#HealthNetworkHelpsPeople

Securing access to medical care for migrant agricultural workers is complicated, difficult, and sometimes impossible, especially when it comes to expensive services such as sub-specialist care, non-emergent surgery, and cancer treatment, to name a few. Migration, especially international migration, multiplies the odds that something will go wrong, impeding or disrupting care and leading to a negative outcome. As migrant clinicians at Keystone Health in Pennsylvania, we are familiar with and become frustrated by the many things that can and often do go wrong. Yet we remain hopeful, because every once in a while, everything goes right.

Gerardo* came to our evening clinic in the fall of 2020 to seek evaluation and treatment for bilateral knee pain and fatigue. At the time, he was a 22-year-old, otherwise healthy young man with a memorable smile and an air of optimism and gratitude about him. He had arrived just weeks before in Pennsylvania on an H-2A visa for the apple harvest season. His journey became a triumph of the human spirit and proof that migrant clinicians can help make miracles happen. Here, we recount the story, in which the advocacy of a migrant health center, the conscientiousness of a local health system, the generosity of an agricultural employer, the care coordination of MCN’s Health Network, and the gift of a brother came together to make everything go right and, ultimately, to save the life of this young man.

Published June 29, 2023 on our blog and in Streamline Summer 2023.

Health Network Associates help migrants find care anywhere in the world. But the job is heavy with almost impossible tasks: find care for people without insurance, without income, frequently with no understanding of the US health system and with low English language skills, as new residents in a town they’ve never been in before. Stay in contact with a patient who doesn’t have any reason to trust you, is scared about the immigration process, doesn’t have any money to buy data for the phone, and is actively moving across the country. Get medical records forwarded from overtaxed health center to overtaxed health center as the patient moves. Inevitably, Health Network Associates hit barriers, dead-ends, and obstacles. But they often push through, regardless.

Published April 13, 2023 on our blog.

How many barriers to care can one asylum-seeking patient encounter? In this case, too many. Five-year-old Anita* crossed the US-Mexico border with her mother and father. She has spina bifida, as well as bilateral hip dysplasia and a neurogenic bladder that leads to frequent urinary tract infections. Even under more stable conditions, in which she was not moving, finding care would be challenging and expensive. 

Her first obstacle was in detention. Her equipment to self-catheterize was confiscated by Border Patrol officials after she and her parents asked for asylum. Anita’s parents ensured she self-catheterized every four hours back home in Guatemala; now, in the detention facility, she couldn’t do it at all. When they were released, pending their immigration hearing, their supplies were not returned. After release, Anita was seen by a clinician at an immigration shelter in Texas, who enrolled her to Health Network for her complicated and urgent care. 

Published January 3, 2023 on our blog.

"She came to the immigration shelter we work with in McAllen, Texas in March. She was traveling by bus from the border to Florida, and I got her right away established into prenatal care. She had her baby in early June – a boy. I checked in with her regularly through WhatsApp, as she went through her prenatal care, her birth, and now her postpartum care. I haven’t received medical notes from the hospital yet. Those might take a while to come back. If I don’t get them again in two more weeks, I’ll check in with her again, and will ask her if she’s still needing the service or if she feels ready to close the case. I want to keep cases open until patients can say they feel comfortable with their area and don’t have any plans to move. Then, we can close the case. Today when I checked in with her, she sent me a note. ‘Thank you very much, Enedelia. The help was the best thing that could have happened to me.’ She is by herself – no family members there in Florida. I think that’s why she appreciates all the help that we gave her.” - Enedelia Basurto, Health Network Associate 

Published July 18, 2022 on social media

Ene is our Health Network Associate in McAllen, Texas, where she works to enroll asylum seekers who arrive at a local immigration shelter after being released from detention. Presently, most of the new patients are pregnant or newly postpartum, since very few asylum seekers are allowed to leave detention to await their court date in the states except those who are about to give birth.  Ene says: “I got an enrollment that was a little different than our more straightforward pregnancy cases. This postpartum mom was in Corpus Christi. Her baby was in the hospital there. I didn’t know why. And I couldn’t get ahold of her because the number we had on the enrollment form from the hospital was for her final destination, in Florida. I had tried calling the anchor several times – that's the person on the enrollment form who isn’t migrating but has regular contact with the patient – and I spoke with him, but he hadn’t heard from her either. All I could see from her records is that the newborn was in the hospital in Corpus, her other children were in a shelter on the border, and the father was in Mexico.” 

“After 7 days and multiple calls and emails, I finally got in contact with the mother. Her baby was finally being released from the hospital, and she was ready to leave Corpus. She told me she had changed her mind, and wasn’t planning to move to Florida anymore. She told me the name of her new town and I got to work right away. I found a health center that is in her new town, and called them and made postpartum appointments for her and vaccine and wellness appointments for her newborn, so they can establish care there.  I also connected her with the health center’s social worker so she could sign up for sliding scale fees. All this I did while she was moving, so that by the time she started to get settled in, her care was ready to start. She was able to get her children, who were still in detention, and move to Louisiana in just a few days. We talked a few times since her first appointments. Her baby is healthy, and they are settling down. Since they aren’t moving anymore and they don’t need ongoing care, I closed their case." 

