Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

NEW YORK — Alejandra Jimenez, 27, her husband, and young daughter stayed in their hometown of Barquisimeto, Venezuela, for as long as they could.

Jimenez’s daughter, Nicole, 9, has cerebral palsy, with microcephaly and epilepsy, which require ongoing care, something that the city, and nation, could no longer provide, with its deteriorating economic, security, and healthcare situations, including hospitals without potable water or consistent electricity, lack of medicines to manage convulsions and unreliable transportation options. Jimenez had to find a better solution for Nicole.

“I am, and will always be, in the place where I can give good care to my daughter,” Jimenez said. “[Nicole] has her particular condition, but I know she is happy. I try everything to make her feel happy,” she said through a translator during a series of interviews with Direct Relief last month. Throughout the interviews and reporting, she was inseparable from her daughter, constantly cuddling and kissing her.

The family moved to a border town next to Colombia, which allowed medical visits there. But after some time, the crisis in Venezuela reached them there, too, and they were pushed to move into Colombia. They experienced a degree of respite there, but Jimenez wanted to give her daughter a fuller life, one that would only be possible with surgery to relieve the symptoms.

“I have to achieve that surgery. I have to achieve that dream,” Jimenez recalled repeating to herself when they had few opportunities to make that dream come true.

It was ultimately this commitment to Nicole that catalyzed the family to make an epic journey north to the United States, with an eye towards New York City, where Jimenez’s sister lives and where she believed she had the best chance to get the surgery for her daughter.

Safety net clinics adapt to care for migrants

Jimenez is one of over 541,000 people to be allowed into the U.S. under new policies enacted by the Biden administration. About 100,000 migrants arrived in New York City from spring 2022 to August 2023.

“No one could anticipate that we were going to get over 100,000 asylum seekers in a year at the beginning of this humanitarian catastrophe,” said Daniel Pichinson, executive director of Ryan Health’s Chelsea-Clinton clinic. Ryan Health is a federally qualified health center, part of a national safety net clinic system that provides care for everyone who requests it regardless of their ability to pay. “We reached out to the mayor’s office, catholic charities, and shelter providers in the area to offer our services because we suspected individuals would need health care,” Pichinson said, estimating that Ryan Health has onboarded about 3,000 migrants in the past year.

“Step by step, I can do it by myself. This is a country of opportunities, and I will find one of those opportunities people talk about.”

– Alejandra Jimenez

The crisis catalyzed changes at Ryan Health, which saw 47,950 patients last year across its clinics, community outreach centers in homeless shelters, and schools.

“We are very fortunate to have a very dedicated staff, but they’re tired, post-Covid, post-everything the past few years. Imagine if a dozen people walked into your doctor’s office; what would they do? Turn them away. We can’t. So we did some triaging and then gave them appointments to come back,” Pichinson said. Beyond administrative issues, the clinic was also forced to reexamine some of its basic assumptions regarding patient care.

“Some people thought taking blood and seeing a nurse is the whole thing. They didn’t understand they still have to get the results and see the doctor,” he said, noting that some patients at the clinic had never been in a doctor’s office before.

“No records, no vaccinations, you go from point zero. You need to do a full medical exam before integrating them into U.S. society,” said Dr. Christian Olivo, an infectious and tropical disease specialist originally from Venezuela, who has been on staff at Ryan Health since November.

Olivo pointed out that migrants in the past received a checkup and certain medicines before entering the U.S. This is also the reason that Olivo and his team had to create a new screening protocol to check for certain parasites and diseases that are common in the Darien Gap, an area of jungle in the Panama-Colombia border region known for its difficult terrain and lawlessness. Chagas, which can lead to heart failure, and leishmaniasis, which can lead to skin sores and organ failure, are two examples Olivo gave.

Adding to the challenge of understanding new patients’ medical history, Olivo has also found that many patients who believe they have been vaccinated against certain conditions, in fact, have no antibodies. The reason, he said, is the frequent power outages in some South American countries, notably Venezuela, lead to certain vaccines rising above the temperature needed to keep them effective.

Olivo noted that the most effective care is given when the provider speaks the same language as the patient and understands or at least is familiar with their culture and experiences.

“Imagine using an interpreter to ask about sexual assault. It’s not an easy question to ask through a third person, so that’s a barrier to the care of these patients. Sometimes providers don’t really understand what these patients have suffered,” he said.

A Long and dangerous journey north

Jimenez’s more than 2,000-mile journey to the U.S. began in Ipiales, which sits on Colombia’s southern border with Ecuador, and ended in Brownsville, Texas. The route she, like hundreds of thousands of other migrants, took through Panama, Costa Rica, Nicaragua, Honduras, Guatemala, and Mexico to the United States is highly fraught.

“98, 99% of patients experience extortion by police, local thugs, and organized crime along the way, especially in the Darien gap, by Guatemalan police and in Mexico, it’s with a mix of cartels and immigration police. Also, in Mexico, you have kidnapping, slavery, and sexual assault for both males and females,” Olivo said, based on what his patients have shared with him. He is also conducting a study of 500 migrants related to tuberculosis.

