Many Closets

If coming out of the closet was so effective for gays and lesbians, could the same strategy work for abortion rights, undocumented immigrants, and people who have been victims of sexual assault and harassment? Chapter 16 explores the potential and the potential limitations of coming out of the closet for different kinds of groups. Women victims of assault and harassment have organized around #MeToo and #TimesUp and have managed, by coming out of the closet in numbers, to force many prominent people to be held accountable for their actions. Undocumented immigrants face segregation and status disadvantages, so their ability to change minds by coming out of the closet is limited. Womens’ abortion experiences are almost entirely closeted and this veil of secrecy has allowed opponents of abortion to remain unaware of how many people in their personal circles have actually had abortions. The closet for abortion histories has constrained the ability of abortion rights activists to win a fierce and ongoing public debate with abortion opponents. Marriage equality also had the advantage of being nondisplacing while some other kinds of movements have to displace the rights of others in order to succeed.

The mechanism and pattern of injuries of undocumented immigrants crossing the Texas-Mexico border along the Rio Grande Valley

Background Apprehensions of undocumented immigrants in the Rio Grande Valley sector of the U.S.-Mexico border have grown to account for nearly half of all apprehensions at the border. The purpose of this study is to report the prevalence, mechanism, and pattern of traumatic injuries sustained by undocumented immigrants who crossed the U.S.-Mexico border at the Rio Grande Valley sector over a span of 5 years and were treated at a local American College of Surgeons verified Level II trauma center. Methods A retrospective chart review was conducted from January 2014 to December 2019. Demographics, comorbidities, injury severity score (ISS), mechanism of injury, anatomical part of the body affected, hospital and ICU length of stay (LOS), and treatment costs were analyzed. Descriptive statistics for demographics, injury location and cause, and temporal trends are reported. The impact of ISS or surgical intervention on hospital LOS was analyzed using an analysis of covariance (ANCOVA). Results Of 178 patients, 65.2% were male with an average age of 31 (range 0–67) years old and few comorbidities (88.8%) or social risk factors (86%). Patients most commonly sustained injuries secondary to a border fence-related incident (33.7%), fleeing (22.5%), or motor vehicle accident (16.9%). There were no clear temporal trends in the total number of patients injured, or in causes of injury, between 2014 and 2019. The majority of patients (60.7%) sustained extremity injuries, followed by spine injuries (20.2%). Border fence-related incidents and fleeing increased risk of extremity injuries (Odds ratio (OR) > 3; p < 0.005), whereas motor vehicle accidents increased risk of head and chest injuries (OR > 4; p < 0.004). Extremity injuries increased the odds (OR: 9.4, p < 0.001) that surgery would be required. Surgical intervention was common (64%), and the median LOS of patients who underwent surgery was 3 days more than those who did not (p < 0.001). Conclusion In addition to border fence related injuries, undocumented immigrants also sustained injuries while fleeing and in motor vehicle accidents, among others. Extremity injuries, which were more likely with border fence-related incidents, were the most common type. This type of injury often requires surgical intervention and, therefore, a longer hospital stay for severe injuries.

Sanctuary in a Trumpist Context: Creating Spaces of Democratic Exception

This paper first identifies the necessity for sanctuary as a form of protest against the discretionary and often absolute forms of power shaping the current immigration system, particularly as it affects undocumented immigrants. Although the plenary power doctrine has removed legal personhood from immigrants at the federal level since the late 1800s, immigrants’ rightlessness and vulnerability to detention and deportation has grown since Trump was elected. It distinguishes between a sanctuary city and church-based sanctuary, holding that the latter fits more ancient conceptions of sanctuary. Faith-based sanctuary is also more radical than sanctuary cities, challenging sovereign power over immigrants who are largely rightless. The discourse of “earned citizenship” holds that undocumented immigrants must make amends to U.S. society and pay back taxes as well as earning the trust of the American public. In contrast, church-based sanctuary exposes the faulty logic of such claims, educating the public about the undocumented individual’s existing ties to the community and his/her contributions. In humanizing the legal non-person, church-based sanctuary practices explode conventional binary between citizen and foreigner, problematizing claims of merit on the one side and lack of deservingness or alien status on the other.

Severity of Inpatient Hospitalizations Among Undocumented Immigrants and Medi-Cal Patients in a Los Angeles, California, Hospital: 2019

Objectives. To compare the severity of inpatient hospitalizations between undocumented immigrants and Medi-Cal patients in a large safety-net hospital in Los Angeles, California. Methods. We conducted a retrospective analysis of all 2019 inpatient stays at a Los Angeles hospital (n = 22 480), including patients of all races/ethnicities. We examined 3 measures by using insurance status to approximate immigration status: illness severity, length of hospital stay, and repeat hospitalizations. We calculated group differences between undocumented and Medi-Cal patients by using inverse probability weighted regression adjustment separately for patients aged 18 to 64 years and those aged 65 years and older. Results. Younger undocumented patients had less severe illness and shorter lengths of stay than their Medi-Cal counterparts. Older undocumented immigrants also had less severe illness, but had similar lengths of stay and were more likely to have repeated hospitalizations. Conclusions. While existing work suggests that undocumented immigrants could have more severe health care needs on account of their poorer access to medical care, we did not see clear health disadvantages among hospitalized undocumented immigrants, especially younger patients. There were fewer differences between undocumented and Medi-Cal patients who were older. (Am J Public Health. Published online ahead of print October 14, 2021:e1–e8. https://doi.org/10.2105/AJPH.2021.306485 )