Prescription for Disaster
One family's experience illustrates the problem of access to health and mental health care for children of immigrants nationwide.
By Susan Donaldson James
Five-year-old Anthony Tajiboy waited for the school crossing guard to raise a stop sign at the busy intersection in Trenton, New Jersey, one warm May day in 2001. He was just steps ahead of his mother as she turned to clutch the hand of his 10-year-old sister, Yohana, who was lagging behind.
No one saw the car coming. It careened into Anthony, tossing his little body 40 feet, crushing his arm and twisting and shattering the femur bone in his leg. The driver--a 40-year-old "American woman"--received only a ticket for failing to stop, according to Anthony's father, Salvador Tajiboy, a soft-spoken Guatemalan who refinishes furniture to support his wife and four children. "For the police, the accident wasn't a big deal," he says, "but it was the hardest day of my life."
After a four-day hospital stay, Anthony returned home in a wheelchair with a cast on his arm and a metal pin in his leg. But the little boy's emotional wounds went untreated. Until only recently, he couldn't sleep alone in his bedroom, and he awoke crying every night with frightening dreams.
The family never sought help for their little boy. It wasn't a question of money--Anthony is U.S.-born and entitled to the full range of Medicaid benefits, including counseling--but for the last 14 years, his parents have been undocumented immigrants. Every encounter with police, hospitals, and other authorities poses a risk their invisible lives will be exposed.
"I felt powerless and hidden--not able to talk, to express myself freely," Tajiboy explained in Spanish, as a friend and his U.S.-born children translated. "It is better to not say anything."
Coping with More Stress, Less Help
Government data released in January 2006 shows Hispanics are falling further behind in receiving quality medical care in areas like mental health. Half of all immigrant children live with families with incomes below the national poverty level, and nearly all are uninsured. Their lives are fraught with emotional distress, yet few have access to mental health care.
The Urban Institute, in Washington, DC, estimates some 12 million undocumented immigrants live in the United States. As many as 500,000 live in New Jersey, home to the fifth largest immigrant population in the nation, according to Seton Hall University's Study on Migration and Work.
Like the Tajiboys, about 85% of all immigrant families have mixed legal status. The New Jersey Immigration Policy Network says undocumented parents rarely take advantage of Medicaid benefits for their U.S.-born children because they don't know their rights or are afraid to confront authorities. They fear deportation, having to repay costs, or jeopardizing family members who are noncitizens.
Anthony, now 10, and his two younger siblings qualify for programs like Medicaid, but 15-year-old Yohana, who was born in Guatemala, does not. Immigration advocates say parents are confused by eligibility rules and hesitate to ask questions. When families do seek help, agencies often lack bilingual services.
"The disparity between citizens and immigrants is alarming," researcher Helene Tobin wrote in a report about New Jersey's Immigration Policy Network Access Project, adding that many families deal with depression, anxiety, and separation issues.
Established in 1965, Medicaid was one of many sweeping initiatives under President Lyndon Johnson's War on Poverty. Today, the federally funded program, which is administered by the states, serves 53 million Americans. Nearly half are uninsured children of working parents.
The 1996 welfare reform law, signed by President Bill Clinton, restricted access to Medicaid, however, barring undocumented immigrants from benefits. Under new regulations for eligibility, only Anthony and his U.S.-born siblings are entitled to assistance. Their older sister and parents are not. Only "qualified aliens"--those with green cards; political refugees, such as Cubans and Haitians; asylum seekers; and women and children who have been battered by citizens or lawful residents--are allowed benefits.
Although Medicaid technically covers children who are U.S. citizens, fewer New Jersey agencies are accepting those patients, according to family therapist Maryanne Corica. Until last year, she treated patients at Family and Children's Services in Hightstown, New Jersey, which dropped Medicaid because it only reimbursed service providers $26 a visit. Typically, psychologists charge $90-$150 for one session. Those agencies still accepting Medicaid, such as Catholic Charities, have long waiting lists.
