Even In Mass., Hundreds Of Young Central American Refugees Seek Care

By Richard Knox

CHELSEA, Mass. — The young Honduran woman appeared at the Chelsea HealthCare Center last February, fearing she was pregnant.

“Flor” — a pseudonym to protect family members back in Honduras — had paid a “coyote” $8,000 to escort her and her 3-year-old daughter to the U.S.-Mexican border. But when they got to the border town of Nuevo Laredo, the coyote sold her to a gang that held her in a tiny room with seven other women.

They raped her, then told her to pay $17,000 or they’d sell her daughter’s organs and force her into sex slavery.

Up in Massachusetts, her mother and father scrambled to borrow the money and wire it to Nuevo Laredo. Her kidnappers released Flor and the little girl; she doesn’t know what happened to the other women.

Flor and her daughter are among hundreds of Central American immigrants who’ve made their way to the blue-collar town of Chelsea, Mass., over the past year.

They represent a quiet influx that began months before the phenomenon hit the headlines and protests began flaring in communities from Cape Cod to California.

They come to Chelsea because many of them have family there. Sixty-two percent of the town’s 35,000 residents are Latino, and many are from Honduras, El Salvador and Guatemala.

As we sit in a conference room at the Chelsea health center, the sun backlights the thick dark hair that frames Flor’s broad face as she tells me how and why she made the 2,300-mile trek from the Honduran capital of Tegucigalpa.

“The decision I made, why I came here, was to give a better future to my daughter,” Flor says in Spanish, silent tears trickling down her cheeks. “In Honduras, it is very difficult. The gangs, they’re killing a lot of people. You have to give money month-to-month or they go to your house and they kill you.”

To Flor’s enormous relief, the doctors determined she was not pregnant. But she still lives with constant anxiety. “I am very scared that they send me back,” she says. “But I believe in my God, that I’ll have the opportunity to stay here.”

Many other American clinics and health centers are seeing these new asylum-seekers, even if their presence often hasn’t registered in a public way.

The MGH Chelsea HealthCare Center, run by Massachusetts General Hospital, is by far the most heavily affected in the state. The Joseph M. Smith Community Health Center in Allston has also seen a significant uptick in these new immigrants, according to the Massachusetts League of Community Health Centers.

Although the flow has slowed in recent weeks, Central American immigrants are showing up at the Chelsea health center in a steady stream. They reveal their harrowing stories to caregivers only slowly.

“We do eventually get the whole story, but it may take a long time,” says pediatrician Kimberly Montez. “We try to do it in ways that don’t uncover things before we’re in a position to address them. We don’t want to pull all this trauma back up and then say, ‘OK, we’ll call you in a few weeks when we can get you a mental health counselor.’”

The refugees’ ability to stay in this country may be unknown for months or years, pending hearings before an immigration judge.

Under international treaties, the United States “may not return an individual to a country where he or she faces persecution from a government or a group the government is unable or unwilling to control based on race, religion, nationality, political opinion, or membership in a particular social group,” according to a recent report from the American Immigration Council.

But establishing this can take considerable time and legal support. “It can be difficult, and often complicated, to determine whether an individual has a valid claim for asylum,” the report notes.

Meanwhile, the new Central American refugees need medical care, immunizations, psychological and social support. They often need psychiatric care for post-traumatic stress syndrome, depression and threatened suicide.

“They have a lot of needs,” says Dr. Brent Ragar, the Chelsea center’s chief of urgent care. He first noticed something unusual was going on in March, although a look back at the numbers showed the influx began last fall and winter.

"They’d eaten bad food and bad water and had lost a lot of weight from diarrheal disorders. They had problems with their feet from walking so much."

Dr. Brent Ragar

“In urgent care, the first thing we touched on were needs related to their journey,” Ragar tells CommonHealth. “They’d been on the road for weeks or months in some cases. They’d eaten bad food and bad water and had lost a lot of weight from diarrheal disorders. They had untended injuries. They had problems with their feet from walking so much.”

One thing Ragar and his colleagues did not see were cases of infectious disease. Worry about that has garnered a lot of attention among people who believe these asylum-seekers could pose a public health threat and should be returned to their home countries as quickly as possible.

“A lot of times, children come with vaccination records, or we can access them fairly quickly by fax from clinics in their home countries,” Ragar says. “Their vaccinations are equivalent to what’s given here, for the most part.”

Children in Honduras, Guatemala and El Salvador are usually vaccinated against tuberculosis, something not done in the United States. Chelsea clinicians say they have not seen any active cases of TB among the new immigrants.

One thing Ragar and his colleagues have seen frequently are women, teenagers and children who have been victims of rape and other assault on their journey north.

While some immigrants are young women like Flor, many are teenagers and children as young as 5 — many or most of them unaccompanied by adults. The Chelsea health center has seen about 250 such children since last winter.

This reflects the nation’s overall experience. Children under 5 are the fastest-growing group of unaccompanied children crossing the U.S. border, doubling in the past year. A growing number of these children are girls, especially among those from Honduras.

Chelsea pediatrician Rebecca Cronin says many of her young patients have suffered trauma of various kinds in their home countries, rather than en route to the United States.

“I think there’s a reason people are leaving those places,” Cronin says. “They don’t feel it’s safe there. The only way is to leave. Otherwise, I think everyone would choose to stay there.”

The American Immigration Council agrees. “Conditions in El Salvador, Honduras and Guatemala have reached a tipping point,” the group reports, “and more people are reaching the conclusion that they can no longer stay safely in their homes.”

But once they have reached Chelsea and other U.S. havens, these refugee children are not beyond risk.

“We think, ‘Wow, these kids are getting a better opportunity,’ and they are,” says Mary Lyons Hunter, chief of the behavioral health unit at MGH Chelsea Health Center. “But we still have to realize that they’ve left behind all that they knew.”

Hunter says these young asylum-seekers are currently in a “honeymoon period,” experiencing relief and elation at escaping desperate circumstances, surviving the long journey here and, in many cases, reuniting with families they haven’t seen in years.

But by October, she predicts, serious behavioral problems will surface.

“The reality sets in,” Hunter says. “Kids will be acting out in school. We’ll see anxiety, an inability to sit still. The younger ones might be throwing tantrums and the older ones might be very disrespectful, mouthy, angry.”

She also expects family troubles. “The kids will say, ‘I haven’t seen my mom in eight years, I don’t know who this mom is.’ And the mom will say, ‘This child I’ve fantasized about reuniting with isn’t what we expected.’”

Hunter says the mental health needs are beginning to show up. “These kids are terrified. They were terrified there, they’re terrified here,” she says. “They have flashbacks. They can’t sleep. They have fear of attachment or [they have] over-attachment, which comes under the heading of PTSD for kids. We see the gamut.”

The Chelsea health center will be strained by these needs, Hunter says, but it will find a way to meet them.

“The ethos here in Chelsea is we’ve got to support what’s coming to us,” she says. “The ethos is to welcome.”