April 24, 2023

Latine/DACA-From Undocumented Immigrant to Family Medicine Doctor: The IMPACT of DACA

Latine/DACA-From Undocumented Immigrant to Family Medicine Doctor: The IMPACT of DACA
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In this episode, I share the inspiring journey of Dr. Duran, a family medicine resident who immigrated to the US from Mexico at the age of 14. Despite facing obstacles such as being undocumented and not having a Social Security number, Dr. Duran pursued higher education with the help of supportive individuals like her high school teacher, Mrs. Holland. We delve into the challenges Dr. Duran faced in financing her medical education and navigating the DACA program, as well as the impact it has on her mental health and career. We also discuss the importance of being curious and respectful when interacting with colleagues who may have experiences related to DACA. Join me in this thought-provoking conversation that sheds light on the resilience and determination of DACA recipients like Dr. Duran, who continue to contribute to their communities and the healthcare profession.


(0:00:00) - Achieving a Career in Medicine

(0:13:44) - Navigating DACA and Med School

(0:25:51) - DACA Impact on Mental Health

(0:34:48) - DACA's Mental Health Impact

(0:42:08) - Be Curious and Respectful of Colleagues


Chapter Summaries:

(0:00:00) - Achieving a Career in Medicine (14 Minutes)

In this podcast episode, we discuss the journey of Dr. Duran, a family medicine resident who immigrated to the US from Mexico at the age of 14. Despite facing obstacles such as not having a Social Security number and being undocumented, Dr. Duran pursued higher education with the help of supportive individuals like her high school teacher, Mrs. Holland. Dr. Duran's interest in medicine was sparked by witnessing the health disparities in Southeast Georgia, particularly among the immigrant community.

(0:13:44) - Navigating DACA and Med School (12 Minutes)

We delve into the challenges faced by Dr. Duran in financing her medical education due to her immigration status and limited financial resources. Through persistence and support from organizations like the Resurrection Project, she was able to obtain a loan and attend medical school. We also discuss the uncertainty and stress surrounding the renewal of her DACA status, which directly impacts her ability to continue her residency and work as a doctor. Despite these obstacles, Dr. Duran remains determined to excel in her profession and contribute to her community as a family medicine physician'

(0:25:51) - DACA Impact on Mental Health (9 Minutes)

We explore the impact of the Deferred Action for Childhood Arrivals (DACA) program on Dr. Duran's life and career, allowing her to fulfill her intellectual goals and become a doctor. The conversation also addresses the anxiety and vulnerability faced by DACA recipients due to the program's uncertain future and the fact that the United States Citizenship and Immigration Services has all their personal information. Dr. Duran discusses her decision to be open and vocal about her immigration status, as well as the intergenerational effects of policies like DACA on recipients' children.

(0:34:48) - DACA's Mental Health Impact (7 Minutes)

We examine the history and limitations of the Deferred Action for Childhood Arrivals (DACA) program and its effects on recipients like Dr. Duran. With over 800,000 DACA recipients and 1.3 million people living with a DACA recipient in the United States, the consequences of ending the program would be far-reaching. Despite providing temporary relief, DACA has significant constraints, such as no clear path to citizenship, limited travel permissions, and challenges in obtaining mortgages. Additionally, since July 2021, no new DACA applications have been accepted, and processing times for renewals can cause applicants to lose their status.

(0:42:08) - Be Curious and Respectful of Colleagues (1 Minute)

We emphasize the importance of curiosity and humility when interacting with colleagues who may have experiences related to the Deferred Action for Childhood Arrivals (DACA) program. By listening to and learning from their stories, we can gain valuable insight and foster a more supportive and understanding healthcare community. Remember to approach these conversations with respect and genuine interest in their experiences, rather than simply satisfying personal curiosity

Next Steps:



  • Timespan: 47 minutes and 20 seconds
  • Transcription Type: Cleaned Verbatim
  • Speakers: (Dr. Ale Duran & Raj Sundar)


Raj Sundar:What do you think it feels like to live with DACA status?



Dr. Ale Duran:So that was, I think, probably the hardest part of med school. Dealing with, am I still gonna be here? Like how do you stay motivated and study hard for step one and then study for step two and then apply to residency when you're not 100% sure, if you're gonna be here next year. You're not 100% sure if you're actually going to be able to do the job that you are expending 1000s and 1000s of dollars in like, hundreds of hours studying for it.



