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Pediatric Bioethics

April 2019

Caring for Children at the U.S.-Mexican Border

 

Column editor: John D. Lantos, MD | Director of Pediatric Bioethics | Professor of Pediatrics, UMKC School of Medicine

On March 29, 2019, Children’s Mercy hosted a remarkable series of lectures and presentations about immigrants, refugees and caring for children at the U.S.-Mexico border. The first presentation was at Pediatric Grand Rounds by pediatricians Marsha Griffin and Minnette Son. Together, these two doctors started an organization called Community for Children. It provides an elective for medical students and residents in social justice advocacy and leadership development for medical students and residents. Students who participate in the elective work together with physicians, lawyers, social workers and psychologists to provide care to refugee children. The elective is designed to prepare future physicians to provide compassionate, effective leadership within community collaborations.

Marsha Griffin, MD, is Professor of Pediatrics and Director of the Division of Child and Family Health and the Community for Children Program at the University of Texas Rio Grande Valley School of Medicine. She was awarded the Clifford G. Grulee Award in 2018 from the American Academy of Pediatrics, for her advocacy for all children, and her service to the American Academy of Pediatrics. Dr. Griffin is board president for the Migrant Clinician’s Network and co-chair of the AAP Immigration Special Interest Group. She lives one mile from the Texas/Mexico border and bears witness daily to the very real ethical problems in the treatment of immigrant and refugee children and families.

Minnette Son, MD, recently joined the Division of Critical Care, Children’s Mercy Hospital. She has traveled extensively, supporting the development of sustainable pediatric cardiac programs internationally in countries such as Mongolia, Palestine, Kurdistan, Iraq, India, Kosovo and Nepal. In 2009, she was recognized by the Mongolian government as Physician of the Year for nine years of service establishing their cardiac program. Through her international work, she has gained significant expertise in providing medical care in settings with limited resources and a deep understanding of the ethical challenges for the global child.

You can read more about their work here: https://www.migrantclinician.org/featured-clinician/griffin and here: https://riograndeguardian.com/author/marsha-griffin-md1//

They also gave a webinar that is available here: https://players.brightcove.net/70829860001/default_default/index.html?videoId=6022587886001

Following Grand Rounds, we had a seminar with Professors Tamara Falicov and Marta Caminero-Santangelo, both from the University of Kansas in Lawrence. They presented a film that students had made as part of a course entitled “Bridging Borders: Latin American Immigration in Film and Fiction.” One of the students who made the film, Veronica Belvedere, joined them to talk about the experience. After the film, the three of them led a discussion about the immigrant experience, about helping immigrants and refugees in Kansas and Missouri, and about some of the special needs of children who emigrate. Professors Falicov (tfalicov@ku.edu) and Caminero-Santangelo are available to screen their 18-minute film and to speak to community groups or student groups.

There have been a number of editorials and commentaries about the plight of children at the border in peer-reviewed medical journals. Ataiants and colleagues in the J of Immigrant and Minority Health (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805654/ write that, “The U.S. is failing on a grand scale to protect children who are most vulnerable and seeking refuge, creating an American human rights crisis. Fortunately, we can highlight clear guidance from the U.N. on how to promote and protect the rights of unaccompanied children. The U.S. must act quickly, however, to improve its screening and adjudication processes, provide appropriate training for organizations and staff, avoid dehumanizing and inaccurate terminology, and pass comprehensive immigration reform.”

Tsou describes accompanying an 8-year-old girl and a 9-year-old boy through immigration court in Harlington, Texas. She writes, “As a pediatrician, I could envision how this level of toxic stress, such as separation from family and detention, could have dire physical and mental health impacts. In studies of detained unaccompanied immigrant children, researchers have found negative physical and emotional symptoms, with higher rates of posttraumatic stress disorder, anxiety, depression, and suicidal ideation.This stress has the real potential to affect long-term health and development.” (https://pediatrics.aappublications.org/content/141/1/e20170921.long)

Tsou suggests resources that are available through the AAP for those who want to help. The Immigrant Child Health Toolkit (https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-Community-Pediatrics/Pages/Immigrant-Child-Health-Toolkit.aspx), compiled by the American Academy of Pediatrics, provides comprehensive guidelines for the care of immigrant children. We should use a trauma-informed approach and assess mental health needs when caring for these vulnerable children (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx#trauma). We need to continue to work with our state and federal representatives to advocate for these children’s access to care, public education services, and legal representation.

To view the Grand Rounds Presentation referenced in the first paragraph of this article, click here, then log in and select the appropriate presentation.

Resources

• Immigration Advocates Network - Maintains a searchable online directory of free or low-cost nonprofit immigration legal services providers in all 50 states.

• U.S. Department of Justice - Provides a list of legal providers who serve individuals in immigration proceedings.

• National Center for Medical Legal Partnership - Maintains a directory of partnerships across the United States.

• National Immigrant Law Center - Provides a "Know Your Rights" fact sheet that describes the rights of all individuals living in the United States. It includes suggestions for individuals who may interact with immigration or other law enforcement and is available in English and Spanish.

• American Civil Liberties Union - Provides "Know Your Rights" information in multiple Asian languages.

• Immigrant Legal Resource Center - Provides a detailed Family Preparedness plan for families who may be impacted by family separation.

• National Child Traumatic Stress Network - Provides tips for clinicians to help children cope with a traumatic separation.