Fall 2019 Quarterly Conservations Recap – Migrant Caravan & Health

The UC San Diego Global Health Program, Students for Global Health, and Global Forum (International House) held our tenth event in Quarterly Conversations in Global Health on Wednesday, November 6th, 2019 with over 120 in attendance! This quarter’s panel spoke to the topic on the migrant caravan and its impact on global health.

Quarterly Conversations provides a forum for the Global Health community to come together to discuss relevant issues in the field from an interdisciplinary perspective and increase community interaction at UC San Diego.

Thank you to the community tables who participated in the event’s networking session: Expanding Visions for Health, Health Frontiers in Tijuana, San Diego Border Angels, Students for Global Health, I-House, and Flying Sams.

Members of Students for Global Health

We would like to give our special appreciation to our event co-sponsors: UC San Diego Global Health Institute, UC San Diego Division of Social Sciences, The Global Forum at I-House, and Associated Students for offering their continual support of QCGH.

The Fall 2019 QCGH featured four panelists who presented their research, insights and experiences on various health issues as they pertain to the dynamics of the migrant caravan and health.

Panel Recap

We were delighted to have Dr. Thomas Csordas, Director of UCSD’s Global Health Program, moderating the event as our Master of Ceremonies.

Dr. Hans Reihling:

Dr. Hans Reihling presenting on PTSD.

Dr. Hans Reihling first held the floor as the panel portion began. He is a medical anthropologist and psychotherapist in private practice. He conducts psychosocial evaluations to assist attorneys with establishing credibility in asylum cases. As a research affiliate at the University of Amsterdam, he is currently completing a book on masculinities and affective health in South Africa. Dr. Reihling’s presentation began with a discussion of the asylum process. He emphasized that despite sizable increases in the amount of immigrants detained daily, immigration courts grant asylum to a slim 9% of these asylum seekers. Dr. Reihling specified that 88% of Mexican asylum cases are denied, a figure comparable to those of El Salvador, Honduras, Guatemala and other Central American countries. He went on to mention that mentioned that chances of success are not only determined by nationality but also by whether one is represented by an attorney and the judge presiding over the case. This discussion of compounded factors was intended to give the audience the impression that the asylum process is an imperfect one. The latter half of Dr. Reihling’s discussion relied on a psychosocial lens to  illustrate the traumas experienced by refugees. He introduced the concept of the triple trauma paradigm which outlines the chronological interaction of three distinct periods of trauma; pre-flight, flight, and post-flight. Dr. Reihling also reminds the audience that these traumatic periods can ultimately leave a refugee with post traumatic stress disorder (PTSD) which significantly alter their way of being. He argues that these intrusive memories often generate negative moods, heightened arousal and reactivity. Dr. Reihling concluded by discussing the implications of this trauma, which leave these migrants susceptible to private companies which make free and extremely low paid labor from these traumatized migrants.

Lea Bush, LCSAW, MPA: 

Lea Bush presenting her work with JFFSD.

Lea Bush is the Senior Director of Family and Community Services at Jewish Family Service in San Diego (JFSSD). Founded in 1918, Jewish Family Service San Diego was built on a mission of serving refugees at the San Diego border that started over 100 years ago. Lea holds dual master’s degrees in social work and public administration from the University of Southern California. Lea has held roles supporting families and youth in a variety of settings for more than 17 years and has worked at JFSSD for 8 years. Ms. Bush currently leads the team that has served more than 18,000 asylum seekers at the JFS Migrant Family Shelter. She proceeded to describe the populations that the shelter works with, mentioning that 100% are asylum seeking families. Before the shelter stepped in, these families were often released at the port of entry with nowhere to go, often sleeping in the high-risk San Ysidro greyhound station. Ms. Bush points out that these conditions highlight the need for this type of shelter, which ensures vulnerable families are kept safely off the streets. Ms. Bush went on to explain the JFS shelter operations “by the numbers.” She cited that as of October 2019, the shelter has provided over 19,000 individuals with food, clothing, medical care, case management, legal services, and travel assistance and coordinators. On average, 10-25 individuals are dropped off or picked up at Port of Entry (POE). Upon arriving at the shelter, the medical providers find that most have mild health issues, with some cases of more significant medical and behavioral health issues. These guests stay an average of 12 to 48 hours, after which 99% of asylum seeking families travel to reunite with family and friends outside of San Diego, most outside of California. The shelter employs 35 staff and approximately 250 volunteers a month to help with the associated shelter operations. The latter portion of Ms. Bush’s discussion reflects on the successes and challenges of these migrant shelter operations. She reemphasizes that this temporary shelter provides safe, secure transitional services to vulnerable families with young children. Furthermore, the services they offer, such as the health screenings, ensure these migrants care otherwise unavailable to them, and are only made possible through strong community partnerships. Ms. Bush notes that despite the successes of such services, she believes there are various barriers which can make this work challenging. She cites constantly shifting federal policies and complex family needs as such challenges. Ultimately, Ms. Bush believes that her work depends on innovation and new systems approaches because only by taking strategic risks and responding quickly can we hope to address urgent community needs. 

Dr. Lucy Horton:

Dr. Lucy Horton during the Q&A panel discussion.

Dr. Horton is a Board-certified physician in Internal Medicine and Infectious Diseases. Lucy has translational and clinical research experience with a focus on viral immunology, tropical medicine, and global health. She has a strong commitment to non-profit service work and is currently involved with medical volunteering and community outreach in San Diego and Baja, Mexico. Dr. Horton began by discussing the development and implementation of a health screening program for asylum seekers at the U.S. Mexico border. She explained this new arrival health screening as dedicated to protecting the health of the public, including families seeking asylum. This is done by conducting health screening assessments and referring for outside medical care as appropriate to identify and prevent the spread of communicable diseases. Dr. Horton then proceeded to provide an overview of the health services made available to migrants at the shelter. She explains how important it was to develop shelter specific health screening protocols. Although she and her colleagues were familiar with how treating communicable diseases such as lice, the shelter setting in which people sleep in large rooms of over 160 beds necessitated protocol adjustment. These methods of isolation and treatment were reconfigured in collaboration with HHSA and UCSD refugee health program with input from JFS. This work provided the shelter with evidence based, easy to follow protocols produced for a variety of diseases including; lice, scabies, influenza-like illness, gastroenteritis, pregnancy, tuberculosis like symptoms and mental health and trauma. Dr. Horton provided the group with a detailed overview of the protocols in place for scabies as well as pregnancies and the challenges associated. She concluded by discussing the diversity of languages she and her colleagues encounter while at the shelter, these languages include Spanish, Vietnamese, Haitain, Creole, and Mayan indignous languages. Ultimately, Dr. Horton believes it is this diversity of individuals and experiences which makes her work so gratifying by constantly providing her with opportunities to learn.