Immigrants from Mexico and Central America seeking asylum in the United States frequently end up at border shelters in Tijuana, Mexico. They stay in them for weeks as they wait for the U.S. government to approve or deny their applications.
Most of the refugees get sick during their journeys due to insufficient food, a lack of clean water and poor sanitation at camps and shelters along the way. But perhaps their biggest health problem is depression and anxiety: They have suffered violence and been threatened by gangs and left behind everything they know in the world.
Volunteer health care workers from Southern California recently visited the Movimiento Juventud 2000 (Youth Movement 2000) shelter in Tijuana, and spent the day treating the migrants there. KHN’s Heidi de Marco captured the scene.
Volunteer doctors, nurses and other health care professionals board a bus in downtown Los Angeles before dawn to ride to the migrant shelter in Tijuana. They spent the day there dispensing free health care, supplies and advice to shelter inhabitants.
For about 25 years, the shelter primarily housed Mexicans deported from the United States. Its director, Jose Maria Garcia Lara, shown here, recently opened its doors to asylum seekers and other migrants fleeing violence and economic deprivation in Central America. The biggest health problem they face, Lara says, is depression: “The people who are coming here are leaving their homes. They are leaving a lifetime.”
A mural inside the shelter explains the rights of the migrants dwelling there. It says they have the right to safe shelter; health care and education; freedom from discrimination; due process under the law; protection for their families; and respect for cultural diversity.
Jose Manuel Salinas, an asylum seeker at the shelter, holds his friend’s baby as he waits to be seen by a nurse. He was fighting a cough that had worsened since his arrival a month earlier. Inhabitants of the camp do not get regular health care. One doctor and two nurses visit once a week, but can spend only five or 10 minutes with each migrant in need of care.Email Sign-Up
Subscribe to KHN’s free Morning Briefing.Sign Up Please confirm your email address below: Sign Up
Volunteer health workers at the shelter set up folding tables, where they offered help for both physical and psychological ailments. They provided first aid as well as pediatric and dental care, and they took glucose, blood pressure and pulse readings.
The shelter, which houses up to 150 people, has only one bathroom for men and one for women. Conditions are cramped, making the migrants susceptible to illness if they are not sick already.
Jose Manuel Salinas is living temporarily in a tent inside the shelter. He says he walked and hitchhiked for a month from his home in Acapulco. “You can’t live in the state of Guerrero,” says Salinas, 31. “There’s too much violence, and the truth is the salary we make isn’t enough to feed my family.”
¿No puedes escuchar el audio? Haz click aquí.
Forma parte del grupo de Facebook de Kaiser Health News en español “KHN-Hablemos de Salud”.KHN-Hablemos de Salud
Las personas que solicitan asilo y los refugiados de México y Centroamérica se dirigen a menudo a refugios fronterizos en Tijuana, y a veces permanecen semanas esperando que el gobierno de los Estados Unidos apruebe o deniegue sus solicitudes. Su situación ha sido particularmente precaria con las amenazas del presidente Donald Trump de cerrar la frontera con México, aunque Trump dio marcha atrás la semana pasada. Recientemente, un grupo voluntario de médicos y enfermeras visitó uno de estos refugios, llamado Movimiento Juventud 2000, donde pasaron el día atendiendo a los migrantes amparados aquí.
Jose Manuel Salinas, quien se aloja en una tienda de campaña en el refugio, llegó aquí en enero después de un mes de caminata y haciendo autostop desde su casa en Acapulco, Guerrero. El herrero, de 31 años, dice que no tuvo más remedio que buscar asilo en los Estados Unidos.
“No se puede vivir en el estado de Guerrero. Hay mucha delincuencia”, dice Salinas. “Es muy poco lo que paga el salario de uno y no alcanza para la familia”.
Pero el viaje lo desgastó. Se enfermó y ahora está luchando contra una tos que ha empeorado desde que llegó.
José María García Lara, director del refugio, dice que muchos migrantes se enferman durante el viaje por la falta de agua potable, la escasez de comida y el pobre saneamiento en los campamentos y refugios a lo largo del camino. Cuando está lleno, el Movimiento Juventud 2000, acoge a cerca de 150 personas.
