Latest / The SHEA Podcast / Infection Prevention In ICE Facilities

Transcript

Infection Prevention In ICE Facilities · The SHEA Podcast

• 0:07
  SPEAKER_00: Welcome to Shay's podcast.
• 0:09
  SPEAKER_00: My name is Vanasa Kung, and I'm a member of Shay's Committee for Healthcare Access, Inclusion, and Representation, or Chair.
• 0:16
  SPEAKER_00: And this podcast is an initiative from Chair, and I'm honored to moderate today.
• 0:21
  SPEAKER_00: We have the great privilege today of being joined by Dr.
• 0:24
  SPEAKER_00: Carlos Franco Paredes.
• 0:26
  SPEAKER_00: Dr.
• 0:26
  SPEAKER_00: Franco Paredes is an infectious diseases physician with affiliations to the Hospital Infantil de México, the Gorgas Institute in Panama, and Colorado State University in the U.S.
• 0:37
  SPEAKER_00: Dr.
• 0:38
  SPEAKER_00: Franco Paredes has dedicated his career to researching and addressing infectious diseases that impact vulnerable populations worldwide.
• 0:46
  SPEAKER_00: His areas of expertise include travel and tropical medicine focusing on social justice and health equity.
• 0:53
  SPEAKER_00: His main interest in recent years has been addressing health disparities among migrant populations across the Americas, including work at the Darien Gap in Panama as a Fulbright Global Scholar.
• 1:05
  SPEAKER_00: In addition, he has served as a medical expert in lawsuits and inspected correctional facilities across the U.S.
• 1:12
  SPEAKER_00: in collaboration with civil rights and immigration attorneys and advocacy groups.
• 1:17
  SPEAKER_00: As an activist working with Colorado re-entry organizations, he promotes healthcare access and equity for formerly incarcerated or detained individuals.
• 1:27
  SPEAKER_00: Welcome to the Shape Podcast, Dr.
• 1:29
  SPEAKER_00: Franco Paredes.
• 1:30
  SPEAKER_00: We're delighted and thankful to be hosting an expert to discuss infectious diseases and infection prevention in the unique congregate setting of ICE facilities, as well as your broader work with migrant populations.
• 1:43
  SPEAKER_00: The intention of this episode is to learn about the medical issues and focus on humans and patients, regardless of political worldviews.
• 1:51
  SPEAKER_00: Shay's vision is safe health care for all.
• 1:54
  SPEAKER_00: And we want to spotlight healthcare needs in this population that impact us all, both directly and indirectly.
• 2:02
  SPEAKER_00: So starting off, Dr.
• 2:03
  SPEAKER_00: Franco Paredes, how did you become involved in work with ICE detention centers?
• 2:09
  SPEAKER_01: Hello, Vanessa.
• 2:10
  SPEAKER_01: It's good to thank you for the honor and I would say the responsibility to be here with you today.
• 3:08
  SPEAKER_01: And doing consultations on issues such as tropical diseases, malaria, very rarely then, because you know, by the time we see him, it's it's a few weeks or months, or the inquiry period has passed.
• 3:19
  SPEAKER_01: But uh cuttenus leisurasis was another important condition that we saw.
• 3:24
  SPEAKER_01: And then also we saw um, I mean, I would say not frequently, but sometimes uh skin and soft tissue infections caused by by mRSA um and uh or staphorius uh cellulitis or skin-soft tissue infections in general.
• 3:40
  SPEAKER_01: Um and then I learned about their struggles and their journeys across basically the globe and reaching the Americas to start their journeys to reach the US-Mexico border.
• 3:52
  SPEAKER_01: And um, because of that, um I also began volunteering with the human rights clinic at Denver Health that offered um what is called forensic medical exams for individuals seeking asylum or just simply sometimes using these medical reports for um seeking release from detention uh on a volunteer basis.
• 4:15
  SPEAKER_01: And I started learning a lot of their efforts.
• 4:18
  SPEAKER_01: And then the COVID-19 came in too um into place, uh, in obviously worsening the situation for many people in these concrete concrete selling uh settings.
• 4:29
  SPEAKER_01: And you know, we can talk about this, uh not not to go deep into that, but that was a a very important period in in detention centers.
• 4:38
  SPEAKER_01: Um and you know, through that, as as you mentioned, thank you for the introduction also, is that uh I began interested in in learning more and collaborating with other colleagues and uh trying to understand uh as you you also said, you know, what the the uh the mission of uh Shea is providing safe care for everyone.
• 5:02
  SPEAKER_01: Um I think that's the goal, understanding that this this is a very vulnerable population.
