Public Health for Undocumented and Documented Migrants through a HT94 Lens

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Public Health for Undocumented and Documented Migrants through a HT94 Lens

In beginning to do this independent study project, I wanted to really focus on the connection between the Hostile Terrain 94 project, a participatory exhibition detailing the deaths of migrants crossing the border based on the research of Jason de León in the Undocumented Migration Project that extends far outside of Wash U to other institutions, groups and communities, and the public healthcare system, or the lack thereof in regard to migrants, both documented and undocumented in crossing the border. Through working with the team this past semester, I was able to better understand and contextualize both the lack of accessible healthcare and the lived reality of not only migrants, but people who work in healthcare serving migrant populations through interviewing them on their lived experiences and perspective on what they have perceived and learned through both serving migrant populations and patient care. To really understand the Hostile Terrain 94 Project and its correlation to immigrant access to public healthcare, I focused on the status and stance of the healthcare system particularly regarding undocumented Latinx immigrants and how that functions in relation to the Hostile Terrain 94 project.

The Hostile Terrain 94 Project is ultimately composed of 3,200 handwritten toe tags that represent migrants who have died in the Arizona Desert between the mid-1990s and 2019. These tags are geolocated on a wall map of the desert showing the exact locations where remains were found. In many ways, the Hostile Terrain 94 Project focuses on the immigration enforcement strategy known as “Prevention Through Deterrence,” formally implemented by the United States Border Patrol in 1994 as a method of ultimately deterring and discouraging undocumented immigrants from trying to cross the US-Mexico Border, particularly near urban points of entry. By doing so, The United States Border Patrol hoped to push immigrants from known trails into more unknown territories that came with new unforeseen challenges and difficulties. And in using this environment as a deterrent, the United States Border Patrol ultimately failed and caused more than six million people to attempt migration through the Sonoran Desert of Southern Arizona between mid-1990s and the current day. At least 3,200 people have died in this hostile terrain migration, primarily from dehydration and hyperthermia in attempting this journey through Arizona. However, more recently, “Prevention Through Deterrence” has shifted people towards Texas, where hundreds have perished while migrating through unpopulated wilderness. “Prevention Through Deterrence” is still the primary border enforcement strategy being used on the U.S.-Mexico border today.

While “Prevention Through Deterrence” has pushed more people on routes through Texas, Texas legislature in many ways refuses to recognize the need to care for undocumented immigrants, especially regarding the public healthcare system. Currently, there are 1.6 million undocumented immigrants in Texas, and while this population continues to increase, legislation between 1986 and 2013 has made it much more difficult to address these gaps in healthcare equality. In receiving care, federally qualified health centers (FQHCs) and safety net hospital systems function as means for primary care. While both care for uninsured and undocumented patients, FQHCs are funded by the federal government and are equipped to provide both primary and preventative care. In comparison, safety net hospital systems (also called “county” or “public” hospitals) tend to be in larger cities like Houston or San Antonio) and are funded by their specific county. Although they offer a multitude of services, including specialist care and elective surgeries, a longer wait time is usually involved. One unfortunate consequence of the current system is that patients often present to the emergency room with a more advanced disease due to lack of early diagnosis or treatment. The resulting health care costs more and is often either uncompensated or inadequately compensated. Besides the relative lack of access to specialists, undocumented immigrants face cultural and social barriers in obtaining care. One major cultural barrier is language; more than 75% of undocumented immigrants come from Spanish-speaking countries, and most are not fluent in English. Two social barriers often encountered are difficulty keeping medical appointments because of an irregular work schedule and fear of deportation or exposure to the law.

Regarding the lived experience of healthcare advocates helping migrants navigate healthcare, I was fortunate enough to be able to conduct an interview with Kevin Gomez, the Community Engagement Coordinator of Casa de Salud. Casa de Salud operates as the primary healthcare resource for the immigrant community of metropolitan St. Louis, and part of the infrastructure that welcomes people of all origins to the St Louis area. Casa de Salud aims to provide healthcare and healthcare access to individuals that face financial, linguistic, and cultural barriers to healthcare.  Mr. Gomez has a very specific role in this organization, focusing on outreach in disadvantaged communities, facing the barriers mentioned before in providing resources and services, and helping people navigate the healthcare system here in St. Louis. For him, as a Hispanic person from St Louis, serving people in his own community is incredibly important and as his family are immigrants, it makes sense to give back and help this personal and intimate community. Through this role, Mr. Gomez has also been able to widen his perspective and help connect other immigrant groups to the proper organizations and resources; he deeply understands the value Casa de Salud provides his community and is trying to make sure other people have the proper access. Mr. Gomez sees his own lived experiences and interactions with immigrants as essential, saying; “We’re working people, laborers, restaurant workers, caregivers, and a lot of the work this population does makes things work. People are healthy and have roofs over their head. Ensuring their heath is imperative to keeping society working, as they play such an important role in our society. Maybe not so much in Missouri, but our population feeds, houses and takes care of America.” Unfortunately, through the work he does in these communities, Mr. Gomez has also synthesized that the American healthcare system is expansive and complicated. Insurance plays a role in if people have access to the healthcare they deserve, regardless of it being a human right. With that understanding, Casa de Salud provides the tools to both educate and navigate the healthcare system. Paying for insurance and the costs of medical care are scary and stressful, which often affects both physical and mental health. Being able to help immigrants with these concerns in making things seem less complex and clearer allows Mr. Gomez to feel good about the necessary work he is doing in fighting both a healthcare system and insurance system designed in such a way that allows people to fall through the cracks constantly. Mr. Gomez is inspired by the immigrant population he works with and said, “The population that we serve are extremely resilient people. They travel from far-away places, put up with all the societal challenges they are presented with and can carry forward and work hard to make better futures for themselves and the community. While they are marginalized, they are an inspiration, and it is an honor to be able to work with immigrants and refugees and be able to make a welcoming and comfortable environment for them. They are more entrepreneurial than your American average and work harder because of it.” Regarding what he thinks other people can or should do to better understand the issues Casa de Salud faces, Mr. Gomez hopes more people will come to volunteer, see it with their own eyes, help with administration if possible, help serve immigrant populations and build their own understanding and perspective while helping to build and support the immigrant populations here in St. Louis.

Being a part of The Hostile Terrain 94 Project, this past semester provided me with an opportunity to do just what he suggested, and in being able to work as a tangible part of a team focused on something so much bigger than myself that I was able to understand in such an intersectional way, it has felt truly transformative. From my first synthesis of depersonalization of bodies in death and how I could be a part of something larger, I’ve been able to be involved in events, gain a better network of people, and incorporate more of my public health understanding into a research project built around the intersectionality of healthcare and international area studies. I am extremely grateful for the opportunity I was afforded this past semester in being able to pursue a project like this one.