#HealthNetworkHelpsPeople

Children of immigrants, even those with US citizenship, can face significant barriers to accessing health care. Lola* was born in Texas with both atrial and ventricular septal defects that created increased pressure on her lungs. Her parents, newly arrived asylum seekers, were still migrating to their final destination in the mid-Atlantic when they sought care for newborn Lola. Health care obstacles for such families are plentiful, and teams of case workers, advocates, and doctors often need to work together to create a plan of action.

For a newborn, these heart defects can be detected early by tracking growth, labored breathing, and exhaustion the baby experiences when doing activities like feeding. Lola was on track when it came to growth, but the signs of exhaustion prompted doctors in Texas to perform an echocardiogram, which uncovered the defects. Surgery to repair the holes would be needed to ensure Lola could live a happy and healthy life. Because the family intended to move, the infant was quickly enrolled into Health Network, Migrant Clinicians Network’s virtual case management system for migrants with ongoing health needs. While Lola’s doctors did not believe Lola needed emergency surgery in Texas before moving, the severity of her condition warranted approval of travel plans by her medical team before she could leave the state.

Published April 4, 2024 on our blog and in Streamline Winter 2024.

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. 

Last year, Health Network Associate Luis Retta received a call from a nurse at a Pennsylvania health department who was concerned about her patient, Li Jun Wang,* a 20-year-old university student who had recently started treatment for tuberculosis. Wang was planning a 1.5-month trip to several regions in his home country of China. As he would be traveling throughout the trip, visiting friends and family, he would not be able to attend one clinic to complete directly observed treatment (DOT). DOT is a process by which a designated trained worker watches the patient take medication as directed, ensuring the continuation of treatment and thereby decreasing the risk of drug resistance resulting from erratic or incomplete treatment. With a health concern like TB, where drug resistance is rampant and dangerous, DOT is an important tool, but one that can be difficult to utilize if the patient does not remain geographically stable.

The nurse, who had just enrolled Wang into Health Network, said she worried that he would have to find a clinic. But Wang’s expected travel would complicate his ability to continue DOT at one clinic to continue treatment. He would need medical records forwarded to each clinic, every time he traveled, every week he was in China. The nurse particularly worried that, if he attended another clinic in China, Wang might be prescribed a different TB medication. “That was a big red flag for us,” Retta said. “If you switch medications, you could develop a resistance to certain medications. But, if we pushed for him to continue the medication he started with, he might not be able to get that medication in China – or we might not be able to get the medical records to a clinic there in time” for the local Chinese clinicians to know what his drug regimen had been.

Retta suggested that Health Network provide virtual DOT through a video chat, if the enrolling clinic provided sufficient medication to cover Wang’s trip duration. Health Network had recently begun to provide virtual DOT to migrating or traveling TB patients. The nurse was relieved, and said she believed the patient would also be amenable to the arrangement.

Published September 30, 2020 on our blog. 

Courage comes in many forms. Often, American holidays zero in on depictions of such strength, celebrating ordinary human beings performing extraordinary acts. Catapulted into cultural concepts of bravery, these individuals are held up as iconic models for the rest of society to emulate in turn. This is true even for motherhood, a role defined by nurturing, emotional validation, and strength beyond measure, where the embracing of these concepts serves as a reminder of the power in self-sacrifice.

Sacrifice is something mothers at the US-Mexico border know all too well; whether accompanying their children to cross into the United States, or sending them on ahead, these are acts of love.

In the years that Health Network, Migrant Clinician Network’s virtual bridge case management service, has been operational, hundreds of expectant mothers have undertaken the journey anyway, driven by the conviction of something better on the other side.

One such mother came to Health Network’s attention last year. At just 21 years of age, Leticia Garcia* knew what it meant to face terror. Like many of her relatives and neighbors , Leticia fled the dangers of home and crossed the Rio Grande, seeking asylum on American soil. In the months she spent traversing the treacherous path, she barely paid attention to her growing abdominal pain, far too fixated on the hope of what could await her.

Published May 3, 2021 on our blog. 

A young Guatemalan mother and father and their two young sons crossed the border earlier this year seeking asylum.* The family crossed the Rio Grande without a US visa, then waited for immigration officials to approach them in order to ask for asylum. At some official points of entry, few -- sometimes just two -- applicants a day are accepted. This has led to hundreds or thousands of asylum seekers waiting on the Mexican side of the border, frequently without access to consistent food, shelter, restrooms, or other basic resources, and often in areas with high crime and kidnapping rates. This family may have chosen this route because of the urgency of health needs of the youngest son. Juan, six years old, suffered from numerous and overlapping health conditions: microcephaly, severe hypoxic-ischemic encephalopathy, epilepsy with recurrent seizures, and profound visual impairment. He also had a gastrostomy feeding tube.

After processing at a Border Patrol facility, the family was released to the Catholic Charities Respite Center in McAllen, Texas, with an order to appear in court a few months later in the East Coast state where they planned to stay with extended family. The young family would spend one day of recovery at the Respite Center and then continue on to their final destination. At the Respite Center, Juan was given a medical evaluation, during which his clinician found that he had pneumonia, and was also underweight and had dental caries. He was immediately hospitalized for four days for his pneumonia. After being discharged from the hospital, he was signed up with Migrant Clinicians Network’s Health Network, the bridge case management system that helps migrant patients connect to care in their next location. Juan’s doctors wanted to make sure he had follow-up appointments with a pediatrician and a neurologist within two weeks of being discharged. Norma, a Health Network Associate, was assigned to Juan’s case.