• 5:08
  SPEAKER_01: Um and sometimes with you know very uh I think very important stories to tell, um, not only medical but like human rights issues um and struggles that that we all need to to at least understand and and and learn from.
• 5:27
  SPEAKER_01: And um and then I began developing uh projects or working with projects with colleagues uh across Central America and South America and in Mexico and in the US and uh Canada also, developing some some um some studies, some projects, not to advance um you know my career, but mostly to advance the knowledge about or the experiences about issues such as what you asked about, um, or what says about infection control, my microbial resistance, uh frequent medical conditions, um, causes of death among migrant people.
• 6:07
  SPEAKER_01: So that's basically my journey, um, Vanessa, is through through this, you know, the last I would say decade working on this very vulnerable population.
• 6:17
  SPEAKER_01: And you know, we can talk more, but I think one of the important things about this population is that I would like to say from the very beginning is that um there there's an overlap of social forces um that are shared by people, for example, uh migrants in transit, uh people displaced by civil conflicts, uh, war zones, and and many other vulnerable populations, which you know, I I know you are interested in uh you have been working too, uh, and I have been working even before working with migrants uh or people in detention um or people in correctional facilities, but it's basically the fact that um that many of these factors um facilitate the or or enable these populations or place them in a vulnerable population to acquire some infectious diseases.
• 7:08
  SPEAKER_01: And then also the other, I would say, structural vulnerability that this population has is their um their outcomes, right?
• 7:17
  SPEAKER_01: Is that it's not only that they're more vulnerable to acquire some of these infections uh or some particular infectious diseases, but also the outcome in terms of you know these infections causing uh a more devastating impact in terms of you know, maybe sometimes premature death, uh disability, uh, or just a bad outcome just because they're they lack the uh the access to health care or suboptimal health care, uh, or maybe you know the sanitation issue, uh ventilation in some of these facilities, and all these factors are shared by these again, the social forces become confluent in this population.
• 7:58
  SPEAKER_01: So that that's the journey I I've had to with this this particular population, Vanessa.
• 8:05
  SPEAKER_00: What would you say are the unique infection prevention challenges in ICE detention facilities in particular compared with other congregate settings like hospitals, correctional facilities, or homeless shelters?
• 8:19
  SPEAKER_01: That's a very important question, and thank you for asking that.
• 8:23
  SPEAKER_01: I think that similar to other congregate settings, there's the there's a high risk of um infections that are highly transmissible to be or to spread rapidly, as the COVID-19 pandemic showed, and and it occurred.
• 8:39
  SPEAKER_01: And I think you know, if you look at just using, I would say public health terms like the basic reproductive rate of an infection, um, the transmissibility of some of these agents uh these infectious agents in these facilities is um it is very easy, you know, because there's a high uh population density.
• 9:00
  SPEAKER_01: The ventilation may not be ideal in some of these places, and uh sanitation is not also or is is suboptimal uh from what I've learned and what I've seen too uh by going to particularly the uh the local facility here in Colorado to do this, not to do an inspection, but to specifically to do um these uh forensic medical exams in people in migrants in detention.
• 9:29
  SPEAKER_01: Um so so those are the factors that we know that are shared also with you know big congregate settings such as jails and prisons in the US and other settings.
• 9:38
  SPEAKER_01: But what I think is very unique to these facilities is that um compared to I would say federal prisons, um, that I really don't have much experience, but state prisons and particularly jails, there seems to be an issue of uh accountability and responsibility and maybe adherence to some of these protocols that protect uh people in detention.
• 10:04
  SPEAKER_01: That that is my overall impression.
• 10:06
  SPEAKER_01: And I think you know, all detained um immigrant health care falls under the authority of the um ICE Health Service Corps.
• 10:17
  SPEAKER_01: Um, and this this is uh I would say a group of individuals that I don't have any contact directly, but that develop sort of guidelines for uh adherence um to protocols such as infection control um or medical care of people in detention.
• 10:37
  SPEAKER_01: The the issue with these these uh facilities compared to again jails or prisons in the US is that it seems to be that the the model where these facilities are based on is basically a pro for profit um model where there's two major corporations that own most of these private enterprises or these detention facilities.
• 11:01
  SPEAKER_01: Um and as we know, there's many more over the last year and a half or so have grown uh based on allocation of funding by by the US Congress and Senate for expanding um what is called Aero, the enforcement of removal and operations by ICE.
• 11:19
  SPEAKER_01: And one of those factors is building more, or not building, but creating more facilities.
• 11:24
  SPEAKER_01: And the problem with this issue is that the um that some of these facilities that the ones that are uh coordinated or um I would say managed by ICE directly, they tend to seem that based on information that I have reviewed over the years, they adhere adhere more to these guidelines.
