Notes from the field

How I Helped a Pregnant Mum Avoid Severe Complications Whilst Volunteering in Reynosa

by Katie G., GRM Volunteer Nurse

*Please note, names have been changed to protect our patient’s identity

In November 2022, GRM met Fabienne*,  a Haitian refugee living in the Senda de Vida Shelter, who was 28 weeks pregnant and presenting with a medical condition called pre-term premature rupture of the membranes (PPROM), meaning her water broke too early. This condition is dangerous for the mother due to high risk of infection and high probability of emergency cesarean section and also for the premature baby, whose lungs are not fully developed and will need NICU care immediately after delivery.

Photo: Nurse Katie, a GRM volunteer and the author of this story, setting up for clinic hours in Reynosa.

Doctors Without Borders notified GRM that this woman had been turned away from the Reynosa emergency department because they did not have NICU capacity. So I went with others to collect the patient and her family from the shelter and brought them to the clinic at Casa de Lulu.

When Dr. William, a local GRM staff doctor, contacted the maternity hospital in Reynosa, he was told that all of the NICU beds were in use and they could not accept any more patients. At this point, the GRM team agreed that Fabienne would not be able to receive the immediate care she needed in Mexico and arranged for her to be received at a U.S. hospital in Texas via our medical referral cost coverage program (a program that is facilitated through GRM’s generous donor community for urgent and complex medical cases like this).

GRM contacted Lawyers for Good Government in order to initiate medical asylum paperwork and expedite Fabienne’s crossing. In the meantime, Dr. William and Nurse Katie gave her an injection of steroids to help the baby’s lungs develop and an injection of antibiotics to prevent infection.  As soon as the legal paperwork was completed, GRM started assisting Fabienne and her family cross the border.

At this point, Fabienne was in pain, feeling contractions and leaking a significant amount of amniotic fluid. Nurse Katie used a GRM wheelchair to push the patient across the border bridge while another volunteer nurse, Lia, accompanied her family close behind. Once at the bridge, they were met by CBP agents and brought to the Immigration Center. It took about an hour to get through the Immigration Center before the patient was released and an ambulance was called. Katie accompanied Fabienne in the ambulance to the Rio Grande Hospital with Lia and the family following behind in an Uber.

Above right: Nurse Katie and patient in U.S. Ambulance after crossing.

At the hospital, Fabienne was immediately transferred through the ER and into the Labor and Delivery Unit. The L&D staff were pleased to hear she had already received antibiotics and a steroid injection at the GRM Clinic, noting GRM’s quick thinking and fast action potentially helped the patient avoid an emergency premature c-section, and certainly helped prevent infection or worse complications.

Once Fabienne was safely settled in the L&D unit, GRM staff focused on the patient’s family. Unfortunately, the hospital would not allow the family to stay in the hospital room with the patient. However, our Reynosa Project Manager contacted our friends, the Angry Tias and Abuelas, another local nonprofit, who provided a three-day stay in a nearby hotel for the family.

Photo: Patient receiving treatment in McAllen, TX in Labor & Delivery Unit.

Our patient and her family were grateful for the medical services provided by GRM and told our staff this was the first time in months that they felt safe and optimistic about the future.

While it is terrible to think of what the outcome could have been without the intervention of the GRM team, Lawyers for Good Government, Doctors Without Borders, the Angry Tias & Abuelas, and everyone else involved in this patient’s care, this situation illustrates exactly how important our work is.

GRM is truly an organization that stands by the principles of the humanitarian imperative, they bring impartial assistance to those most in need and deserving. They are an organization I am proud to say I work with.

 

BLOG POSTS ARE THE OPINION OF THE AUTHOR AND DO NOT NECESSARILY REPRESENT THE VIEW OF GRM

Notes from the field

From CEO to NGO: Why I Joined GRM’s Ukrainian Mission

by Natalia Zachynsky

 

February 24th. Just another day for most people in the world. But for me and the other 42 million Ukrainians, it divided us into ‘before’ and ‘after’. 

We woke to explosions and petrifying news, spreading around the country at the speed of light: 

“Russia attacked Ukraine at 4.30am.” 

BEFORE the war, I was a successful young owner of an educational business, a teacher-trainer, an international examiner, and an author. I presented at international conferences, worked hard to achieve success; everything was carefully planned and under control. 

AFTER February 24th…  our lives were put on hold, like a terrible dream with no way to wake up.  I no longer belonged to myself.  I lived at the whim of a ruthless dictator who decides if I live or die.  He chooses whether or not innocent children will be bombed, another building destroyed, or whether to grant a temporary respite in the form of a few hours of peace.  

I felt panic, despair, helplessness, and a feeling of indescribable emptiness as I asked myself repeatedly: “Why?” 

However, by nature I am a doer, not an observer. I wanted to be useful and not sit at home in Khmelnytksy, a city in the west of Ukraine. Millions of Ukrainians were less fortunate than me, having lost their homes, jobs, or family and many had been forced to flee.

I started offering shelter to those who needed it, I worked at the train station as people evacuated from targeted and occupied regions of the country, and I gave food and water for those in need. I searched for medicine for the military and volunteered as a translator for those delivering essentials from abroad.

But it felt like I could do more. That opportunity came at the beginning of March when a friend asked me to translate for an American medic.

