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American Dreamers

HMS DACA students concerned about future status in the U.S. 

DACA student Dalia Larios Chavez talks about her future as a doctor. Video: Rick Groleau and Bobbie Collins

One student is researching thoracic disease, hoping to work in communities that have little access to such specialized care. One hopes to be a primary care physician advocating for her patients. Yet another is interested in how diseases like diabetes affect the heart as he plans a career in cardiology or cardiothoracic surgery. A fourth wants to become a primary care physician so she can work on finding ways to deliver unbiased care.

Despite their potential and perseverance, these four Harvard Medical School students may not be able to complete their training here. Their parents, undocumented immigrants, brought them to the U.S. as children, and they have prospered under an immigration policy called the Deferred Action for Childhood Arrivals, or DACA, which allowed them to remain in the country. 

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Last fall, however, the Trump administration announced that it plans to eliminate the program and rescind DACA status for the approximately 700,000 to 800,000 people who enrolled in it. This threatens their ability to have Social Security numbers, driver’s licenses or work permits. In short, their ability to stay in the U.S. 

Under DACA, the students’ status must be renewed every two years, a process which includes background checks and a fee, but for the HMS students it is a worthwhile process that gives them the ability to work in research labs and clinical settings on the Quad or at HMS affiliate hospitals.

Now, however, their futures—and their dreams of giving back to their adopted homeland—are in jeopardy. 

Staying focused

For the past six months, Blanca Morales Temich has wondered how she is going to keep her physician’s white coat on.

Uncertainty has been a companion since she arrived in the U.S. at the age of 5. Her parents came to America, she said, because there was no work in their home state of Guerrero, Mexico. Growing up undocumented in Santa Ana, California, she said, there was always a sense of insecurity, of being found out. But it also came with a fierce drive to succeed.

“It’s just part of being an immigrant and just continuously trying to improve your surroundings and improve yourself,” she said.

Morales Temich attended California public schools from kindergarten through high school. She then enrolled at Santa Ana Community College and initially thought she might become a nurse, but she found she was so curious about the mechanisms of disease that she soon realized she wanted to become a doctor instead.

She was hesitant to transfer to a four-year university because of her pre-DACA undocumented status so she remained at Santa Ana with its lower tuition rates. Eventually, however, she made the leap, transferring to and graduating from the University of California, Irvine, with a degree in neurology. She now plans to become a primary care physician when she graduates from HMS in 2020.

Morales Temich is currently in clinical rotations at Brigham and Women's Hospital. She is being exposed to different clinical settings, areas of practice, diversity of patients and a variety of physicians in her rotations, and she is envisioning how she will build her medical career. But she wonders now if any of it will even be possible. Her DACA status is expiring next year.

“I’m not even sure if I can finish medical school,” she said.

Despite court injunctions and recent deal brokering in Washington, D.C., over the past six months involving DACA, Morales Temich has tried to remain focused on the job at hand.

“I’m still a medical student,” she said. “I’m in my pediatrics rotation now, working with kids, and I try to be present for that. But I’m also realizing that this is not guaranteed.”

Lucky breaks 

Image: Jordan Said

First-year medical student Anthony Tucker-Bartley was born in Jamaica and came to the U.S. with his parents and older sisters when he was 7 years old. He became eligible for DACA the year he graduated high school, so his path to college was less complicated than that of some of his fellow HMS classmates. 

He was recruited to play football at Wagner University in New York, but he received mostly academic scholarships to attend school, which he said may have been a good thing. He broke an ankle his freshman year and his other ankle during his sophomore year. Deeply inspired by the surgeons, doctors and nurses who treated him, and unable to pursue football, he decided to study medicine.

After his sophomore year in college, Tucker-Bartley threw himself into his chosen career, participating in a summer internship at Cooper Medical School, volunteering at homeless shelters in Camden, New Jersey, and shadowing a physician in orthopedic surgery.  After his junior year, thinking it would be valuable experience, he completed a 10-week summer research internship studying heart disease and diabetes at Johns Hopkins University.      

“Research gives you a different appreciation for what’s going on in your patient’s body,” he said.

Because all of these experiences required a work permit, DACA status was key for Tucker-Bartley to pursue his life’s vocation.

“I wouldn’t have been able to do any of the programs if I didn’t have DACA,” he said.

But since last September, new applications for DACA status are no longer being accepted by the U.S. Citizenship and Immigration Services. The Trump administration has promised that no one’s status will be revoked, but it is unclear whether renewals will be allowed after a March 5 deadline, especially because of a stipulation that Congress must come to an agreement on immigration by Feb. 8, when funding for the federal government will again expire.

“My fear is that DACA will not be fixed, and I won’t be able to finish my medical school and residency,” said Tucker-Bartley.

Patchwork quilt

Image: Maria Larios

From the time Dalia Larios Chavez was an infant until she was about 10 years old, her family traveled back and forth across the Mexican-U.S. border seeking work.

The family business, a meat market in Jalisco, Mexico, was failing due to poor economic conditions in that country. Her early education was a patchwork of schooling in both the U.S. and Mexico, but the family eventually settled permanently in Arizona.