• 11:46
  SPEAKER_01: But once you go into that, like the for-profit model, which is the majority of these detention facilities, you know, it's it's a for-profit, you know, where you know resources are are limited, you know, and and then the focus on safety for for the people in detention is not is not the goal.
• 12:04
  SPEAKER_01: I mean, even though it may be stated in documents, you know, we know from doing at least 180 or so uh forensic medical exams that these experiences are very, I mean, very consistent, you know, what is described.
• 12:20
  SPEAKER_01: And again, although I haven't done an inspection per se, the adherence to infection control protocols in a facility, at least in the Aurora facility here in Colorado, and knowing from other um facilities during the COVID-19 pandemic, uh, because I also participated with many uh civil rights attorneys and immigration attorneys uh during lawsuits, not to the detention facilities but to jails and prisons, that what we learned about the detention facilities is that um that again, you know, the the application of these protocols um and even during the pandemic, the the the use of masks, uh, you know, um just basic standards were not not ideal, you know, the the population were not as protected and as perhaps in other congregate settings.
• 13:10
  SPEAKER_01: Um and again, that's that's the main issue.
• 13:12
  SPEAKER_01: So in some way, I think that you know the the similar to other congregate settings, ice detention facilities uh share those factors that are similar to jails and prisons.
• 13:27
  SPEAKER_01: But the only difference here I think is that the adherence to protocols vary across the more than 270 detention facilities, uh depending on the how they're managed.
• 13:41
  SPEAKER_01: And then also it also depends on the you know, the mechanisms of accountability are not as important as for jails and prisons.
• 13:52
  SPEAKER_01: Um and that's that's I think that's the word that I think is the key part here, accountability.
• 13:56
  SPEAKER_01: And because of that, that's where you know, either due to whistleblower reports, uh reviewing some of the inspections by the Office of Professional Responsibility within the Department of Homeland Security, that one can read, you know, from from previous uh inspections, um, you know, reporting some of these issues, for example, on uh outbreaks of foodborne illnesses or outbreaks of missiles or outbreaks of influenza within the facilities, that the standards of care uh or safety are not not ideal.
• 14:29
  SPEAKER_01: The other important thing to say here is that you know that's why also there's been some uh I would say congressional um oversight uh of some of these facilities.
• 14:38
  SPEAKER_01: For example, in Colorado, uh Congressman uh Jason Crow during the COVID-19 pandemic was very influential in in trying to adhere to some of these protocols to protect people uh from COVID, particularly uh during the pandemic, um, and um and have some accountability.
• 14:58
  SPEAKER_01: So so in summary, um is the accountability and the adherence to protocols where I think is a major concern.
• 15:04
  SPEAKER_01: And with the growth of these warehouses that they have acquired in the last year or so, is very concerning because some of these warehouses were not designed in the first place to hold many people, and sometimes many people going to these uh facilities or these locations where uh or localities where where the um the standard of hygiene and so on are are very concerning.
• 15:33
  SPEAKER_00: How can infection prevention programs address the risks of respiratory, gastrointestinal, and skin and soft tissue infections in migrant populations?
• 15:45
  SPEAKER_01: Well, you know, similar, thank you for for that question.
• 15:47
  SPEAKER_01: I think that uh the um I think some some some of the issues that I could think here, uh Vanessa would be uh, you know, for example, mandating um systematic infectious disease surveillance um for reporting on some of these these um these uh potential outbreaks of you know, as you said, foodborne uh respiratory um illnesses in these facilities.
• 16:13
  SPEAKER_01: I think that will help out to to better respond to these these um these potential events.
• 16:20
  SPEAKER_01: And I think similar to to what I was mentioning, the um yeah, uh adhering and adhering to to protocols and um placing more emphasis on providing uh preventive and uh medical care um that is appropriate and optimal for this population is important.
• 16:43
  SPEAKER_01: I I just want to remind again that you know we talked about that the emergence of of some of these conditions in these facilities are facilitated by by crowding, you know, overcover facilities facilitate the spread.
• 16:57
  SPEAKER_01: Uh many of them are, you know, say biologically, medically very vulnerable, uh, having a history of food insecurity uh for some time before arriving.
• 17:08
  SPEAKER_01: Um there's, you know, as you as we talked about on safe food uh practices in some of these facilities, insufficient medical care in general.
• 17:18
  SPEAKER_01: I think one of the things that I would like to mention is in the aural facility over the years, not very recently, but in the past, uh one of the things that we've been able to achieve uh is contact, having communication with uh medical staff within the facility that sometimes, if they're like part of these two private corporations, GEO is one of them, and the other one is Core Civic, is that they subhire their medical staff there.