And that is how I first met Luke. He needed a translator to help him with various meetings, including at the Department of Health in Khmelnytsky. I didn’t know anything about Global Response Management or their work at the time, but I saw a person who wanted to help with all his heart.

It was chaos, not just in my city but in the country in general. Few people had time for us, as meeting after meeting was postponed or canceled.

My professional career had given me a wide circle of useful contacts who had previously trusted me to work with society’s most valuable assets – children. I realized I could do more than just translate. I used my network to find friends and colleagues in the medical field and many patriotic people who were more than happy to help us.

We began to organize medical training on Tactical Combat Casualty Care (TCCC or is the accepted battlefield prehospital standard of care), POCUS (Point-Of-Care UltraSound refers to portable ultrasound systems that allow the assessment of patients without requiring them to be physically present in a radiology department.), and Advanced Trauma Life Support, as well as piloting a project with the Ministry of Health and WHO to send GRM surgical teams to the front line to support Ukrainian surgeons.

My role as translator quickly morphed into a much bigger role organizing training throughout Ukraine and liaising with the Ministry of Health as well as other medical institutions of the country. I was responsible for logistics, training, supplies, translators, lodgings, and essentials for the productive work of the entire team.

It wasn’t an easy transition, my ‘before’ to ‘after’ career.  Not being a medical doctor, I was in a new world where my previous professional achievements and life before the war were a distant memory.

I suddenly had others around me, who could support me and advise me when I was unsure how to act. Usually, I am the leader, but I learnt to step back and work a part of a large team. The only thing that mattered was to get help to the people who needed it the most. I couldn’t let anyone down.

I am infinitely grateful to GRM for allowing me to find another side of me, to understand the true value of a team, the support and care it brings as I became part of a whole without losing myself. I learned to make suggestions and to, occasionally, have them rejected, putting aside my ego for the good of the project.

I learned how to make the impossible possible. Always with urgency. They say ‘teamwork makes the dream work’. It’s true!  GRM gave me new colleagues and friends but most importantly, it showed me the beauty of the human soul and the desire to help regardless of country, religious beliefs, profession, and values. We are united by the desire to help and fight together.

As to my recurring question – Why is there a war in Ukraine? – I still don’t have the answer. But now I know why I should live: I have to help those who need it and GRM showed me how.

 

BLOG POSTS ARE THE OPINION OF THE AUTHOR AND DO NOT NECESSARILY REPRESENT THE VIEW OF GRM

Notes from the field

My Transition from Military to Civilian Life

by veteran in GRM 

*Due to the sensitive personal nature of this blog post, the author asked to remain anonymous.  

 

It was sometime after 0300, but the Iraqi summer heat and the stagnant air in our bunker kept me awake. I was at my computer desk in the Battalion Operations Center in Qayyarah Airfield West, staring at a pros and cons list of leaving the military.

 

I loved my job. I had graduated college and was commissioned in the Army where I found both purpose and direction on active-duty. Entrusted with the responsibility of managing a platoon of paratroopers—and later a staff section of non-commissioned officers—I learned how to lead, how to multitask, and how to take care of people. 

 

I trained hard.  I jumped out of aircraft. I learned self-discipline, courage in the face of adversity, and how to put the mission before myself. Among other lessons, the Army taught me how to take criticism, how to stand by my convictions, and the importance of selfless public service. As I reflected, I realized that my time in the military is when I really grew up, became an independent adult, and fully formed my personal set of values and morals.

 

However, the high operational tempo and deployment schedule of the military made it difficult for me to pursue other personal goals – I wanted to get married, to start a family, to enter higher education, and find other ways to make a positive impact on the world. 

 

Just like my first parachute jump, I hesitated slightly, and then lept.  I transitioned out in 2018, after 6 years of active duty service and just a few short months after returning from a tour in Iraq.

 

“You’re too bossy!”

 

The transition was harder than I expected.  Graduate school didn’t have that same sense of camaraderie as the Army. In short, it was a total culture shock. 

 

During my first semester of graduate school, our professor assigned a group project. At our first group meeting, after about 15 minutes of chatter amongst the group, I decided to take charge – after all, we only had an hour a week to meet, and we needed to get the project done. I set deadlines, allocated tasks, and set expectations for each meeting. 

 

I thought to myself – rather indulgently – that my colleagues probably appreciated me taking a leadership role. So I was taken aback when someone bluntly announced: “You’re too bossy”. I perceived myself to be exercising decisiveness and work-ethic (skills that would’ve earned me praise in the military). I was hurt, embarrassed, and frustrated. Were my leadership and management skills outdated? Could I still rely upon the lessons and skills the Army had taught me? Would I have to entirely abandon them and learn all over again?

 

I was frustrated, but sat back and let the group work out the project details naturally. Even without my leadership, we still got an A, leading me to question my methods and whether or not I could adapt to a dynamic new civilian world.

 

Light at the end of the tunnel

 

Upon graduation, I, like many other veterans, found myself yet again struggling as I searched for employment in the civilian workforce. It wasn’t easy to translate my resume into civilian terminology that would be understood, appreciated, and valued. I received rejection after rejection as I grew increasingly nervous that I had made a terrible mistake by leaving the military.

 

A few months later, I met with a friend at the dog park. He was also getting out of the military and we were discussing the new job he had taken with a veteran-founded NGO, Global Response Management (GRM). I told him how my new graduate degree qualified me to work in non-profit development and he offered to set up a meeting between me and their Executive Director (ED).