Raj Sundar: Hi, I'm Dr. Raj, Sundar, family physician, and a community organizer. You're listening to Healthcare for Humans Podcast, the show dedicated to educating you on how to care for culturally diverse communities, so you can be a better healer. This is about everything that you wish you knew, to really care for the person in front of you, not just a body system. Let's learn together. Welcome back, everyone to Healthcare for Humans. You just heard from Dr. Duran, a DACA clinician and our guest today. In this episode, you'll hear more about the challenges she has faced holding a DACA status. How she has persevered despite the uncertainty of DACA as a program, and what this means for you caring for DACA mented patients. Before we get into the episode, let's talk about what DACA is. Daca or Deferred Action for Childhood Arrivals is a US immigration policy that allows individuals who are brought to the country as children and meet certain requirements to apply for temporary protection from deportation. So it allows people who came to the US as kids undocumented to be able to work. I mean, kids, the average age of a DACA recipient when they came to the US was seven years old. And they've lived here for more than 20 years on average. The United States of America is the country they know and what feels like home. If I had to sum up the experience of living with DACA status, it will be uncertainty. Living with uncertainty is the reality for many individuals with DACA. While DACA does provide temporary protection from deportation, there's no pathway to citizenship. And the program can quickly change because DACA is an executive order. This means that a president can rescind it and change it at any moment. Think about living your life with that kind of uncertainty, people are often unsure of their future in this country daily. Despite this uncertainty, DACA recipients like Dr. Duran show their resilience. I say resilience, but Dr. Durian puts an asterisk on that point, and notes that a system should not only allow you to succeed if you're resilient. To be honest, all of us have probably heard about DACA a lot. But most of us probably have not spoken with someone directly impacted by it. This distance, the distance between us and quote unquote, them, who we hear about but don't interact with as why it's so difficult to truly understand, hold compassion and advocate for those who are affected by it. Especially, especially in a polarized environment where discussions around immigration always end up heated. I hope this episode changes that for you and helps close that distance. Here's Dr. Duran. Dr. Duran Welcome to the show.



Dr. Ale Duran:Hi Thank you.



Raj Sundar:Tell me your story. Where are you at? What are you doing these days?



Dr. Ale Duran: I am a third year resident at a family medicine residency. I'm not sure where do you want to start or like?



Raj Sundar:Starr at the beginning, Ale. I want to know it all.



Dr. Ale Duran:Okay, let's see. I was born in Mexico. And I came to the US when I was 14 with my family. So I have four siblings. I'm the oldest of five in total, with my mom. When someone asked me where I'm from? I'm from Mexico, but also from Georgia. Right now my family lives in Savannah. So that's also where I call home sometimes. We settled there. Then there's that on the other kind of some odd jobs, cleaning tables and restaurants, washing dishes, sometimes the wind the crops, so wherever it wasn't a season, I lived in northern Florida for a while. So pretty much whatever brought money to the house, my sister and I and mom did kind of like to keep things going. It was a very interesting kind of growing-up situation.



Raj Sundar: Okay, you're in Georgia. Then when did you decide to be a doctor?



Dr. Ale Duran: At some point there was a question in one of the high schools that I attended in Florida, Maria Anna Florida. I was figuring out what people were doing after high school just because I heard some people talking about college and my mom was not college educated. She did finish what's equivalent to elementary schools here. So they only have a plan. And I started asking around, I asked my guidance counselor, and they're like, Oh, you apply for financial aid, you apply for different things. And then you can start looking for colleges. But then I realized that they didn't have a social security number. So what Americans normally did, I just couldn't do it. I couldn't apply to financial aid, because I didn't have a social and they couldn't apply to most colleges because of the same situation. So I realized that was probably not going to happen. For me, I came here walking through the Arizona desert with my family. So I realized that I wasn't documented until that time. I don't know if this makes sense. But I was a kid I didn't know. So it wasn't until then. And then I realized, oh, man, I guess this is not happening. But I don't want to go to school. So I went home. And I asked my mom about these things. And then she said, yeah, I don't know. But maybe we'll get some people and I went back to this guidance counselor, when I did tell her that I was undocumented, it was just like, yeah, you're just never going to be able to do anything. And it was kind of out of spite, you're just never going to be able to do anything. I'm not sure why you guys are here. And I thought I had gotten my family in trouble, because of saying this thing out loud. But she was very negative and borderline racist there. So I'm like, I'm just gonna go ahead and go because you say I can't, in a way. And then we move.



Raj Sundar: Well, like that says a lot about you.



