COE’s 2019 Global Health Symposium The Crisis at the Border: Using our Privilege to Influence Change

Kristen Jogerst, MD MPH

Surgical Education Research Fellow at MGH

PGY 3

12/09/2019

The Plenary Session taught us about unequal treatment at the border.
Concurrent sessions taught us about unequal treatment in our
everyday medical practices. 

The Global Health Symposium was highly informative and inspiring. I enjoyed learning from colleagues’ global health projects during the Friday evening poster session and from the small groups sessions Saturday. Particularly memorable was the plenary session by Dr. Scott Allen, MD, FACP on Family Detention and the Role of the Medical Profession. He discussed the importance of medical professionals not walking away from difficult situations in an effort to wash our hands clean of the situation. He spoke of many stories describing unethical care of inmates, of detained immigrants at the border, and of children separated from their families and housed in family detention centers. He spoke on the importance of using our privilege to get proximal to issues in order to learn and grow from them. I agree with his perspective that we have a unique and privileged role as medical providers. We must use this privilege to learn from our patients and then work diligently outside of our lane in order to influence change for the betterment of our patients. He used the example of the NRA telling doctors to “stay in their lane” and the massive response from trauma surgeons and emergency medicine providers stating the societal issue of gun control is their lane, to show how a social movement can happen. This example was one of many that showed we can move towards change when we use our physician privilege of knowledge and proximity to the issues to enact change.

It was the summer of 2018 and the border crisis was growing. The Trump policy had ramped up its mandatory detention of families at border-crossing facilities. It had also begun the forced separation of children from their families to send a “message of deterrence” to families fleeing for safety while fearing for their lives because of violence in South and Central America. I was an intern on my two months of trauma surgery at a level I trauma center in Phoenix, AZ. During my two months I cared for many patients, including some suffering traumatic injuries after falling from the Mexican-American border wall. One of these patients was a woman who fell from the border wall and broke her arm. She was transferred to the trauma hospital and admitted to our trauma service for further workup while awaiting operative repair by the plastics and hand surgery team. I was paged as the intern on call when a nurse became concerned that the patient might not sign the operative consent form. The patient was described as being “hysterical” because she was unwilling to stop crying. No matter how hard the nurse tried, the patient would not stop crying, despite denying pain, in order to have a conversation - through a Spanish-speaking interpreter - reviewing the risks and benefits of an operative hand fracture repair. When I arrived at bedside to see why she would not have a conversation with the surgical team or sign her consent form, I learned she had been crying all night. She had not stopped since time of her admission to our trauma surgery service despite refusing all pain meds for her hand fracture. When asked why she would not stop crying, the nurse and Spanish-speaking interpreter explained it was because her children were taken away from her at the border and she had not seem them or heard from them since she was put in the ambulance to be transferred to our trauma center. When I questioned the ICE officer standing outside her room - who had been guarding her room since her admission - he refused to answer my questions. He said he could not tell me or the patient where her children were. I was deeply disturbed by this. This patient was not “unduly anxious” or “hysterical” and did not simply need a bit of Ativan to “calm her down” so she could sign the surgical consent. She was rightly distressed by the forced separation from her children after traveling all the way from Central America, fleeing for their safety. I eventually was able to complete the consent form and the patient was able to have her surgery. Once medically cleared, she, like many other patients admitted after traumatic falls from the border wall, was discharged with ICE to a detention facility. Despite working hard with our social worker - who I believe is a bigger miracle worker than any physician on the trauma surgery team - we could not locate this patient’s children.

To this day, when I think of this patient’s story, I have a visceral reaction. I become angry and remember the terrible guilt that I felt, wishing I had done more to convince the ICE officer to work on finding out where this woman’s children were. While a busy surgical intern working 80 hours a week, I felt I had little time to sleep or complete activities of daily living, let alone start a political movement near the border in Arizona. Still, reflecting back on this story during the weekend’s symposium, the guilt resurfaced and I shared this story with Dr. Allen after his keynote address.

He and I spoke about the importance of balancing risk and benefit: risk of our own job security, career trajectory, and that career trajectory’s long-term influence with short-term benefits of enacting change. We discussed the power that experience can have on us as medical providers and how sharing our patient’s powerful stories can lead to slow, but meaningful impact at a political and societal level. He and I agreed that as a resident it can be difficult to disobey legal governances over our patients and may not be worth losing our ability to train and become practicing physicians, but that we must share our patients’ stories. As we accrue more privilege during our physician journey, we must then work to change the overarching political and societal infrastructure that led to the initial injustices woven in these patients’ stories.