Life, death or deportation

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LAS CRUCES — At an appointment in late January 2024, Angelica’s doctor delivered the results of her biopsy: stage 2 cervical cancer. She needed aggressive treatment right away, but getting it in her hometown of Las Cruces would mean a monthslong wait.

One month went by, then six weeks, then two months. By April, the doctor said she couldn’t afford to postpone treatment any longer. She needed to get to Albuquerque immediately, where he could quickly arrange an appointment.

“I can’t go to Albuquerque,” Angelica (her middle name) responded. “I don’t have papers. I’m undocumented. I can’t make it past the border patrol checkpoint. Am I going to die if I stay here?”

The diagnosis put Angelica in a life-or-death situation — one faced by every undocumented person in New Mexico’s southern borderlands who needs life-saving medical treatment. They must either find local care or take their chances with the U.S. Customs and Border Protection checkpoints that sit along every route to the state’s most cutting-edge hospitals in Albuquerque.

Las Cruces and Doña Ana County — home to one of New Mexico’s highest shares of immigrant residents — suffer from a shortage of doctors and medical specialists even more acute than the rest of the state.

A 2023 Legislative Finance Committee report found that the county already contends with one of the worst deficits of primary care doctors. Medical specialists, particularly in pediatrics, are virtually nowhere to be found. And the problem is only expected to deepen: By 2030, New Mexico is expected to have the second-largest physician shortage in the country, with a projected shortfall of 2,118 doctors, a gap that will likely hit especially hard in the already strapped southern part of the state.

An additional challenge emerged following the U.S. Supreme Court’s Dobbs decision of 2022, which eradicated a woman’s constitutional right to abortion. A year later, more than 14,000 patients from Texas traveled to New Mexico for reproductive health care. That surge has pushed many local patients to the back of waiting lists, advocates say, often forcing them to travel to clinics in other parts of the state for care.

The result is a health care landscape that leaves “a significant number of families here in a really difficult position,” said Las Cruces Mayor Pro Tem Johana Bencomo. “We have these giant gaps that affect almost every kind of health need. It’s hard for everyone, but undocumented and mixed-status families are just stuck.”

Many are forced to seek treatment in El Paso, a city contending with its own severe shortage of providers, or travel north to Albuquerque or Santa Fe — and through the border patrol checkpoint on I-25, approximately 30 miles north of Las Cruces. 

“Most people who live outside of checkpoints have no clue of this problem,” said Yolanda Diaz, who runs Cancer Aid Resources and Education Inc., a Las Cruces-based nonprofit that connects patients with medical services. Diaz has made as much noise about the issue as she can, speaking in city council meetings and writing editorials in newspapers throughout the state. Despite her efforts, she says there’s been little progress in fixing the problem.

Barriers to care 

This latest crisis isn’t the first time a lack of local care jeopardized Angelica and her family. Six years ago, her 12-year-old daughter suffered a brain hemorrhage while at school in Las Cruces. She died in the ambulance while being transported to the nearest pediatric emergency center 45 minutes away in El Paso.

“Any parent that loses a kid isn’t afraid of dying anymore,” Angelica said. “I wasn’t scared for myself when I got my diagnosis. I was scared for my son,” who is 16 years old. “Who’s going to take care of him without me?”

The choice was clear: If she didn’t get treatment quickly, her remaining child would spend the rest of his life without a mother. With the help of her doctor, Angelica contacted Diaz, the patient advocate, who agreed to help.

It wouldn’t be simple. The barriers faced by patients like Angelica are “horrifying,” according to Diaz. Making matters worse, Memorial Medical Center — southern New Mexico’s biggest hospital and only facility accredited for cancer treatment — recently came under fire for allegations of denying care to underinsured patients.

With the clock ticking, Angelica and Diaz decided to try and find a backdoor route to Albuquerque. “Cancer doesn’t wait,” Angelica said, and neither could she.