“Enfermos de gripe, enfermos de cansancio, y lo más importante: que esta comunidad viene enferma con un problema psicológico de depresión”, dice Lara. “Porque la gente que está saliendo está dejando sus casas… está dejando toda una vida”.
Por 25 años este refugio sirvió como vivienda para mexicanos deportados de los Estados Unidos. Pero más recientemente, Lara lo ha abierto a una ola de migrantes que huyen de la violencia en sus países de origen.
Lara dice que el refugio ha atendido a las primeras tres caravanas que llegaron desde 2017.
Normalmente sólo un médico de México y dos enfermeras visitan la instalación cada semana para tratar a los enfermos, dice. Y pueden pasar sólo entre cinco y diez minutos con cada paciente, debido a la multitud de migrantes que necesitan atención.
Pero esta tarde, un grupo de unos 75 trabajadores de salud de los Estados Unidos llegó con una clínica médica móvil para ayudar a los migrantes que necesitan atención.
Salinas se encuentra entre las cerca de 100 personas que hacen cola. Le pide ayuda a una enfermera. “Vengo a ver si me pueden apoyar. Lo que pasa es que tengo bastante tos, gripa”, dice. “Y siento que las venas se me van a reventar cuando empiezo a toser”.
La enfermera le da aspirina, toallitas antisépticas y consejos. Salinas quiere más, pero es todo lo que ella tiene.
“¿Estas toallitas son para que se limpie, ok? Para que se desinfecte las manos así no se va la tos para otra persona”, le explica la enfermera. “Lo que tiene que hacer también es tomar bastante líquidos. Se toma una aspirina por si tiene fiebre o escalofrío”.
Los trabajadores de salud arreglan mesas en donde ofrecen ayuda tanto para dolencias físicas como psicológicas. Ofrecen primeros auxilios, así como atención pediátrica y cuidado dental, y miden la presión y la glucosa.
Laura Ramírez, enfermera de Riverside, California, dice que siente una conexión con los migrantes.
“Mis papás son de México y también trabajo en un hospital donde la mayoría de los pacientes hablan español,” dice Ramírez, quien está aquí por primera vez como voluntaria. “Los miro aquí. Quizás en unos años los tengamos como pacientes allá”.
Es un sentimiento compartido por Jose Manuel Salinas y los casi 150 otros que ahora pasan sus días en este refugio fronterizo esperando que el gobierno de los Estados Unidos decida su destino.
Can’t see the audio player? Click here to download.
Lauren Weber, one of Kaiser Health News’ new Midwest correspondents, joined St. Louis Public Radio reporter Jeremy Goodwin on “St. Louis on the Air” Friday to discuss how syphilis is making inroads into rural counties across the Midwest and West. In Missouri, the total number of syphilis patients has more than quadrupled since 2012, testing the weakened public health safety net in areas unfamiliar with the potentially deadly infection. Listen to the interview on the St. Louis Public Radio website.
Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.
Happy Friday! This week, I discovered a new, salty Twitter account that really speaks to my soul: @justsayinmice. The creator behind the thing is fed up! with click-baity headlines on stories about research done in mice — you know the ones that make it seem like the findings are about to revolutionize treatment in humans. The person has a simple suggestion (as you can tell from the handle). Researchers figure out the best time to exercise … for mice. High-carb diets can stave off dementia … in mice. You get the idea.
Now, on to health news you might have missed this week … just in case you were distracted by reading through 448 pages of a certain report.
In a move that flew a bit under the radar, the Justice Department announced it has stopped defending a federal prohibition on female genital mutilation. While the story itself might not be groundbreaking enough to grab national attention, the decision follows closely on the heels of the kerfuffle over DOJ siding against the health law. Although the reasoning behind each decision is different — the department says there are flaws in the mutilation legislation that need worked — taken together, it’s a highly unusual trend that has experts worried. Defending laws on the books is a principal function of the Justice Department, and only about once a decade since World War II has it declined to support a law enacted by Congress, according to a solicitor general during the Clinton administration.
Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.Sign Up Please confirm your email address below: Sign Up
In a moment that probably did not play out as expected, moderator Bret Baier asked audience members at a Fox News town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) if they would support shifting to a government-run health system. The room erupted in cheers. The video went viral because … who doesn’t love a moment of real surprise on TV? But, more deeply, it reflects past polling showing that “Medicare-for-all”-type plans do garner conservative support (though that drops when certain stipulations —like getting rid of private insurers — are added to the questions).
Meanwhile, in a story that shocked absolutely zero people, UnitedHealthcare, the nation’s largest insurer, spoke out against “Medicare-for-all.” The outcry from UnitedHealth came at the start of a four-day stock free fall that ranks as one of the worst routs in more than 20 years. About $150 billion of market value was erased from companies in the S&P 500 Health Care Index in the four days through Thursday.
And in case you’ve lost track of where the 2020 presidential candidates stand on the plethora of health plans circulating on Capitol Hill, here’s a helpful cheat sheet.
House Oversight and Reform Committee Chairman Elijah Cummings (D-Md.) is accusing the committee’s ranking member, Rep. Jim Jordan (R-Ohio), of actively obstructing Cummings’ investigation on high drug prices, escalating the political battle between the two lawmakers. This time, the conflict stems from letters Jordan sent to a dozen different drug company executives warning them that Cummings was conducting a partisan investigation, essentially telling them not to participate.
There was so much state-level abortion news this week, I’m going to break Breeze protocol and just list it out for you.
— Are babies actually born alive after an attempted abortion? What happens then?
— The Supreme Court is asked to knock down a Louisiana admitting-privileges law.
— The Florida House OK’d legislation to require parental consent for an abortion.
— The Michigan attorney general says she won’t defend a state law that bans abortion if Roe v. Wade is overturned.
— Oklahoma sends abortion-reversal legislation to the governor.
— The North Dakota governor defends his decision to make it a crime for a doctor performing a second-trimester abortion to use instruments such as clamps, scissors and forceps.
— Advocates say “heartbeat bills” are designed to spark a court challenge.
New reported cases of measles have set the country on track for experiencing the worst year yet this century for the illness. And public health advocates are worried that the issue of vaccinations is becoming so politicized that it will be as vulnerable to the pitfalls of tribal politics as other topics, like climate change and gun control. Once that happens, there’s usually little movement in any debate.
And experts warn that Passover — when families and friends gather together to mark the holiday — will exacerbate the outbreak in the ultra-Orthodox Jewish community.
Saturday is the 20th anniversary of Columbine, which, at the time, was the deadliest shooting at a high school in U.S. history. In a sobering piece, CNN brought together Columbine survivors and Parkland students to talk about their trauma, which, despite being separated by nearly two decades, looks heartbreakingly similar. “It terrifies me to know that this is going to be throughout my life, forever,” says Sari Kaufman, who was a sophomore during the Parkland shooting.
Three more veterans killed themselves last week on Department of Veterans Affairs health care properties, in a trend that has become disturbingly familiar to anyone paying attention. Despite the increased focus on the problem of veteran suicide and their mental health in general, there has yet to be a dent made in the grim statistics. Experts say that there’s not one easy solution here. For example, 70% of veterans don’t even try to routinely use the VA services, so expanding access within the system isn’t going to make much of a difference to them.
In a massive sting, federal prosecutors nabbed dozens of doctors on charges that they were trading painkillers for sex, drugs and other favors. The cases included: a man in Tennessee who called himself the “Rock Doc” and allegedly prescribed hundreds of thousands of pills in exchange for sex; a doctor in Alabama who prosecutors say recruited prostitutes to become patients and let them use drugs at his house; and another who wrote prescriptions on behalf of Facebook friends. “When medical professionals behave like drug dealers, the Department of Justice is going to treat them like drug dealers,” said DOJ official Brian Benczkowski.
In the miscellaneous file this week:
• Frankenstein Pig! OK, not quite, but scientists were able to revive the cells in brains taken from slaughtered pigs. The work challenges the idea that once the brain is dead, it’s all over folks — and, as you can imagine, will probably provoke some interesting ethical debates in the upcoming years.
• Researchers were able to use modified HIV to help cure babies born with “bubble boy” syndrome.
