Immigration and Healthcare: Crossroads and Borders
Dr. Mok’s Notes March 2008
There are a number of issues faced by those of us in the healthcare profession who see patients who are immigrants. A recent conference at The Children’s Hospital addressed these issues, and I thought they were important enough to summarize for your consideration in this edition of Children’s Link.
The conference goal was to help us understand the boundaries of our obligations in taking care of immigrants who are in the U.S. already, whether legally or undocumented, and not to answer the larger question of national immigration policy.
The conference reminded me of my own immigrant heritage. With a name like Mokrohisky, you can probably guess I am not a native. My own story started in upstate New York when my grandparents emigrated from Slovakia toward the end of the 19th century to work in the shoe factories there. Believe it or not, they actually changed the spelling of the name to make it easier to pronounce—it always broke the ice when I had to introduce myself to a new class at school—I learned a sense of humor at an early age.
With hard work and careful saving, the family sent my dad to medical school. During World War II, he served as a radiologist at Fitzsimons in Building 500, about a block from my TCH office. It’s a small world, and there is a little immigrant in most of us.
During the conference, speakers and panelists addressed the many problems that arise when complex forces like health and immigration meet at the crossroads of patient care. Case examples help illustrate the issues, but solutions are often not readily available.
Language
A non-English speaking family with diarrhea misunderstood the instructions to collect stool specimens in vials containing preservative and instead gave the liquid to their two children thinking it was medicine, which caused severe renal failure. We know the federal guidelines requiring medical interpretation, but have we assured the availability of interpretive services in all practice settings?
Clinician-Patient Relationship
We sometimes develop a therapeutic relationship with patients and later discover they are undocumented and cannot qualify for public programs like end stage renal disease treatment. What is our obligation to help these patients find care in the U.S. or in their home country?
Resource Availability
An immigrant child who needs a heart transplant was accepted on a time-limited subsidized insurance program and received the transplant, but when the coverage expired the family could not afford ongoing medication and follow-up treatments. Was this a justified use of a scarce resource?
Cultural Diversity and Health Disparities
Do I treat an overweight 8-year-old child from an immigrant family the same way I treat all other overweight children in my practice, and how can I be sure? There is substantial evidence now that we must work hard to avoid treating patients differently due to the influence of culture, language, gender, socio-economic status, sexual orientation, etc. How do I gain knowledge, skills and attitudes to minimize the impact of personal bias on patient care?
The panel discussions at the conference involved representatives from many safety-net programs in the community that deal with immigrant families. An e-mail list serve of interested advocates is being developed to further the cooperation of these groups.
As an academic medical center, The Children’s Hospital has a responsibility to understand the best ways to support and cooperate with community programs that provide medical homes to all types of patients who need care.
Immigration and Healthcare Reform
The comprehensive proposal for health care reform in Colorado, the 208 Commission, did not address the politically charged question of health care for immigrants. The national debate on immigration will be concerned with the following issues:
- Address the root causes of migration in sending countries
- Clarify the current legal avenues for migration
- Support family-based immigration
- Resolve the question about legalizing undocumented immigrants in the U.S.
- Support employment-based immigration
- Employ humane immigration enforcement policies and due process in
individual cases
- Protect human rights in migration
A DVD of the conference will be available through Conference Services at (720) 777-6123.
Contact Dr. Mokrohisky at mokrohisky.stefan@tchden.org or (720) 777-6130.