 

Through my conversation with the ED, I learned that GRM prioritized developing meaningful opportunities for veterans to rejoin the workforce. She was also a veteran, a former Army officer, and I told her the anecdote about being told I was too bossy in school. 

 

She empathized but helped me ultimately realize that although the methods of communication are sometimes different, the lessons and skills I developed during my time in the military are eternal. People first, always. Lead with courage and conviction. Make decisions and follow through. Listen to the input of your teammates, coworkers, and subordinates. Commit to a culture of continual improvement and the never-ending pursuit of organizational excellence.  

 

She immediately brought me onto the team as a volunteer, and then a few months later they offered me a contract, and shortly thereafter, full-time employment. Working with GRM, I found myself yet again on a team of like-minded individuals who were motivated by the same values and principles as I was. 

 

GRM’s important, life-saving mission drives me and my colleagues to work hard, collaborate, and continually ask how we can better achieve the mission of providing healthcare to vulnerable populations impacted by conflict and disaster. GRM gave me a place and a purpose. 

 

The transition from the military to the civilian world was difficult, but there was a light at the end of the tunnel, and for me, that light was GRM. 

 

If you’re a veteran struggling with transitioning to civilian life or in search of opportunities to continue serving you can email us ([email protected]) about volunteering in one of our programs.  Alternatively, Military One Source and the Veterans’ Association have further resources to assist with transitioning.

 

BLOG POSTS ARE THE OPINION OF THE AUTHOR AND DO NOT NECESSARILY REPRESENT THE VIEW OF GRM

Notes from the field

A Day in the Life in Reynosa

by our clinic coordinator in Reynosa, Mexico, Jorge Flores 

I’d like to use this blog to tell you a little about what happens in this small part of the world and the conditions in which migrants live in Reynosa.  My work involves helping my boss, Brendon Tucker, with the administration of the clinic, stocking medicine and supporting the local staff, to ensure that we have everything needed to work and  in the best possible conditions.  

It is not easy.  The high demand for medical services coupled with little support from the Mexican federal, state and municipal government makes it hard to offer good medical care to all migrants who are waiting to progress their asylum case on the border.  

The provision of GRM’s services is reliant on collaboration with other NGOs, volunteer doctors and nurses and the support, financial or otherwise, from everyone who believes in, and donates to, our project.  These factors allow us to offer medical support and to provide long term medicines and antibiotics for children and adults. 

I also want to explain what day to day life is like in Reynosa.  As the weather turns, the cold and rain make it harder to work.  Poor roads and bad drainage means that the rains regularly convert the area into what is essentially a muddy swimming pool, which restricts our access to shelters and other areas where the migrants congregate.  

Obviously access is important for medical support, but it’s more than that.  It’s about the inhumane ways in which these people have to live during the rainy season, where many of them are sleeping on muddy streets in small tents cooking food on tiny structures that have been built to contain fires.  The residents trudge through mud to go about their business.  Mothers and children sit out the rain in their tents waiting for their husbands, fathers or brothers to return ‘home’ with something to eat or drink that might have been donated by a nearby shelter.  

Exposure to these elements causes a huge toll on their health.  

This is just a small example of what is happening in the community, imposed on people who have been forced to leave their homes to protect themselves from the danger in which they were living, from political wars and crime.  They had to choose between living in constant fear or trying to travel somewhere just as dangerous, but at the end of the day, one that includes a small hope of a better life.

Jorge Flores is a licensed psychologist with a masters in Administration, he currently works for GRM in Reynosa, Mexico, as coordinator of the clinic.

Spanish Version

 

Hola mi nombre es Jorge Flores, soy Licenciado en Psicología y Máster en Administración, actualmente trabajo en GRM Reynosa como coordinador de clínica y a continuación quiero platicarles un poco de lo que pasa en esta pequeña parte del mundo.

Mi trabajo radica en ayudar a mi jefe Brendon Tucker con la administración de la clínica a revisar la compra de medicamentos y apoyo al equipo local de médicos, principalmente que tengamos todo para poder realizar nuestro trabajo en las mejores condiciones posibles.

Esto no siempre es fácil debido a la alta demanda de atención médica y los pocos apoyos del gobierno municipal, estatal y federal complica poder brindar un buena atención a todos los migrantes que se encuentra parados en la frontera esperando solución a su proceso migratorio, con esto y  la colaboración con otras ONG,  Doctores y enfermeras que trabajan como voluntarios y principalmente todas aquellas personas que creen en nuestro proyecto y realizan donaciones a nuestra fundación  han sido un factor fundamental para poder suplir la demanda de atención médica y medicamentos crónicos y antibióticos para niños y adultos.

Pero en otro tema quiero platicarles de nuestro día a día en Reynosa, con la entrada del cambio climatológico en la zona nuestro trabajo se ha complicado más, la mala infraestructura vial y el mal drenaje pluvial convirtieron a Reynosa en una gran piscina de lodo fangoso.

Esto limitando nuestro paso a los albergues y a las zonas donde la comunidad migrante se encuentra asentada, y el tema del acceso a la atención médica tema que importante para todos, no puedo omitir la forma inhumana en la que viven los migrantes ahora por la entrada del invierno con lluvia, muchos de ellos duermen en las calles fangosas dentro de pequeñas casa de campaña.  En esos mismos espacios cocinan sus alimentos en pequeñas estructuras que levantan el fuego del agua, caminan entre el lodo para hacer sus necesidades fisiológicas, caminan entre el lodo a buscar comida que donan dentro de los albergues, madres y niños dentro de las carpas aguantando la lluvia y el frío esperando a sus esposos, padres o hermanos que regresen del exterior con algo para comer o beber.