Published January 23, 2020 on our blog. 

Marisa*, a 40-year-old asylum seeker from Central America, was seven months pregnant when she was detained by border patrol. While in custody, she started having difficulty breathing, lower abdomen pain, and severe leg pain. After a transfer to the hospital, she was diagnosed with deep vein thrombosis (DVT) and given a prescription of Lovenox, an anticoagulant to prevent blood clots from forming. Her doctor informed her that she must stay on the prescription until directly before her c-section, and then must continue for six weeks postpartum to ensure a clot won’t break loose and migrate to other parts of the body, which could cause serious complications or death. Reviewing the patient's history, her doctor discovered that she had had two previous children, both via cesarean section. A long vertical scar on her abdomen indicated a “classical” c-section, which has a higher risk of rupture. Given the DVT diagnosis, previous “classical” c-sections, and advanced maternal age, Marisa was considered very high risk.

Shortly after her hospital visit, Marisa was released by border patrol. She immediately traveled to a small state on the Eastern Seaboard. After arriving, she and one of her young children went to a local community health center as a walk-in. An obstetrician assured she was continuing her Lovenox and referred her to the local hospital for her C-section. The doctor learned that Marisa was staying with a friend. The doctor was concerned that Marisa wasn’t geographically stable, so she also enrolled Marisa in Health Network, to make sure that, should Marisa continue to move after her C-section, she wouldn’t lose continuity of care, particularly in light of the DVT diagnosis.

Published December 21, 2019 on our blog. 

While Health Network is available for any patient regardless of age, sex, race, or ethnicity, and for any health condition, it’s rare that we receive an enrollment for a young child. This case is about Gina*, a brave seven-year-old who has grown up her entire youthful life so far only knowing the life of a migrant. Both of Gina’s parents are mobile seasonal workers; their medical records show their pattern of travel, from one Southeastern state to another, as they follow the availability of work.

Last year, Gina and her family relocated from Georgia to North Carolina, where her parents brought her to a local health center for an earache. She was only five years old. It would turn out that Gina would need surgery on her right ear. Gina was first enrolled into Health Network by her health center. We spoke with Gina’s parents, determined where they were next moving, and were then able to help find a surgery team at her next location, and we sent Gina’s medical records to a hospital in Virginia, where her family was next planning to move. This helped ease the transition from clinic to hospital after the appointment was made to have her surgery. This was especially important due to the fact that the family had plans to travel and would have to do the surgery in another state. With this prompt response from Health Network to set the appropriate appointments and to maintain a consistent follow-up between the physician and the patient, Gina was able to successfully undergo treatment for her condition.

Published February 27, 2019 on our blog. 

Health Network Associates encounter numerous obstacles to ensuring continuous care for the mobile patients enrolled in Health Network, MCN’s innovative and effective bridge case management system. Health Network Associate Olivia Hayes, for example, has occasionally had trouble connecting with patients’ families in Vietnam.

“I call with an interpreter,” she explained, since she is not bilingual in Vietnamese. She has to wait for the family member to pick up the line, after which she connects with the interpreter to tell her in English that the line has been picked up. “But, when family members hear English, they often hang up!”

Health Network Associates employ a great variety of communication tactics to increase the likelihood of regular contact with patients or their family throughout their enrollment. The “anchor contact,” combined with the recent inclusion of communication technology like Skype, text, and WhatsApp, have been implemented to reduce the communication breakdowns that result from wrong or out-of-service numbers, poor connections with far-off rural locales, or wary call recipients.

For several months every winter, 66-year-old Phuong* visits family and friends in her homeland of Vietnam. This year, however, Phuong, a US citizen, tested positive to tuberculosis in her lungs and spine, requiring a 12-month treatment regimen. After eight months of treatment, she was ready to travel, so her local health department signed her up with Health Network to assure that she could continue treatment despite her travel plans.

Published November 8, 2017 on our blog. 

“When James* was first enrolled with Health Network, he was on the verge of death,” recounted Health Network Associate Olivia Hayes. James was enrolled in January 2016 by a mid-Atlantic state’s health department because the patient was determined to return to his home in West Africa, despite being hospitalized with HIV and tuberculosis co-infection at the time of enrollment. James had intended to visit his brother in the US for only a short period of time, but his trip was lengthened due to his rapidly declining health and a TB diagnosis. He had begun TB medications two months prior in the US. Health authorities were concerned that without Health Network James would go home against medical advice and without a plan to continue his medications, so they contacted Health Network. Olivia called the patient, who spoke with a weak whisper from his hospital bed. James signed a medical consent form and asked that Olivia speak with his brother to coordinate his care.

Health Network had not yet worked with James’s home country. Olivia was unable to find contact information for the country’s TB program, so she referenced an international TB advocacy directory to find an international NGO partner in the country who could better direct her search, whom she called and emailed. Olivia received an email response back stating that the NGO worker had contact with the country’s TB program and could assist in finding a clinic that could serve the patient in the patient’s home town. That same day, Olivia sent the NGO partner James’s contact information for when he returned to his home country. Almost two weeks later, after James had had three negative sputum results and had demonstrably improved, Olivia contacted the NGO to see if they had located a suitable clinic for James, but she did not receive a response. Two days later, in early February, Olivia once again contacted the NGO partner because James was planning to depart the following weekend and would need follow-up soon after his arrival. The NGO partner responded that day with information about a local clinic for James.

Published April 5, 2017 on our blog.