Other dangers are present on La Bestia, a freight train that runs from southern to northern Mexico. Extreme weather faces passengers, who must endure temperatures that can reach 90 degrees during the day and drop below freezing at night. When the train stops, bandits will jump on the train, sometimes robbing and kidnapping migrants. Olivo said sometimes they will escape, “but it’s not because of the police.”

“Knowing you can be kidnapped, killed, raped, your level of desperation has to be high enough to decide to cross this. To me, it’s super impressive,” Olivo said about people who make this journey.

Jimenez said she and her partner, the father of her youngest son, were aware of what they could face. But within a few days of making the decision, they began their journey on April 17: Alejandra, her partner, Nicole, her three-year-old son, and her 20-year-old nephew.

Upon reaching the Darien gap, she encountered a “dense maze of mountains as beautiful as they were lethal.”

“My biggest fear was to go out of that place without any of my kids alive,” she said, sharing the story of another family who had all died after falling into a ravine. She took turns with her husband carrying the small children.

Early on in the jungle, they began to run out of food. Luckily, they met a local man who, after looking at Nicole’s condition, agreed to help them cross through a shorter and less dangerous but usually more expensive route. With that godsend, Jimenez and her family emerged from the jungle, though she contracted diarrhea and a fever.

the last leg

Jimenez continued through Central America with Nicole in a baby carrier, which presented physical difficulties but was somewhat mitigated by an ever-present sense of solidarity. They traveled via a mix of walking and buses. In Mexico, Jimenez said she and her family passed through quickly and without incident.

On May 9, they arrived in Matamoros, in the Mexican state of Tamaulipas, across the Rio Bravo from Brownsville, Texas. Exhausted and facing a river that was deeper than expected, Jimenez gave Nicole to her nephew to carry across.

She remembers seeing his feet go deep into the muddy bottom as a strong flow of water pushed against him. Most people were struggling to advance. Alejandra was panicking but determined, as were all the people, screaming and rushing to the other side.

When they made it across, they turned themselves in to U.S. border authorities and were detained. Nicole was vomiting and had a fever, but no care was rendered to her, something Jimenez said could have been due to the large group size they were in. Still, it shocked her that law enforcement ignored her daughter’s condition. They were then taken to a detention center for three days before being released and taken to a shelter in McAllen, where conditions were “very bad,” according to Jimenez. They were forced to sleep on the ground with little protection from the elements.

A new city and New mantra

After a couple of days, Jimenez’s sister managed to buy plane tickets to fly them to New York City, where she lives. Upon arriving, the family was assigned to a shelter in the Bronx. While the family reunion was joyous, it soon became clear that Nicole would need emergency care to treat her ongoing high fever. Shelter workers took Nicole to a local hospital and helped with the paperwork. Since then, Nicole has been treated by a neurologist, pediatrician, and orthopedist. She and her daughter also receive ongoing care at a local Ryan Health clinic. While surgery remains an option for Nicole, Jimenez said none of the doctors she met with recommended it for now.

In early August, outside the Roosevelt Hotel in New York’s Midtown neighborhood, one of the world’s most expensive locations for real estate and just two blocks away from the famed Rockefeller Center, migrants – mostly young and middle-aged men as well as families – walked in and out of the once landmark hotel, which was guarded by a mix of private security, NYPD officers, and National Guardsmen. A U.S. Marine, unarmed, was seen helping on-site staff with logistics. Next to the former hotel, a café was selling lattes for $6.

People staying at the former hotel said they came from Venezuela, Mexico, Russia, Senegal, Colombia, Bolivia, Ecuador, and Pakistan. People shared different focuses for the day. Some were focused on getting school supplies for their kids. Others were signing up for cell phone service, Medicaid, or a job with a delivery service—good work since it was flexible, paid daily, and required little knowledge of English. Another linking factor was New York City pizza, which was by far the lunch of choice.

Near the cell phone sign-up kiosk, Eddingson Vera, a Venezuelan national who crossed the border into El Paso last December, was waiting with his moped and chatting it up with some friends. He said he spent some time in San Antonio before arriving in New York.

“The work of delivery, even if unstable in some ways, has been paying well,” Vera said. “I’m happy my kids are going to school and that my wife is in good health.” She had been pregnant and ill around the time when they crossed.

“I’m thinking about developing my own business for street food,” Vera said.

Charter buses, some with out-of-state license plates, and vans routinely pulled up to the hotel. Asked where they were going, some migrants said they were going to different shelters. Some said they chose to go to a different city. Others said they did not know where they were going. Many had just arrived and were visiting the hotel to get registered and have a place to stay assigned.

After a couple of months in New York, Jimenez is still trying to find her work path while caring for her children. Her family is around, ready to help, but they live in different parts of the city. As she visits the doctors, the migration offices, and her relatives, she has a new mantra, which she repeats to herself.

“Step by step, I can do it by myself. This is a country of opportunities, and I will find one of those opportunities people talk about.”

Photos and translations provided by Oscar Castillo.

Direct Relief has supported medical facilities in Colombia, Panama, Guatemala, and Mexico, through which many migrants travel, as well as Ryan Health in New York City.