Y si hablamos médicamente esas condiciones que están viviendo ahora dentro de unos días nos dejaran problemas de salud por la exposición a todas estas condiciones.

Este es un simple ejemplo de lo que pasa la comunidad migrante en su travesía, en su esfuerzo por salir de sus casas para salvar sus vidas del peligro por las guerras políticas y de la delincuencia, ellos tienen que elegir seguir viviendo con miedo o emprender un viaje que es igual de peligroso pero que a final del día les brinda una esperanza de una vida mejor.

 

BLOG POSTS ARE THE OPINION OF THE AUTHOR AND DO NOT NECESSARILY REPRESENT THE VIEW OF GRM

In The News

Fox13 News – Utah paramedic returns from volunteer medical mission in Ukraine

Original posted on Fox13 News, Jul 20, 2022

After serving in the Air Force for more than seven years, Courtney Pollock felt that she needed to continue finding ways to serve and give back.

She finished paramedic school in August and recently started as a paramedic with Weber Fire District.

“As soon as it started, I remember wanting to figure out how to get over there,” said Pollock about Russia’s war on Ukraine. “I knew that I had medical knowledge now that I was just ready to go and wanted to get there.”

Courtney had been on the job with Weber Fire District for just three days before she got a call from ‘Global Response Management’, who vetted her credentials and offered her a spot on their upcoming volunteer mission in Ukraine.

With support from her new colleagues and fellow first responders, Courtney headed to Poland with nearly 150 pounds of donated medical supplies to aid her response.

She flew from Salt Lake City to Frankfurt, Germany and drove to Poland where she met her fellow mission volunteers. From there, they drove a convoy of ambulances into Ukraine.

“I wasn’t scared, I was ready,” said Pollock. “I was really ready to be there and do what we came to do.”

For the next four weeks, Pollock learned from local doctors, used constantly “google translate” to communicate and helped save victims of war.

“It was a lot better and a lot worse than what I was expecting,” said Pollock about Ukraine after having seen the images on the news. “I saw some lives being completely destroyed, I also saw a lot of people continuing on with their day-to-day life as if nothing was going on and then the air sirens start going off and everything changes.”

Pollock worked with a team that would triage patients in train stations, provide first aid, transport patients to hospitals and convoy patients to Poland.

“There was a moment I vividly remember sitting down and writing my will to my dad,” said Pollock when asked if she ever felt unsafe. “You’re going thru that and you’re like, if this is it then this is it, at least I’m doing the thing and I’m here doing my best helping everybody that I can.”

While she saw some patients in tough shape and spent time in bunkers after air raid sirens went off, Pollock says she wants to go back and help again.

“I realized when I was there for a month that this line of work, helping people in other parts of the world is going to be a part of me now forever,” said Pollock.

In The News

Cronkite News – ‘Nothing here is enough’: Systemic gaps in health care system affect migrants in Tapachula

TAPACHULA, Mexico – On a cool Monday morning in early March, dozens of people – migrants and citizens alike – line up outside a public health clinic as rush hour traffic hums by.

One man’s knee is wrapped. Another has a large growth on his face. A teenager is pregnant. Mothers and fathers hold coughing babies, some parents cough themselves. A child vomits onto a pink cloth on a woman’s shoulder.

As she waits, Karla Matute, 35, holds the right hand of her son, Joryí, 7, whose left hand is wrapped in thin gauze at the wrist. They are migrants from Honduras.

When Matute gets to the front of the line, she shows the nurse a letter from the Mexican government’s refugee agency, known as COMAR, giving her permission to seek free treatment for her son. She says someone from the Red Cross told her that he may have a fractured arm.

They came to the clinic, Matute said, after a public Tapachula hospital told her they could not treat Joryí for free because she hadn’t started the asylum application process and they aren’t Mexican citizens.

Public directories list more than a dozen hospitals in Tapachula – but depending on interpretation of law and policy by hospital staff – some turn migrants away if they can’t pay, others only treat them after a referral from a primary care clinic, and others only after they have paperwork proving they are in the asylum system. The situation is confusing for migrants seeking care.

The nurse asks, “Where do you live? I need your proof of address so that you can pass through to consultation.”

“Parque Bicentenario,” Matute replies, referring to a park in the city center where she and her son sleep in a tent.

The nurse looks up, confused.

“In the park?”

After further discussion, Matute and Joryí are allowed inside.

RELATED STORY

Health care in Tapachula was not built for this moment. It is a city of 350,000 in one of Mexico’s poorest, most under-resourced states. Tens of thousands of migrants heading north are stuck here as they await asylum meetings, humanitarian visas and other documents that will allow them to gain residency or legally continue their journeys to Mexico’s border with the United States.

And as policies enacted by Mexico and the U.S. have trapped migrants in Tapachula for months at a time, the city’s health care system has been entirely overwhelmed. The crush comes in addition to the ongoing effects of the pandemic, limited amounts of medication, the high costs of medical testing, paperwork inefficiencies and reports of discrimination based on race and nationality.

But experts say the situation in Tapachula would be far more dire without the involvement and dedication of nonprofits, nongovernmental organizations, and local health officials.