• 17:47
  SPEAKER_01: So they they uh have contracts with uh different companies that come and provide care.
• 17:53
  SPEAKER_01: Uh using that model, you know, it's it's difficult to have uh great communication with uh with the uh medical staff and uh from a public health perspective and from uh just medical perspective of providing care.
• 18:06
  SPEAKER_01: But I think one of the things that I've learned over time is that trying to develop some rapport with them, um, and then always, they're always, you know, not always, but many times very well-intentioned um medical providers, uh, nurses, uh, physician assistants that work uh in these facilities that um that are willing to talk to to an infectious disease provider uh like myself or yourself and and receive uh advice about how to improve conditions for for the people in these detention facilities because of these these factors.
• 18:43
  SPEAKER_01: So I think that um those those are some, you know, the I know these are not ideal responses, what I'm telling you, um, but I think in you know, as far as I can think of, is developing this report um with the medical staff to to try to incorporate some ideas, some low-cost uh interventions um have paid off over time, you know.
• 19:06
  SPEAKER_01: I think one of the times.
• 19:07
  SPEAKER_01: The second thing is again trying to go above, you know, above the valley and look at the at the mountain and and think about you know, where I talk about you know, reaching uh uh congressional offices, uh congressional people, um leaders in in um in public health and civil rights to to advocate for this population because honestly, as I pointed out over the last uh year and a half, the the growth of uh these centers is is is very concerning.
• 19:43
  SPEAKER_01: Um and uh I would say the unregulated uh uncoordinated growth of these these uh places is very concerning.
• 19:52
  SPEAKER_01: There's a second uh detention center opening here in Colorado soon.
• 19:57
  SPEAKER_01: Um and the goal, the goal, you know, as I said, and I want to emphasize this, although I know we're talking about infection control, at the end of the day, infection control depends on the population density, and the more people they detain, the more risk, especially in this vulnerable population, again, share that they come from low from low-income populations, they come from experiencing food insecurity, they're malnourished some some of the time, they're undervaccinated too.
• 20:23
  SPEAKER_01: But once they reach there and there are many people together, it's just a perfect uh storm in a way for these outbreaks.
• 20:31
  SPEAKER_01: So, so one of the things that that we know as as we hear on the news and reading the official reports, even by Congress, is that um right before President Trump uh took office last year, um, there was the Lake and Riley Act that provides basically$200 billion for three years to increase the enforcement and removal operations of ICE.
• 20:58
  SPEAKER_01: Um, and that includes detaining people like me, for example.
• 21:02
  SPEAKER_01: They can detain me just because I'm Hispanic and go into detention and then investigating if I'm a citizen or if I'm legally in the country.
• 21:11
  SPEAKER_01: So, so that and the$200 billion uh is it's very important.
• 21:16
  SPEAKER_01: You see all these hiring of people, and then they usually have a quota to to uh people to be arrested, so that's how they get their bonuses and so on.
• 21:26
  SPEAKER_01: So there's a stimulus for these officers to uh put people in detention or to arrest people.
• 21:34
  SPEAKER_01: Secondly, I think it's the the the so-called big beautiful uh bill that was passed uh last year, too, incorporates$45 billion extra for increasing the number of facilities.
• 21:48
  SPEAKER_01: So there's a lot of money to these, and most of this money goes to these corporations.
• 21:53
  SPEAKER_01: So so what I'm saying here basically is that the the for profit model, similar to To the to the uh war industrial complex.
• 22:03
  SPEAKER_01: I mean, there's a business of immigration detention that has grown over the last year and a half, basically.
• 22:10
  SPEAKER_01: And they rely on detaining people that because there is a policy to stop people from crossing the border, they're going to inside for the people who may be um undocumented to be detained.
• 22:26
  SPEAKER_01: But the goal here is not necessarily the removal of these people, but it's actually the detention because the business is in the detention of people.
• 22:34
  SPEAKER_01: Uh, where you know, fees going from you know from$300 to$500 per day uh per person, and then most people are detained for months.
• 22:45
  SPEAKER_01: So this creates a lot of business.
• 22:46
  SPEAKER_01: And and again, just thinking about this, you know, and translating that or moving that into uh infectious disease transmission in these facilities where the for-profit model uses this uh, I would say this equation of not spending much money and trying to make money for the stakeholders, is uh is very important.
• 23:08
  SPEAKER_01: And that's why I think it's uh what what we can do is from a political perspective, you know, push for uh more congressional oversight, uh, advocacy, uh, trying to make sure that uh if this is going to happen and continue, which will continue based on this economic model, is that we try to at least try to protect the people in detention as much as possible against some of these, some of these uh these outbreaks or some of these uh vulnerability.
