In March 2007, news showed a military-style ICE raid on a leather goods factory in New Bedford, Mass. after which 2 breastfeeding infants had to be admitted for dehydration because their mothers were among the 361 Guatemalans, Hondurans and Brazilians arrested in that raid. Once seen and heard, these things could not be unseen. Deeply shaken, I thought I needed to understand what was happening to my patient families and so many others in their communities.

I began to volunteer in a free clinic that serves largely immigrants, the Metro West Free Medical Program. The stories I heard from patients, about constant fear, about having to drive without a license, “living like rats who leave their hole in the morning and don’t know if they will get back at night” (one patient’s words), about wage theft as a constant in their lives, impelled me to do more.

To learn more systematically what my immigrant patient families go through, I connected with immigrant organizations including the Metro West Workers’ Center, which serves the same communities as the Metro West Free Medical Program, Centro Presente, the Brazilian Women’s Group and Brazilian Workers’ Center, and the Chelsea Collaborative (now La Colaborativa). I realized I could do 4 things: 1. directly serve children, families and individuals as a medical professional, 2. support the work of immigrant organizations in solidarity, 3. bring their concerns into my professional spaces in order to generate more support for them and indirectly lighten their burden of work and 4. connect and organize with likeminded health professionals to potentiate our effectiveness.

In direct service, I volunteered at the Metro West Free Medical Program for 7 years. For patients I met there, others referred to me by immigrant organizations, friends or other health professionals, and patients and their families I met as a clinician, I acted as a care navigator and accompaniment. I made appointments with the appropriate specialists, accompanied the patients to the appointments, ensured that they were able to access the insurance they were entitled to and the medication they were prescribed, sorted out transportation issues, enlisted immigration lawyers and wrote letters for them, accompanied a parent to court for driving without a license (which she could not get without immigration status) in order to bring her hospitalized child home-cooked food, etc. I still do these things; some children are now referred to me by a national network initiated at Baylor University and supported by the Migrant Clinicians’ Network. In this accompaniment service, I’ve learned much about our medical system. I’ve seen some of the best, most caring, humanistic clinicians and also the stark opposite. The best sometimes overcame steep barriers our medical system placed in their patients’ path to effective care. I witnessed successes that were near-miraculous.

In solidarity and support, I joined immigrant organizations at the State House for hearings of bills they need for their communities, like the Work and Family Mobility Act of 2023 that finally made drivers’ licenses dependent only on driving ability and not on immigration status. I testified in support of these bills. I joined immigrant organizations in rallies and marches. In 2015, I received a grant from the American Academy of Pediatrics’ Healthy Children 2020 program, to support unmet healthcare needs of vulnerable children. I envisioned a mental health program for the many children that were arriving unaccompanied from Honduras, Guatemala and El Salvador, fleeing violence, repression and hunger in their places of origin. The 2-year grant funded brilliant and inspired clinicians to conduct a weekly therapeutic group in the space of the Chelsea Collaborative, a strong grass-roots organization (now La Colaborativa) that had been organizing support for the “unaccompanied minors” and their families in Chelsea. It was named “Chelsea Wants To Dream/Chelsea Desea Soñar” by the organization’s director, Gladys Vega, and was supervised by amazing mental health professionals at Boston Medical Center who volunteered their time. Having been an art therapy program for the greater part of its 2 years of AAP funding, Chelsea Desea Soñar became a long-term after-school art program for children at La Colaborativa.

I offered immigrant organizations medical information when requested, e.g. in broadcasts of the Brazilian Women’s Group’s station, Estação Mulher. In the spring of 2020, I realized that Spanish- and Portuguese speaking communities were getting minimal public health information about COVID. I began offering information sessions to immigrant organizations, radio stations and a church which were conducted as livestreamed conversations; these sessions over the next 2 ½ years had ~60,000 views. I organized a team of medical professionals and students to doorknock with COVID vaccine information in Chelsea together with La Colaborativa’s community health workers. We doorknocked every Saturday for 3 months. I attended vaccination sessions of community based organizations that had joined forces in Equity Now & Beyond. With these grass roots organizations, I continue to strategize about pandemic- and other health issues.

Bringing immigrant organizations’ concerns into my professional spaces and organizing with like-minded colleagues, I gave talks for pediatric departments about the situation of our immigrant patient families. Via these talks and other connections, I found caring colleagues and we organized hospital-wide informational events on immigrant rights and immigrant health. Together with a pediatrician from Oakland, Ricky Choi, I lobbied my professional organization, the American Academy of Pediatrics (AAP), to start an immigrant health council, and in 2012/13, the AAP founded the Special Interest Group for Immigrant Health. In 2019 the SIG became the Council on Immigrant Child and Family Health (COICFH). In 2014 I founded the Immigrant Health Committee of the Massachusetts Chapter of the American Academy of Pediatrics (MCAAP). Boston health care professional colleagues like Martha Sola-Visner, Carmen Noroña, Judy Goldberger and I founded an organization, Clinicians for Healthy Families, that lent support to immigrant-led initiatives. After Donald Trump was elected, in 2017 many Massachusetts medical and legal professionals joined forces on behalf of immigrant health and rights in the Health and Legal Immigrant Solidarity Network. Clinicians for Healthy Families dissolved into this collaboration/listserv which, in addition to an excellent information network, became an effective means of referring patients to the appropriate professionals – medical or legal –  for their needs. Some of the children whose care I navigate/d and accompany were referred to me through this network, and for some of them, I found life-transformative legal assistance through it.

An offshoot of my work in the MCAAP’s Immigrant Health Committee became the Chagas Disease project Strong Hearts/Corazones Fuertes/Corações Fortes. Sheila Cleary, a committee colleague and pediatrician at Springfield’s Brightwood Health Center, had previously created a checklist for initial primary care visits of refugee children, and during the 2014/2015 “surge of the unaccompanied minors”, she and I adapted it to use for Central American children. We stated that Chagas disease is one of the infections for which children arriving from Central America should be screened. Then hearing a talk by Jennifer Manne-Goehler on the prevalence of Chagas disease, estimated to be 300,000 in the US and 3,200 in Massachusetts, I realized my Infectious Disease expertise and my connections with immigrant communities could be brought to bear on this issue. In a collaboration with many brilliant people, most importantly, Dr. Juan Huanuco of the East Boston Neighborhood Health Center, as of May 2023, over 14,000 patients of the health center were screened for, and 96 patients diagnosed with, Chagas disease. The Strong Hearts team supports them in getting specialty care and antiparasitic therapy.

What I’ve learned, since seeing the horrifying news reports of the 2007 new Bedford ICE raid, is that as long as immigrants’, especially the undocumenteds’ health needs are ignored and discounted, none of our health needs will count. Health justice for immigrants will require health justice for all. And that will take many people of good wills’ strong and courageous efforts. Many are already working on it. Hopefully many more will join.