All the chairs in the waiting room were filled by dozens of newly arrived migrants waiting to be seen by a Cook County health worker at a clinic in Chicago. Julio Figuera, 43, was among them.
He didn鈥檛 want to talk much about traveling to Chicago from Venezuela, where a social, political and economic crisis has pushed millions into poverty and , Figuera and three of his kids included.
But somewhere along the way, he鈥檇 gotten pneumonia.
Figuera, who was living with at O鈥橦are International Airport while waiting for more permanent shelter, returned for follow-up care at the county clinic. The stubborn cough came back, so he did, too. The staff checked his vitals, listened to his chest and gave him a hepatitis vaccine.
鈥淚 rarely get sick,鈥 he said. 鈥淚t was the journey that got me sick.鈥
Tens of thousands of migrants who鈥檝e come to the United States are navigating a patchwork system to find treatment for new or chronic health concerns.
Doctors across the country say it鈥檚 rare that migrants receive medical screenings or anything beyond care for medical emergencies when they arrive at the U.S.-Mexico border, and there鈥檚 no overarching national system to track the care, either. Migrants鈥 options dwindle or expand after that 鈥 depending on where they end up 鈥 with some cities guiding new arrivals into robust public health systems and others relying on emergency departments or to treat otherwise preventable health issues.
鈥淵ou have these little islands of care. You have these little islands of shelter,鈥 said Deliana Garcia, of the nonprofit Migrant Clinicians Network, which supported more than 1,000 migrants in need of medical care in the first 10 months of this year. 鈥淏ut how does anyone know what鈥檚 going on east to west or north to south?鈥
More than 2 million people crossed the border illegally between October 2022 and September 2023, according to Border Patrol data. For the most part, doctors told The Associated Press, the migrants are healthy; they have to be to make the arduous journey. It鈥檚 the travel that can turn manageable health issues into emergencies.
Because of that, public health leaders across the country 鈥 from New York to Los Angeles, Boston to Denver 鈥 say there鈥檚 high demand for care. And providing it is central to their organizations鈥 missions.
鈥淚t鈥檚 so core to what we do that I don鈥檛 feel like anyone鈥檚 really hesitated around this is the right thing for the organization to do,鈥 said Craig Williams, chief administrative officer of Cook County鈥檚 health system. 鈥淚 don鈥檛 feel like over the last year that we鈥檝e backed off from really anything else because of doing this initiative.鈥
The cost of care
The work is not without a price: Roughly 14,500 migrants have visited the Cook County clinic this year, as many as 100 are picked up in vans from the shelters each day for immediate care, vaccinations and a foothold into the public health care system. The county spends about $2.2 million a month 鈥 or nearly $30 million since it opened the clinic about a year ago.
New York City Health and Hospitals logged 29,000 migrant patient visits in the last fiscal year, which ended in mid-June. There, health workers have administered more than 40,000 vaccines and provide medical screenings for all new arrivals.
Other cities are trying to manage as best they can, like Denver, where nearly 26,000 migrants have arrived within the last year. Dr. Steve Federico, a director at Denver Health, said the city鈥檚 process is inadequate.
Migrants are asked by shelter staff if they need immediate medical attention. If they say yes, they鈥檙e either sent to an emergency room or connected by phone with a nurse through Denver Health, a public hospital and health organization.
There are no basic health screenings, Federico said, which can increase the risk of infectious disease outbreaks among those living in shelters. In Chicago, one shelter saw a small outbreak of chickenpox.
Without catching and treating illnesses early, Federico said, 鈥淣ow everybody has it. And then if somebody is at increased risk, they鈥檙e going to get sicker.鈥
Federico and city spokesperson Jon Ewing both said Denver is already strained for resources 鈥 given the need to shelter and feed migrants. Ewing said Denver is looking to enhance its medical screening process, but added that it鈥檚 not clear how much that will cost or whether there are enough resources to achieve it.
The challenges of care
Migrants face a lack of access to steady medical care in the U.S., as well as healthy food and stable housing. It can mean that someone with a chronic medical condition, like diabetes or hypertension, can end up in the hospital simply because they lost or ran out of their medications, or had them confiscated during their travels. Doctors said they鈥檝e also seen migrant children with asthma who need new inhalers.
鈥淵ou have what were essentially healthy people put in really remarkable circumstances, where they are not able to survive thoroughly and then they come across (the border) in a really compromised state,鈥 said Garcia, of the Migrant Clinicians Network.
Some women are arriving far along in their pregnancies, and never had prenatal care.
鈥淲e gave the first prenatal visit to a woman who was nine months pregnant just two weeks ago,鈥 said Dr. Ted Long, senior vice president at New York City Health and Hospitals, where more than 300 healthy babies have been born to migrant mothers.
Even when care is available, migrants can have a hard time getting it. Some avoid asking for help entirely out of fear of a large bill or longstanding distrust of the medical system.
Dr. Stephanie Lee is the medical director of refugee resettlement and coordinator of the unaccompanied youth program at Penn State Health鈥檚 Family Practice Pediatrics Clinic. She said she sees many patients who don鈥檛 have health insurance or don鈥檛 know how to get it.
One mother who'd been waiting on an asylum request for more than a year told Lee she was paying out of pocket because her family didn鈥檛 have insurance.
鈥淭he process is so broken that you can鈥檛 even do anything,鈥 Lee said. 鈥淭hey came in to see me just paying out of pocket because the kiddo needed a physical and needed to get checked before going to school.鈥
The Migrant Clinicians Network, which has been connecting patients to health providers for 30 years, just received a $5 million grant from the 春色直播 Institutes of Health. Its case workers keep in touch with migrants, doing things like setting up medical appointments, helping fill out applications for social services, taking people to appointments and figuring out payment options.
They even keep in touch with a trusted family member in the migrant鈥檚 home country, in case they fall off the radar.
鈥淲e have a lot of babies who are named after the people who work on our team,鈥 said Garcia, who oversees the program.
But that鈥檚 the best-case scenario.
in Massachusetts is so full that the governor brought in the 春色直播 Guard in August to assist. Dr. Fiona Danaher and her colleagues often cannot find migrants when she needs to follow up because they don鈥檛 have a U.S. phone number.
鈥淲e see situations even in migrants who are just moving around between shelter locations in the greater Boston area where they get completely lost to follow up,鈥 said Danaher, a primary care pediatrician in the Mass General Brigham health system. 鈥淎nd then the wheel gets reinvented and the same tests get done.鈥
She encourages her colleagues to give patients a physical copy of everything that was done on their visit: vaccines administered, medications prescribed, benefit programs applied for. That way, they can simply hand it to whoever sees them next 鈥 like a critical game of telephone.
There鈥檚 鈥渁 lot of low hanging fruit鈥 when it comes to caring for migrant patients, she said, and a 鈥渧ery old-school level of note passing鈥 is 鈥渁n important investment to make.鈥
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Associated Press writers Sophia Tareen in Chicago and Jesse Bedayn in Denver contributed to this report. Shastri reported from Milwaukee.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