Under Mexico’s complex health care system, the law guarantees that all people, citizens or not, have access to basic care. That care is provided by a complex web of coverage that includes private insurers (for those who can afford it), employee-provided coverage, and various public coverage programs. But migrants can’t always access care, say experts and advocates. Communication between policymakers and providers on how to cover migrants and under which programs has been slow and unclear.

Underlying these challenges is the inability of Tapachula’s health care system to meet the needs of its own citizens. Medical providers face resource shortages and structural challenges brought on by limited government funding. Chiapas state has a poverty rate that far exceeds that of other Mexican states; almost 70% of the state’s population qualified for free public health care in 2020, according to Mexico’s Government Institute of Statistics and Geography.

Migrants, particularly women, children and those with chronic conditions, are among the most vulnerable to these gaps and disparities.

Haitian migrants – from left, Christela Saint-Louis, 30, Dorvensky Junior Dorme Saint-Louis, 1, Erliwe Germain, 29, Blandina Docile Germain, 5 months, and Dieulifoute Dorme, 33 – sit on the floor of the home they share in Tapachula, Mexico. After migrating from Haiti to Chile to Mexico, they’ve faced numerous challenges in receiving consistent and effective medical care. (Photo by Laura Bargfeld/Cronkite Borderlands Project)

 

‘They threw them in the trash’

 

When Erliwe Germain went into labor in September, she had been sleeping in Tapachula’s Central Park for five days. Hungry, tired and unable to find housing, she made her way to the public hospital, an experience she described as difficult and scary.

Germain gave birth in a room with seven other mothers. They didn’t even clean the baby, she said, only giving one unidentified injection and no followup care.

Germain had arrived in Tapachula with her husband, Dimitry Docile, just a few weeks before that. The couple, who are from Haiti, had been living in Chile, but she said they were subjected to racism there and wanted better for their unborn daughter. They migrated north and eventually made their way to Tapachula.

Having a baby in Tapachula has allowed Germain to get permanent residency status in Mexico, which affords her access to more services. Germain’s cousin, Christela Saint-Louis, and her cousin’s husband, Dieulifoute Dorme, are not so lucky.

Christela Saint-Louis, 30, has been taking medications she received at a local clinic for lung problems, but she says they haven’t helped and her symptoms are worsening. (Photo by Laura Bargfeld/Cronkite Borderlands Project)

 

Saint-Louis said her year-old son was born in Chile before the family started the journey to Tapachula with Germain. She suffers from ongoing medical issues that have gotten worse on the trek north.

Although UNHCR, the U.N. agency for refugees, claims they should be able to seek care and gave them the paperwork to do so, Saint-Louis said, they haven’t gotten the help they need.

In Haiti, Saint-Louis said, doctors operated to remove fluid in her lungs, and she had ongoing medical care after migrating to Chile. However, after walking through the Darién jungle from Colombia to Panama for five days, her breathing problems started again. She said she has lost weight and the pills she was given at a clinic in Tapachula, an antibiotic and anti-inflammatories, don’t work for her.

Dorme, who developed a rash on the journey, said the antifungal ointment he was given didn’t work either. Their children are well-prioritized by local organizations, he and Saint-Louis said, but in their experience, care for the adults is minimal.

Leila Castro came to Tapachula in March with her 7-month-old baby girl and 4-year-old son. They were dropped off at the shelter Jesús El Buen Pastor by immigration officials. Castro left behind two more children in Honduras.

One recent night, Castro’s daughter developed diarrhea, and then a rash on one shoulder. Castro said the doctor and nurse on staff at the shelter gave her electrolytes for the diarrhea but had no medication to treat the rash.

Leila Castro’s 7-month-old daughter developed diarrhea while the family stayed in the Albergue Jesus El Buen Pastor shelter in Tapachula. The child also has a lung condition. (Photo by Laura Bargfeld/Cronkite Borderlands Project)

As the baby coughed, Castro held her tightly. The girl has a lung condition, and her health already is complicated, Castro said, but she intends to keep trying to find treatment for her daughter.

Roberto Báez Castillo was detained by immigration authorities just a day after arriving in Tapachula in late February. He was taken to Siglo XXI, the city’s immigration detention center, where he remained for 11 days.

When he got there, he said, he showed officials the prescriptions for his three-month supply of antiretroviral medication, which he’d received for free in Panama to treat HIV. But the paperwork didn’t matter, said Báez, who has been living with HIV for 12 years.

“These are all the documents I gave them so they would know I have my condition. And yet my medications were thrown away at Siglo XXI,” he said. “They threw them in the trash.”

As he waited outside the COMAR office, he recalled his long struggle with getting the medication he needs to manage his condition.

Báez, who is gay, said he fled Cuba to escape ongoing, violent discrimination from authorities. He spent a year in Peru without medication. Eventually, he made his way north to Panama City, where he finally started getting medical care in mid-2019.

On this day, he spoke with someone at the UNHCR office in Tapachula who told Báez the agency would connect him with a local nonprofit that serves HIV patients. It’s progress, but he remained distressed that it could be another week before he would get antiretrovirals, putting him at further risk for complications from the virus.

