CIUDAD JUÁREZ – At Clínica Hope, Luz swept a hand through the brown curls of her 1-year-old son José, who sat on her lap wearing a baby blue onesie and clutching a cracker. While José was entertained by a game of peek-a-boo, Luz explained her concern to the medical staff. Her little boy had been up all night with an upset stomach and had diarrhea.

She left the doctors’ office with a bottle of a guava-flavored electrolyte drink for rehydration and the advice to return if he didn’t get better.

Baby José is one of more than 115 patients who’ve received medical attention at the weekend clinic inside Leona Vicario, the federally run migrant shelter in Ciudad Juárez. El Paso-based organization Hope Border Institute opened the volunteer-run practice, led by Dr. Brian Elmore of El Paso, in October. The clinic provides basic health care and free medication.

To service those who’ve crossed the border, another humanitarian organization, Doctors of the World, set up a health clinic in one of El Paso’s migrant shelters in December. Doctors and medical students from Texas Tech University Health Sciences Center El Paso volunteer at the clinic. In the next academic year the university plans to offer the program as an elective for fourth-year medical students and rotation for residents.

Together they address a myriad health issues, from the common cold to more serious conditions that require a hospital referral. Migrants may leave their home countries with untreated diseases, while others become injured or sick during their journey. They are also vulnerable to the spread of illness while staying in close proximity to other people in temporary shelters.

The shelter in Juárez is noisy and crowded, but that’s better than being out in the cold, Luz said. 

She and her family arrived in mid-January, after a long and winding path from Venezuela. They planned to go to New York, but came to a halt in Juárez because U.S. border agents are using Title 42 to turn back many migrants and asylum seekers.

The Border Network for Human Rights and other groups have criticized the Trump and Biden administrations for using the public health policy – meant for containing the COVID-19 pandemic – as a border enforcement tool.

Policy analysts expect Title 42 to lift on May 11, when President Joe Biden plans to end the COVID-19 public health emergency. But the Biden administration recently announced a new rule that migrants would be ineligible for asylum unless they can prove they were denied safe refuge in Mexico or another country. Immigration advocates say this will only push people to take more dangerous canals into the United States.

Inside El Paso migrant health clinic

It was a subdued January night at an Annunciation House shelter in El Paso’s Lower Valley, punctuated by the sound of music playing from a cell phone and parents putting their children to bed in their cots. A dozen or more people were spending the night there. 

Downstairs, the basement turns into a health clinic from 5 to 10 p.m. every Tuesday. Some nights, the seats are full of patients waiting for their turn at the doctor’s office, which is set up in the corner with plywood walls and curtain sheets for privacy. 

Other nights there are more doctors and medical students than patients, but with the cyclical rise and fall of border crossings, volunteers feel it’s better to be prepared. 

Annunciation House, a volunteer organization, works with the Catholic Diocese of El Paso to provide meals and temporary housing for immigrants and refugees. Texas Tech University Health Sciences Center El Paso runs a health clinic from one of those shelters, while national nonprofit Doctors of the World provides medical equipment and funding.

The collaborative effort points to one of many ways the El Paso community pools resources to aid migrants. 

When border agents process migrants, they throw away their personal belongings, which can include medication, before releasing them into the community. Even for migrants with sponsors, it could take several days before they secure transportation out of El Paso and onto their intended destination.

“It’s important we’re in the hospitality centers,” said Dr. José Manuel de la Rosa, who acts as community liaison for TTUHSC El Paso. “Their first contact with anybody in the United States is a law enforcement person. They’re greeted by somebody who is going to detain them. The obligation is not to be friendly, it’s to get them processed.” 

One of the patients he saw that night was a teenager who had spent the last month journeying from Ecuador with her mother, who asked that their names not be published. The teen’s throat had been hurting for two weeks and she was coughing up phlegm, her mother said while her daughter underwent a checkup. 

“I feel terrible, how all mothers feel when their child is sick,” she said.

Dr. Glenn Fennelly, chair of pediatrics at TTUHSC El Paso, hopes that by identifying acute health concerns that can be treated at the clinic, his team can reduce the number of unnecessary referrals to the emergency room. 

Fennelly said some of the most common complaints include the physical aches and pains that come from traveling a long distance, as well as symptoms of respiratory illness such as cough, sore throat and runny nose. Patients also come in with chronic conditions – asthma, high blood pressure, diabetes – and need a prescription for their medication that Border Patrol confiscated. 

Doctors send prescriptions to a nearby pharmacy to fill, and then a volunteer goes to pick it up. Data collection is also an important aspect so when patients pass through El Paso, they can access any diagnosis or assessment later in their journey, usually via cell phone, Fennelly added.

