V.B. Undocumented Migrant Children’s Health and Well-Being The combination of precarious immigration status and financial hardship often has serious effects on migrants’ physical and mental health, often resulting in chronic conditions such as asthma, migraines and depression. A Jamaican mother in the U.K. explains how her immigration status affects her: “Mentally, it’s really bad. We’re just sitting here, staring, wondering where the next meal is going to come from, when the next bill is going to be paid.” The precarious situation, in which many of the interviewees live, has often meant that any change in their situation or negative experience easily lead to a downward spiral. Talking about her father’s funeral in Jamaica, one mother in the U.K. said: “Everyone was like going over, I couldn’t go… my sisters, brothers, they all went over. I was the only child that wasn’t there. I couldn’t eat, couldn’t do nothing.” In the U.S., one interviewee noted: Many parents escaped wars and civil unrest, children experience the effects of family separation and feel abandoned by their parents. Undocumented status contributes to this trauma; people change names very often and the feeling of constantly hiding does not help build a better life in the U.S. A common theme was that interviewees saw a strong connection between their chronic physical ailments and their emotional/psychological stresses. Signs of stress, exhaustion, anxiety and other impacts on health due to financial and immigration status insecurities could be detected in most interviews. The majority of the interviewees that explicitly talked about their mental health problems were parents and a number of them were being treated with either or both anti-depressants and counseling. Reasons given for feeling depressed or “low” included fear of being deported or detained, not knowing what will happen in both the near and the distant future, not being able to talk about their problems, losing support networks or not having any in the first instance thus feeling lonely and isolated and in inadequate accommodation arrangements. Of particular concern was the well-being of children who had experienced detention and deportation. In the U.S., parents, children and stakeholders raised issues related to gang violence, domestic violence and teenage pregnancy as public health concerns that affected the entire community. Obesity is also a problem that affects children of unauthorized parents, as it does many young Americans. The differences in the U.S. and U.K. healthcare systems were apparent in the access of children to primary care. Most of those interviewed in the U.K. were registered with a GP and able to access primary care. Where parents were interviewed, this applied to both parents and children. Children who were born in the U.K. were usually referred to a GP by hospital staff and registered with their birth certificate without problems. Migrant children who were in the U.K. with their family were more likely to be registered with a GP and felt that going to the GP was normal and safe. Independent minors were more likely to feel apprehensive about going to a GP, or they would not even try to register. Several mothers made a distinction when accessing healthcare for adults and for children under 16 (“under-16s”), which they felt was much easier. Furthermore, many thought that for children under 10
16, health care was automatically free, whereas they were not always clear about the adults’ entitlements to healthcare. Although the initial picture that emerged looked positive in terms of access to primary healthcare, it is important to look at how and which GPs were accessed. In the majority of cases, individuals registered very soon after their arrival in the U.K. while having some form of residence status, either as a visitor, a student or an asylum-seeker. A number of interviewees were not able to register with the first GP they approached, and it often took several attempts with different GPs before registration was successful. Once registered, interviewees tended to remain with the same GP, regardless of changes in their situation, such as moving to a different area. This would usually mean long travel times to get to the GP, further complicating access to healthcare. Retaining the same GP was often a conscious decision because they were worried they would not be able to re-register with a new GP. Overall, migrants in the U.K. seemed to have good relationships with their GPs. Sometimes the relationships were so good and trustworthy that interviewees openly discussed their immigration situation with the GP, who became the first port of call for advice. Several interviewees told us that their GPs had written letters of support to the Home Office. The main problem reported around accessing and receiving good healthcare by interviewees were issues around language. Such problems could be particularly distressing in emergencies. Problems in describing and explaining one’s health needs were common and often resulted in confusion. Arranging for an interpreter remained complicated (Gill et al., 2011). Some resorted to seeking help from a friend to interpret, and, in some instances, children interpreted for the parents. A number of interviewees were also able to find health professionals that spoke their native language. Furthermore, many preferred to speak English to their physicians to practice the language and said that that staff were mostly patient with them if they had difficulties expressing themselves. However, if the illness was serious, an interpreter would commonly be requested. In the U.S., no system of healthcare corresponds to what is available in Britain. As discussed above, the U.S. citizen children interviewed are eligible for CHIPS and Medicaid. Access for the undocumented children depends on whether the parents have employer-provided private health insurance. Few employers of low-wage workers offer such coverage to their employees. As a result, levels of uninsurance are extremely high among immigrant families in general and undocumented in particular. A 2004 study found that 51 per cent of recent immigrants (those in the U.S. for less than six years) were uninsured, as compared to 15 per cent of natives.10 For unauthorized children in the D.C., Maryland and Virginia areas, there are some options for free healthcare. For example, Mary’s Center in Columbia Heights has a health clinic that vows to assist patients regardless of their ability to pay. In Virginia and Maryland, there are similar programs, such as the Arlandria Clinic and the Arlington Free Clinic,
http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&pageid=44857