Larios Chavez completed fourth grade and then junior and senior high school in the U.S. In Chandler and Mesa, raids by Immigration and Customs Enforcement (ICE) were common when she was a child, and she lived with the daily fear that her parents might not return from work. But in spite of those imminent threats, she managed to thrive. She felt secure at school, she said, because “it was also the one thing I could control in my life.”

But more uncertainty was to come. It wasn’t clear how she would be able to make the jump from high school to university. And even if she did get to college, she didn’t know how the tuition would be paid.

Because of their status, undocumented students do not qualify for in-state tuition at most state schools or for federal financial aid at either public or private institutions. But many DACA students are able to obtain grants from private foundations to supplement whatever cash they can raise to pay for their education.

Despite the hurdles, Larios Chavez was eventually able to earn a degree in genetic cell and molecular biology from Arizona State University, paid for by grants from a private foundation. Within months of graduating, as she was wondering how she would make her way to medical school, President Barack Obama enacted DACA. She immediately applied for DACA status while studying for the MCAT, and she entered HMS in 2014.

Even in the precarious situation in which she now finds herself, Larios Chavez said she is committed to concentrating on her work in the lab at Dana-Farber Cancer Center/Brigham and Women's, where, as a fourth-year medical student, she is doing lung cancer research.

Her DACA status expires in October but she is unsure when she will be able to submit her application and is concerned that something more drastic may occur before that happens. But the feeling of uncertainty is familiar, she said. It isn’t unlike what she experienced as she made the transitions from high school to college and then to medical school.

“There’s a certain comfort in knowing I have been here before,” she said. “Knowing that I have made it gives me the strength to know that I will make it again.”

Her sister’s story

Image: Brittany Jones

Alma Oñate Munoz’s younger sister was born with congenital glaucoma. She said that’s why her family emigrated from Guadalajara, Mexico, to the U.S., settling in Cincinnati, Ohio, when she was 8 years old and her sister only 5. The doctors in Mexico said they did not have the technology to treat what would be a lifelong condition for her sister, so her family came to the U.S. seeking care.

Oñate Munoz’s experiences serving as a translator for her parents at her sister’s many doctor’s appointments and surgeries helped shape her dreams of becoming a doctor, but she said she also saw great hardship during those visits. Her sister was initially rejected by a specialist in the U.S. because her family had no income, no insurance and did not speak the language. She hopes to address these types of issues as a physician.

“Whether they are a family from rural Kentucky or a family from urban Chicago, I don’t want anyone else to have to go through that. That inspired me,” she said.

Graduating high school in 2012 and becoming eligible for DACA, Oñate Munoz received a scholarship to attend Northern Kentucky University. She graduated with a bachelor’s in chemistry. The school’s motto is “Dreamers Welcome,” and she said that spoke to her and her dreams of becoming a physician.

Now she wonders how she will be able to finish medical school and become a resident, with her DACA status expiring in October. But she is not deterred.

“In terms of medical school, I’ve never had a Plan B. I think I’m just going to continue pushing until I can’t anymore,” said Oñate Munoz.

Urgent need

An estimated 100 medical students across the country are currently on DACA status. Although the first wave of DACA medical school students is set to graduate this spring, these four HMS students are wondering whether the new graduates will be able to take the next step in medical training, which is residency.

“You need to be employable by a hospital in order to be a resident,” said Larios Chavez, who will apply for residency in cardiothoracic surgery next fall, hoping to graduate in spring 2019.

“I think it makes residency directors very nervous to know that they will take in somebody who might not be able to finish their residency program.” 

All four gathered with their classmates to organize a rally last September on the HMS Quad to speak out about the plan to eliminate DACA. They have continued their efforts to secure a solution by advocating for themselves and DACA medical students across the country through meetings with Harvard administrators and elected officials and by speaking out through the media.

With the U.S. facing a shortage of physicians, particularly primary care doctors, the HMS DACA students wrote in a January commentary that their generation is poised to contribute to filling that need.

“It is estimated that DACA students in this country can contribute to a new physician workforce of 5,400 doctors in the coming decades,” they stated. “Since more than 90 percent of DACA recipients are Latinos, they can help diversify the physician pool.”

Despite growing up with the ever-present uncertainty about their future—whether fear of deportation or how they will make the next step in their education—the HMS students believe in their value as contributing members of American society. They said they have exhibited perseverance and resilience to get to where they are now and they are confident they will be able to make meaningful contributions to the country as physicians. All said they remain undeterred in their desire to become U.S. citizens, in no small measure because they feel indebted to this country for the opportunities that were available here. 

“We are willing and able to contribute to the fabric of this country, which we consider our home,” said Morales Temich. “It comes from feeling like an American, even though on paper we’re not Americans.”

They are disappointed when they hear some say they are not contributing, and they are frustrated when they encounter what they say is a common misperception that there is a path to citizenship for those with DACA status. Nevertheless, they persevere.

“I grew up saluting the American flag with my peers in grade school,” said Oñate Munoz. “I want to be a part of the fabric of this society. And I think it’s time for that. I think I’ve contributed, or hope to contribute enough, and that merits something.”

“The problem is here, but I feel like the solution is also here,” said Morales Temich.