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An Immigrant's Heart 

To survive the ordeal of escaping Guatemala, Julia needed a big Heart. But not this big.

Wednesday, Jun 30 2010

Page 2 of 4

By the time she gave birth to Wilmar, she knew she couldn't stay in the war-torn country any longer, but she had to wait until he was older and save up money in the meantime.Several of her brothers and sisters were already in the United States.

In the spring of 1998, Julia walked for a month and 22 days to get from Salamá to Houston. She crossed the Mexico-U.S. border with 17 others, including two coyotes, or smugglers, whom she paid $5,000. "It was so terrible. There was always this feeling that I was going to die," she says. She packed three black shirts and a pair of black pants, and wore black Nike sneakers. "We walked at night, and we wore black to hide from Immigration helicopters," she explains. She survived off rancid chicken legs and drank whatever rainwater collected in holes in the desert. Three people were left behind during the trek.

"The coyotes told us that if you can't stand walking, we'll just leave you there." One woman was very large, and too heavy to carry. They moved on. Another man wore cowboy boots, and his feet were shredded. He was unable to stand up. They moved on. Another man drank saltwater. He began vomiting, and they moved on. "I don't know what happened to them," she says.

"After we crossed the Rio Grande, the homework started, they would tell us. We would walk day and night and we would hide from Immigration in trucks. It was very sad." At one point during the walk, Julia's knee swelled to twice its normal size and turned purple. She figured it was either a snakebite or a rat bite. "Eventually, you can't feel your legs," she says. Two smugglers carried her, but she begged them to take her back to Guatemala. "They said it would be more expensive to send me back than get me to the U.S." At another point, she was vomiting. Someone stole her fresh water at a rest stop, and she went without for days. When she arrived in Houston, she had head lice, she had tick bites, and her knee was useless. By the time she got to Brooklyn, she had no clothes except for the dusty ones on her back. She was bedridden for two months, eating pears and drinking coconut juice, she recalls with a slight smile.

Wilmar, her ill son, followed her three years ago. He was 12 by the time she had saved up enough to pay for him to come to the U.S. He was picked up and incarcerated in Texas, but her brother contacted a church that managed to negotiate his release. A deportation case is still hanging over her son, but Julia admits that she doesn't understand the legal details.

After her own arrival, Julia found a part-time job at a cleaning company contracted by Con Ed. In 2002, she gave birth to a daughter, Jasmin, the only American citizen in the family.

Today, Wilmar takes special education courses at school and says he wants to be a nurse. Jasmin, eight, prefers to read books and tells her mother she wants to become a writer.

"She's very, very smart," Julia says. She tries not to rely on her young daughter, who speaks fluent English, to translate for her when it comes to her medical case.

"Back in the 1980s, we basically used kids [for speaking to patients]," says Ofri. "Because the kids were the ones who were bilingual. Which is completely inappropriate."

Surprisingly, it wouldn't be impossible for Julia to end up with a new heart, even as an illegal immigrant. But it wouldn't be easy, either.

"Being undocumented, by itself, does not make a person ineligible for transplant," says Stuart Katz at NYU's Division of Cardiology. In a telephone interview, he explains that, in a case like Julia's, insurance coverage is crucial. He says that even if a heart transplant were performed, there are costs associated with post-transplant care that can overwhelm patients without insurance. "More than anything, we have to access how sick a person is," and base a transplant on blood type, body size, and urgency. Katz has advised a number of undocumented patients who can't afford the costs of a heart transplant. "I tell them, when they aren't too sick, 'You have to get documentation.' Sometimes, I tell them to hire a lawyer. I mean, unfortunately, a medical plea to the State Department falls on deaf ears."

Documentation, Ofri says, can help in gaining insurance. "You have to have the wherewithal in all respects—and part of that is financial. If she can get insurance, that will help her tremendously."

As this week began, there were 324 patients waiting for heart transplants in New York. The United Network for Organ Sharing (UNOS), which controls the policies associated with transplants, says it doesn't disqualify transplant patients based on immigration status. But, UNOS spokesman Joel Newman writes in an e-mail, "The presumption is that most non-resident foreign nationals have legal documentation—a visa or a work permit—and I believe that's true for the vast majority of non-residents listed for a transplant. That said, we have no mechanism to track or enforce legal residency status."

Undocumented immigrants have received transplants—the best known was 17-year-old Jesica Santillan from Mexico, who died in 2003 when her heart-lung transplant at Duke University Medical Center failed because doctors gave her organs from someone with a different blood type. It's assumed that transplants to illegal immigrants are rare, but UNOS does take note of hospitals that perform transplants to non-residents. "If a transplant program happens to transplant more than 5 percent of its recipients in a year who are non-residents, they will get a review letter from UNOS asking them to provide more information about the circumstances. If a transplant program appears to have a pattern of listing and transplanting an undue number of non-residents, we could issue a membership sanction, but the two most serious and public sanctions we can give have never been applied for this issue." Newman also states there is no hierarchy on the transplant list when it comes to legal status.

About The Author

Shefali Kulkarni


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