November 7, 2013
November 7, 2013
With health care services improving but still limited at public hospitals and clinics in Tapachula, a city in southeastern Mexico, shelters are shouldering the burden of the medical needs of migrants during their journeys north.
Los Invisibles: Nuances of Migration Along Mexico's Southern Border
Part 5 in a Series
TAPACHULA, MEXICO – The last thing Lesbin Perdomo, a 19-year-old Honduran migrant, remembers from his accident is that he was feeling sleepy and decided to wake himself up by standing on the cargo train he was riding on top of. He did not feel it when a high-voltage power line hit him in the face.
Unconscious, Perdomo fell onto the roof of the train – a common form of transportation for migrants crossing Mexico on their way to the U.S. The two friends he was traveling with to New York City did not see the accident, he says. They only smelled the odor of melted plastic, which came from the steel cable’s polyethylene covering as it burned.
By the time Perdomo’s friends realized what had happened, he was already dead, he says. One friend took action and revived him.
“He pressed on my chest, and I was revived after like six times,” Perdomo says. “I came back, but I did not know anything.”
Perdomo’s face bears the record of where the cable hit: A burn extends from his left temple to the space between his eyebrows. He also suffered a burn on his left foot, where the electrical charge exited his body. But he did not lose his foot, his sight or his life.
“I am miraculously alive,” he says from his recovery bed at a migrant shelter in Tapachula, a city in southeastern Mexico near the border with Guatemala.
The shelter – Albergue Jesús el Buen Pastor del Pobre y el Migrante – helps migrants who suffer injuries in accidents or crimes during their journeys across Mexico.
After the accident, Perdomo spent three weeks at a public hospital in Palenque, a city about a four-hour drive from the shelter. Then agents from the National Institute of Migration’s team charged with protecting migrants in perilous situations brought him to the shelter.
Perdomo is confused and desperate and only wants to go home, even though he still needs to recuperate, he says. But he needs to wait to hear from the Honduran consul about when or how he could return home. While he waits, he will stay at the shelter.
Although public hospitals and health agencies in Tapachula have improved health care for migrants, a lack of resources still limits their capacity to provide long-term care. So they often refer migrants to shelters, where volunteer doctors attend to them. Many migrants also choose to seek health care in shelters rather than clinics or hospitals because they fear detention or face discrimination. Between referrals from hospitals and clinics and migrants’ preferences, shelters struggle financially to serve everyone in need, but their staffs remain committed to their mission to offer support to all.
Chiapas’ location on Mexico’s border with Guatemala makes the state part of a major corridor for Central American migrants heading to the U.S. in search of work, according to a 2013 report by the National Institute of Migration and other governmental and educational organizations.
Between 2009 and 2010, one-fifth of migrants who passed through Tapachula had suffered a medical problem, accident or illness in the previous two weeks, according to a 2011 survey by the National Institute of Public Health.
The most common health problems among migrants in Tapachula are dehydration, malnutrition and injuries, says Antonio Aguilar, who is in charge of the migrant transfer program at the International Committee of the Red Cross in Tapachula.
Respiratory infections, foot fungus, gastroenteritis, diarrhea and stomach infections are also common, says Irmgard Pundt, coordinator of Albergue Belén Casa del Migrante, another migrant shelter in Tapachula that offers care.
Mexican law enables all migrants – regardless of their immigration status – to access medical care in public and private hospitals and clinics. The law requires public institutions to provide care and to so without charge.
Still, some 80 percent of those who sought medical attention in the 2011 National Institute of Public Health survey did so with the doctor at Albergue Belén Casa del Migrante and not in a clinic or hospital.
Although public health care for migrants has improved, the system still has its limitations, governmental officials and hospital administrators say.
The government of Chiapas has developed its approach in recent years from simply treating migrants’ immediate medical problems to creating public policies to make health care accessible to migrants, says Luis Flores, who heads the Tapachula office of the International Organization for Migration, which provides technical support to the Mexican government. For example, the government issues a special document to migrants that allows them to receive free health services in public hospitals and clinics.
The Ministry of Health also offers public health programs for migrants in Tapachula. Among them are programs to reduce maternal mortality, promote reproductive and sexual health and prevent sexually transmitted diseases, according to the National Institute of Public Health.
Yet despite these programs, migrants who need to recuperate after an accident have limited options.
Tapachula’s general hospital, for example, does not have the space to accommodate migrants during a prolonged convalescence, says Héctor Suárez Ríos, the hospital’s director. The hospital is the only general one in the municipality that the nation’s Ministry of Health runs. The ministry runs another hospital, but it handles only highly specialized cases.
As such, the hospital is operating at 200- to 300-percent capacity, Suárez says. It has only 60 beds and receives patients from Tapachula and seven nearby communities.
Because of the overcrowding, the hospital relies on migrant shelters to house and to care for migrants as they recuperate, Suárez says.
The state of Chiapas is fulfilling its responsibility to make sure migrants can receive the medical attention that Mexican law guarantees, but it also has its limitations, Flores says.
“The ideal would be that comprehensive care could be offered from the beginning until the end,” he says. “Here, what we find is a series of gaps that do not only affect the migrant population, but also affect the local population.”
To fill the gaps, hospitals, migration officials and even the International Committee of the Red Cross send migrants to shelters to obtain comprehensive health care.