Dr. Ale Duran:I know. There was a thing, and then we moved to Georgia, where I ended up graduating and I think it was a situation again, I am presented with this obstacle where most people don't think about this. But if you don't have a social security number, then you don't have a way of really applying anywhere. In Southeast Georgia, there are a few different universities, I will take you but you have to pay out-of-state tuition, because you are technically not a resident. So I think it was half luck, half other people realizing that I was kind of a little bit of a smart cookie, and they're like, I can't believe you're not going anywhere. Because we're in that senior year, I was just like, I don't know, I don't know where I'm going. Everybody already had things lined up, whatever their parents went to college, and I just didn't know. It wasn't until about the last three months of high school where I told them my geography teacher, Mrs. Holland, who I still keep in contact with through Facebook, I think she's like, 97 or something in they should like, I can't believe this. I'm gonna look, I'm gonna do the Google search. And I'm like, okay, she's gonna do the Google search. We didn't have a computer at home. We didn't have a lot. So I'm like, yeah, she's gonna do the Google search. And I thought it was something way faster than it actually is. And she came up with a list of places that if you had enough, like, high enough grades, and I had almost 3.9 GPA. So like, Yeah, I think if you have like high enough grades are just gonna overlook the other stuff. And I was lucky enough to see that happen. I ended up going to Armstrong State University on a full-merit scholarship, where I majored in chemistry. And yeah, that's kind of how that happened. It was more of realizing that I was going to go because people think I could do it, and then just tell them enough people in the universe conspire in my favor. Kind of situation I have so much low, and for Mrs. Holland that just kind of like taking this SR side project and just, again, did the Google search and made this happen. And then, I don't know I wrote an essay and they had all those things and didn't need a social security number, as long as you were smart enough kind of situation.



Raj Sundar:Kudos to Miss Holland. We need more people like that, right?



Dr. Ale Duran: Yeah Mrs. Marlene Holland. She still lives in Fayette County in Georgia.



Raj Sundar: Maybe we could share this podcast with her after it's completed. I want her to be recognized for the help she provided you.



Dr. Ale Duran:Absolutely. Yeah. So I went to college. It was pretty fun. And then throughout college, I realized that I initially started in biology. I was not going to be able to do that. And it was just great for people who took biology, but I wanted something that was way more applied, something that was a little bit more hands-on. I tried chemistry, like physical chemistry, and that was fun. And then at some point, I became aware of it. In Southeast Georgia, there's a large immigrant community that works mostly in the crops. I became aware of in Southeast Georgia there is a huge health disparity, not only for immigrant women but for women in general. There are a couple of OBGYNS in a span of 240 Miles like a whole radius. Very close. Where we live, there was a huge disparity in prenatal care and just the ability to access care. The majority of health care, like in many parts of the country has been through the ER in how I feel that it was one. I never really needed to go to the doctor because I was young and healthy. And the only reason I ever went was to do a free clinic with my mom for short shots. Having health insurance wasn't a thing for us, we were healthy people. If something hurt my mom put Vicks on it, and it was fine afterwards. during college, I was volunteering as an interpreter in the emergency room. And I realized that people were coming in with situations that were just so sad like people coming in with limbs and then eventually you're going to need amputation because they had diabetes. And they just were never able to see a doctor there were uncontrolled, or women coming in with no prenatal care to deliver in the IDI. It was a lot of like Hispanic people. And it was a lot of my people. And a lot of those cases I was involved in because of my ability to speak English in Spanish. And I thought, oh, man, there has to be a better way about this, there has to be something that someone can do. There has to be something. And that's where my interest started my interest in medicine in knowing that, hey, I could actually do this. I could actually be good at this and could really care about this and be there for these people. So that's kind of where it started and then it hit me again; I don't have a social, how are you going to go to med school, that's one of the most competitive kinds of fields in the USA, even getting into med school for anyone that has all the resources or the family support, guidance on storing all these things. MCAT applying to difference, that was going to be an uphill battle. But my personality again, I went home and told my mom, I'm like, Hey, you think I could like to be a doctor? And around here? Like, yeah, I think so my mom was very supportive. And she doesn't know how to do these things. But she knows we are capable of these things. And sure that we just have to tell enough people and do enough looking around and I think you could, it was a thing of I started talking with some of the ER doctors who reasonably were kind of hoping that things would change and they also saw what I saw. And they were so concerned as I was about men, these situations are really preventable, a lot of them had amputations, decay, a lot of the things that are happening here, mostly with diabetes, hypertension, and prenatal care are things that are easily fixable with just a couple of visits. So from there, I kind of had to make up my mind and decide I'm going to do this, I'm just going to go ahead and do this, it is going to happen no matter what I'm just going to figure it out. And that's kind of what I did, I realized I went on Google again. And I figured out that you had to take a thing called the MCAT. And then you had to do well on that. And then eventually you had to put in applications. And then you had to volunteer, which I was already doing. And then I started talking with some doctors about just shadowing them in their clinics, and hey, I want to do this. And at this point, many of the doctors didn't know I didn't have a social, it was not something that you just say to anyone. Because of where we live in Southeast Georgia. It's a place where I love that place. But it's dangerous to be undocumented, it's dangerous because you will risk your family being deported. You are as if someone knows about your situation, you risk immigration, knocking on the door, or just many things. And then eventually DACA happen. So this is what DACA comes into the situation here. In 2013. I was able to apply to that guy and get it and what that meant was, I went from a person who had no social security number, no legal ability to work in the US to someone who was here for now, because of an executive order by den President Obama, with the aid of many people recognize that many of us came here as kids in through no fault of our own. We were in this situation where we are not American because we don't have the documents. But we're also not Mexican because we're not from there. And we can go back because we came here as kids so we know this country to be our own. We know ourselves to be Americans in our hearts. But the paper was just not there. Or what that Korea essentially that was it provided some relief. It provided a two-year at a time work permit so you can work legally a social security number, and, very importantly, a driver's license. Because many times driving to college. It was an equal chance of making it to eight o'clock biology. We're going to jail for driving without a license. It was interesting and I did stress about that a lot just because it's it was a difficult situation. So this provided a stepping stone. At that time, there was only a couple of universities or a couple of medical schools that were accepting DACA students. Well, you can apply. So there was not like a like quota like a number of DACA students they were going to take, but pretty much what they said was, if you have the chops to get in here, they really can't stop you. So if you have the MCAT scores, if you have the letters of recommendation, if you have the grades, will let you compete with the other 1000s of kids that want to be doctors. One of the universities or schools that did that was the illustrious School of Medicine. It's a private medical school. And in Chicago, where I did my medical school, the other school that was accepting DACA applicants was Harvard, medical school, and UCLA at that point. So it was kind of like, three spots, as you probably know, would be in a doctor. Applying to med school, it's a situation where people apply many times, sometimes people don't get in. And that's just the way it goes in the you apply next year. So I went ahead and apply to only one med school, I applied to Loyola because I realized that that was the place that align mostly with my beliefs, not because of their Jesuit teachings, but because of the way they advertised this. So at that point, on their website, it was the first time that we were recognized as Oh, my God, you're capable. And if you think you can do you will look at your application kind of situation, instead of being like a Hershey situation, which was, what it was in the other medical school is that it wasn't really on their website, you had to call it it was like being transferred between a couple of people. Yeah, we'll do it. But kind of situation. People were very open about yes, we're doing this yes, if you're a worthy candidate, we will take you in that was awesome. I just wanted to have a place where I could do that. So I applied and I got in, but I was so happy. But then the problem came with, how are you gonna pay for this?



