Takeaway
Clinicians are in a powerful position to advocate for undocumented people, who are among the most vulnerable patients. By acknowledging the courage of this population, we can affirm their strength and resilience.
Passion in the Medical Profession | September 29, 2022 | 2 min read
By Jane Abernethy, MD, MBE, Johns Hopkins Medicine
“Recuerdo cuando me mudé acá.” My patient laid his hand on mine, stopping me from clicking through the rest of his long medication list. “Espero que esté bien.”
“I remember when I first moved here. I hope you’re ok,” he said. His sympathy silenced me, as I knew our paths to Baltimore were starkly different. He had escaped gang violence in Honduras, now renting a room alone as he worked two jobs to send money back to his wife and children. I had moved from Philadelphia with my husband to start my first job after residency. I had left neighbors and patients I loved; he had left three generations of family, a home he had built with his brother, a professional identity, a native language, an entire culture.
As a primary care physician who cares for a large population of Latinx undocumented people, I am privileged to learn about the unique struggles this group faces—and their incredible resilience. They create rich lives in unfamiliar places, and despite constantly navigating the low hum of fear and instability, they conjure the spiritual generosity to steady my hand in a 20-minute patient visit, which I know they also extend to the people around them.
There are over 10 million undocumented immigrants in this country who rely on limited safety net systems for medical care. Their medical needs can be complex, and when I cannot give them the standard of care due to structural reasons beyond my control, I feel defeated. Recent political discourse reveals a tendency to dehumanize this group, a discouraging indication that their lack of medical access is a crisis that will likely deepen before it improves.
Despite this, and the reality that many societal protections remain unavailable to them, my patients engage in our appointments with gratitude and openness.
Clinicians are poised to be keepers of their humanity—they have trusted us with the stories of the lives they have left behind and the new ones they are bravely creating. By witnessing their courage, we can affirm both their humanity and our own.
Advocacy for these patients can be an antidote to the moral distress we all have experienced when facing jarring disparities in care. There are legions of physicians who have dedicated their lives to this important endeavor. They are my heroes, but in my most depleted moments, it is the immeasurable strength and generosity of the undocumented people I care for that inspire me most.
Here’s what you can do:
1. Familiarize yourself with medical resources available to undocumented patients in your area.
2. Highlight disparities in care and pursue quality improvement projects within your institutions.
3. Promote increased access by asking for institutional charity care commitments.
4. Practice culturally competent care by learning about the specific health challenges of this population. Acknowledge the obstacles to care that a patient has had to overcome in your individual encounters.
5. Vote and advocate for federal, state, and city legislation that expands insurance coverage and advances immigrant rights.
6. If you find this work fulfilling, make a point to share your experience with your colleagues.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.