Roberto Báez Castillo, a Cuban migrant who traveled to southern Mexico from Panama, says his three month supply of HIV medication was thrown away when he was held 11 days at Siglo XXI, a detention center in Tapachula. (Photo by Juliette Rihl/Cronkite Borderlands Project)

‘Not as bad as it was’

To understand how so many gaps in access exist for Tapachula’s migrant population, it’s necessary to look at the complex network of available care.

The vast majority of primary health care for migrants is provided by NGOs – nonprofit, nongovernmental organizations – including shelters, many of which are still reeling from the huge increase in migration over the past few years and the effects of the pandemic.

“Nothing here is enough,” said Laura Benitez, the project manager for Global Response Management’s site in Tapachula. Among other things, the international NGO provides free medical services in Tapachula on a walk-up basis. No paperwork is necessary.

Benitez, who also has experience working with migrants in Tijuana, said things have been especially difficult in Tapachula since 2019, when U.S. demands that Mexico slow northward migration led Mexico City to institute a containment policy for migrants who entered the country from Guatemala. The previously transient population became a static one, overwhelming health and aid workers.

“The health system collapsed, basically,” Benitez said, “and there’s not many NGOs. If we compare this with Tijuana, it’s like, we don’t have enough.”

Global Response Management addresses a need among migrants for good primary care they can easily access. The agency recently moved its office from a public clinic to a park complex called Tapachula Station, where other services, including dentistry, are available. Workers treat such issues as dehydration, foot injuries, fevers and skin conditions.

The team of fewer than 10 serves 20 to 50 people a day, and Benitez predicts those numbers will increase as word of their new location spreads.

“I’m sure in a few weeks, we’ll have more patients,” she said.

Laura Benitez, coordinator for Global Response Management, waits for migrants at the NGO’s pop-up medical clinic in Tapachula. “There’s a lot of people who need medical attention or psychological help, but they have other priorities,” she says. (Photo by Juliette Rihl/Cronkite Borderlands Project)

 

Paperwork has been a major barrier for migrants seeking medical care, Benitez said. When migrants apply for asylum in Tapachula, their first point of contact is with the COMAR office to get an appointment date and time. At that appointment, they receive official documents that allow them to more easily access services, including health care at public clinics and hospitals.

However, Benitez said, at the end of 2021, asylum seekers were receiving appointments as far as six months out, causing delays for those with urgent health needs.

“In six months, they cannot work, they cannot leave, they don’t have money, they don’t have food to eat, and they don’t have access to medical health services because they don’t have the document,” she said. “So it was desperate times. It was chaos.”

Although wait times have improved, COMAR staff members still are overwhelmed as the flow of asylum seekers into the city continues.

“People were coming to us crying. They didn’t know what to do,” Benitez said, “but now it’s better. It’s not OK, but it’s not as bad as it was.”

Paperwork, however, is just one hurdle. Haitian and African migrants in particular face shortages of interpreters in medical settings, as well as widespread reports of systemic racism and anti-immigrant bias.

“It’s not just about them being migrants,” Benitez said. “It’s about them being dark-skinned.”

Research by Amnesty International and the Haitian Bridge Alliance released in October contained accounts from Black migrants in Tapachula of “intersecting forms of discrimination in accessing health care, based on language, race and nationality.”

And one 2020 study from the Population Council in Mexico about migrant women’s access to reproductive health care in Tapachula found that discrimination and racism has a measurable effect and “acts to the detriment of these women’s health.”

Female migrants of multiple ethnicities have reported physical reactions to this discrimination, the study said, including “high blood pressure, tachycardias and stress and anxiety symptoms.”

Although the report highlighted efforts to hire Haitian migrants as interpreters and translators, the researchers made it clear these resources aren’t sufficient.

The U.N. refugee agency UNHCR donated this van to the Ministry of Health in Mexico to transport migrants who need medical care. (Photo by Jennifer Sawhney/Cronkite Borderlands Project)

‘There’s a magic word’

Dr. David Jiménez, coordinator of attention to the migrant population in Sanitary District VII of the Ministry of Health of Chiapas, is a big believer in order.

Every day, he reviews data sent to him by COMAR and other agencies. Jiménez is responsible for 108 health units – clinics, hospitals and ambulances – in Tapachula and the vicinity. There are services in each of the shelters, too. As he spoke, he answered multiple calls requesting ambulances and medical services from around the city. In essence, everyone in Tapachula answers to him when it comes to the government response to migrant health care.

“There’s a magic word,” Jiménez said. “It’s called teamwork.”

Although the health system as a whole faces challenges, Jiménez cited many ways in which the state health ministry has been successful in working with such NGOs as UNHCR and UNICEF to facilitate medical care for migrants in Tapachula.

UNHCR has donated ambulances, masks, gloves and auxiliary ventilators to medical settings in Tapachula and throughout the region. It also has provided access to prenatal ultrasounds and support for newborns.

Additionally, UNHCR works with the local university to make more interpreters for Haitian migrants available and makes pamphlets and banners in Spanish and Creole that provide instructions on preventive health care and how to seek services.

“And these materials also benefit the entire population, because it is material that everyone needs, not only refugees and migrants,” said Pierre-Marc René, a public information associate for UNHCR Mexico.

UNICEF also is filling gaps in maternal health care by hiring a gynecologist and providing resources to support children, adolescents and pregnant women. It serves about 150 patients a week, according to a UNICEF report from mid-March.