Raj Sundar: Because you can’t get financial aid.



Dr. Ale Duran: You cannot get financial aid. So with DACA with financial aid, you have to have a social, which I did. But my social only works for two years at a time. So for you to get a loan, you either had to get a personal loan from a bank for $320,000. So it was my case for the full four years, with no credit, or family assets or money, or anyone to like, be a cosigner for anything. Because at that time, we can gather our assets, and quotation marks there. And we had all of like $22,000 worth of things that included our trailer, like, we lived in a trailer park, and that included our colors and everything. Those were our assets, which were worth nothing apparently to the bank. They're like, yeah, that's cute. But no. So eventually, I got into contact with the resurrection project. That's actually how I got my loan. It was a personal loan, there was a restoration reduction project because even though you're here for two years, you can't get any. For consumers which was like a small miracle on its own, like being able to get that money and being able to not only get accepted to med school but being able to pay for it. And then now you get to do the easy part, which is medical school.



Raj Sundar:How are you finding all these resources? Oh, it just seems incredible that you're coming on to this, I guess it's so hard. There's nobody around you helping you or telling you, hey, you might not be able to but here's four places you can call them, they'll give you loans. How did you do it?



Dr. Ale Duran: In all honesty, I called about like 150 spots. Throughout the whole time, I got information in then it was just persistence, to be honest. Throughout most of what I've done the persistence of we don't know, but we'll ask somebody and then get back to me. They're like, No, and then you go to the next part, and then you I mean, you put it out in the universe, and the universe has to conspire in your favor. That's what my mom says all the time. And I believe that. So it was a wild situation. Because the first day of med school, I was so relieved. It was an easy part there. I got like stuff. I got my knowns. Now I just need to do the learning stuff. And then the doctrine stuff, which it did not seem that daunting after what I had to do to get into med school. I think I was relief on the first day of med school started. And it was great. I love it. Med School was like great and awesome and fun. And it was the first time that I felt like one of my peers because we were all scrolling a little bit we were all like Oh pharmacology we hate it I'm like the kitchen I also cater that to like I get to first world problems, for the first time in my life. I'm like yes, I wasn't very happy. happy about that. And then 2016 hit, which was the election, right? So the election where then President Trump was elected, and he was selected on this kind of campaign of we don't like immigrants, we're just going to go ahead and revoke DACA, because DACA sees an executive order. So whoever is in the office can do that. So you're not here for God, you're just here. Well, people can tolerate you a little bit, or while he is, but politically advantageous for people, for both Republicans and Democrats. I don't mean either way, because we've been used by both of them as political tool games. So at that point, it became stressful. It became really stressful because of a lot of the things that were happening in at some point, there will not just be some point, there were a couple of points where DACA was on the verge of being revoked. Even what that meant for me was that my loan was contingent upon my being able to have DACA. If at any point, I had a lapse there, it would become due. So $320,000 will become due at whatever point, I didn't have that. And I couldn't continue medical school, if that happened, because you don't have social because of many situations there. So for four years, I felt like things were always on the balance. So that was, I think, probably the hardest part of med school dealing with, am I still going to be here? Like, how do you stay motivated, and study hard for step one, and then study for step two, and then apply to residency, when you're not 100% sure, if you're gonna be here next year. You're not 100% sure if you're actually going to be able to do the job that you are expending 1000s and 1000s of dollars in like, hundreds of hours studying for, it was kind of mental preparation of attention to the best I can for now. And then do the best I can to be the best doctor I can possibly be. Just on the off chance that I can still be here, like, in the next year or something. Which was okay, most of the time, except when it was like hard times, like, studying for step one. Everybody has some PTSD from that. Oh, boy. Yeah, yeah. Totally.