• 23:39
  SPEAKER_00: What role does antimicrobial stewardship play in ICE facilities or in migrant populations as a whole?
• 23:45
  SPEAKER_00: And how can stewardship principles be applied when access to diagnostics, follow-up care, and specialty consultation may be limited?
• 23:53
  SPEAKER_01: Thank you.
• 23:54
  SPEAKER_01: You know, that there's uh I learned this uh by preparing for this this podcast, and I also learned this from my I was experiencing in doing some of these uh medical exams over the last the last years is that you know antimicrobial resistance and in the setting of people migrants in transit or recently arrived migrants is an important issue.
• 24:18
  SPEAKER_01: Um and I think trying to develop uh stewardship programs within these facilities and that the facilities, the medical, the hospitals, the healthcare clinics that sometimes uh may uh serve these detention centers are aware of this because I don't want to sound like you know uh migrants come and they have an increased risk of having um or transmitting diseases to the local population.
• 24:45
  SPEAKER_01: I mean, I think it's it's a natural thing to say that sometimes there may be a population that may have an increased vulnerability as we already discussed, but I'm not implying by any means that there's any evidence that um migrants are responsible for transmitting diseases like tuberculosis or leprosy.
• 25:03
  SPEAKER_01: There is an increased risk among them, and there is some secondary transmission.
• 25:07
  SPEAKER_01: But I think the important thing here is as you said from the very beginning, and the the the again repeating from the mission, the Shea mission, is providing safe care for everyone.
• 25:17
  SPEAKER_01: And I think the um issue understanding antimicrobial resistance and antimacrobial stewardship is is uh is crucial because we know that there's different stories that show that uh there's an associate association between the emergence of antimicrobial resistance and poverty, low-income populations, uh, different stories with MRSA, for example, or with um um gram-negative uh multi-drug resistant organisms, uh, where you know migrant, as I mentioned before, you know, migrant people are exposed to conditions favoring the emergence of drug resistance, such as again being from low income, being uh low, um undervaccinated, for example, against pemococcus, uh limited access to healthcare in general, um, living or staying in overcrowding conditions, not only in detention, but during their migratory journey to some of them have been detained in other countries like Mexico, for example, which also in the southern border of Mexico is a very difficult area, similar to the Daringa, the border between Panama and Colombia, where they have to cross this very, very difficult terrain for days or weeks sometimes.
• 26:30
  SPEAKER_01: But once they get to Mexico, sometimes they undergo uh, I would say illegal detention, um, unwarranted detention that that also place them into a very confined settings with many people in rooms and being exposed.
• 26:46
  SPEAKER_01: And so, you know, I think also we we um we have seen uh many of these populations are used to self-medication practices too, that favors the use, for example, of quinolone fluoroquinolone resistance and many other antimicrobial resistance factors.
• 27:04
  SPEAKER_01: So I think that uh these are factors that we need to take into account in um in providing care, uh, knowing that there's an increased risk of some of these multidrog-resistant organisms in in this population sometimes, uh, because of these factors that I mentioned.
• 27:22
  SPEAKER_01: And therefore, the antimicrobial uh stewardship programs are important because then I think we may favor uh the I always say the spread or the uh emergence of food that resistance.
• 27:35
  SPEAKER_01: So I think that that's an important issue.
• 27:38
  SPEAKER_01: Now, from going back into the issue of the accountability and the adherence to protocols, I think you know, if you compare the immigration attention facilities from the experience of again doing these forensic medical exams over the years, and then also I participated during the COVID-19 pandemic in doing inspections.
• 27:58
  SPEAKER_01: This is not providing care, but doing inspections for um civil rights organizations during the pandemic of uh particularly jails and some state prisons in Colorado, but uh jails across the country.
• 28:13
  SPEAKER_01: I I inspected 29 or more than 29 facilities across the US.
• 28:18
  SPEAKER_01: And what I learned is this is that you know, there are protocols, for example, depending on jails, jails may be a little different, but they usually have protocols that that were placed put into place, sometimes maybe late, but they were put in into place.
• 28:33
  SPEAKER_01: The Bureau of Pronsons that oversee the federal prisons and some of the state prisons, they also have very strict um infection control practices.
• 28:41
  SPEAKER_01: So I would say the prisons in general, the state or federal prisons, they have um a very clear antimicrobial surgery programs, infection control programs.
• 28:51
  SPEAKER_01: But again, going to the ICE detention facilities and moving to think about them is a different, it's a different um issue.
• 29:00
  SPEAKER_01: And some of these civil rights attorneys and some of the colleagues that I work in these detention facilities, they said, you know, ICE detention facilities may be like a black hole in the system, you know, because they're again going back to the accountability and so on of adhering to these protocols is a concern.
