Leadership

Protecting the Tired, the Poor, the Huddled Masses

Article · April 18, 2017

I met Beatrice when she was 18 years old. She came from one of the larger countries in West Africa and was seeking asylum in the United States. During our meetings, Beatrice often gazed at the floor and sometimes spontaneously broke out in tears. Before coming to the United States, she had suffered a childhood of beatings and whippings at the hands of her father before being forcibly married off to a man twice her age. Her husband had repeatedly beaten and raped her, and she had borne his child.

I am a pediatrician, and I volunteer to conduct evaluations of people seeking asylum in the United States. Working with a nonprofit organization, I use my medical skills to document the physical evidence of abuse or torture that asylum seekers have endured. The women, men, and children I have examined are kind and hard-working people who are often embarrassed by the abuse they have suffered, as if it were somehow their fault.

During Donald Trump’s presidential campaign and transition period, I worried that the climate of xenophobia and the widespread misunderstanding of the immigrants and refugees already in our country would dissuade others from seeking asylum here. Now, after President Trump’s executive order banning refugees, the United States is no longer a bright beacon of hope to suffering people around the world. A glimmer of hope recently appeared in the ruling by the U.S. Court of Appeals for the Ninth Circuit, which upheld a lower court’s stay on the executive order. That move is not an assurance against future enforcement of the order, however, and as a person who believes that health is a human right and that ensuring basic human rights promotes health, I remain terrified for the world’s well-being.

The suspension of the U.S. Refugee Admissions Program for 120 days was poorly planned and discriminatory, and it has only intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background. The President’s actions have repudiated our country’s long history as a leader in refugee resettlement. Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported.

Refugees already undergo strict scrutiny, sometimes waiting many years before they are allowed to resettle in the United States. And like Beatrice, many have endured brutal treatment, sexual violence, or torture. Take, for instance, the Chinese woman who underwent a forced abortion at 8 months’ gestation when the government discovered she was pregnant with her second child. Years later, government officials assaulted her and threatened to kill her for her sibling’s involvement in the Chinese Democratic Party. When she finally fled, her journey to the United States took almost 2 years, most of which was spent in the bottom of cargo boats. During this time, she had little access to food and water, developed chronic skin infections, and was raped several times.

These people are not trying to game the system. They are sacrificing nearly everything they have and love simply to find safety. To permanently leave one’s country is a terrible and heart-wrenching decision, made all the more difficult by the circumstances that force people to flee.

As the protests all around the United States — at airports, city halls, state and federal government buildings, and elsewhere — have made clear, a large number of Americans vehemently disagree with President Trump’s stance on refugees and immigration. Though national security is certainly of utmost importance, so is continuing to lead the world as a model of inclusiveness and diversity. Major universities and numerous U.S. cities are refusing to cooperate with the potential deportation of immigrants. I believe more should follow suit.

As a physician, I have proudly watched my profession’s reaction over the past several months. Almost daily, I receive letters from leaders of local teaching hospitals and medical schools adamantly standing behind their missions to support and care for everyone, including undocumented immigrants and refugees in transitional status. They believe the right to seek asylum in our country must — and will — be defended.

Beatrice eventually gained asylum in the United States, but she has a long road ahead of her. She is separated from her son, mother, and sister. She is working to learn English so that she can finish high school and pursue further studies. She is frequently tearful and is grateful to be here, but she misses her country and her family. Returning, however, is out of the question. Women who flee arranged marriages in her home country are treated as pariahs, and she believes that her husband — incensed by her departure — would probably kill her.

These are the kinds of people who are desperate for the shelter the United States has always offered, for a safe place where they can rebuild their lives. Refugees and immigrants have helped to make this country what it is. But for thousands of people like Beatrice around the world, that door has been slammed shut. President Trump took office only weeks ago, but the values our country stands for are fading fast. In addition to continuing the protests and fortifying our towns’ resolve to stand their ground as sanctuary cities, physicians can continue to welcome all patients into our clinics and hospitals and defend the right of our undocumented medical students to study and learn. That is what will make America great again.

 

The patient’s name has been changed to protect her privacy.

SOURCE INFORMATION

From the Department of Pediatrics, Harvard Medical School, and the Division of Medicine Critical Care, Boston Children’s Hospital — both in Boston; and the Asylum Network, Physicians for Human Rights, New York.

This Perspective article originally appeared in The New England Journal of Medicine.

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Few Truly High-Performing Health Care Organizations

Survey Snapshot: What the High Performers Have to Say

NEJM Catalyst Insights Council members from high-performing institutions share their perspectives on what’s working and what needs improvement.

Morris-Singer01 pullquote clinician burnout community-building

Combating Clinician Burnout with Community-Building

Improving morale and reducing turnover with peer-support meetings and shared group email lists for clinicians.

Time Is What Matters Measure Figure D - Time Saved Compared to FY17 Average

Measuring Patient Quality of Life: Time Is What Matters

How Anne Arundel Health System created a meaningful measure for patients and providers.

Little Consensus Over Definition of High-Performing Organizations in Health Care

Leadership Survey: High-Performing Organizations

Health care is rife with metrics and rating systems that purport to differentiate the good, bad, and mediocre. Every clinician and leader wants to be affiliated with a high-performing organization. But what constitutes high performance in health care?

Eisenstein01_pullquote burnout collective action SDOH

To Fight Burnout, Organize

The social determinants of health — and physicians’ sense of powerlessness in the face of them — seem crucially missing from the discussion of burnout.

Framework for Comprehensive Community Wellness

Public Health–Health System Coordination: Upending the Siloed Status Quo

A five-point plan unveils ways that leaders of health care and public health organizations can take action to enhance community wellness.

Mangi01_pullquote - patient flow dynamic work design

Improving Patient Flow with Dynamic Work Design

Staff make big improvements in post-operative care by changing small details.

Lerman01_pullquote leadership development

Leadership Development in Medicine

It is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders.

Perlo01_pullquote community organizing principles for restoring joy in work in health care

Applying Community Organizing Principles to Restore Joy in Work

IHI offers four lessons on how to nurture joy in the health care workforce.

MHCM Physician Leaders Career Paths Post-Graduation

Physician Leader Training: The Value, Impact, and Challenges

Alumni of Harvard’s postgraduate Master in Health Care Management degree program reveal the benefits of academic training, and the real-world challenges for new clinical leaders that can lead to success as well as frustration.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Physician Burnout

39 Articles

Combating Clinician Burnout with Community-Building

Improving morale and reducing turnover with peer-support meetings and shared group email lists for clinicians.

Team Care

93 Articles

Improving Hospitalist Patient Experience Scores: The…

With the Centers for Medicare and Medicaid Services incorporating patient experience into Value-Based Purchasing metrics,…

Leading Transformation

216 Articles

Survey Snapshot: What the High Performers…

NEJM Catalyst Insights Council members from high-performing institutions share their perspectives on what’s working and…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now