Left: Elder Gonzales, 25, from Nicaragua, receives medical care at Albergue Jesús El Buen Pastor in Tapachula. He’s complaining of cold symptoms, which are common in shelters like Buen Pastor. Right: Dr. María José Espinosa Reyes gives a patient medication at Albergue Jesús El Buen Pastor. Many of the medications at the shelter are donated by the local health center or such organizations as Jesuit Refugee Services. (Photos by Laura Bargfeld/Cronkite Borderlands Project)

 

Lastly, with assistance from the federal programs IMSS-Bienestar and Grupo Beta, Jiménez and his team have assured that most every shelter in Tapachula has some level of medical staffing and transport to hospitals when necessary.

Despite these steps, some gaps remain.

Herbert Bermudez, a worker at Albergue Jesús El Buen Pastor, said he sometimes uses his own money to buy medicine for migrants who can’t find what they need in the shelter’s supply of donated medications.

In addition, COVID-19 continues to be a challenge in many shelters, creating staffing shortages and safety concerns because of overcrowding, which forced some to shut down, UNICEF reported in late March.

Jiménez acknowledged that it was difficult at the beginning to treat so many people from so many cultures, but said they’ve come a long way.

“I do not think I know perfection, but I think that we are already getting to know each person: the migrants from different countries,” he said.

But he also expressed long standing frustrations.

In his experience, Jiménez said, Haitians in particular are constantly in conflict with those who’re trying to help them, always pushing to the front of the line. He wants everyone to follow the system laid out for them and go through proper channels.

Jiménez also said migrants prioritize their health after everything else, especially immigration appointments and their attempts to leave Tapachula.

“More than anything, you need to know how the migrant puts other things first,” he said. “The least important of those things is their health.”

Benitez at Global Response Management also spoke to this phenomenon, although with a differing perspective.

“There’s a lot of people who need medical attention or psychological help, but they have other priorities,” she said. “Even if they know they need it (medical care), they prefer to go look for a job or make money to feed their family.”

More support needed

President Andrés Manuel López Obrador (referred to as AMLO) addressed the inefficiencies in this web of health care in a large-scale reform of Mexico’s health care system in early 2020. Healthcare reform was a major talking point of his campaign in 2018.

Although the strengths and weaknesses of the old system, known as Seguro Popular, were nuanced, it did guarantee asylum seekers three months of free health care access once they had their asylum appointments.

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AMLO’s government created a fully public option, known as INSABI, to make health care more accessible for all, including migrants. Public funding was expanded by 35% in 2020 to meet these goals. That ended the three month limit for asylum seekers and expanded access, on paper anyway.

But communications about policy and expectation remain poor, according to some medical researchers, and there are widespread accounts of medication shortages and access issues for migrants and Mexican citizens alike. In addition, there have been reports of corruption within hospitals, which, when supplies are low, may charge patients for resources that should be free.

Experts also have criticized López Obrador for severely underfunding health care. An independent analysis in 2020 indicated health care in Mexico is under-resourced by as much as 658.5 billion pesos. And despite some funding increases, that gap hasn’t been closed.

Although the Chiapas health ministry contributes resources for migrants, the majority of the funding Jiménez distributes comes from NGOs. Jiménez is proud of the strides his team has made, but more support is needed, he said.

Jiménez said the NGOs he works closely with would soon be petitioning AMLO, who visited Tapachula on March 11, asking that “more resources be allocated to the health system.”

Benitez agreed that resources from the Mexican government have been lacking.

“The government doesn’t do enough,” she said. “That’s why it’s important that we NGOs are here.”

Government reforms have also been affected by the ongoing pandemic. Mexican public hospitals, which serve people who need more than basic care, often have found themselves overwhelmed, and wait times in emergency rooms remain high.

Furthermore, private and specialized treatment is beyond the financial reach of many migrants.

Caught in these currents are migrants like Karla Matute, the Honduran mother who sought help for her son’s injured arm.

At the clinic, a doctor put a more durable wrap on Joryí’s arm and referred him for an X-ray at the local hospital. Matute said the arm likely isn’t broken – Joryí would be in more pain if it were – but it’s worth checking to be sure.

They left the clinic with painkillers, but instead of heading to the hospital, Matute went to the National Immigration Office (INM). The night before, she had heard the agency might be giving humanitarian visas to the single mothers with children who’ve been sleeping in the park.

For the moment, anyway, Joryí’s arm will have to wait.

She’s hoping to leave soon and make her way north to Monterrey, where she heard there is work.

Additional reporting was contributed by Jennifer Sawhney, Juliette Rihl and Salma Reyes. Translations were done by Jennifer Sawhney and Salma Reyes.

In The News

WINK News – Naples doctor sharing his story after returning from Ukraine

by Matthew Seaver
Original posted on WINKNews, May 11, 2022

In The News

Suspilne Media – American paramedics who worked in Syria and Iraq conducted training for the Rivne ambulance

by
Original posted on Suspilne Media, May 9, 2022

Paramedics from the USA, who worked during hostilities in Syria and Iraq, arranged training for emergency medical workers in the Rivne region. They talked about modern approaches to stopping bleeding, pain relief, caring for patients with burns and conducted practical sessions.

An instructor of the international charitable organization “Global Response Management” named Vlado worked with Rivne medics without an interpreter. The man knows and speaks Ukrainian, because his mother is from Ukraine.

American paramedics conducted training for the Rivne "emergency"
Photo: Public Rivne

During 12 years of volunteering, Vlado participated in many charitable missions, he decided to come to Ukraine from the first days of the war.