Raj Sundar: What a  mindset, Ale.  That's hard.



Dr. Ale Duran:It is kind of hard. But you know, I'm stubborn. My mom is also stubborn. And she's like, well, just because they say you couldn't, doesn't mean you can't. So if you want to, you can just do it. That's how we grew up being myself and my four siblings. So I got through med school, and it was great. And then I was actually lucky to be I can I say lucky a lot. But I do think that there's an element of luck in these situations and people who see the value in what you're doing and help you along. I do think that I didn't get here by myself. I think that many people helped me throughout the way. But yeah, I was lucky I got to be here for residency for family medicine. I was just so excited. It was like the combination of oh my god, okay, now I'm gonna get a real job. I've never earned so much money. I know, this does not reflect what most people think about earning money in residency. But my new my full family assets were like to, like $22,000, at the beginning of med school. So I come here and I'm earning like, $70,000 a year, I am feeling rich. I don't feel like man, I kind of made it. I'm getting to be a doctor and I'm earning money. And I can help my mom in I'm doing really well. In that husband, the thing sometimes I think about well, residency is hard for everyone. But I think for me, the hardest part of residency has been whenever it's time to renew my DACA status. In Sometimes there was a little bit of a delay during the pandemic. So for many reasons, and , I was very scared. I was very scared that I was not going to get to keep doing this. I started residency in June of 2020, of having to work through a pandemic. And like some of the most dangerous situations like most doctors have during this time. It was about man, what if I don't get to do this? Because one of my status doesn't come in, eventually it did thank, God, but yeah, so that's like my whole story. That's me. So I am almost at the end of my residency, and I'm about to take a faculty job within that same residency that I really like, and I'm very excited about so. Yeah.



Raj Sundar:Ale,  I'm so excited. You're gonna work with me?



Dr. Ale Duran.Yes, I am.



Raj Sundar:Ale, thanks for sharing that. Yes, I think there are so many parts that I want to talk about a little bit more. And maybe I will start first with the process, because you were talking about the uncertainty and the difficulty of waiting. I think it was especially hard during the pandemic. But tell me what the process is for applying for DACA? Because the processing time for that is like eight months. And I know people who've gotten into trouble because you have to renew every two years. Since the processing time is eight months, even if you don't get it back in time, what happens, right?



Dr. Ale Duran:So the thing is, you don't actually know how long it's going to take to process it. So the official instructions on the website are apply no more than 180 days before your expiration date. So it's about six months. So you're like, okay, but in many cases, it can take up to a year for this whole thing to process. So you have to, again, go through a background check, get your fingerprints, and all of that, you have to maintain yourself out of trouble. That's never really been hard for me in terms of, you really can't go to jail, though, you don't want to get in trouble for any reason. Because that can prevent you from being able to apply again. You also want to make sure that you have the money for it, one of the things that it's very expensive, each time that you apply it with all the fees, it ends up being about a little shy of $1,000. So for many people that can be burdensome, and then you have to send all the paperwork, have to keep them updated with your addresses, what you're doing as well. And then make a case of why you still need your status renew. And then you send that and cross your fingers. And then you hope that it comes back on time before your work permit expires. Because if it doesn't, and I got really close to this last time it made this happen. It came four days before my permit expired. But you have to start making arrangements. I was holding my breath. Oh gosh, yes.



Raj Sundar: Yeah, that's talking about mental stress. What do you mean arrangements? Right? What were you thinking?



Dr. Ale Duran:If you can work legally in the US, which is what happens, you really can't stay in your residency program. So what I had to do is in my residency has been super helpful in very supportive, but you have to tell them, You know what, it applied for this thing about eight or nine months ago? It's still not coming? I haven't heard from them. And it's not a process of there's a tracking number and you can figure it out. There isn't a you have to just wait. So I was already making arrangements for a leave of absence from residency when it got there. And we all collectively had a moment of a deep breath. Hell, Thank God this happen. But that can happen at any point that can happen when I'm gonna attend in that can happen. At any point in if it does come the point where there's a lapse in my work, I'm not 100% sure what's going to happen. Yeah, it's, that is the stressful part of our residency, residency itself is pretty okay. It's pretty cool. It's actually like, a really cool job.



