World Travel

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World Travel

Janine Young, MD, FAAP

Today, I traveled the world, beginning at 8AMand ending at 12PM, to 11

countries in 4 hoursﬂat. It is exhausting and can be grueling; however, far-ﬂung travel has opened my mind to different cultures, languages, foods, beliefs, and respect for the multitude of ways that life can be lived.

However, today my travel was not for vacation.

I am a pediatrician who takes care of immigrants daily and also runs a new-arrival refugee clinic. Through my work, my patients and families allow me to virtually travel, through their lives and collected experience, and witness our shared humanity. They have taught me how to greet them and to say“beautiful child”in a multitude of languages; about foods of preference, including fou fou, injera, and couscous; that grandmothers in virtually all countries recommend warm herbal tea and soup for colds; and that whether a parent is from Djibouti or Denver, we all worry about our children and strive to offer them opportunities to grow, learn, and remain healthy and strong.

New refugees see our team, including family physicians, psychologists, and medical trainees. We receive funds from the Ofﬁce of Refugee Resettlement1to cover screenings by the number of refugees evaluated. Every state resettles refugee arrivals,2most commonly through public health departments or state-community health center collaboration. Once refugees are screened, they most often stay in our clinic, which has 50 000 annual visits and hundreds of languages spoken.

We have 2 grant-funded refugee patient navigators, former refugees themselves from the Democratic Republic of the Congo and Myanmar (formerly Burma), and between them, they speak 11 languages. They are essential team members who assist with appointment scheduling and transportation, provide cultural interpretation, and serve as de facto extended family to many. Staff members include 2 former Bhutanese refugees (a patient navigator and insurance enrollment assistant; a nurse from Mongolia and another from Vietnam; a North Sudanese nutrition counselor in the Special Supplemental Nutrition Program for Women, Infants, and Children; and medical assistants and clerks from Mexico. We recently started a Human Rights Clinic, a medical-legal partnership to address legal status for undocumented immigrants, providing medical and

Department of General Pediatrics, School of Medicine, University of Colorado and Denver Health and Hospitals, Denver, Colorado

DOI:https://doi.org/10.1542/peds.2019-1504 Accepted for publication Jul 15, 2019

Address correspondence to Janine Young, MD, FAAP, Lowry Family Health Center, Denver Health and Hospitals, 1001 Yosemite St, Denver, CO 80230. E-mail: janine.young@dhha.org

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

FINANCIAL DISCLOSURE:The author has indicated she has no

ﬁnancial relationships relevant to this article to disclose.

FUNDING:No external funding.

POTENTIAL CONFLICT OF INTEREST:The author has indicated she has no potential conﬂicts of interest to disclose.

To cite:Young J. World Travel. Pediatrics. 2020;145(2): e20191504

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mental health forensic examinations to those applying for asylum and other legal status so that they can gain legal rights to health insurance and other beneﬁts that legal status currently affords.

The annual number of refugees who are allowed US entry and the countries from where they are accepted is determined by presidential decree. Forfiscal year 2020, the US will accept no more than 18 000 refugees (the lowest arrival number since the beginning of the US Refugee Admissions Program in 1980).3Infical year 2019, the US accepted no more than 30 000 refugees, and infiscal year 2018, 22 491 refugees were accepted. This compares to a 68 629 annual refugee arrival average (fiscal years 2008–2016).4Refugee status is legally defined as those who have“… a well-founded fear of being

persecuted for reasons of race, religion, nationality, membership in a particular social group, or political opinion.”5

In my daily work providing health care to immigrants and refugees, lowered refugee ceilings, xenophobic rhetoric, travel bans, deportations, and increases in attacks on those who are identiﬁed as“other”or“different” defy comprehension, ethics, and any moral compass. The only differences I see in my patients are in language and clothing. Otherwise, we are all the same.

However, the reality of a steep drop in refugee arrivals has made it increasingly difﬁcult to maintain state and national infrastructure to continue to support the degree of resettlement that was so recently standard. Fewer funds translate into fewer refugee supports, making it increasingly challenging to maintain standard of care.

And with this reality, my workday begins: to Mexico, a country ravaged by violence that is fueled by drug

trafﬁcking to the United States,6where my patients cannot gain refugee status

and asylum is a rare exception.7 “Buenos días. Tiene-usted algunas preocupaciónes sobre su hija?” (“Hello. Do you have any concerns about your daughter?”) I ask my patient’s mother. The mother is an undocumented immigrant, and her child is a US citizen. Our conversation proceeds in a brisk Spanish with a Mexican dialect learned through patients and families. Her daughter is 3 years old, and "no come nada" (she eats nothing). We spend our visit getting a dietary history, including what she drinks throughout the day. She is growing and developing well, and by the end of the visit, we determine that the mother’s fears are related to excess juice intake. She leaves relieved and with a plan.