• The debate over the effectiveness of workplace wellness program may have been put to rest with a new sweeping study that finds that they … drum roll, please … don’t work at all. Not only do they not cut costs, but they don’t improve workers’ health either.
• But! There was some hope in the battle against the obesity epidemic this week. Researchers found that a genetic risk scorecard can somewhat predict if a person is going to be obese by looking at millions of variants in your genetic code.
Have a great weekend!
Viewpoints: Those Who Have Contracted Deadly Diseases Know The Value Of Vaccinations; ‘Medicare At 55’ Is The Politically Feasible Step We Should Be Taking
Longer Looks: Roller-Skating For Reproductive Rights, The Truth About Dentists & The Measles Resurgence
State Highlights: Money Hinders Push For Mental Health Urgent Care Clinics In Massachusetts; Calif. Drinking Water Contaminated With Carcinogenic Toxins From Wildfires
From The State Capitols: Conn. Lawmakers Fret Over Price Tag For Covering Undocumented Children; Washington’s Long-Term Care Benefits Measure Gains Momentum
Insurers To Be Allowed To Prevent Drug Coupons From Applying To Annual Limit On Out-Of-Pocket Costs In Some Cases
North Carolina Governor Vetoes ‘Born Alive’ Legislation Calling It An Unnecessary Interference Between Patient, Doctor
Facial Expressions Are Crucial To Human Interactions, But Botox And Cosmetic Surgery May Disrupt All That
Genetic-Risk Scorecard Able To Predict Obesity, Making It Possible To Suss Out Who’s Been Dealt An Unlucky Hand
Saira Diaz uses her fingers to count the establishments selling fast food and sweets near the South Los Angeles home she shares with her parents and 13-year-old son. “There’s one, two, three, four, five fast-food restaurants,” she says. “And a little mom and pop store that sells snacks and sodas and candy.”
In that low-income, predominantly Latino neighborhood, it’s pretty hard for a kid to avoid sugar. Last year, doctors at St. John’s Well Child and Family Center, a nonprofit community clinic seven blocks away, became alarmed by the rising weight of Diaz’s son, Adrian Mejia. They persuaded him to join an intervention study run by the University of Southern California and Children’s Hospital Los Angeles (CHLA) that weans participants off sugar in an effort to reduce the rate of obesity and diabetes among children.
It also targets a third condition fewer people have heard of: fatty liver disease.
Linked both to genetics and diets high in sugar and fat, “fatty liver disease is ripping through the Latino community like a silent tsunami and especially affecting children,” said Dr. Rohit Kohli, chief of gastroenterology, hepatology and nutrition at CHLA.Email Sign-Up
Subscribe to KHN’s free Morning Briefing.Sign Up Please confirm your email address below: Sign Up
Recent research shows about 1 in 4 people in the U.S. have fatty liver disease. But among Latinos, especially of Mexican and Central American descent, the rate is significantly higher. One large study in Dallas found that 45% of Latinos had fatty livers.
The illness, diagnosed when more than 5% of the liver’s weight is fat, does not cause serious problems in most people. But it can progress to a more severe condition called nonalcoholic steatohepatitis, or NASH, which is linked to cirrhosis, liver cancer and liver failure. This progressive form of fatty liver disease is the fastest-growing cause of liver transplants in young adults.
The USC-CHLA study is led by Michael Goran, director of the Diabetes and Obesity Program at CHLA, who last year made an alarming discovery: Sugar from sweetened beverages can be passed in breast milk from mothers to their babies, potentially predisposing infants to obesity and fatty livers.
Called HEROES, for Healthy Eating Through Reduction of Excess Sugar, his program is designed to help children like Adrian, who used to drink four or more sugary drinks a day, shed unhealthy habits that can lead to fatty liver and other diseases.
Fatty liver disease is gaining more attention in the medical community as lawmakers ratchet up pressure to discourage the consumption of sugar-laden drinks. Legislators in Sacramento are mulling proposals to impose a statewide soda tax, put warning labels on sugary drinks and bar beverage companies from offering discount coupons on sweetened drinks.
“I support sugar taxes and warning labels as a way to discourage consumption, but I don’t think that alone will do the trick,” Goran said. “We also need public health strategies that limit marketing of sugary beverages, snacks and cereals to infants and children.”