Raj Sundar:Yeah, that makes sense. So, we heard about DACA, from perspective of you becoming a doctor, and all the difficulties that you had to face and overcome for them. I want to talk about you as a person and its mental effect on you and your family. There's been so many studies done on DACA recipients, the documented since somebody said that I don't know if you've ever heard that term, yes. But they found that it improves high school graduation rates and employment outcomes. That makes sense because you finish high school and you can get a job. It decreased rates of poverty, again, makes sense because you can get a job, lower teen birth rates, improvements to mental health, and stronger feelings of inclusion and belonging. This whole debate is so polarized, as you just noted, the DACA program was rescinded in 2017. And that legal challenge, but as clinicians, healthcare systems, and people caring for each other, the evidence overwhelmingly says DACA helps people feel better and helps their health, right Ale? And I think as a person, I can hear from you.



Dr. Ale Duran:I think as a person, it gives you the opportunity to be your best self. And to actually put to use some of the skills that you already have, because of the lived experiences that you have. For many people who just have that. For me, for a long time there was like this, this wall that you just couldn't get over because you just didn't have a social and you just couldn't do it. And it didn't matter how smart you were, if that didn't happen, I wouldn't be a doctor, in for my siblings, they all are doing really well in each of their careers because of the same reason. It's nothing wrong with having some other job. My mom cleans houses for a living still. And I probably wouldn't be doing about the same thing, which is a job that I know how to do, which is a job that is that has provided for a family for a long time. But I don't think that it's a job that for me at least would have fulfill my intellectual kind of requirements. What I want to be doing in providing There's so much of the happiness that I have, because I get to be a doctor I get to be, I get to this really cool profession where people allow you into their lives where you have to exercise your mental abilities, and you get to be there for people and you get to, to get through some of the hardest parts of their lives for many, in some of the happiest moments in life for others, like the birth of a child or like the death of a loved one. So I think for me, being able to have DACA really did change my life in that aspect, that I could be who I was meant to be.



Raj Sundar:Yeah, and we all benefit when people are their best selves, right, whatever that is, and contributing to the community with the impact that can make, like you said, for you. This is like your calling all day, every time you talk about it, you say, it wasn't that hard. I love it. I don't think everybody thinks that way about medicine. So we need people like you. That's for sure. And the other part of I think the anxiety, at least what I've read and heard from people is that the United States Citizenship and Immigration Services, the office that processes the documents now has all your personal information, including your address, and everything. So if the program gets rescinded, or canceled, there's a sense of vulnerability of now somebody, especially the government, knowing everything about you and your status. Is that feeling exists with you and your family, too?



Dr. Ale Duran:Oh, god, yes. So whenever DACA was first rolled out, so this was 2012. It was a whole family decision. The whole family comes together. And if we do this in something goes wrong, or is this is some kind of scam or if this is something that it was too good to be true, honestly, at that moment. Then we all can get deported. And we're gonna get deported to a country that we really don't know. I really didn't have much schooling for the first 14 years of my life because we lived in the country like I know ranch within Mosul rescoring through like a one room house situation. So I'm like, am I going back over there? I don't know anyone. But yeah, there is a true concern of you update your address, you update pretty much everything. It's a requirement of this program. And should something happen, we are the easiest people to deport have, because not everybody knows where you live, where you work, pretty much everything about you.



Raj Sundar:Yeah, that's scary, Ale to be in that position, and so vulnerable. And I think even when you have DACA, I think for many people, after 2017, this vulnerability became so clear. And the vulnerability of it being Executive Order became clear. Many individuals think started avoiding healthcare facilities, despite having active DACA status, and maybe even insurance because of exposing their identity to more places. And I think that uncertainty has shown somewhere in the evidence, because all of these positive health outcomes decreased, even though the DACA program still exists. Because people are unsure of its future, depending on the presidency, right?



Dr. Ale Duran:Yes, I don't think so. I think personally, I still worry about these things. We are in limbo, really, because we are not. This is not permanent. And I foresee that coming in this next election, anyone can use our status as a politically motivated situation. And it can be really bad for us. It can be really difficult for many people who depend on this. People who have children, people who depend on that one person's job for the income for the entire family, perhaps. It definitely provides a level of anxiety. Well, it's better than what we had. It definitely has created another problem of Yeah, many people do have jobs to have insurance. But we're just going to try and not draw too much attention to ourselves.