• 29:18
  SPEAKER_01: So that would apply to antimacro stewardship.
• 29:22
  SPEAKER_01: I think having programs there um you know may not be the ideal one.
• 29:28
  SPEAKER_01: So I think enforcing or developing it, there's not um and um implementing them uh in these in these uh in these facilities, I think is very important.
• 29:40
  SPEAKER_01: And and again, the last comment is um about the uh developing rapport with the medical officers in these facilities, uh, informally or formally, I think it's crucial um to try to say, you know, try to avoid, you know, in this case, antimicrobial stewardship.
• 30:01
  SPEAKER_01: You know, maybe it's not a good idea using these antibiotics, or you know, I would use this differently and trying to guide them based on what we know as an infectious disease practitioner.
• 30:10
  SPEAKER_01: Um, I think it's it's something that I saw at least uh with some colleagues in in their working, uh subcontracted by by the Aurora detention facility as a very good way to do something, you know, to try to improve conditions.
• 30:28
  SPEAKER_00: Can you share examples of successful strategies or interventions that have improved infection prevention practices or antinecrobial use within detention settings?
• 30:39
  SPEAKER_01: Well, I I think that just just mentioned one, you know, basically having these conversations formally or informally with the medical officers, um, which again is not always, you know, I think there's always you know good intentions, in good intentions, but I think sometimes they they they follow their their own practices, and sometimes having these conversations are I found to be very helpful um with as an infectious disease physician talking to a medical provider in the um in these facilities.
• 31:13
  SPEAKER_01: So my experience is only with the Aurora facility, and I found that talking to the person that, for example, schedules the patients when they were coming to the infectious disease clinic or talking to the physicians have been very helpful.
• 31:27
  SPEAKER_01: I think during the COVID-19 pandemic, I think that's another good, I think maybe the best story I can share.
• 31:35
  SPEAKER_01: Um, you know, I I think that I like the story because, you know, it's one that I look back and and I think it's it's a story of many people working together to make sure that we do what we're supposed to as physicians or healthcare workers, you know, which is to protect um people um without limitations, you know.
• 31:58
  SPEAKER_01: So going back to that, you know, what happened is that um I I would like to tell you a story, if it's okay, is uh in detail.
• 32:06
  SPEAKER_01: Um the I collaborate with the Rocky Mountain Advocacy Immigration Advocacy Network, which is a group of attorneys um that provide uh most of the time free advice or counsel to people in detention, which is interesting, by the way, because 86% of people in detention they represent themselves because they they don't have the information and that there's uh actually this last administration has blocked any um most efforts to have attorneys representing the um people in detention.
• 32:39
  SPEAKER_01: So 86%, including children, represent themselves um in in immigration courts in the US.
• 32:45
  SPEAKER_01: Uh, but anyway, this this group of really wonderful attorneys, by the way, all women, uh, which I always like to say that because most I would say everyone in um that I met, you know, in immigration law uh are women um and uh in civil rights too.
• 33:04
  SPEAKER_01: Um so just to to say that because I I admire and respect that.
• 33:10
  SPEAKER_01: So what happened is when the pandemic began in December 2019, January 2020, one of the attorneys actually approached me and said, you know, you're an infectious physician, why don't we start writing letters uh to uh the ICE director at that point, to the governor of Colorado, to the uh the president uh at that point, uh President Trump, uh, to you know consider releasing people from detention because you know, historically, you know, in the 1980s, 1970s, detention were about 5,000 people, 10,000 people, then it went up to.
• 33:51
  SPEAKER_01: I mean, there's always been a history, you know, which is another interesting part, which I haven't gone to, Vanessa, but the history of immigration detention in the US is very, very important to talk about because there's uh even a nice book by Brianna Nofril, N-O-F-I-L.
• 34:10
  SPEAKER_01: It's called Um The Uh Migrant Jail.
• 34:14
  SPEAKER_01: And she talks about the history, how we began all with the um in night in um 1902, 1903 with the um the Chinese uh exclusion act of 1882 affecting the entry of uh migrants.
• 34:29
  SPEAKER_01: And I think that um that what is important to say about this, and going back to the COVID-19 pandemic, is that immigration detention has been a business in the US since then, you know, because then there were no facilities, and what they did starting the history began uh perhaps at least documented in New York, in uh Franklin County, in our Tankong Malone, where people were detained.
• 34:53
  SPEAKER_01: Um, people from China were detained in the local jails.
• 34:57
  SPEAKER_01: And from there, you know, the local jail will start making money and so on.
