Dreamers deferred: Protecting the vulnerable in uncertain times

In September, the Trump administration moved to rescind the Deferred Action for Childhood Arrivals program, leaving nearly 800,000 young undocumented people fearing for their futures. Known as Dreamers, these young people are at risk of losing their health care, social networks and for some, the only home they’ve ever known.

Majo Acosta Robayo is one of those undocumented immigrants whose life could soon be turned upside down. She spoke at a Tuesday Annual Meeting session on “Cross-cultural care: Doctors, Dreamers, Muslims,” giving audience members a glimpse into the hardships many immigrants face coming to the U.S. and working toward the proverbial American dream.

Robayo was born in Bogota, Colombia, where drug cartels threatened her family. In 2004, her father made the difficult decision to move her family to the U.S. so they could live in safety. Unfortunately, their asylum application was denied. Her parents, who were successful entrepreneurs back home, could only get low-paying jobs as undocumented immigrants. Robaya struggled with a new language and culture and leaving loved ones behind.

To see this young woman now is awe-inspiring. Robayo is a student at Harvard University and hopes to one day become a missionary doctor with Doctors Without Borders. But her work authorization expires in March 2019 and her big dreams of helping others could come to a halt. It’s a heartbreaking possibility that hundreds of thousands of students like Robayo are grappling with at this very moment.

“Hard work is really important and I think it really pays off, but there’s some big obstacles,” she said, such as her inability to continue her education and move freely between countries. “Those are things that no amount of work can change, only legislative actions.”

As the deadline for the end of DACA looms, immigrants of all stripes continue to face numerous health disparities, explained Martha Cesena of Boston Children’s Hospital. Not only are many immigrants already escaping violence, which takes an immense psychological toll, but they regularly endure emotional distress here as well. Intolerance, social exclusion, stress and depression are all consistent with immigrants’ experiences in the U.S., regardless of their status. And a sociopolitical climate in which xenophobia and racism is on the rise certainly doesn’t help.

Rescinding DACA presents a public health crisis that practitioners in the field must address. Mohammad Dar, of Brigham & Women’s Hospital, offered health care providers suggestions for protecting immigrant and Muslim patients and offering a culturally competent experience. He urged providers to be vigilant in protecting patients from U.S. Immigrations and Customs Enforcement. For instance, implement measures such as designating a staff person to handle requests to detain patients. Having a good relationship with a lawyer could also be useful, he said.

A little respect goes a long way in offering culturally competent care, such as checking people’s dietary restrictions and considering how their religious affiliation will influence patient-provider interactions. Even showing a bit of kindness holds deep meaning for patients suffering in a discriminatory climate. Dar referred to the one question his mentor would always ask patients at the beginning of their visit: “How’s the world treating you these days?” For our most vulnerable community members, there’s probably a lot to unpack.