Albergue Jesús el Buen Pastor del Pobre y el Migrante – where migration agents sent Perdomo to recuperate – attends to migrants who are injured or are victims of crimes, says Aracy Matus, the shelter’s operations manager. It also helps Mexican residents who are sick, who have been abandoned or who have mental illnesses.
In 1990, Olga Sánchez Martínez, a housewife, started out caring for migrants in her own home who were injured or mutilated by the cargo trains they were traveling on and did not receive medical attention. Later, she founded the shelter.
Injured migrants get better attention today at hospitals and clinics than they did when Sánchez began her work, Matus says. Still, doctors tend to provide only the minimal level of medical care required by law. So the shelter cares for wounded migrants referred by hospitals, immigration officials, the International Committee of the Red Cross and consulates.
Albergue Belén Casa del Migrante also offers health care services to migrants. The shelter’s doctor and dentist work on a volunteer basis, providing free appointments for migrants for two hours per day Mondays through Fridays.
It is after 4 p.m. when a migrant announces with a shout the arrival of the doctor to the shelter. Some of the migrants temporarily staying here to eat and rest during their journey toward the U.S. sign up for a consultation. Before seeing any patients, the doctor gives a talk on how to prevent sexually transmitted diseases.
Noé Ramos, 30, is among those who want to see the doctor. This morning, the Honduran man arrived at the shelter on badly blistered feet after walking for seven hours from the Guatemalan border to Tapachula.
He now wears flip-flops the shelter lent him, and he hopes to find a similar pair before continuing his journey because the shoes he previously wore were uncomfortable, he says. He is traveling to the city of Monterrey in northern Mexico, where he used to work before authorities deported him for entering the country illegally.
Although the shelter intends its medical services for migrants in transit, the volunteer doctors there sometimes see migrants who have permanently settled in Tapachula or who have chronic illnesses and need medicine.
This is because migrants trust the shelter more than clinics or hospitals, Pundt says.
Most migrants seek medical care at shelters because they fear clinics and hospitals, according to the 2011 National Public Health Institute report. They see these health care institutions as government entities where officials may detain them. In contrast, the report calls a shelter “a space free from stigma and discrimination, in addition to accessible.”
Migrants also avoid clinics and hospitals because they sometimes receive poor medical care there, Pundt and Matus say.
Doctors at Tapachula’s general hospital attend to migrants reluctantly, Pundt says. Often, migrants have to insist repeatedly or bring a staff member from the shelter with them before medical personnel will see them.
There are doctors at the hospital who mistreat sick migrants, yell at them, and make discriminatory comments to them, Matus says.
Even though public policies guarantee migrants’ access to medical care, there is no guarantee that doctors will adequately apply them, Flores acknowledges.
Suárez denies that hospital personnel treat migrants poorly or refuse them care.
“Everyone – migrants or nonmigrants, we do not distinguish nationalities – they are people,” he says. “And, as people, they are treated, and they are provided the same care as everyone with all of the typical deficiencies of our institution, but everyone is provided it.”
Migrants may prefer to seek medical attention in shelters rather than hospitals because they feel at home in the shelters, Suárez says. He underscores the fact that his hospital lacks the resources to see more patients.
The subject of medical attention to migrants is complex because migrants may confuse the right to receive medical attention with the privilege of being served before others, which can create conflicts with the local population, Flores says.
“The only thing that it generates is conflict between the local population and the migrant population,” he says. “So the question many people ask themselves is, ‘And my rights as a Tapachulan to health care, where are they?’”
Matus says the problem is that some authorities – including governmental officials, hospital administrators and doctors – lack sensitivity toward sick or injured migrants and see them as garbage.
“A sick person no longer serves a purpose, no longer is optimal,” she says. “The whole world wants to get rid of him. In every place, they are the ones whom nobody wants.”
As shelters receive referrals and migrants prefer their care, these places struggle to provide services to all who need it.
Albergue Jesús el Buen Pastor del Pobre y el Migrante receives no economic support from the government, Matus says. Rather, its operating funds come from donations, sales at two corner stores that it owns, and the sales of doughnuts that shelter residents prepare and sell in the street.
Although the state does not provide constant formal support, it does donate money and goods to shelters when needed, says Sergio Aquino, the undersecretary for migrant services for Chiapas’ Ministry for the Development of the Southern Border and Liaison for International Cooperation. These shelters include Albergue Jesús el Buen Pastor del Pobre y el Migrante and Albergue Belén Casa del Migrante.
The Ministry of Health gives some economic support to Albergue Belén Casa del Migrante, Pundt says. But it does not offer other medical support.
Authorities’ reliance on shelters to treat migrants without sufficient economic support is more an abuse of authority than a reaction to infrastructural problems, Matus says. Still, the shelter’s staff remains happy to provide care.
“The authorities take advantage of that because they send us whichever person and resolve their own problems,” she says. “Really, that does not interest us as long as these people are being supported.”
Although the struggles of migration have frequented the media, coverage has been shallow about the diverse issues that Central American migrants who enter Mexico illegally face as they try to settle in the country or travel north. Mayela Sánchez, senior reporter for GPJ's Mexico News Desk, spent one month along Mexico's southern border delving into the nuances of employment, health, violence, gender justice and various human rights issues that push people to migrate and confront them along their journeys. GPJ will feature this series on the first Wednesday of October, November and December.
GPJ translated this article from Spanish.