HEALTH CARE/Joan Retsinas

Immigrants Behind Our Health

So many dark faces! So many languages! Such odd customs! So many people who exude “foreign.” Behind the “debate” – a kind euphemism – over immigration, is a xenophobic hysteria. What is the country coming to? What is the future if we admit everyone eager to come?

Let me be clear: the future is here. Consider health care. Without the stream of immigrants, we all – those whose ancestors arrived on the Mayflower, those whose ancestors arrived here one, two, three generations ago, arriving on slave ships, on shaky boats, on planes, those lured into indentured servitude, those fleeing persecution, those who persecuted – would be worse off.

I propose a fact-finding trip for the legislators hysterical about “them.” Not a trek through glamorous lands, but a trek through Health Care America.

Start with nursing homes. Talk to the people who make the meals, clean the bedpans, do the laundry, feed the patients, and take them to the toilet. We call these staff “low-skilled,” though they generally rank high in strength, persistence, and kindness. A lot – in some facilities, more than half – were born elsewhere, mostly in Latin America. Some are here legally; some, illegally; some came legally, but overstayed their temporary visas. If we instantly deported all these people – a variation of the movie, “A World Without Mexicans” – patients would suffer. Although the nativist legislators might accuse low-skilled, high-persistence foreign workers of taking jobs from our own home-grown pool of low-skill workers, there is no indication that millions of high school graduates (including drop-outs) would rush to work in nursing homes, or that nursing homes would want them.

Now talk to the nurses. Roughly one in five nurses here were born outside our borders; the percentage is higher in nursing homes. Go on to hospitals. Again, talk to nurses – you will talk to more than a few hailing from Asia. Talk to the human resources staff: some hospitals explicitly recruit foreign-trained nurses. Our health care facilities need them. Although we train nurses in the United States, we do not train enough of them.

In hospitals, talk to the physicians. In health centers, talk to the physicians. In public health departments, talk to the physicians. Nationally, roughly one in five hails from elsewhere. As with nurses, we need them. A special visa is designed to encourage physicians to work in our nation’s underserved areas. And even in our most prestigious health care centers, foreign-born physicians fill vital roles. Indeed, once the Affordable Health Care Act takes effect, when more Americans will be entitled to see primary care physicians, we will need even more physicians. The Association of American Medical Colleges projects we will need more than 90,000 physicians by 2020. As with nurses, we train physicians here; we just do not train enough of them.

Finally, visit all the research labs where scientists – biochemists, biologists, physiologists, biophysicists, pharmacologists – are working to understand our bodies, to analyze our ailments, to develop treatments, vaccines, and drugs. More than half the people who hold PhDs in the sciences were born outside our borders. Increasingly, they come from Asia, especially China. Some came here after college, got their doctorates here. There is no indication that if we sent them home, made them forego their places in our universities, and opened those slots to native-born students, we would fill the empty seats. (In fact, we have failed to invest sufficiently in primary and secondary to graduate a wealth of students equipped for doctorate-level education. Those countries that are sending us their students have invested in education.)

We need bridges, not borders, to get the health care professionals our aging population will require.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, August 1, 2013

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