Next is examination room 3: to Thailand, the Mae La refugee camp, on the Thai-Myanmar border.“Na or-choo ah?”(“How are you?”in Karen). I learn about my Karen family’s adaptations to US life as new refugees from Myanmar, how theirfirst winter is going, and what the 10-year-old boy thinks of snow (answer: pretty for the first 5 minutes then way too cold). I met the boy at his US arrival 1 year ago. He was scared and shy and spoke no English. He now speaks to me in almost-flawless English and tells me about school and his new friends, that math is his favorite subject, and that he wants to be a lawyer when he grows up.

Twenty minutes later, I virtually travel to my next examination room: the Democratic Republic of the Congo. My 16-year-old patient greets me, “Bonjour. Ça va?”(“Hello. How are you?” in French). She arrived in the United States when she was 10 years old, also as a refugee from the chronically war-ravaged Democratic Republic of Congo. Now a teenager, she worries of acne, friends, boys, and SATs and college applications. She leaves with a prescription for acne and promises to update me on her offers for full scholarships to some of the top US universities.

In and out of examination rooms I go, traveling with my patients, to my

ﬁnal stop: Northern Kenya, the Dadaab refugee camp. I am seeing a 6-year-old girl and her mother. “Iska waren?”(“How are you?”in Somali). Some family arrived in the United States 2 years ago; older brothers and sisters are still in Dadaab and cannot join their family because of the 2018 US travel ban that excludes Somalis from the United States.8My Minnesotan Somali interpreter is on the line. The child has a fever, cough, and stuffy nose. What can we give her? Does she need antibiotics or other medications? No, it is a common cold. I ask what her grandmother used to treat colds when she was young; the answer is herbal tea, honey, and warm soups. The same is true here, I tell her. I reassure her that this is what I do for my children and what my grandmother did for me.

I teach medicine to the children and parents I see. They teach me life in the multitude of ways it can be lived and experienced. They teach me tenacity, adaptability, verve, hard work, survival, and hope in the face of unfathomable obstacles that I and my family will hopefully never have to experienceﬁrsthand. Whether my patient is from Afghanistan, Ethiopia, Myanmar, or Texas, our common language is the same; it is the language that expresses worries and anxieties about children, pride of accomplishments, and a need to support children and watch them grow, thrive, and learn to become the adults who will make us proud. There is no room for xenophobia here. Our language is one of shared humanity, mutual respect, and a need to continue to advocate for what is moral, just, and right.

REFERENCES

1. Ofﬁce of Refugee Resettlement. Refugees. Available at: https://www.acf. hhs.gov/orr/refugees. Accessed May 27, 2019

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2. Department of State, Bureau of Population, Refugees, and Migration. Admissions and arrivals. Available at: www.wrapsnet.org/admissions-and-arrivals. Accessed May 27, 2019

3. Presidential Memoranda. Presidential determination on refugee admissions forﬁscal year 2020. Available at: https://www.whitehouse.gov/ presidential-actions/presidential-

determination-refugee-admissions-ﬁscal-year-2020/. Accessed November 26, 2019

4. Bruno A; Congressional Research Service. Refugee admissions and

resettlement policy. 2018. Available at: https://fas.org/sgp/crs/misc/RL31269. pdf. Accessed May 27, 2019

5. United Nations High Commissioner for Refugees. Convention and protocol relating to the status of refugees. Available at: https://www.unhcr.org/en-us/3b66c2aa10. Accessed

May 27, 2019

6. Beittel JS; Congressional Research Service. Mexico: organized crime and drug trafﬁcking organizations. Available at: https://fas.org/sgp/crs/row/R41576. pdf. Accessed May 27, 2019

7. Plevin R, Ornelas O; Pulitzer Center. Fleeing violence, Mexicans seek asylum in the US. Available at: https:// pulitzercenter.org/projects/ﬂ eeing-violence-mexicans-seek-asylum-us. Accessed May 27, 2019

8. US Department of Homeland Security, Department of Justice. Executive order 13780: protecting the nation from foreign terrorist entry into the United States. 2018. Available at: https://www. dhs.gov/sites/default/ﬁles/publications/ Executive%20Order%2013780%20Sectio n%2011%20Report%20-%20Final.pdf. Accessed May 27, 2019

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DOI: 10.1542/peds.2019-1504 originally published online January 14, 2020;

2020;145;

Pediatrics

Janine Young

World Travel

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DOI: 10.1542/peds.2019-1504 originally published online January 14, 2020;

2020;145;

Pediatrics

Janine Young

World Travel

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