Physician Resolve On Display as the Immigration Conversation Continues

June 20, 2018

New immigration policies are affecting the health of thousands of migrant children, and physicians want the world to know about it.

When Attorney General Jeff Sessions ordered federal prosecutors to implement a “zero-tolerance policy” for illegal immigration at the US-Mexico border, the Trump Administration drew the kind of mixed support and condemnation you’d expect from such a move. But when Americans began to realize that the policy had consequences that included migrant shelters full of parent-less children, the conversation changed tone.

Polls suggest that separating children of immigrants from their parents at the Mexican border is highly unpopular, except among Republicans. First Lady Melania Trump and former first ladies Michelle Obama, Laura Bush, Hillary Clinton, and Rosalynn Carter have all united in opposition to the practice. But few groups have been as vocal — and few have brought more powerful evidence and potent anecdotes to the table – as physicians.

I’m inspired by the fact that physicians are taking time out of their often busy schedules to analyze current political maneuvers, and that they are committing themselves to reshaping future ones. I recently wrote (and truly believe) that meaningful pathways toward curbing gun violence must include the steadfast commitment and expert consultation of physicians. In light of the recent conversation around immigration and the intimate link between familial connections and health, it’s appropriate to take that statement a bit further.

Replace “gun violence” with many of today’s most pressing challenges — immigration woes, human trafficking, racism, the opioid epidemic, the school-to-prison pipeline, all-too-high suicide rates, etc. – and I’ll continue to stand by the statement. If we want to gain ground and make progress in these areas, physicians must be involved. And as the debate around immigration and familial separation has risen in fervor, they have been.

Universally separating children from their parents or caregivers entering U.S. borders could create negative health impacts that last a lifetime. Instead, prioritize supporting families and protecting children's well-being. https://t.co/vWQu0iqa26 (via @chicagotribune)

— AMA (@AmerMedicalAssn) June 18, 2018

About 2 weeks after a Fox & friends Twitter poll questioned whether the American Medical Association (AMA) should “get so political” about gun violence (71% of voters agreed that yes, they should) the AMA entered the immigration conversation by spotlighting the long-lasting negative health effects that often result when children are separated from their primary caregivers. Physicians across the spectrum of specialties echoed that sentiment, often drawing support from the literature. It’s not hard to find data bolstering the idea that separating children from their primary caregivers can have long-term negative health effects.

Research confirms that early childhood trauma changes the way a child brain reacts to stimuli and their ability to form healthy relationships.

These children need to be reunited with their parents.

There is NO REASON for separation.#FamiliesBelongTogether https://t.co/Pqgas7LtGE

— Margaret Stager, MD (@DrStager) June 18, 2018

In residency I took care of a dying infant who contracted pertussis in a family detention center. I already blame our immigration system for that death. When people are ‘warehoused’ communicable diseases spread. Think they care about a coughing kid? #FamiliesBelongTogether https://t.co/sLWszpsIoi

— Emily Hahn (@TexasKidDoc) June 19, 2018

The memory of that little girl crying for her mother stays with me every day. We know there are many more children crying for their families. Family separation at the border needs to end. #ProtectFamilies https://t.co/Q2a1X2h87J

— Dr Colleen Kraft (@AAPPres) June 18, 2018

So far today I have done an interview on family separation at the border, another on kids & guns, and am about to speak at a press conf on firearm violence. I am torn between anguish that these are the subjects affecting our kids, and gratitude that I get to be a voice for them.

— Elizabeth Meade, MD (@EMeadeMD) June 19, 2018

In an interview with MD Magazine at Psych Congress last year in New Orleans, Vladimir Maletic, MD, clinical professor of psychiatry at USC, highlighted studies showing that early life adversity is a significant prognosticator of future occurrences of major depressive disorder, addiction, and several other conditions. “Individuals who have suffered more than 2 adverse early life events had double the rates of depression, but interestingly enough, they also had double the rates of inflammation…they had double the rates of metabolic disorders, and they had double the risk of developing 2 or more chronic medical illnesses,” he said. In addition to psychiatric conditions, physicians have raised concerns about increased risk for communicable diseases among children in high-density shelters. Data suggest that jail- and prison-like environments present an important infection-control challenge for infectious disease practitioners and epidemiologists. During incarceration, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus.Pediatricians have been especially active on Twitter in response to the news that new immigration policies have resulted in more than 2300 children being separated from their parents at the southern US border. Many have rallied behind American Academy of Pediatrics President Dr Colleen Kraft, who shared the story of her visit to a Texas facility for migrant children separated from their families on June 18. Kraft said she was not allowed to “comfort or hold a crying child. And we all knew that this child was crying because she wanted her mother.” Other pediatricians lamented the simple fact that such a drastic situation could arise in the first place. What impresses me most about these physicians — the ones vying for change, whatever their opinions may be – is their resolve. Many doctors chose medicine as their life’s calling because they wanted to change people’s lives for the better. Many more quickly find out that it often is not glamorous work. As one physician wrote on Reddit under the user name mrmao, “You’re overworked, underappreciated, spend most of your time doing paperwork, and fighting upstream in a broken system.”

Tomorrow @AmerAcadPeds was supposed to have a Subspecialty Day of Action. It’s canceled. We cannot - will not - talk about anything other than separation & detention of migrant children until this program is ended. Pediatricians will not let this continue. Don’t mess with us.

— Emily Hahn (@TexasKidDoc) June 20, 2018

Kids, families in cages. Getting them out needs to be our primary preoccupation until this is fixed. https://t.co/ou3EVl0yRP

— Dr. Choo, Medicine Woman (@choo_ek) June 17, 2018

How can he possible be reunited with the right family? OMG the trauma of a separation at this age and the lasting damage, it is unthinkably cruel https://t.co/yxWcXVgJ6S

— Jennifer Gunter (@DrJenGunter) June 18, 2018

Watching the number rise. @physicianwomen have raised $30,058 for KIND in <24 hrs--legal defense for migrant children separated at the border or for unaccompanied minors. Will you help us? A $5 donation multiplied by many helps kids who have nothing and no one to fend for them. https://t.co/XXPrOtY5gb

— Heather Sher MD. (All opinions are my own) (@hshermd) June 19, 2018

This morning I went to the basement to change the laundry.

“Mommy?” my 3 y/o called from the top of the stairs.

“Yep, coming!” I replied.

“I was so scared! I didn’t know where you were!”

I hugged her for a long time.

Then I donated to the @ACLU.#KeepFamiliesTogether

— Sarah Matathia MD MPH (@SarahMatMDMPH) June 19, 2018

The funny thing about that? It’s exactly the kind of chip-on-the-shoulder attitude needed to spur real change. When you pair deep-seeded ambition to help others with unwavering resolve, amazing things can happen — and physicians are making them happen every day. Editor’s note: This is a column written by Tom Castles, associate director of editorial. His analysis reflects his views, not necessarily those of the magazine.