Would This Happen in your Emergency Department Waiting Room?

Michael H. Greenwald, MD

Jakelin Caal Maquin.  That is the name of the 7 year old girl who died in the custody of US officials soon after arriving at our border. More details about her death may follow, but, as of now, we know that she reportedly died from dehydration after a long journey from Guatemala. Apparently she was in US custody for 90 minutes before receiving any medical attention. Finger pointing will now ensue and the death of this little girl may serve as a political football for advocates on different sides of the issues.

But for physicians — particularly Emergency Medicine physicians — this is familiar territory. When patients arrive at our doors our mission is clear. It does not matter how they arrived nor what led to their condition. We don’t ask where they were born nor whether they can pay for medical care. We recognize their humanity as the only relevant identifier. This is not only a legal imperative — it reflects the soul of a physician.

There is plenty to argue regarding border security. Please consider some realities as you form or reinforce your opinions. Leaving your home for an uncertain future in a foreign country is an act of desperation. According to Doctors Without Borders, a record 68.5 million people around the world fled their homes due to violence and instability in 2018. This is an issue in nearly every corner of the globe. Hot spots include the Middle East and Mediterranean Sea, Bangladesh (where 700,000 Rohingya refugees have fled Myanmar), Southern Sudan, and Central America. At one time, the US resettled more refugees than any other country; but now the yearly limit, set by the president, has dipped to an historic low of 45,000 in 2018. Actual settlement is a fraction of that cap as the process has slowed dramatically over the past 2 years.

We need to decide whether our current approach to the international refugees crisis matches the needs, our capabilities, and, most importantly, our character. If you feel that we are falling short of our responsibilities, then perhaps we should begin to address this terrible situation like a medical professional. Instead of devoting billions of dollars to larger walls and detention centers that separate children from their parents (opposed by ACEP and the AAP), we should use those funds to improve triage resources. While ensuring that hopeful immigrants are vetted for criminal history, we should and can improve medical care for those who risked their lives to get to our door. Let’s take an honest look at what this country can do for millions of refugees and devote more resources to effectively reduce the stimulus for the migration.

Please review the facts (see resources below) and use your voice to help make a difference in this crisis. Jakelin Caal Maquin died in our waiting room. Our task is to prevent that from happening again.




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