• 35:01
  SPEAKER_01: And that model continues up until today, basically, you know, just to just to be exact.
• 35:06
  SPEAKER_01: But anyway, going back to the COVID-19 pandemic, is that um that we we were concerned about, you know, the so-called coming plague.
• 35:15
  SPEAKER_01: We wrote uh an article with my other colleagues uh interested in uh in this population, providing care and advice to uh people in detention.
• 35:25
  SPEAKER_01: And um, and that was the concern.
• 35:28
  SPEAKER_01: At that point, in um there were the number, I don't I don't remember the exact numbers, but there were about 16, 17,000 people in detention at that point in uh throughout the immigration detention centers.
• 35:42
  SPEAKER_01: So, because of the efforts of many people, you know, and many people over the next few months, and when the pandemic hit and there were major outbreaks in detention facilities, with a few deaths among people detained, a few deaths of people who work in the these facilities, that over the next few months, and again, due to many efforts by many people, and that doesn't mean I'm talking about myself or talking, it's many people across the country, uh, the number went down to 11,000 or less than 11,000.
• 36:15
  SPEAKER_01: So it was, I believe that was a history of success because many people were released on a compassionate basis, and um, and due to efforts by many immigration attorneys across the country in doing what is called the habeas corpus petitions for many people in detention to be reach, to reach the um or fighting their their uh illegal detention, reaching a judge, and then the judge releasing them.
• 36:44
  SPEAKER_01: Within that story, there's one that I would like to say that there was a concern about protecting um transgender people that were actually for some reason, many of them in 2020, like mid-2020, maybe by May, April, May 2020, there were about 19 or 20 uh people who consider transgender in the Aurora facility.
• 37:09
  SPEAKER_01: And there was an issue about providing not only their their medical care, uh, but also protecting them from the officers, from the officers and from the other inmates, because there were some complaints that were released here in the Aurora facility during the pandemic.
• 37:26
  SPEAKER_01: So all those efforts that were were you know paid off by by making sure that I think everything as as bad as we talk about all those factors that come together to increase that vulnerability, their structural vulnerability, those factors are not the same factors, but other factors came together.
• 37:46
  SPEAKER_01: Um many people came together, work together.
• 37:50
  SPEAKER_01: And I think many of the um many of the leadership in the ICE uh department and then the judges, the immigration attorneys, they all all work together to be able to release those numbers.
• 38:02
  SPEAKER_01: And and you know, saying 6,000, 7,000 people being released, um, it's it's a lot of effort.
• 38:09
  SPEAKER_01: And I think at the end of the day, I think the goal was to protect them.
• 38:13
  SPEAKER_01: So and to protect them from the pandemic at that point, which we didn't have vaccines, we have you know the testing protocols began to be implemented.
• 38:22
  SPEAKER_01: So it was a time where if you go back in time, I believe it was a it was a good success story of of protecting people from from the pandemic.
• 38:31
  SPEAKER_01: And and I think by that, you know, I think that's to me a good example where it was political will, uh, a lot of activism, a lot of um, you know, uh Congressman Jason Crow was a big part of that.
• 38:45
  SPEAKER_01: Uh and so on, you know, many, many attorneys, as I mentioned, that that put their their nights, their time, their effort into releasing people to protect them.
• 38:56
  SPEAKER_00: How can infection prevention and stewardship teams collaborate with facility leadership, healthcare providers, and public health agencies to respond to outbreaks and emerging infectious disease threats?
• 39:08
  SPEAKER_01: Thank you, Vanessa, for for the question.
• 39:10
  SPEAKER_01: I think, you know, one of the things I would say again to summarize maybe some of the key points is that um, you know, these detention facilities are um an increasing concern for the occurrence of uh outbreaks of diseases that, you know, I would say that are preventable, um, many of them.
• 39:33
  SPEAKER_01: I think uh as we have discussed, these uh immigration detention centers share um features such as holding large amounts of people where hygiene is limited sometimes, you know, depending on on how um well established and how well managed may be.
• 39:52
  SPEAKER_01: Um and and as I mentioned, you know, many of them are uh part of these corporations are just based on profit, so the allocation of resources for for these issues are are limited sometimes or suboptimal.
• 40:07
  SPEAKER_01: And the access of care is also a concern.
• 40:10
  SPEAKER_01: So I think it's um these are you know marginalized population, I would say.
• 40:17
  SPEAKER_01: Um uh they're highly contagious diseases that may occur in this setting, and there's no really, for example, vaccination um safeguards for for many of them.