Published November 11, 2021 on social media 

Brenda: "When Rocio (name changed) arrived at her new destination after leaving the ICE detention center, she was feeling fine. She was 35 weeks pregnant. I checked on her two days later. I was having trouble getting in contact with Rocio, so I called her anchor contact -- that's the second phone number in Health Network enrollment that a patient needs to include, in case we can't get in contact with the patient, usually a family member who’s not traveling with the patient. The anchor contact was her sister. She told me that Rocio had a headache and didn't want to do anything. I told her to stay hydrated and rest. Two days later, the patient wasn't answering my calls, so I texted her, and she responded, saying she had numbness in her hands, tingling, and she couldn’t stand because she was dizzy. I immediately called her. I feared she had preeclampsia, but she hung up on me. I called her sister, and she was also hanging up on me, and kind of rude – she didn't want to take Rocio to the hospital. So, I asked another Health Network Associate, Norma, to intervene – just a second voice, to help them understand that this was not normal, that this was a serious situation.” 

Norma, Prenatal Health Network Associate: “I put my ‘calm’ nice voice on and I just called them, and the sister of Rocio, she was mean and rude. When I asked how the patient was doing, she said that she will not take the patient to the hospital unless Rocio asked her to do so. But then I was able to speak directly with Rocio, but, you know, we hadn't yet built a good relationship with her because we hadn't found her a clinic for her prenatal care, because prenatal care centers rarely want to have patients begin care so late in their pregnancy. Rocio explained her symptoms again, and I told her it is not normal, especially if you haven't had them before, and a good way to check to make sure you and your baby are fine is going to the ER. They might do an ultrasound, to check to see if the baby is okay. And then, she completely changed, hearing that they would check the baby, make sure the baby is in the right position, is safe and healthy. I think she finally realized that this was not normal, and she said, ‘I will just ask my sister to go to the ER.’ I think it helped that I started focusing on the health of the baby – not only of the patient.” 

Brenda, Health Network Associate: “I'm glad Norma and Alma called that day because they ended up taking Rocio to the hospital that late evening. Rocio did have preeclampsia, and she had an emergency Caesarean section. The baby was in the NICU and they were watching Rocio closely. That was Friday. On Monday, the anchor told me she was feeling sad, and was sorry. She told me, ‘I know you really care for us, and you constantly kept calling and trying to make sure she was okay. I just had a baby, and I didn’t want to leave my baby alone, and I'm sorry I hesitated in taking Rocio to the hospital.’” The doctors had told her that if they hadn't come in, something very serious could have happened to Rocio and her baby. They could have died. The baby will be in the hospital for a few weeks, since she was born so early, but it was urgent.” 

Published June 30 to July 2, 2021 on social media

Nahiely Garcia, who we know as Pinky, a Health Network Associate, has worked closely with Marisol (name changed) since she crossed the border and asked for asylum while eight months pregnant, escaping threats of violence and death in her home country. When she was released from ICE custody, Marisol moved to a state in the Northeast where she had family. Finding her a clinic that would accept her so late in her pregnancy was an incredible challenge. After many phone messages, lots of time on hold, and multiple rejections, Pinky found her an appointment! Pinky then spent time transferring medical records from Marisol's last clinic. But did you know that Health Network doesn't just get patients appointments? Pinky is helping with much more: “She doesn’t have any support – and she also doesn’t have a car seat.” Through working with the health center, Pinky got Marisol vouchers to ride public transportation to her prenatal appointments. Marisol doesn't have a car of her own, but she will need a car seat, considering her very rural location where public transportation is limited. “I called the health center and tried to speak with the social worker there, but she said she couldn't help me. She said they didn't have any services to get car seats, but she referred me to another group in the community who might be able to help. When I called the community resource, they were closed because of COVID, they weren't doing that type of in-person program.” 

“She referred me to another person. Well, lots of calls later, I was referred to someone who actually works back in the health center where Marisol had her prenatal care! I was so excited to find Marisol a car seat, but there were still problems. Part of the program is that Marisol would be trained in how to install a car seat properly, but the person who provides the trainings didn't speak Spanish, so we had to arrange for a translator to come to the appointment too. It took a long time to find a time that everyone could come to... but then, after all that work, the car seat installer had to cancel. So then I had to try to find another time, reschedule all three people again.  Marisol was by then nine months pregnant and could go into labor at any moment. She wouldn't be able to leave the hospital without a car seat.” Thanks to Pinky’s ongoing work, this new mother and her baby found prenatal care and the much-needed car seat as well. Thank you, Nahiely Garcia!

Published June 16, 2021 on social media