Saturday, June 29, 2019

When immigration detention makes healthy people sick

We’re two doctors who work as part of a growing network of volunteer medical providers advocating for adequate medical care for people in immigration detention.
A troubling case demonstrates that increased Immigration and Customs Enforcement (ICE) detention of immigrants is causing the people they detain avoidable medical harm.
Suheila, 2 1/2, daughter of Abdikadir Mohamed holds a sign during a rally in support of her father, who has been detained by immigration authorities for 18 months. June 11, 2019 (Photo: Monsy Alvarado/
Abdikadir Abdulahi Mohamed (“Abdi”), a man in his 30’s from Somalia, was athletic and healthy 18 months ago, before ICE placed him in a New Jersey for-profit immigration detention center in Elizabeth.
During his medical intake, Abdi was found to have latent tuberculosis (TB). Latent TB doesn’t cause symptoms and isn’t infectious to others. But people with latent TB are at risk for developing active TB disease when exposed to malnutrition, stress, and conditions that weaken the immune system.
ICE did not treat Abdi’s latent TB, as recommended by the Center for Disease Control’s guidelines for treatment. This matters in crowded and poorly ventilated immigration jails because if TB becomes active, it could spread. And active TB can be fatal.
Abdi complained of worsening health for months. He began to lose weight and became too weak to exercise. He complained of rib pain and was given over the counter analgesics. Even when he developed a cough, pain with breathing, and fevers, his lungs were not examined.
In November 2018, six months into these symptoms, Abdi worsened suddenly. For 10 days he asked to see a physician. He stopped eating, he had fevers, and was too weak to get out of bed. The pain was excruciating. He was told he needed a chest x-ray, which he got five days later.
That chest x-ray showed Abdi had fluid in his lungs. Only then was he was taken to the hospital. It turned out that he had developed pleural TB, an infection in the lining of the lungs.

Abdi was shackled to the hospital bed throughout his 10-day stay. He understood few details of his illness, because at no point in all of this time, was he offered an interpreter.
After this avoidable delay in diagnosis, Abdi suffered further inadequacies in care. One physician told him he only needed one month of TB treatment, instead of the standard six months, leading to a dangerous interruption in his care. He was not provided with consistent transport to follow-up appointments with the TB specialists. He did not get the recommended blood work to monitor his liver function, because TB medications can rarely cause liver failure. 
Luckily, he has survived. But Abdi still has pain and may have permanent scarring in his lungs. It is not clear if his untreated latent TB became active in the setting of toxic stress and poor nutrition, or if he contracted a new infection. It is clear that he did not get the medical care he deserved.
TB control efforts in the community have kept the spread of TB in check for decades, even with ongoing immigration. Outbreaks of mumps, chicken pox, and flu have led to quarantines at over 50 ICE detention centers across the country.
Currently, individuals in ICE detention at Bergen County Jail in New Jersey are being quarantined for mumps, leading to interruptions in their court hearings and visitations. Given that detention centers are located in our communities and staffed by community members, these outbreaks threaten the health of everyone.
In a patchwork regulatory system, it is unclear whether ICE, or the county and state health departments, are responsible for ensuring public health oversight. Adequate latent TB treatment takes months, but since people may be in ICE custody for only days to several years, treatment is often not initiated. This means peoples’ lives are in danger of falling through the cracks.
The exponential increase in detained individuals is overwhelming the capabilities of immigration jails and prisons to attend to peoples’ basic health needs and prevent the spread of disease. If Abdi’s case and the mumps outbreak at the Bergen County Jail are any indication, we can expect more outbreaks in the future. Meanwhile, his health will continue to be at risk until he is released.
Chanelle Diaz and Elizabeth Chuang are doctors and part of the medical providers network organized by New York Lawyers for the Public Interest.



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