Caring for all Californians

In California, one in eight children has an undocumented parent, according to a recent study from the Pew Research Center. As the Trump administration increases immigration enforcement, there is increasing concern that the crackdowns will impact immigrant communities — and in particular, children’s mental health.

Dr. Raul Ayala, Chief Medical Officer for the Adventist Health Central Valley Network, saw this first-hand when one nine-year-old girl visited his clinic after spending a night in the ER for abdominal pain. While there, the little girl told caregivers that her schoolmates said that if her family didn’t have papers to be in this country, they would be kicked out. “The mom said that her daughter was concerned, she kept wondering what was going to happen to her dad,” said Dr. Ayala.

“It turns out the abdominal pain and not wanting to go back to school was centered around this fear or anxiety. For a nine year old to be concerned about immigration at that age — either we’re not asking the right questions, or we’re not in tune with the reality of what’s happening,” said Dr. Ayala.

Dr. Ayala serves on the Board of California Academy Family Physicians, whose members recently discussed an increase in cases of anxiety tied to concerns and misperceptions about immigration. At Dr. Ayala’s clinics, outreach has been crucial. Recently, one clinic’s back-to-school event catered directly to children, focusing on physicals & vaccines, nutrition, dental hygiene, and other basic care for children — in a kid-friendly, welcoming environment.

Dr. Ayala hasn’t come into contact with patients that are reluctant or have stopped seeking care because of concerns about their status, but he and his colleagues have kept the issue top of mind. “We’ve been more forward when discussing it. If people have questions, we help them through that.”

Data on this reluctance to seek medical care is still anecdotal — in one poll by Migrant Clinicians Network, two-thirds of providers said their patients were reluctant to seek health care. And in one California health center with a large Hispanic population, twice as many patients as normal canceled their appointments in one week, with some saying they were afraid of immigration officials.

California’s leaders are looking to ease this fear for the state’s 10+ million immigrants, of which about two million are undocumented. Many cities, including San Francisco, have declared themselves sanctuary cities. This sanctuary designation would put limits on federal immigration authorities’ ability to operate in the state and would offer additional protections for those visiting state facilities such as schools, hospitals, and courthouses. This measure is intended to ensure that California residents use public facilities with minimal fear that they or a family member may be arrested by immigration agents.

Whether the sanctuary state bill passes or not, when it comes to hospitals and clinics, health care providers are clear — their doors are open. In California, hospitals will only ask questions that are medically relevant or about health insurance coverage. Hospitals do not ask anyone about their citizenship status.

Dr. Ayala suggests that patients talk with their doctors if they have concerns, and to be confident that providers are focused on providing care.

“We don’t turn people away — regardless of their background, language, religion, or immigration status,” said Dr. Ayala. “Everyone can have peace of mind that hospitals and other health care organizations are here to care for people when they need us.”

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