“I am a professional medic, so what I have learned and my general experience, which I have gained in many countries of the world, on many continents, will help these medics,” Vlado explained.

American paramedics conducted training for the Rivne "emergency"
Photo: Public Rivne

Paramedics from “Global Response Management” conduct tactical medicine trainings in various cities of Ukraine.

“We teach how to apply a tourniquet, control blood loss, how to safely care for patients in the war zone and areas close to them. For doctors who have the knowledge, we provide in-depth training using specific medications and procedures: helping patients with significant burns, blood transfusion in the field,” said Daniel Taylor, head of the Global Response Management training department.

American paramedics conducted training for the Rivne "emergency"
Photo: Public Rivne

According to him, emergency medical workers and medics of ground defense units are being trained. Protocols for providing pre-medical care are constantly being improved, and American paramedics introduce Ukrainian colleagues to the latest scientific research.

“This is very powerful material that they provide regarding the organization of improvised hospitals, which can be done in combat conditions. Such nuances that we did not even know,” admitted Andriy Stakhniuk, head of the training department of the emergency medical aid center of the Rivne region.

After completing the training, Anna Sokolova, a doctor at the Varas emergency medical center, said that she would pass on the acquired knowledge and skills to her colleagues.

“We didn’t have such experience in terms of time, how to work, what should be paid attention to, what can be done later, which condition can be postponed for later, and which should be bought now and here,” she said.

Also, the American paramedics handed over to their Ukrainian colleagues individual first-aid kits, equipped according to modern requirements.

In The News

Penn Medicine News – Nurse Case Manager Supports Her Ukrainian Homeland from Afar

by Kim Maialetti
Original posted on Penn Medicine News, May 5, 2022

When Alena Blain, MSN, was growing up in Ukraine, she and her schoolmates volunteered to work in one of the country’s many museums dedicated to the history of World War II.

“Everybody grew up understanding that war is horrifying and should never happen again,” said Blain, who is a nurse case manager at Penn Medicine Princeton Medical Center (PMC). “You would never think it is possible to be where we are today.”

This spring, as Russia’s war on Ukraine continued, Blain was volunteering again. But this time she was collecting and packaging much needed medical supplies to send to hospitals in Ukraine for treating people injured in the war.

Blain is one of many Penn Medicine employees and students who are stepping up in various ways to support Ukrainians during their time of need. Penn Medicine partnered with Global Response Management, a relief-focused non-governmental organization engaged with the World Health Organization, to help deploy interested staff members to provide medical care. Additionally, more than $300,000 in monetary donations were collected, including more than $200,000 from the Penn community and $100,000 matched by Penn and Penn Medicine.

What’s more, students at the Perelman School of Medicine have been organizing donated medical supplies and raising funds for relief campaigns, and employees at Chester County Hospital organized a drive to collect medical supplies, hygiene products, and necessities for children and babies. Pennsylvania Hospital donated surplus personal protective equipment. And at Penn Presbyterian Medical Center, staff donated more than 100 bags and boxes of humanitarian aid to be shipped to Lviv.

“It is amazing how many regular people are reaching out and wanting to help,” said Blain, who was born in 1979 when Ukraine was still a part of the Soviet Union. She was 11 when the country gained independence and 22 when she emigrated to the United States.

Blain’s Volunteer Super-Power

When Blain first learned of Russia’s invasion, she was devasted. She would start crying any time someone asked her about it. Often, she was unable to talk through her tears.

Blain decided the best salve was to do something to help.

She joined a team of volunteers with the Ukrainian National Women’s League of America (UNWLA) Philadelphia Regional Council to sort and package items donated by local communities.

As a nurse case manager at PMC, Blain helps coordinate and manage patient care. She works with multiple specialties to ensure her patient’s needs are being met effectively and efficiently.

She put those skills to work as a volunteer for UNWLA, focusing on organizing and boxing essential medical supplies that are in high demand.

These included suction kits and ventilation bags, crutches, walkers and wheelchairs, along with medications for adults and children.

“Having a medical background was very helpful when I was packing the boxes,” Blain said.  “I was thinking ‘what would I need most and what would I need to get to fast.’ You must work in the medical field to understand what needs to get there.”

To date, the UNWLA Philadelphia Regional Council has collected and shipped more than 12,000 boxes of  goods to Ukraine, Blain said.

A Family Connection in Dnipro

Alena Blain speaks with her godfather on a virtual call on her laptop

While Blain has made the United States her home, she said she views Ukraine as you would your parents’ house.

“You may want to leave,” she explained. “But it is still very important that the house is going to be OK.”

Blain, whose mother and father are deceased, still has extended family in Ukraine, including aunts, uncles, cousins, a niece, and her 72-year-old godfather, who owns a business in Dnipro and is working to distribute supplies to support the Ukrainian forces.

“He is very determined and said he is going to stay and fight,” Blain said, her voice catching. “I’m not sure how much he can fight at 72.”

Holding Onto Hope

“Before I started volunteering, I felt defeated,” Blain said. “But going to the UNWLA center and seeing all the people there who were like me and wanted to help, was uplifting.

“It gave me hope,” she continued. “Hope that people have not forgotten the lessons we learned from World War II.”

In The News

WINK News – Southwest Florida nurse practitioner travels to Ukraine to help

by Sydney Persing
Original posted on WINKNews, April 13, 2022

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