Raj Sundar:Yeah, exactly. And just the feeling of you could be doing amazing things and not wanting attention. Even though you're such a great clinician, I'm so glad that you're coming on this podcast, but I don't think everybody would want to do something even like that.



Dr. Ale Duran: Yeah, I think so. Initially, I'm no stranger to the lights. in med school. I did a lot of work with Senator Dick Durbin from Illinois, in a lot of work in DC with advocating for a path to citizenship because while many people say get in line will just apply. There is no line. There is no just apply situation. What many people many activists and I dare say still call myself an activist to that aspect. Hold for is a permanent solution to this because it will change so many people's lives. It will change health outcomes for so many it will change the amount of mental health issues that people have, including anxiety, depression? Yeah, it was a question I asked myself in 2016, am I going to be open and vocal about this? Or am AI hiding? and I'm not the hiding person situation, if something has happened, I'm just going to go ahead and say the things that I need to say, because I think it's important. I think it's important for people to know that there is a doctor who is DACA mented. That I too have been through these situations, and perhaps better than most can understand what's happening in a family's life. What's happened in an individual's life, when immigration status is part of the equation. It's a huge burden for many people. And I think being able to say this out loud, and people knowing about this is one of the first steps in people are realizing that this doesn't just affect the people who clean your house. This doesn't just affect people who are removed from you, it affects your colleagues too. It affects people who work in your same office. So I think that's one of the reasons I'm very outspoken about this, because people just need to recognize that this affects much more than many more people than they realize.



Raj Sundar:And it's not just about the people. But there's intergenerational effects. I like to make sure people acknowledge that because so much will be what we talked about in this podcast is trauma from historical events, or community trauma. And for DACA, specifically, there's been research to show that kids of DACA recipients have less anxiety and mental health disorders. Again, it's easy to imagine why. But there's generational effects of policies like this.



Dr. Ale Duran:Yes, absolutely. Because if you can imagine that, your children, I will say for myself, I'm an adult now. But when I was 14, and then through high school, eventually, when I learned the full extent of it, I realized why I was always concerned when my mom was a little bit late from work. Because there was always that concern of, am I not going to see my mom again? Is she going to be stopped? Because of driving without a license? In? What are we going to do about that there's five kids at home in what if she doesn't come back? That's something that, thankfully, is less common with children of documented people, because they don't have to wonder if their parents are coming home. And they don't have to wonder if they're going to be there for the next day. And they don't have to really make plans. So if this happens, where can we go? Which adult can we talk with? Or stay at? You don't have to have those kinds of crisis planning. And I think that's huge. Because for a long time, I was always worried about my mom in where she was in, what if she didn't come back? So I think for many kids, that's going away. And that's really going to help them in so many aspects. There's no reason why a kid should be worried about whether or not their parents are coming home.



Raj Sundar: And imagine the trauma and the effects that that could have. And part of the history of DACA is a you know this well, is when in June 18 2020, the Supreme Court held the Trump administration's termination of DACA violated the Administrative Procedures Act, because they just said, Oh, we're gonna end this program with thou acknowledging all the consequences of that. And I think that more than 800,000 people have DACA. And more than 1.3 million people live with a DACA recipient with 300,000 children born to one parent with DACA. So if you rescined DACA, all of a sudden, 300,000 children would lose a parent just like that, if they were all deported.



Dr. Ale Duran:It's powerful to think about this in numbers. It's something that not only affects the individual. And again, you have to think about this. People who have DACA came here as children. There's people who came here at the age of one or two, I came here as 14. But people who have lived here the entire lives, people who don't really, in many instances don't speak their native languages. rescending something like that would affect I don't know, like so many people in so many ways.



Raj Sundar:And some more statistics that give context, just to everything that you're saying. The average age of a DACA recipient, when they arrived to the US was seven, you said people who are one to two, you're 14, because the criteria for DACA is strict. Not everybody can get DACA because you had to be younger than 31 and 2012. And came to the US when you're less than 16 years old. And here since 2007. You got to do some math there, but it means most people as you noted, were really young when they came.



Dr. Ale Duran:Yes. And so more criteria there is you have to do something with it. So You either have to get your GED, you have to get your high school diploma. And if you're applying for a work permit, you have to be employed. So it's one of those things that when people decided, Oh, we're just not going to do this, it was really not well thought through. Because of there is really no downside to this. And I may not be the most objective person because I am a DACA recipient. In terms of finding out what is actually wrong with this and, why would people want to eliminate it, I don't see a valid reason for it. In all honesty.



Raj Sundar: And DACA itself, as you're noting, you need a more permanent solution. But DACA itself is constraining. There's no pathway to citizenship. And can you travel Ale?



