Dr. Brian Elmore is an emergency-medicine resident physician in El Paso, Texas. He’s also the cofounder of Clínica Hope, a free clinic for migrants in Ciudad Juárez, Mexico, which he runs with the nonprofit Hope Border Institute. Elmore frequently treats patients who have been injured by razor wire or fallen from the border wall that divides El Paso and Ciudad Juárez. He’s coined a term for these injuries: political pathologies. “These are normally healthy people, most of them young, who have been injured because of political decisions made thousands of miles away,” he says. “These are the political repercussions of the border.”
You work as an emergency room physician in El Paso. What’s an average day like in your practice?
About half of our patients are uninsured or underinsured. We get patients from Ciudad Juárez who have delayed seeking care and have very advanced presentations of disease. We have patients who are migrants, who come with tropical pathologies, things like malaria and dengue. And then we have all the political pathologies of the border. like wall falls, barbed-wire injuries, and Border Patrol pursuits. Over the summer, we had heatstroke injuries. So, we see all these political repercussions of the border.
That’s interesting that you use this term political pathologies. Is that a term you coined yourself?
It’s what I’ve started calling these injuries that otherwise healthy folks are receiving. These are mostly young people in their 20s, 30s, and sometimes kids, who out of sheer desperation decided to climb the wall or cross the river or desert. Other than for decisions that politicians made thousands of miles away to fortify the border, and make it as dangerous to cross as possible, they wouldn’t have these injuries. It’s really tragic.
You recently treated your first patients who had multiple injuries from razor wire. This is the razor wire that Texas governor Greg Abbott has strung all along the Rio Grande as part of his Operation Lone Star initiative.
I’ve treated quite a few border wall falls. I’ve become used to this. But last week, I had a child who came in with multiple lacerations from barbed wire. She came in with her family, and they were all cut up from barbed wire. It’s jarring to see this, especially when it’s a kid, who’s innocent and has no idea what’s going on.
I started talking to the dad, and he told me they were from Venezuela. He said they’d heard a rumor in Ciudad Juárez that officials were letting Venezuelans cross outside of ports of entry. So a huge crowd showed up to present themselves to U.S. border officials [and ask for asylum]. Everyone became frustrated and irritated when they discovered that it wasn’t true.
And this family were pressed up against the barbed wire by the crowd, and they couldn’t go back. The only way for them to move was forward. So they started crawling under the barbed wire. This is the mother, father, the child, who is about 10, and an infant.
So, I’m stitching them up, making small talk because sewing up lacerations takes time and you’re face-to-face, and I’m talking to the dad and he lifts his shirt, and I see that he has a thoracotomy scar. When you perform a thoracotomy, it’s a last-ditch Hail Mary effort to save somebody’s life. The majority die after a thoracotomy. It’s when you crack open a chest because there’s either aortic bleeding or a penetrating injury to the heart. He told me he’d been stabbed and robbed in Caracas. And it was stunning to see his scar and to know that he’d survived. And the thing is, this is the second thoracotomy scar I’ve seen on a Venezuelan patient I’ve treated. This really reinforced for me the constant levels of violence people are facing. I feel like Americans have very little context for what’s going on in that country and how desperate things are there.
In May, we interviewed Dr. Alexander Tenorio, a neurosurgeon in San Diego, who has treated several patients with severe injuries from border wall falls. He’s researching these injuries and is calling it a growing public health crisis. What has your experience been treating border wall falls, and have you spoken with Dr. Tenorio? I know he’s planning on extending his research beyond California and incorporating the rest of the border.
The number of patients I see fluctuates based on the policy in place at the time and how desperate people are. For example, last December, when Title 42 was still in effect, we were probably averaging more than one a day, because there was no way to cross at ports of entry, everybody would be removed under Title 42. After Title 42 was lifted, there was a huge drop in cases. Now they’re up ticking again, the number of border wall falls, as people get more desperate as they wait for the CBP One app to work or not.
I have spoken with Dr. Tenorio and need to speak with him again soon. In San Diego, where Dr. Tenorio is based, the wall, it’s 30 feet high. So, they see a lot of neuro trauma. Here, our wall, I believe, our tallest section in El Paso is 21 feet. So instead of neuro trauma, we see a lot more ortho trauma.
There’s a very characteristic injury. It’s called a pilon fracture. It’s a lower-extremity kind of ankle fracture, very debilitating. And it’s often associated with a lumbar spinal fracture. Sometimes the bone has broken through the flesh and may require surgery. A lot of times they’ll be fitted with a device that keeps the bone in place while the swelling goes down, so they can get surgery. They’re then discharged to a migrant shelter in town while they wait for surgery.
If this was an American citizen, and somebody with insurance, it would be a long road to recovery. These are just devastating injuries. They would receive intensive physical therapy, intensive follow-up. But in the case of undocumented migrants, either they’re deported, or they’re released while their immigration court date is pending. And who knows what happens to them or what sort of follow-up they get. Most of the people that attempt to climb the wall, they’re younger, they’re fit, they’re active. They come to America to work. And this injury, it’s devastating, it could have lifelong debilitating impacts on their functional mobility, and a lot of them may not be able to work like they intended to.
You’re a second-year resident and just starting off in your career as a physician. Why did you decide to practice in El Paso and Ciudad Juárez?
I moved to El Paso from South Carolina. I think El Paso is the most unique place to practice medicine in the country, especially as a young physician. It’s a place where you can do global health every day, and then in your free time go do humanitarian medicine in another country.
Before going to medical school, I had another career working in the Middle East with migrants and refugees. In 2019, during a break in medical school, I volunteered at Annunciation House and truly fell in love with El Paso. You see on the news, all these headlines, “migration crisis” and “invasion.” And that’s not what people in El Paso are experiencing or how they’re responding to it. They’re responding to the humanitarian crisis with compassion. You see people at shelters volunteering their time, offering to cook, and giving donations. I think the people of El Paso are amazing in the way they’ve responded. As opposed to how the rest of the country is just totally freaking out. I think El Paso is the most inspiring place to be and to practice.
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