Waitlists go on ‘forever’ 

Gaps in health care access are not uncommon in small communities along the southern border, whether in New Mexico or neighboring states. But Angelica — like all undocumented residents of Las Cruces, New Mexico’s second-largest city — faces hurdles not typically shared by those living in major cities.

“I’ve seen patients wait a year or more for treatment for certain illnesses,” said Angelica’s oncologist, Dr. Luis Padilla-Paz. “No matter how well-intentioned the providers, there’s so little supply of health care providers to take care of these patients. And that compromises the outlook and survival for the patients.”

In Arizona, checkpoints lie to the south of large population centers, for example. The health care infrastructure in California is robust enough that San Diego residents are more likely to obtain local care.

In New Mexico, by comparison, the situation has now reached crisis levels, said Karen Kopera-Frye, a professor of public health sciences at New Mexico State University.

Patients are “waiting on a waitlist to get seen forever,” and end up with no choice but to try to get care elsewhere. “You can try to go to El Paso, but they’re busting at the seams as well,” Kopera-Frye said. “And undocumented patients, where do they go? If you want the good care, you go north. But you can’t, because there’s a checkpoint.”

There have been some bright spots in getting basic care to underserved communities, she noted. School-based health centers have shown success in some areas. And the state’s border region has an unusually high number of federally qualified health centers, a type of clinic meant to provide primary care services regardless of patients’ ability to pay.

“But if you need a specialist, you can forget that,” Kopera-Frye said.

Too great a risk

Little, if any, data exists to show the extent of the border checkpoint’s health impacts on undocumented families, or how many residents have been affected. Undocumented immigrants are unlikely to respond to surveys and are among the hardest residents for researchers to study, resulting in a profound lack of data about their plight.

A U.S. Customs and Border Protection spokesperson told Searchlight New Mexico that the agency rarely encounters undocumented patients at the checkpoint north of Las Cruces. That could indicate the problem doesn’t affect a large number of people — or that few undocumented residents who need care in Albuquerque are willing to risk the trip.

Advocates and patients say it’s the latter.

“There are a lot of families dealing with this,” said Elizabeth, a single mom in Las Cruces who gave only her first name because she is undocumented.

The mother of four teenagers, Elizabeth’s second child was born with a chromosomal disorder that affected her eyes, kidneys and bones. When she was an infant, the girl required a dizzying number of appointments with doctors, surgeons and therapists, sometimes three or more per week.

The referrals to doctors in Albuquerque came by the dozen. “I asked them, isn’t there anyone she can see here or in El Paso? They told me ‘No, there’s nothing. You have to go to Albuquerque.’”

It was too great a risk, she said. If she were ever to be picked up by border patrol, her children — all U.S. citizens — would be left without a parent.

“It’s humiliating,” said Elizabeth. “These are my kids. I’ll never leave their side. We try our hardest to do the best and to protect our kids.”

Over the years, she has managed to obtain some local care for her daughter, who is now 16, usually after many months of waiting for appointments with the few doctors in town who can partially address her medical needs. In many cases, she’s had to forego treatments completely.

Longing for home

Two and a half months after Angelica’s diagnosis, Diaz managed to arrange a way for her to pass the border checkpoint undetected — a route Diaz refuses to discuss. The relief was short-lived: At Angelica’s first appointment in Albuquerque, doctors told her that, in the time that had elapsed since her diagnosis, her tumor had doubled in size.

She would need at least three months of chemo, followed by a month and a half of radiation. Because of the checkpoint issue, she’d need to stay in Albuquerque for the duration. Even then she might need further treatment. 

“I can’t be here four and a half months!” Angelica initially thought. “How will my son make it that long without me?”

In recent months, Angelica has shown improvement, taking chemo in doses, as she jokes, “that would kill an elephant.” An Albuquerque nonprofit that supports cancer patients is providing housing — a modest one-bedroom apartment in the southeast part of town, where she passes her days, window shades drawn, waiting for news that she can return home. 

“I’ll be back soon enough,” she said, thinking about her son. “He’ll have to deal with me for another 40 years.”