staff checked his vitals, listened to his chest and gave him a hepatitis vaccine.
\u201cI rarely get sick,\u201d he said. \u201cIt was the journey that got me sick.\u201d
Tens of thousands of migrants who\u2019ve come to the United States are navigating a patchwork system to find treatment for new or chronic health concerns.
Doctors across the country say it\u2019s rare that migrants receive medical screenings or anything beyond care for medical emergencies when they arrive at the U.S.-Mexico border, and there\u2019s no overarching national system to track the care, either. Migrants\u2019 options dwindle or expand after that \u2013 depending on where they end up \u2014 with some cities guiding new arrivals into robust public health systems and others relying on emergency departments or volunteer doctors to treat otherwise preventable health issues.
\u201cYou have these little islands of care. You have these little islands of shelter,\u201d said Deliana Garcia, of the nonprofit Migrant Clinicians Network, which supported more than 1,000 migrants in need of medical care in the first 10 months of this year. \u201cBut how does anyone know what\u2019s going on east to west or north to south?\u201d
More than 2 million people crossed the border illegally between October 2022 and September 2023, according to Border Patrol data. For the most part, doctors told The Associated Press, the migrants are healthy; they have to be to make the arduous journey. It\u2019s the travel that can turn manageable health issues into emergencies.
Because of that, public health leaders across the country \u2014 from New York to Los Angeles, Boston to Denver \u2014 say there\u2019s high demand for care. And providing it is central to their organizations\u2019 missions.
\u201cIt\u2019s so core to what we do that I don\u2019t feel like anyone\u2019s really hesitated around this is the right thing for the organization to do,\u201d said Craig Williams, chief administrative officer of Cook County\u2019s health system. \u201cI don\u2019t feel like over the last year that we\u2019ve backed off from really anything else because of doing this initiative.\u201d
The cost of care
The work is not without a price: Roughly 14,500 migrants have visited the Cook County clinic this year, as many as 100 are picked up in vans from the shelters each day for immediate care, vaccinations and a foothold into the public health care system. The county spends about $2.2 million a month \u2014 or nearly $30 million since it opened the clinic about a year ago.
New York City Health and Hospitals logged 29,000 migrant patient visits in the last fiscal year, which ended in mid-June. There, health workers have administered more than 40,000 vaccines and provide medical screenings for all new arrivals.
Other cities are trying to manage as best they can, like Denver, where nearly 26,000 migrants have arrived within the last year. Dr. Steve Federico, a director at Denver Health, said the city\u2019s process is inadequate.
Migrants are asked by shelter staff if they need immediate medical attention. If they say yes, they\u2019re either sent to an emergency room or connected by phone with a nurse through Denver Health, a public hospital and health organization.
There are no basic health screenings, Federico said, which can increase the risk of infectious disease outbreaks among those living in shelters. In Chicago, one shelter saw a small outbreak of chickenpox.
Without catching and treating illnesses early, Federico said, \u201cNow everybody has it. And then if somebody is at increased risk, they\u2019re going to get sicker.\u201d
Federico and city spokesperson Jon Ewing both said Denver is already strained for resources \u2014 given the need to shelter and feed migrants. Ewing said Denver is looking to enhance its medical screening process, but added that it\u2019s not clear how much that will cost or whether there are enough resources to achieve it.
The challenges of care
Migrants face a lack of access to steady medical care in the U.S., as well as healthy food and stable housing. It can mean that someone with a chronic medical condition, like diabetes or hypertension, can end up in the hospital simply because they lost or ran out of their medications, or had them confiscated during their travels. Doctors said they\u2019ve also seen migrant children with asthma who need new inhalers.
\u201cYou have what were essentially healthy people put in really remarkable circumstances, where they are not able to survive thoroughly and then they come across (the border) in a really compromised state,\u201d said Garcia, of the Migrant Clinicians Network.
Some women are arriving far along in their pregnancies, and never had prenatal care.
\u201cWe gave the first prenatal visit to a woman who was nine months pregnant just two weeks ago,\u201d said Dr. Ted Long, senior vice president at New York City Health and Hospitals, where more than 300 healthy babies have been born to migrant mothers.
Even when care is available, migrants can have a hard time getting it. Some avoid asking for help entirely out of fear of a large bill or longstanding distrust of the medical system.
Dr. Stephanie Lee is the medical director of refugee resettlement and coordinator of the unaccompanied youth program at Penn State Health\u2019s Family Practice Pediatrics Clinic. She said she sees many patients who don\u2019t have health insurance or don\u2019t know how to get it.
One mother who\u2019d been waiting on an asylum request for more than a year told Lee she was paying out of pocket because her family didn\u2019t have insurance.
\u201cThe process is so broken that you can\u2019t even do anything,\u201d Lee said. \u201cThey came in to see me just paying out of pocket because the kiddo needed a physical and needed to get checked before going to school.\u201d
The Migrant Clinicians Network, which has been connecting patients to health providers for 30 years, just received a $5 million grant from the National Institutes of Health. Its case workers keep in touch with migrants, doing things like setting up medical appointments, helping fill out applications for social services, taking people to appointments and figuring out payment options.
They even keep in touch with a trusted family member in the migrant\u2019s home country, in case they fall off the radar.
\u201cWe have a lot of babies who are named after the people who work on our team,\u201d said Garcia, who oversees the program.
But that\u2019s the best-case scenario.
The shelter system in Massachusetts is so full that the governor brought in the National Guard in August to assist. Dr. Fiona Danaher and her colleagues often cannot find migrants when she needs to follow up because they don\u2019t have a U.S. phone number.
\u201cWe see situations even in migrants who are just moving around between shelter locations in the greater Boston area where they get completely lost to follow up,\u201d said Danaher, a primary care pediatrician in the Mass General Brigham health system. \u201cAnd then the wheel gets reinvented and the same tests get done.\u201d
She encourages her colleagues to give patients a physical copy of everything that was done on their visit: vaccines administered, medications prescribed, benefit programs applied for. That way, they can simply hand it to whoever sees them next \u2014 like a critical game of telephone.
There\u2019s \u201ca lot of low hanging fruit\u201d when it comes to caring for migrant patients, she said, and a \u201cvery old-school level of note passing\u201d is \u201can important investment to make.\u201d<\/p>\n\n\n\n