"The mental health issues that are most prevalent for kids we see are anxiety, depression, self-inflicted violence, and trauma from physical or sexual abuse," says Corica, who now works in private practice. "So on top of these issues, add in financial struggle and no insurance, and a family is intensely stressed."
Undocumented immigrants earn low wages as laborers, factory workers, maids, and janitors, jobs where health benefits can be scarce. When employers do offer insurance, the premiums are high. With poverty, mental health professionals say, comes stress. Families often live in crowded apartments, sharing with friends and relatives. Children are enrolled in school but often miss class to help working parents with siblings; many drop out at 16 to earn money.
The Tajiboys have depended on an underground network of other immigrants to help them manage their lives and keep their legal status hidden from authorities. Like others, they cannot drive and rely on the kindness of friends to transport them to work or to the doctor. Salvador works at an antique store; his wife, Rumalda, cleans houses. Their combined yearly income is about $24,000, just below the national poverty level of $25,210 for a family of six. But they manage.
After Anthony's accident, the driver's insurance company paid the medical bills for the hospital stay. But the family has paid cash for subsequent weekly doctor visits and physical therapy, which have helped Anthony's leg recover. The follow-up care will continue until he is 18.
The Journey to New Jersey
Salvador and Rumalda Tajiboy began their journey in 1992 in Guatemala, a Central American country wracked by a 36-year guerrilla war that resulted in 1 million refugees and the deaths of more than 100,000 people.
"We were very poor, and it was a struggle to survive," Salvador says. "The economic situation was bad, and because of the guerrillas, we were always afraid."
The journey to the United States was worth the risk. The couple borrowed $8,000 to pay a "coyote" to smuggle them across the Mexican border into Arizona. Their infant daughter Yohana was left in the care of her grandmother, where she would remain for nearly eight years. The trek on foot through the Mexican mountains was frightening. After the arduous crossing, they were left in the desert for four days without food and water, believing they would die.
The coyote eventually returned with burritos and water, but they learned very quickly not to trust anyone. One year later, after their arrival in New Jersey, the couple gave a lawyer thousands of dollars to help them legalize their status as asylum seekers. He ran off with their money. "After a while, we just gave up," Salvador recalls.
By the mid-1990s, employment was plentiful in the central New Jersey suburbs--a high-end housing boom raised the demand for landscapers, roofers, cleaners, and maids. Salvador found a job where he could use his skills as a carpenter; Rumalda worked as a cleaner. After sharing accommodations for years with friends, the couple eventually could afford to rent on their own--a neat, clapboard row house in Chambersburg, a traditional Italian neighborhood in the state capital of Trenton.
Life improved. Anthony was born in 1996, and in 2000, Yohana joined the family in New Jersey. "We thought she would be better off here," said Tajiboy. "But my daughter would cry, because she did not recognize me." Soon came Jessica, now 5, and then James, 3.
Living in Legal Limbo
For the first few years after the accident, Anthony's parents could still see the trauma in his soft brown eyes. The little boy who used to outrun his playmates was easily discouraged when he tired after 30 minutes and couldn't keep up--one of his legs is an inch shorter than the other. But soon, the bad dreams subsided--until a new nightmare began.
On a dark morning in 2004, the family was awakened at 5:00 by a loud banging at the door--10 armed federal agents from U.S. Immigration and Customs Enforcement raided the home, taking Anthony's father and two family friends into custody. The officers were looking for someone else, but when they discovered Salvador had no papers, they arrested him and threatened him with deportation.
After September 11, 2001, the U.S. Department of Homeland Security launched a federal crackdown to find foreign nationals with outstanding deportation warrants. In 2005 alone, more than 157,000 immigrants were deported nationwide.
Rochelle Portalatin, a bilingual therapist, says separations--both when immigrant parents leave their children behind, as well as when a parent is deported--leave children with psychological scars. For Latinos, "family is everything," Portalatin says, and traumatized children like Anthony have no place to turn.
"A lot of these kids whittle their time and do the best they can, and some go to counselors at school," Portalatin says. "But children are put at risk, and it's a complicated grief process."
