BDNH Storytelling Project: Fighting Housing Injustice and Detention Through Medical Advocacy
A Zine and Audio Story
Storyteller: Primary Care Physician, New York Public Hospital
Zine Art and Design: Karla Rosas
In this story — offered in both zine and audio formats — a primary care physician in New York shares a strategy she uses to advocate for patient care while organizing for housing equity and migrant justice.
This story is part of the Beyond Do No Harm Network’s Storytelling Media Project, which seeks to highlight and amplify the actions individual medical providers are already taking to interrupt criminalization in the context of care, in the hopes of increasing awareness of the harmful impacts of criminalization within the medical system and inspiring others to take action at multiple levels.
Check out the zine, audio, and audio transcript below!
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Fighting Housing Injustice and Detention Through Medical Advocacy
[00:00:00] I'm proud to work at a public hospital in New York City as a primary care doctor. Our days as PCPs are filled with trying to fit all the necessary things into short 20-minute chunks: catching up on the events of our patients' lives —like births, deaths, and moves— getting into the weeds of medication lists and lab results, investigating any new concerns, and gleaming in the joys of the work we get to do every day.
[00:00:47] It means loving our patients, holding them in their moments of grief in our clinical rooms, wanting to help our patients on their healing journeys, and, of course, maneuvering the chaos. I can tell you that often, when trying to do all of this, and trying to do it well, it can be hard to make time to talk about what is happening outside of the hospital, in the news, and how those things can affect our patients on an individual level. For me, reintegrating the two things has recentered me, my role, and the work I do as a PCP.
[00:01:24] This recentering came in the form of organizing for housing equity and immigration justice over the past few years. It's no secret that immigration enforcement has intensified nationally, and NYC is no different. Soundbite after soundbite, news clips, and Instagram reels are constantly popping up as sightings of ICE increase in our city, around our beloved communities, in our sacred spaces. I think about the removal of the Sensitive Locations Memo, which removed protections for folks in schools, hospitals, and religious spaces from ICE detention.
[00:02:01] For us as health care workers, there is the added layer of not being able to protect our patients, even within our clinics, from what exists on the outside. I have seen so many patients come into clinic visits carrying visceral and palpable fear.
[00:02:17] I remember one particular patient who, in our first visit together, would respond with one to two-word answers, looking at the ground throughout the visit. When I asked her through the Mandarin interpreter if she was okay, she broke down, tears rushing down her cheeks. She said she didn't know what was to come of her future in this country, that she didn't know what to do.
[00:02:42] I have sat with many patients describing, in tears, the worry, distress, and overwhelm they feel in their day-to-day lives. We've had patients who didn't come to clinic, and when we called for a telephone check-in, they would share their immense concern for their safety. In this context, I was honestly feeling desperate to find ways to advocate for my patients within clinical visits, and hoping to get tools to our hospital system, where so many of our patients were facing the same threats.
[00:03:13] To tell you about how we advocated for our patients, we have to go back a bit. I began my organizing work in the housing justice space in 2023. At that time, there were more folks newly arriving to New York City from the Southern Border, often having been bussed up by hostile officials from states where they first landed in the US, without any support, and sometimes without having planned to come to our city.
[00:03:45] City administrators had created a separate shelter system for these communities in which they were required to move every month or two to another shelter, unless they had a medical reason to stay in place. I want you to imagine this: arriving to a new city, receiving a room placement in a hotel shelter, and, at the same time, receiving a deadline of when you need to move.
[00:04:11] If you have children, they begin going to school near you, and you establish health care with a local clinic. Then, a mere 30 days later, you may have to move to a different shelter that could be in a completely different neighborhood and setting, unless you have the obvious medical reasons to remain in the same shelter.
[00:04:33] All of what you have built on unstable foundations now becomes that much harder to hold onto. Imagine that in 30 more days, the same thing happens again. In this way, folks were never given the opportunity to build stable roots. The correlation between health and housing stability is no secret, and this system was making things worse.
[00:04:58] What I realized was that the medical voice held power in this system, and that our support and advocacy of our patients mattered and had the ability to help our patients maintain consistency in their care. This is what led me to create a template letter dedicated to summarizing a patient's medical needs, and, based on those needs, advocating for continued shelter in the same place.
[00:05:25] We started using this template letter across the department and hospital and saw very real results of patients being able to remain in place for longer, sometimes multiple months longer, and therefore continue to get care as they navigate all the other challenges of adjusting to life here. Now, let's fast forward to how this paved the way for advocacy against increasing ICE presence.
[00:05:53] I leaned heavily on the expertise of local legal, mutual aid, and community organizations committed to directly impacted folks, to build the resources that we continue to use. One of the major parts of this effort was a template letter focused on advocating for medical necessity. In essence, these letters are meant to highlight all of the essential pieces of a patient's medical care — essential medications, appointments, procedures, and to also emphasize that if any of those needs are not met, then there would be a direct and clear connection to the worsening of a patient's health, and to potentially more severe consequences — even death.
[00:06:38] We utilize the letter to advocate against ICE detention or deportation, both for patients who are at high risk of detention, for instance, folks who have been in the country less than two years, and for patients who have severe chronic disease.
[00:06:55] I've unfortunately learned a few times now that a patient within our clinic system has been detained in an ICE facility. Interacting with those facilities, even with the medical providers in those facilities, as medical providers ourselves, is still challenging. Often, we are cut short and interrupted when we relay medical information and told that our recommendations will not be followed within the facility.
[00:07:21] In those instances, having this letter drafted and wording prepared has made it easier to emphasize our medical recommendations and voice our concerns about the risk of medical neglect. The other things we provide our patients in clinical visits now are what are called "red cards" from the Immigrant Defense Project, which are pocket-sized cards in the patient's preferred language that list their specific rights, including the right to privacy and the right to remain silent.
[00:07:51] There are a number of cases in which an individual has shown the red card to ICE officers, and it helped them avoid detention. Now, as I'm thinking about the next evolution of medical letters, we are focusing our efforts on how to advocate for virtual instead of in-person immigration hearings for our patients, based on their underlying medical needs. In this way, we have focused our energies on wielding our health care voice to advocate specifically and urgently for our patients' medical needs in the face of threats of detention.
[00:08:27] These efforts wouldn't be possible without collaborating with legal and community-based organizations. I hope that in hearing this story, more providers consider exploring partnerships with local organizations and consider being innovative in the ways we can advocate for patient safety within our own clinic visits. Our voices can be powerful in the fight for justice.
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How might your approach to care change if you were approaching migrant justice and housing justice not as separate issues, but as intertwined realities impacting health and safety?
Where do you feel tension between what you are expected to do, and what care is required?
What kinds of support would help you act with similar courage and care? Who would you need to be in relationship with, and why?
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Karla Rosas (she/they/ella/e) is an undocumented visual artist from Mexico. Her illustrations have been commissioned for various projects, including collaborations with the Center for Cultural Power, United We Dream, the L.A. Times' "Latinx Files," and Define American. Karla lives in New Orleans. Learn more about her and explore her work here.
