Tijuana's Perilous "Waiting Room"

This past summer, I volunteered in Tijuana, Mexico at a clinic serving patients in the Migrant Protection Protocol program, or MPP.  Also known as “Remain in Mexico,” MPP sends migrants who appear at official places of entry along the U.S. border seeking asylum, back to Mexico to await future immigration hearing dates. 

Introduced in January 2019 to slow the flood of immigrants across the U.S. border, the program has returned 38,000 migrants to wait in dangerous cities like Tijuana and Ciudad Juarez.  The MPP program has been lauded as a “success,” though in my opinion, it is quite the opposite. 

The majority of patients were from Guatemala, Honduras, and El Salvador, however, I encountered many from Haiti, Cuba, and many other countries throughout the world.   MPP policy essentially forces desperate migrants —comprised of single parent families with small children— to wait months in Mexico, where they are often unable to find work, housing, legal support, or proper medical care.

For immigrants awaiting their U.S. immigration hearings and seeking asylum, conditions for those seeking asylum are tenuous at best. If they are lucky enough, migrants reside in local shelters, which are jam packed with others “returned to Mexico.”  The physician in me saw many medical problems, and as an individual and a parent I observed even deeper issues.

One young mother was in desperate need of medical services when I met her.  She lost her husband and teenage son to gang violence in Honduras before making her way north to Mexico with her young daughter in tow.  A petite brunette, wise beyond her years, she was nursing her toddler when I entered the room.  While living at a shelter in Mexico, she had contracted some sort of infection on the back of her leg.

By the time I saw her, the infection had eaten through layers of her skin, soft tissue and even into the muscles of her leg.  It is one of the worst skin infections I have ever seen and was excruciatingly painful.  In reality, she needed hospitalization for more extensive wound cleaning (known as debridement) and intravenous antibiotics, however no Mexican hospital would provide care due to her immigrant status. 

If they can find adequate food and shelter and survive daily setbacks, there are logistical obstacles to attending immigration hearings when they do get on the docket.   Some migrants miss their court dates because they are refused entry when trying to return to the U.S. for their hearing.

Legal representation in the U.S. is hard to come by.  Only 1% of migrants in the MPP program are able to retain an attorney, according to the Transactional Records Access Clearinghouse at Syracuse University.  Often working pro bono, lawyers are reticent to assist migrants at shelters run by the Mexican government because they aren’t licensed to practice across the border or have security concerns. 

What legal advocates fear are the same safety concerns migrants in the MPP program face.  Tijuana is somewhat safe during daylight hours, but a couple had been shot and killed directly in front of the clinic where I treated patients scarcely a month before I walked up its steps. 

But more than anything, it was the arbitrary nature of the immigration process that struck a chord with me while working south of the border. 

Another mother I met, this one with an asthmatic son, Jesus, were an example of the impact chance alone can have on a family’s future. The son was sitting on the exam table struggling to breathe as I examined him.  The worry etched on his mother’s face was palpable.  She began to cry, recounting the journey her family had made together from El Salvador. Her spouse and her older son had made it safely across the border into the United States.  But she and her youngest child were separated from the other two, and returned to Mexico through the MPP.  It had been three months since she had last seen her son or husband.  Every night when I fall asleep, my thoughts return to the mother and her young son and I hope they are both still safe as they await their day in court. 

And finally, there are the already-known casualties of the MPP program, like Vilma Mendoza, a 20-year old Guatemalan woman who entered the U.S. on July 4^th seeking asylum, who was “returned to Mexico.” Though her asylum hearing was scheduled for August 18^th, Mendoza drowned July 29^th while attempting to re-enter the U.S. through an irrigation canal.   Some may wonder why she took matters into her own hands.  I know why.  I saw the reasons first-hand.    

I left Tijuana with more questions than when I arrived, which is difficult to reconcile working in a profession which focuses on easing the suffering of human beings.  I don’t know the answer for our country, and I don’t know that there is a simple solution. 

When I became a physician, I swore to uphold the Hippocratic Oath, an ethical guideline that includes the phrase, “I remain a member of society with special obligations to all my fellow human beings…”

While it’s doctors who are most often associated with that covenant, each one of us is a member of this society, which doesn’t always end at a national boundary or physical border.  So maybe we all need to share that oath’s burden.  Leaving young mothers with untreated infections, leaving sons separated from their fathers, and seeing so many people with a desperation that drives them to decisions you and I never have to make isn’t anywhere close to what I consider progress. 
Tig