Medicine and Migration in Minnesota

In this snowy city where once Norwegians and Swedes had their own hospitals, the 446-bed Hennepin County Medical Center (HCMC) currently spends $3 million on interpreters fluent in 50 languages to translate over 130,000 times a year. Minneapolis is home to the largest Somali community in the United States, some 35-40,000. The Twin Cities also have large Hmong and Latino communities, in addition to Liberian, Sudanese, Russian, and most recently Bhutanese immigrants. HCMC has adjusted its practice to better meet the needs of the diverse immigrant population it serves, a community that comprises 20% of its patient base. (Grady, Denise. “Foreign Ways and War Scars Test Hospital”)

Catering to its patient mix, HCMC’s obstetrics unit is now predominantly female, since Muslim women cannot have their children delivered by male doctors. Imams are often consulted prior to medical procedures, such as drawing blood during the month of Ramadan. No questions are asked about immigration status, and indigent patients are offered a sliding-scale fee, though not all can afford even this. Many of these immigrants are refugees from war-torn countries, and their medical care often includes the surgical removal of shrapnel and more difficult treatment of buried pain. Some 47% of women and 25% of men in the Somali community experienced torture (a number extremely high even for refugees), and their care necessarily includes counseling and holistic treatment. (Grady, Denise. “Foreign Ways and War Scars Test Hospital”)

HCMC’s dedication to its immigrant patient population is surely to be lauded. In an economic climate that has hospitals seriously worried about budgets, this Minneapolis hospital is noteworthy in its continued efforts to better serve its community. It is refreshing to see such a positive community response to the new challenges immigration brings; the impact of these efforts at integration and outreach can be seen in the faces of fellow passengers every time one steps on a bus or the Light Rail in this Silver City.

In this Together

On January 23, Nashville 43% of Nashville voters voted in favor of a bill touted as being able to unite their city and save it money in these difficult economic times. Had it passed, this Tennessee city would have become the nation’s largest to enact such legislation. In 1780, John Adams proposed similar legislation to the Continental Congress, stating it would help to “purify, develop, and dictate usage of” English; his proposal was rejected as undemocratic. Still, some 30 states and a dozen cities have made English their official language, showing not only intolerance to immigrants and international travelers but also a Pollyanna longing for the bygone days before globalization. (Cousins, Juanita)  It is truly scary that only 57% of Nashville voters weighed in against this “English First” proposal. Mayor Karl Dean said, “The results of this special election reaffirms Nashville’s identity as a welcoming and friendly city, and our ability to come together as a community,” but the nation’s largest Kurdish community must have felt more than a little terrified that the vote had been so close. If the economy continues on its downward trend and politicians look to scapegoat, immigrant communities around the States may be faced with similar nativist proposals. (Cousins, Juanita)

Already, immigrants and refugees throughout the nation are struggling to make ends meet. Always the most vulnerable community in any country, refugees arrive in the United States with about $450 of federal aid and a little temporary financial help from private agencies for 3 months. After that, they are on their own. While Nashville proposed English First legislation to help that city’s budget, Utah is answering the cries of low-income families in a different way. Beginning this month, Utah will provide recently arrived families rent subsidies for a period of 2 years. The money, drawn from unspent federal welfare reserves, will mean a world of difference for refugees living with the heat off this winter. Utah will disburse this money through refugee aid organizations like International Rescue Committee and Catholic Community Services. Utah’s compassionate new legislation will mean a world of difference for 1,000 new refugees each year, but for the other 59,000 the United States accepted last year, 2009 looks bleak. (Eckholm, Erik)

An editorial in the New York Times yesterday detailed the horrors xenophobia and its self-defeating nature. According to the article, the American Cause spoke at the National Press Club in Washington, declaring that the GOP’s November defeats were due to Republicans being too soft on immigrants, rather than too harsh. The author points out anti-amnesty and anti-immigrant thinking like this cost House and Senate seats in 2006 and 2008. Xenophobes like Lou Barletta of Hazleton, PA, or former congressman J.D. Hayworth of Arizona both lost due to their harsh stance toward immigrants and diversity. (New York Times) After Latinos’ huge showing in the polls this past election, this author correctly states that any political party which bases its success on the exclusion of immigrants risks deserved irrelevance.