Dr. Ale Duran:Yes, and no, there are only three ways that you can travel. One of them is humanitarian. It's called an Advance Parole. So pretty much you can just decide I'm leaving the country tomorrow for a vacation, and then I'm coming back in two weeks. No. So pretty much you have to plan it and maintenance in advance, it's called an Advance Parole, so you have to apply for it. There's only three instances where you can get it one of them is humanitarian reasons. For example, a parent or grandparent somewhere in another part of the world is dying, or something of that nature, then they may or may not give you permission to go in time for you to see this, that dying relative. The other part is educational, or work related. So it's limited. I mean, honestly, that's my biggest thing with it, but it is limited. It's not, you can just go places, you have to ask permission to go anywhere. And if they give you permission, that's great. But if not, you can go at least you can go and come back.



Raj Sundar: Yeah, so program limits, essentially where you can go. And I think we still have the problem of I think you were sharing with me about getting a mortgage, right? Can't just get a mortgage and get a house either.



Dr. Ale Duran: So there are a few programs in the US where they will consider you for a mortgage. Even when you're DACA status. For many people who do get a mortgage as DACA, they often have a spouse, just in my experience, they often have a spouse who is a US citizen, or has the ability to be able to sign on to that mortgage together. If you are just DACA yourself, it's hard. And I understand the banks has tints with it, you're here only for two years, we're not really sure that we want to give you a 30 year loan. We're not really sure you're going to be here for more than two years. So even when you have the money to put a down payment on things, and your credit is good. It's an uphill battle to try to figure that out.



Raj Sundar:Yeah, all your life has been because of this right, in many ways. Yeah, I think the last point I'll make is that there have been no DACA new applications for DACA. Since 2021. That right now, people are only renewing DACA that were obtained before July 6 2021. And if you let your DACA expire, as you know, then because the processing time it just took too long, then you're considered a new applicant again.



Dr. Ale Duran:Yes. So you have to really be on top of it. Which is in sometimes even if you are on top of it, it might just expire on you. And you may be out of luck. Where you are, again, consider a new applicant in that may mean that you can't apply again.



Raj Sundar:Yeah, I can only imagine how the mental toll and what happens to people if that's how you got your DACA revoked because the processing time was too long. And I'm sure it's happens.



Dr. Ale Duran:For example, if you're a doctor, and in I am one, but you can be fairly certain that next year, you're going to be here. And you can be fairly certain that unless something crazy happens, you're still gonna have your job. And you are still going to have your home and you have security and what you're doing I tend not to think about these things because it does make me depressed. Sometimes you think about oh, man, this is very, this is very on a secured of thinking that something like this can happen to me. It can happen to anyone and all of a sudden you've gone through through school and residency and then all of this stuff, and then it can be gone just like that. That definitely takes a mental toll. But I'm hopeful. I'm hopeful that at some point people will see the sense in providing a path to citizenship because it makes no sense that there's no path to citizenship. Someone will see it and this will happen. I'm hopeful for that. But again, I'm not sure.



Raj Sundar:Yeah Uncertainty. Yeah. So what I keep hearing which Ale you're so resilient.  The way you talk about this. I'm honored to be in the same space as you are. And I want to say that out loud. Because I went out right recognize that.



Dr. Ale Duran: Oh thank you.  I hope for a day where people don't have to be resilient. Where they can just be regular and just like, regular regular. They can just like, chill and not have to be resilient because resilience is awesome. But for many people it just like really chips at their own, at their mind mental health. I think that they may be coming for people. I don't know. I'm hopeful there.



Raj Sundar:Yeah. Okay. Last part of the episode, any takeaway messages or points about caring for folks who have DACA that you want to highlight? For clinicians, healthcare systems, leaders, whoever is listening right now?



Dr. Ale Duran: Oh, man, I think instead of thinking about your patients, think about your colleagues. Do you know someone who has DACA? There's about 100 to 250 of us DACA doctors in the US. And can you learn something from that? Just being curious. I think curiosity is one of the best things and if you know, someone like that, and you can talk with them. I think people learn a lot from just talking with a colleague about these things that that's what I would say, be curious and then see if anyone around you, perhaps has a story similar to this, and they will be comfortable sharing it with you. I think it would benefit many people to hear from their colleagues. Be curious about that.



Raj Sundar:Thanks, Ale. Yeah, I think that's a great point to make. And I like to highlight that curiosity in a way that's humble because doctors and people, clinicians sometimes are curious in a way that diminishes people's humanity, right, probing and asking in a way, that's hostile, because you want to satisfy your own itch rather than honor what you're going through and supporting your colleagues. Right. Yeah. Thank you so much, Ale. It's been fun. Thank you. Thanks, everyone, for joining me on another episode Healthcare for Humans. When you get a chance, please rate and review on Apple podcast and tell us why the show or this episode was helpful for you. This will help other people find this content and help make healthcare more caring.



Speaker 3: This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participants past, current or future employers unless explicitly expressed so, always seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land that makes a regular commitment to Real Rental Duwamish.


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