Medical Examiner

“They Keep Saying It’s Not Their Responsibility”

A doctor explains what happened when a group of physicians showed up at a border detention facility armed with flu shots.

Doctors in scrubs stand with various protest posters, including "No More Flu Deaths" and "No More Deaths"
Doctors protest in San Diego. Patrick McElhenney

Doctors at the border have tried to do one small thing: get the people in detention centers flu shots. This is clearly essential. Flu season is underway. In past months, three children have already died of flu in detention centers. One of those children was a 16-year-old Carlos Hernandez, whose death was the subject of a horrifying story on the conditions in these detention centers published by ProPublica earlier this month. The Centers for Disease Control and Prevention recommended in November that U.S. Customs and Border Protection offer vaccinations to people in detention centers, and members of a group called Doctors for Camp Closure even sent a letter early last month offering to provide and administer the shots for free, to no effect.

Earlier this week, doctors escalated the offer to take care of the shots, showing up at a facility in San Diego with protest signs, lab coats, and supplies. Instead of being let in, they were arrested. I spoke to Julie Sierra, a doctor in San Diego, who had to be at work during the protests but spent a few weeks leading up to it preparing supplies for it. Our conversation has been edited for length and clarity.

Shannon Palus: What supplies did you prepare to go to the detention center?

Julie Sierra: We had to get a mini-refrigerator, with a generator, to be able to keep the flu shots cold while they were out in front of the gates. We also had syringes, the needles, the gauze, the Band-Aids, gloves. If they were going to let us in, we had to be ready to go. We had consent forms, in multiple languages, and the sheets that the CDC gives to patients that we give in our clinic as well, that tells them all the information they need to know. We had all of that ready. And then they just kept saying no. They keep saying it’s not their responsibility.

It sounds like you are taking on the responsibility.

Yeah, exactly. We were offering them free flu vaccines and the licensed physicians to give them. All they had to do was say yes and open the doors. It wasn’t like we were asking them to do anything. They just keep saying, CBP has never done this before. They say they only have people in detention for 72 hours—people are in detention for much longer than that, pretty often. I feel like one of the main reasons they probably don’t want to let us in is they don’t want us to see for ourselves what it’s like in there.

Why is getting a flu shot to people in detention important?

These people, a lot of them start out in Tijuana because they’re being made to wait in Mexico. They’re in crowded conditions there. When they come through our border, that’s the only opportunity we have to vaccinate them. Especially if they’re going to be held for longer periods of time, in those conditions, it makes sense to vaccinate people as soon as possible. A lot of people are going to stay with their family members somewhere across the country. They’re being told you have to come back to San Diego for a court date—people at high risk for disease are flying back and forth across the country, and they’re putting not just themselves, but anybody they’re in contact with, at higher risk for the flu.

CBP says it’s not their responsibility, but their responsibility is to keep people in clean conditions, and not have them overcrowded, and not deny them soap and showers. All the things that they’re doing to make the risk of getting sick even higher than if they weren’t in detention—if you’re going to do this, at least let us help protect people.

What was the expectation of what would happen when the physicians showed up with all these supplies?

The CDC has already recommended that people be given these vaccines, and they ignored that. We were hoping that if a bunch of us showed up in white coats with free vaccinations, free staffing, whatever they need, they would maybe let us in. I don’t think any of us expected them to. It was our hope. We wanted to be ready in case they did.

But we’ve all seen the way that CBP treats people in detention. I take care of people who come out of the other side of detention centers and are sick because they’ve had their medications taken away from them. I’ve seen a lot of people who have had blood pressure medicine taken, diabetes medication, inhalers—I’ve seen a couple little kids who had their asthma inhalers taken away. It doesn’t surprise me at all that they’re not willing to take this action either. It’s intentionally being cruel to people.

Is there any conceivable medical reason to take someone’s medication away?

What they try to say is that they can’t be sure that what they’re taking is what they say it is. We’ve tried a couple tactics. If I see a patient in Tijuana who has high blood pressure and needs to stay on their medication, I will write them a note, and sign it, and put my license number, and say, “This patient needs this medication.” For all I know, they just ignore it.

The people that we see on the U.S. side as they’re coming out of detention, they all tell us the same stories about what conditions are like. It’s not like everybody can make up the same story. People have told us they’ve been given food that’s spoiled, or still frozen. They’re also sleeping on the floor. They’re keeping the rooms cold. They leave the lights on 24 hours a day. It’s a lot of things that they are doing on purpose to make people uncomfortable, but those things also increase the risk of getting sick. It’s not just about flu shots. It’s about treating people with medical conditions like the human beings that they are. It’s messed up.

It’s hard for me to hear you talk about it.

It’s really disturbing.

It seems like providing that basic health care goes against the entire premise of how they’re treating people here.

Exactly. The whole thing is totally preventable. It’s ridiculous to have children dying of the flu.