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The earlier site of a shelter for asylum-seeking migrants. The current shelter is located in downtown San Diego. / Photo by Adriana Heldiz

As national attention shifts to the southern border again, more funds should be allocated toward medical care. Border Patrol facilities need to offer basic medical care for migrant children in custody to avoid deaths, costs of medical complications and disease outbreaks.

The avoidable deaths of two migrant children — Jakelin Caal and Felipe Gomez Alonzo — while in Border Patrol custody prompted outcry from the nation’s pediatricians. Jakelin died of septic shock in Texas, NBC reported. Sepsis is the presence of a serious infection, and can lead to septic shock — the state of an infection overwhelming the body. Organs shut down, one by one, until the heart can no longer pump blood at a pressure that sustains life. The most protective factor against septic shock is early recognition of sepsis. The untrained eye may even not be able to identify sick children, much less administer life-saving interventions.

Voice of San Diego Commentary

A Border Patrol press release states that Jakelin waited 90 minutes before receiving medical attention. Immigration and Customs Enforcement,or ICE, must invest in medical staff to identify and respond to medical emergencies. Had Jakelin and Felipe been identified as sick, they could have received critical medications earlier. They may not have died.

Offering basic medical care in Border Patrol facilities can help avoid complications of illnesses and their associated costs. I have seen numerous examples of this firsthand while volunteering in a San Diego migrant shelter.

For example, I examined a toddler with a cold who was having trouble breathing. He had traveled from Guatemala with his family, and caught a cold while waiting to cross the U.S.-Mexico border. The cold triggered his underlying asthma. His mother bought albuterol in Mexico and was administering it regularly while they waited to cross the border. The toddler responded well to the albuterol in Mexico. But the mother reported that their belongings were locked up and that she was denied access to the albuterol when they were taken into ICE custody. The toddler worsened over the next two days, struggling to breathe, eat and sleep. By the time I saw him in the shelter, he was wheezing heavily and dehydrated. He needed emergency medical attention. We loaded him into an ambulance and directed him to the children’s emergency room.

Had Border Patrol evaluated this child and allowed his mother to administer the albuterol, he would likely not have needed to go to the emergency room.

There is a compelling economic argument for avoiding complications. With a coupon, a canister of albuterol costs about $30 at Walmart. This is at least 100 times cheaper than the alternative. A visit to Rady Children’s Hospital emergency room for this level of illness costs about $975, with an additional $539 for chest X-rays and $239 for inhaled medication treatments. These costs were published voluntarily by Rady Children’s Hospital in 2018 in accordance with AB 1045. Plus, the ambulance itself costs a base rate of $1,631, according to a 2017 KPBS article.

Migrants rarely can pay these exorbitant costs, so the public is left footing the bill. Some migrant children in custody will be sick — it is inevitable. The medical complications from these illnesses, however, are avoidable. Officials should consider the financial impact of not treating basic medical conditions.

Medical staff is needed in Border Patrol facilities to screen and treat migrants for contagious disease. Ideally, migrants applying for asylum status should have had medical clearance months prior to arrival. This is impractical, though, given that many migrants are seeking asylum from immediate threats of violence at home.

If medical exams are not conducted prior to arrival, current regulations state they should be conducted within 30 days of arrival. But the 30-day timeframe is too long. The physical stress of migrating from Central America can decrease the effectiveness of a child’s immune system. After an exhausting, multi-month journey, a migrant child is most likely to fall victim to the flu, like Felipe did.

As migrant children resettle across the country, they can introduce a different strain of the flu to new communities. If doctors in Border Patrol Facilities could test for the flu using a non-invasive, rapid flu test, they could prescribe antiviral medications that reduce the amount of time that migrant children with the flu are contagious. Ultimately, screening and treating migrant children early protects their future American neighbors.

In the coming months, the southern border will undoubtedly remain in the national spotlight. I urge our policy-makers to prioritize offering basic medical care for migrant children in custody. Basic care will help us avoid deaths, exorbitant costs of complications and disease outbreaks. We owe this to our new neighbors and ourselves.

Sejal Parekh is a pediatrician. She lives in San Diego.

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