The battle against the coronavirus has been strained by shortages of ventilators, gloves and N95 masks, but hospitals are also scrambling to keep enough medical staff in place to deal with the surges of patients. Experts say immigrants are helping to fill this need and could play a bigger role if some of the obstacles they face are removed — from long and costly licensing processes to acceptance and even respect.
For the past three years, 33-year-old Jossania Dutra has been working as a nurse assistant at the Beth Israel Deaconess Medical Center in Boston. She trained as a registered nurse in her native Brazil and came to the United States five years ago to reunite with her mother.
She said her ward was originally a vascular treatment unit, but several weeks ago it became a COVID-19 unit.
"My whole floor is an ICU," she said.
The hospital is providing its staff with personal protective equipment, but like elsewhere in the country, there is a shortage, so Dutra is reusing the gear.
"I fear getting contaminated when handling the dirty gear after a shift," she said. But Dutra is committed to nursing, adding, "I love my job, even though it's a big risk right now."
All her patients are intubated, but Dutra can't allow negative thoughts into her head before heading to work.
"All I think of is to do my best for the day and the next day I repeat the thought," she said.
Then there is the issue of "otherness."
"If you're an immigrant or have a different skin color or an accent, some feel they have a license to question or judge whether I can do a good job," she said. "I'm making huge contributions right now, taking care of COVID-19 patients. We immigrants are the ones putting our lives in the frontlines. It shouldn't be about race, it should be about the work we do."
A collective epiphany
For the last three years, Dutra has been working with the Welcome Back Initiative to become a registered nurse in the U.S. The group helps foreign-trained health care workers, like Dutra, with the licensing process. She's spent several thousand dollars in fees and other related expenses such as English classes and testing. Becoming a registered nurse will mean more responsibility and higher pay, "and hopefully more professional respect," said Dutra.
"I hope we have a collective epiphany," said José Ramón Fernández-Peña, director of the Welcome Back Initiative. "This is the time for the country to see what a treasure it has in immigrant communities."
The group started 19 years ago in San Francisco and now operates 10 centers around the country. It has worked with about 18,000 professionals from 167 countries.
"Often the basic assumption is you were trained poorly because you were not trained here," said Fernández-Peña, who practiced as a family physician in Mexico and does career counseling with pre-med students at Northwestern University.
An anesthesiologist trained in India or Cuba may choose not to go through the lengthy and costly licensing process to obtain a license to practice medicine in the U.S., Fernández-Peña said. But that person could become a respiratory therapist who can intubate patients and work with respirators, he added, which is what hospitals need most right now.
Making up for an aging workforce
Some governors are taking notice of the pool of medical professionals in immigrant communities and the bigger role they could play in battling the coronavirus.
On April 1, Nevada Gov. Steve Sisolak issued an emergency order authorizing the state's chief medical officer "to approve the waiver and exemption of professional licensing requirements for any provider of medical services who has received training in another country but is not currently licensed in the United States, subject to verification of their credentials."
Also this month, N.J. Gov. Phil Murphy signed an executive order allowing foreign-trained health care providers, including any medical doctor who is licensed and in good standing in another country, to practice in the state during the pandemic.
In California, Gov. Gavin Newsom gave his state's health and consumer affairs departments authority to relax some of the licensing requirements.
A recent study from the Migration Policy Institute estimates that 263,000 immigrants and refugees have an education in health-related fields, but are either unemployed or underemployed in low-paying jobs because they were trained in their country of origin.
"There is a shortage of health care workers at all scale levels," from doctors to nurses to intake officers and technicians, said Andrew Lim, director of quantitative research with New American Economy, a nonprofit research and advocacy organization focusing on immigration policy.
"Immigrants are making up for an aging workforce," Lim said, including in the health care industry. The immigrant population tends to be younger than U.S.-born Americans.
New data from the NAE show immigrants already make up 16.5% of all health care workers in the country. One in four doctors and one in eight registered nurses are immigrants.
"I just want to keep my family healthy"
Karen Garcia is a nurse at Valleywise Health Medical Center in Phoenix, Ariz., and cares for COVID-19 patients.
"All of my patients are Spanish speaking, and being their nurse definitely gives them a sense of relief," Garcia said. "Each nurse cares for one or two patients at a time, but I worry about the coronavirus peak in late April because we could get many more patients per nurse."
The virus isn't the only threat to Garcia's future. She's a DREAMer, one of thousands of undocumented immigrants brought to this country as children. She was 4 years old when her parents crossed the border illegally from Mexico.
Garcia and thousands of other DREAMers could lose their work permits if the U.S. Supreme Court sides with the Trump administration in its legal challenge to eliminate Deferred Action for Childhood Arrivals, or DACA. The program started during the Obama administration to protect this group from deportation. Attorneys representing DACA recipients estimate there are 27,000 health care workers in the program fighting the pandemic, according to a letter drafted by pro-bono lawyers. The Supreme Court is expected to take up the DACA case this fall.
"I don't want to think about what will happen with the DACA program now," said Garcia, the mother of two young children. "I just want to keep my family healthy."
Garcia said she feels a responsibility to stay at work, especially now when coronavirus cases are surging.
"Being Hispanic, my parents always taught me to go to work," she said. "I'm not going to stay away."
Garcia said she knew she wanted to be a nurse when she was 7 years old, after helping her mother communicate with staff at an emergency room. She realized then that people need nurses and doctors who speak their language.
It's important "especially now that patients can't have family members with them" in the hospital, she added. "When patients are alone, it's a relief for them to see a Spanish-speaking nurse. It's been pretty emotional for me and my patients."
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