Contributed by IOMC Fellow Mona Shattell and orignally submitted through The Huffington Post

Last night, as I sat on my comfortable couch watching the Super Bowl, I was struck (and pleased) by the social commentary on diversity and inclusion that was embedded in many of the commercials. As I was pondering life for immigrants in the U.S. since Trump was elected President, my Rush University College of Nursing colleague, and working Family Nurse Practitioner Dr. Barbara Shaw, was writing this post on what it’s like for her, and for her immigrant and refugee patients whom she treats in an urban low-income and free clinic. It’s not pretty.

In Barbara Shaw’s words…

In the two weeks since the inauguration, I’ve gone to work with a renewed resolve to provide the best possible healthcare for my patients, most of whom are immigrants and refugees.

I’ve been doing this work for a very long time, and I’ve always felt that it’s a privilege to bear witness to my patients’ stories and to be their guide through the mess we call the US healthcare system. Our patients come from all over the world, many from the list of countries banned by the Trump administration. All of them make the long and often dangerous trip to the US because they want a better life for themselves and their families. I’m in awe of the courage of people who make the impossible choice to leave their homes, families and communities for the shot at something better. I’m profoundly saddened by what people are willing to sacrifice for a better life, or any life at all in the US, a country that now targets them as the enemy.

Lately, I’ve seen many patients’ faces tinged with anxiety, confusion and fear. Smiles have been replaced with furtive glances in the waiting room. And now, more than ever, as xenophobia flourishes in this country of immigrants, I’ve the responsibility to listen, to learn, and to advocate.

I listen to patients’ hearts, lungs, and examine their eyes, of course, but it’s listening to the tapestry of their stories that seems to let me hear something far deeper, and helps me to understand each person. Each patient has unique, moving and often profound reflections on their lives, their struggles and their choices.

What are they saying, these voices from the shadows? These people who take care of your children, your elderly mother; who mow your lawns; who work on that new kitchen you’re renovating or your leaky roof, or that new building across the street; who wash the dishes at that favorite restaurant that you go to on date nights?

These are a few voices, from just this past week, that resonate with the immediacy and severity of the problem of refugee health since the inauguration:

One patient, a young woman, an unauthorized immigrant from Ecuador, came to the US with her husband, leaving their 2-year-old son behind. Hers is a story that I’ve heard more times than I care to count. Why did she leave, I asked her recently. “La pobreza nos obliga” she said, somewhat matter of factly. It sounds far more poetic in Spanish, but the English translation is “Poverty forces us”. Obvious. Heart-wrenching. Her son who is now 6, she gets to talk to only once a week, on the phone.

Sitting across from me is a woman in her mid-30s, a refugee who arrived two years ago from Tunisia. She wears a beautiful hijab, with purple vines and flowers. She smiles appreciatively but her eyes reflect a combination of fear, wariness, and sadness. In Tunisia, she was a physician. Here in the US, she stays at home taking care of her three children while her husband, also a physician, works in a restaurant. She’s sad, and lonely, and doesn’t know many people here. Her family is in Tunisia, and she worries that she won’t be able to see them if they become ill. She can leave the country, but can she come back?

At the end of the visit, the older woman with diabetes wipes tears away as we say goodbye. She’s an authorized immigrant who left Mexico after being shot in the abdomen when a gunfight broke out in the restaurant where she worked. Now a grandmother, she cares for two grandsons, born in the US. One has epilepsy and another may be autistic. She asks me, “Will they still be able to get health care? Will I be able to keep coming here to see you?”

A middle-aged man, an unauthorized immigrant from Honduras, whose usual smile is tempered by the strain of lack of sleep. He hasn’t slept well in two weeks, he said. He has dreams of persecution, being chased, being caught, being held captive. And I think, “is there a pill for this? How can I treat fear?”

Healthcare comes with a price . Unauthorized immigrants aren’t eligible to buy into insurance plans. People often can’t return to the clinic when it’s recommended because they can’t pay the fee or the co-pay, or can’t buy their medications. And I’ve noticed that patients seem more and more reticent to come to the clinic—for fear that we will share information. They wonder if they are putting themselves and their families at risk by filling out an intake form. I try to reassure them, because our clinic is in a so-called “sanctuary city”, but nobody seems to know what that will really mean in practice.

No number of blood tests or imaging studies will cure our national descent into finger-pointing and blaming the “other”, of assuming the worst about anybody who was not born in America. This epidemic of fear comes with serious consequences for the public health and the health of all—citizens (born or naturalized), non-citizens, authorized and unauthorized immigrants, refugees escaping persecution and death.

It’s time to acknowledge and act on the reality that fear of accessing healthcare will result in serious public health consequences for our nation. A rise in infectious disease, in poor mental health, and the sequelae of poorly-controlled chronic health conditions are in our future.

It’s time to listen to the stories of immigrants and refugees, and to defend their humanity in the face of an administration that refuses to see them.

- Mona Shattell, PhD, RN, FAAN