Portalatin has seen a lot of major depression in children. One teenager in particular came to the United States with his parents when he was a little boy and was left with his grandmother in the country. The boy eventually reunited with his mother, but it wasn't until he lost a friend in a car accident that all the issues surrounding the early separation from his parents began to reemerge in the form of nightmares, shaking, and uncontrollable crying.
"He couldn't understand his post-traumatic feelings," Portalatin recalls. "But it all went back to the old experiences of loss with his mother."
Her patient did well in therapy, but the mother, who relied on him to babysit younger siblings, pulled him out because it was too expensive. "You cannot do the therapy until these families have food, clothing, a house to live in, and all the bills are paid," Portalatin says.
The consequence of not providing mental health services to families "means they'll get access when they're sicker," she says. "All these things play havoc on kids."
A maze of legislation since 1986 has not halted the waves of immigration, particularly in gateway states like New Jersey. Despite increased border patrols and the presence of controversial vigilante groups like the Minutemen, illegal immigration is up 23%, about 485,000 a year since 2000, according to the Center for Migration and Immigration Studies at Princeton University.
In December 2005, the U.S. House of Representatives passed a sweeping enforcement bill to reduce the illegal immigrant population, dropping many proimmigration provisions, despite objections from business groups and immigration advocates. The turbulent, anti-immigrant atmosphere in America leaves families like the Tajiboys in a state of psychological and legal limbo.
"There's a lot of pain centered on their legal status," says immigration lawyer Ryan Lilienthal. "It's logical to argue they entered illegally. But what is the smartest way to approach this if you want them to be beneficial U.S. citizens? Call them criminals and deport them all? For every 100 deported, 95% will come back."
Feeling Less Afraid
Just three weeks before Salvador's immigration hearing, the family rested in their Trenton home. They were hoping their plea for asylum would allow them to stay in the United States. Rumalda was not charged, but Salvador decided the whole family would return to Guatemala if he were deported, even if Anthony could not continue the physical therapy that had been so successful.
Torrential rain slapped against the windows of their row house, but the living room was warm and inviting. Anthony and Jessica draped themselves across their father's lap on the sofa, as Yohana sat nearby on the floor at her mother's knee. James slid up and down the carpeted stairs, pretending he was Spider Man. Family photos crowded the mantel of the boarded-up fireplace. Towering over the display was the largest framed picture of all--the imposing skyline of Manhattan.
"When I was in Guatemala, I heard this was a just country and a place of opportunity," Salvador said through a translator. "Everybody seems free here, and there's an opportunity to work. I pay my taxes, but I have to ask favors to get my son to the hospital. I see so many broken-up families--it's an injustice, but I still believe in this country."
Salvador appeared in immigration court in May 2005 for a decision on his deportation. The judge approved a "cancellation of removal," meaning Salvador could have his green card and apply for citizenship after a five-year waiting period. Most cases do not have such a happy ending.
"For the first time in my 20 years of practicing before the immigration court, the district counsel has recommended to the judge that he be granted relief," said Tajiboy's lawyer Steve Traylor.
Today, Anthony is less afraid. He is doing well in his fifth-grade studies and just moved back into his own bedroom to sleep at night. The doctor says he can begin to play a little soccer in the spring. Rumalda and Yohana still have no documentation, but Traylor is optimistic about Salvador's petition to the court to grant them legal status. "The government could go after them," he said, "but I doubt it."
For Salvador Tajiboy, the hardest part of the ordeal was not having a voice. "I live with the injustice," he says. "But after Anthony's accident, my plans and dreams disappeared. I feel worthless, because I can't help my children."
Susan Donaldson James is a freelance writer in New Jersey.
What do you think?
Although this article focuses on the experiences of one family in one state, families nationwide face similar obstacles obtaining health and mental health care for their children. Children's Voice invites readers to share their experiences--both challenges and successes--serving families in other states and communities. Those accepted for publication will appear in Readers Write (letters to the editor) or in one of the Voice's other regular departments, such as Agency Briefs or State of the States. Submissions are subject to review and available space, and submission does not guarantee publication. Send submissions to firstname.lastname@example.org.
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