Historically, nativist groups have flourished in troubled times. The Know-Nothings came to power in the 1840s and 1850s on a platform of anti-Catholic and anti-immigrant policies. Their rise to power coincided with the disintegration of the 2-party system, the increasing resistance to slavery, and the influx of Irish immigrants. Similarly, the revival of the Klu Klux Klan in 1915 coincided with the Great Migration of Africa-Americans and low-income whites from the South to the North, as well as a large number of immigrants from southern and Eastern Europe. The influence of this anti-minority, nativist organization eventually faded, but not before Calvin Coolidge signed the Immigration Act of 1924 which limited immigrants based on their national origin (severely restricting Asian and Eastern European immigration). (http://www.historicaldocuments.com/ImmigrationActof1924.htm)

This latest economic situation could instigate the same. However, it also could be a time when the United States grows closer together, seeking to integrate the immigrants within its borders and to become a nation that lives up to its moral responsibility toward refugees. As bank accounts shrink and jobs disappear over the coming months, we must be vigilant to ensure that no one is scapegoated. We are truly all in this thing together.

* Editor’s Note: Monday night’s edition of “The O’Reilly Factor” declared war on the New York Times because of the editorial mentioned in this article.  Pointedly, Bill O’Reilly took offense at the editorial’s mention of his statement that the Times wanted “…to break down the white, Christian, male power structure, which you’re a part, and so am I, and they want to bring in millions of foreign nationals to basically break down the structure that we have.”  Hurrah for such an article, Editorial Director Andrew Rosenthal.

Castle Clinton, Then and Now

Last week, I heard the best compliment about the United States. Two LLM international law students from Ghana were talking about their lasting impressions of the United States and the University of Minnesota Law School, respectively. Unlike Europe, they both said, no one in the U.S. has ever asked them when they were going to leave.

This could be written off as merely overblown American pride. But it could also be the expression of something much deeper, much more important. Perhaps Brihan and Peter have never been asked about their exit because it is assumed they are here to stay and succeed, like so many other immigrants before them. And although the melting pot is a flawed metaphor, the beauty is that everyone is accepted because everyone is assumed to be striving for the same acceptance, same success, the same happiness.

Yesterday I found myself at Castle Clinton in Battery Park of New York City. Standing inside the circular battlements first designed to ward of the British in the War of 1812, I thought of the new welcome people receive coming to our shores. Since the World Trade Center towers fell just a few blocks from here, America has doubled its Border Patrol agents, tripled its budget, and is spending millions deporting some 250,000 extralegal immigrants every year (http://visalawcanada.blogspot.com/2008/10/interesting-perspective-on-canada-us.html). Lines lengthen on our northern border and nativism heightens on our southern boundary in the form of a border wall. Gone are the orange cones between Vermont and Canada which once designated the border and represented our mutual trust.

In 2001, Tom Ridge was instrumental in passing the Smart Accords, border security measures which simultaneously attempted to curb criminal activity on the border while expediting legitimate economic activity. The idea was to “manage risk” by submitting questionable vehicles to lengthy inspection while speeding daily commuters through on their weekday drive from Detroit to Windsor. Canada even went so far as offering the United States a section of Canadian ground for pre-clearance facilities, to cut down on border wait times. The U.S. government, however, pushed for full sovereignty on Canadian soil, and so this Smart Accords measure has stalled.

Our nation’s economic recession changes nothing in the way of its pull for immigrants. While Americans may feel that the “economic crisis” is being borne hardest by us, this is simply not the truth. Any look at international exchange rates or foreign papers will show the fear and downward plunge of foreign markets. No, this change in economy will not solve our immigration problems any more than a wall will. As Cardinal Roger Mahony of Los Angeles has stated, our country has posted both “Help Wanted” and “No Trespassing” signs – only one of which it is possible for us to change immediately (Heyer, Kristin http://www.americamagazine.org/content/article.cfm?article_id=11117). With hate crimes against Hispanics on the rise 25% since 2004, it is clear that the xenophobia behind the protectionist anti-immigrant sentiments is alive and well. May we learn to welcome the stranger among us.

It is clear that our current frenzy of border security measures has only rerouted undocumented immigration into more dangerous, tougher-to-enforce areas. While apprehensions in San Diego dropped by two-thirds from 1994-2000, the deaths have skied to more than 1,000 since the turn of the century(in contrast, 300 people died attempting to cross the Berlin Wall throughout its entire 28 years of operation). http://www.economist.com/displaystory.cfm?story_id=12332971)

As I turn around, taking in Castle Clinton and the unique view of Ellis Island from its stone archway, I think of the 8 million immigrants who came here before it closed its doors in 1890. My ancestors received basic healthcare exams and a brief orientation within these walls before they were set loose on the Pennsylvania coal mines.

New York is a microcosm of American immigration. Walking its streets once again, I am struck by how seamlessly ambassadors from a veritable league of nations pass each other on the busy avenues. In a quiet Midtown café this morning, the barista saw pesos in my hand as I scrambled to make change. “Could I have that to add to my collection?” And in a simple transaction at a café counter between a Minnesota law student and a Kansas-New Yorker, I am reminded how welcoming and curious we Americans truly are. Hopefully our immigrant policies will reflect that in the next presidency.