The clinic has seen about 80 patients so far. Fennelly, who serves as president on the board of Doctors of the World, would like to expand their practice to two more clinics in El Paso. Doctors of the World provided $250,000 in start-up funds and is actively raising money to sustain the program long term, said a TTUHSC El Paso spokesperson.

The practice also doubles as training for medical students. Fabiola Ramirez, a second-year medical student, grew up in El Paso and has been volunteering at the clinic since it opened. At the time, the El Paso-Juárez border saw a record number of arrivals and thousands of migrants were released in the streets.

“This is a bicultural, binational city,” Ramirez said. “Growing up, I was used to the influx of people from Juárez, Mexico, coming across, and both ways. For me that was just the natural flow of people back and forth. But I had never truly experienced an influx like this from other countries.”

A memory that touches her the most was being with a patient for her first ultrasound. The patient learned she was pregnant during her journey, which included a roadless stretch of mountainous rainforest called the Darién Gap.

Ramirez hasn’t picked her medical specialty yet, but the experience at the clinic has made her interested in policy. After seeing the real-life context of the challenges and injustices that migrants face, she wants to continue advocating for vulnerable people. 

A morning at Clínica Hope, migrant health clinic in Juárez

On the other side of the border in central Juárez, the line at Clínica Hope was short but steady on a January afternoon as people trickled in and out of the waiting room.

La migración no es un placer, sino una necesidad ineludible y entonces un derecho, reads a print-out on the wall, a quote attributed to Roman Catholic saint Beato Juan Bautista Scalabrini. “Migration is not a pleasure but an unavoidable necessity.”

Most of the patients the clinic has seen are from Mexico, Venezuela, Honduras, Guatemala and El Salvador. 

One of them that day was a Venezuelan man who traveled alone. His bus crashed in Arriaga, about 150 miles north of Tapachula, a Mexican city near the border of Guatemala and a common crossing point for migrants.

The bus was en route to Mexico City, but in the middle of the night it rolled off the road and caught on fire. He managed to climb out and make his way to a health clinic in Mexico to treat his injuries. He has nerve damage, he said, tracing his bandaged forearm with a finger tip. His pinky and ring finger can’t feel anything.

But he would rather experience the crash again than go back to Caracas, where colectivos – paramilitary groups that support President Nicolás Maduro – tried to recruit him a few years prior. They threatened to kill his family, but fortunately his son has left Venezuela already, he said.

He came to Clínica Hope to get his arm checked and for new bandages. The clinic opens every Saturday and Sunday from about 8 a.m. to 1 p.m. 

The Leona Vicario shelter recently had a chicken pox outbreak, so the clinic has been monitoring numbers, said Mayte Elizalde, a representative for Hope Border Institute. The shelter isolated people who were infected and Clínica Hope is prepared to assist with vaccines, if called on, she said.

With people living in close conditions at Leona Vicario, they tend to get similar diseases, said volunteer Dr. Manuela Garcia, who’s doing her residency in family medicine in El Paso. During the winter that tends to the typical colds and flus.

One way the clinic is able to treat people quickly is by having its own pharmacy on site stocked with common supplies, so volunteers are able to prescribe medication and immediately grab it off the shelf, Garcia said. 

The clinic does have more limitations in resources than she’s used to in El Paso. Where she works, staff can easily order lab tests and conduct medical imaging of a patient’s body interior. Clínica Hope volunteers rely on a physical exam alongside their patient’s symptoms and medical history.

Since the staff only volunteers on the weekends, they also don’t see their patients again until the following week, Garcia said. Leona Vicario does have doctors that come in during the week, separate from Clínica Hope. It can be challenging trying to connect the two systems, ensuring everything is documented without gap and they don’t duplicate care, she said. 

The prolonging of Title 42 placed a strain on the shelter, and it can also be difficult to make sure they’re staffed with enough volunteers on Sundays, added Valerie Sanchez, a first year medical student. If they had more volunteers, they would be able to see more patients, she said.

Dr. Ming Lin, who’s been practicing for more than 30 years, flew in from New York to volunteer in January. One of the patients he saw was a man from Nicaragua with chest pains. As he pressed a stethoscope against the patient’s back, he asked the early-career volunteers what might be life-threatening reasons for chest pain without shortness of breath.

Like the migrant health clinic in El Paso, Clínica Hope is also a learning experience and opportunity for medical students to get hands-on experience. Lin learned about the clinic through the media, and felt motivated to join the effort.

“I think just being an immigrant myself when I was a kid, you kind of realize the hardship,” Lin said. “Then you read about everything that people are going through trying to cross the border, and I can help.”