William Dermody, a spokesman for the American Beverage Association said: “We understand that we have a role to play in helping Americans manage consumption of added sugars, which is why we are creating more drinks with less or no sugar.”
In 2016, 45 deaths in Los Angeles County were attributed to fatty liver disease. But that’s a “gross underestimate,” because by the time people with the illness die, they often have cirrhosis, and that’s what appears on the death certificate, said Dr. Paul Simon, chief science officer at the L.A. County Department of Public Health.
Still, Simon said, it was striking that 53% of the 2016 deaths attributed to fatty liver disease were among Latinos — nearly double their proportion of total deaths in the county.
Medical researchers consider fatty liver disease a manifestation of something called metabolic syndrome — a cluster of conditions that include excess belly fat and elevated blood pressure, blood sugar and cholesterol that can increase the risk of heart disease, stroke and diabetes.
Until 2006, few doctors knew that children could get fatty liver disease. That year Dr. Jeffrey Schwimmer, a professor of pediatrics at the University of California-San Diego, reviewed the autopsies of 742 children and teenagers, ages 2 to 19, who had died in car crashes or from other causes, and he found that 13% of them had fatty liver disease. Among obese kids, 38% had fatty livers.
After Schwimmer’s study was released, Goran began using MRIs to diagnose fatty liver in living children.
A 2008 study by another group of researchers nudged Goran further. It showed that a variant of a gene called PNPLA3 significantly increased the risk of the disease. About half of Latinos have one copy of that high-risk gene, and a quarter have two copies, according to Goran.
He began a new study, which showed that among children as young as 8, those who had two copies of the risky gene and consumed high amounts of sugar had three times as much fat in their livers as kids with no copy of the gene. Now, in the USC-CHLA study, he is testing whether reduced consumption of sugar decreases the fatty liver risk in children who have the PNPLA3 gene variant.
At the start of the study, he tests kids to see if they have the PNPLA3 gene, uses an MRI to measure their liver fat and catalogs their sugar intake. A dietitian on his team educates the family about the impact of sugar. Then, after four months, they measure liver fat again to assess the impact of the intervention. Goran expects to have results from the study in about a year.
More recently, Goran has been investigating the transmission of sugar from mothers to their babies. He showed last year that in nursing mothers who drank beverages sweetened with high-fructose corn syrup — the primary sweetener in standard formulations of Coca-Cola, Pepsi and other sodas — the fructose level in their breast milk rose and stayed elevated for several hours, ensuring that the baby ingested it.
This early exposure to sugar could be contributing to obesity, diabetes and fatty livers, based on previous research that showed fructose can enhance the fat storage capacity of cells, Goran said.
In neighborhoods like South Los Angeles, where Saira Diaz and Adrian Mejia live, a lack of full-service markets and fresh produce makes it harder to eat healthily. “Access to unhealthy food options — which are usually cheaper — is very high in this city,” Derek Steele, director of health equity programs at the Social Justice Learning Institute in Inglewood, Calif., told Kaiser Health News.
The institute has started farmers markets, helped convert two corner stores into markets with healthier food options and created 109 community gardens on public and private lands in South L.A. and neighboring Inglewood, which has 125 liquor and convenience stores and 150 fast-food outlets.
At Torrance Memorial Medical Center, 10 miles down the road, Dr. Karl Fukunaga, a gastroenterologist with Digestive Care Consultants, said he and his colleagues are seeing so many patients with fatty liver disease that they plan to start a clinic to address it. He urges his patients to avoid sugar and cut down on carbohydrates.
Adrian Mejia and his mother received similar advice from a dietitian in the HEROES program. Adrian gave up sugary beverages, and his liver fat dropped 43%. Two months ago, he joined a soccer league.
“Before, I weighed a lot and it was hard to run,” he said. “If I kept going at the pace I was going, probably later in my life I would be like my [diabetic] grandma. I don’t want that to happen.”
Telemundo News featured KHN’s recent Bill of The Month story about a soccer player who was stuck paying big bucks for a fancy hinged knee brace. Paula Andalo, KHN’s ethnic media editor, offered advice about how to avoid overpaying for medical equipment you may not need.
You can read KHN’s full story here.