• 40:27
  SPEAKER_01: So so one of the things I would say uh to answer your question specifically, I think from from the bottom of my heart and from what I've seen and from talking to many colleagues who work in this area, um maybe not not that many, but the ones I know is that the the policy choices that combine people um create these very risky environments, you know, and the only way to address these issues of infection control, anti-bike, antimicrobial sewardship, and in general the safety of people in this in detention, is that um we need political will.
• 41:12
  SPEAKER_01: And and right now that's what I think we're lacking, um unless there's you know individual congressional um support for accountability.
• 41:25
  SPEAKER_01: Um and I think that's the the biggest one.
• 41:28
  SPEAKER_01: I think collaborating with um with you know civil rights attorneys, with immigration attorneys, and um you know, writing letters, writing uh, I would say advocacy letters, um trying to make sure that people, especially in these new, newly growing warehouses that um are planned to be used, and some of them are in use, um, with also military um uh military support too.
• 42:02
  SPEAKER_01: You know, it's kind of concerning.
• 42:03
  SPEAKER_01: But anyway, the point here is what can we do?
• 42:07
  SPEAKER_01: I think I think should start with with political will trying to uh become or and strengthen the advocacy for for this population through different channels, uh, as I mentioned.
• 42:23
  SPEAKER_01: And um and I I keep I keep at that level, you know, because to me sometimes the impact that we have at the individual level is not sufficient, and and I think we should strive for better, right?
• 42:34
  SPEAKER_01: I mean, that's what life is about, and I think that we should strive for a better standard for people.
• 42:42
  SPEAKER_01: Um, but I think that at the end of the day, um you know I think it's it brings us to I think a larger issue is uh it's a public health, but it's also a moral imperative to to protect uh people in detention.
• 43:02
  SPEAKER_01: And and I think just by saying that it's it's it's important, but it's also concerning because people should not be in detention, you know.
• 43:13
  SPEAKER_01: That's the thing.
• 43:14
  SPEAKER_01: You know, I think we ought to make sure that okay, they're in detention, we have to do something.
• 43:21
  SPEAKER_01: We have this, there's again this public health imperative, there's this moral imperative.
• 43:26
  SPEAKER_01: But we going further more, I think we need to stop this, you know, we need to reduce this uh unnecessary suffering suffering, you know.
• 43:38
  SPEAKER_01: For example, I was I was participating in a discussion a few days ago on on the ongoing Ebola outbreak in in DRC.
• 43:48
  SPEAKER_01: And you know, sometimes some of these outbreaks are very difficult difficult to predict and to prevent.
• 43:55
  SPEAKER_01: I mean, the other it's another different topic, but I think taking that example on That's what I'm saying specifically about Ebola and DRC is that if you move to these immigration attention facilities, it's again, it's just again the perfect storm for all these outbreaks that we've seen of influenza, measles, uh chickenpox, baricella, um, foodborne illnesses.
• 44:20
  SPEAKER_01: It's just you put all these people, these number of people in these facilities, they're overcrowding, they're very vulnerable biologically because of their previous situation socially, um, the malnourished and so on, food insecurity, as I mentioned.
• 44:39
  SPEAKER_01: And and then there is just it's just the perfect setting for these outbreaks.
• 44:44
  SPEAKER_01: And therefore, in contrast to what I was saying about Ebola, we can prevent some of these outbreaks by not having so many people in detention or not having people in detention period.
• 44:54
  SPEAKER_01: You know, I think the majority of people in detention have not even committed a crime.
• 44:59
  SPEAKER_01: You know, there's not a good reason for them to be there.
• 45:02
  SPEAKER_01: There's this document that um that was produced years ago um by one of the human rights organizations in the US, human rights, um, that is called Profiting on Cruelty.
• 45:15
  SPEAKER_01: I think that's what it is.
• 45:16
  SPEAKER_01: This is a very cruel way of these corporations making money and looking for the stakeholders.
• 45:22
  SPEAKER_01: And again, I keep emphasizing this issue, but at the end of the day, these issues of infection control, anti-vactor, antimicrobial sewer could be, you know, maybe not all of them, but the majority could be prevented if if this business of migrant detention um is is addressed in a different way where people are not confined to these places.
• 45:48
  SPEAKER_01: Um, I'm not talking about the legal aspect of it.
• 45:50
  SPEAKER_01: I'm talking about why do you have to detain so many people in these places though?
• 45:54
  SPEAKER_01: I mean, that there's not a good reason other than the for-profit model.
• 45:59
  SPEAKER_01: So if you prevent some of these from happening in the first place, I think we can prevent many of these outbreaks.
• 46:04
  SPEAKER_01: So it's different from what I was talking about, the Volga, you know, it's those are unpredictable sometimes.
• 46:10
  SPEAKER_01: Here, I think some of these are predictable.
• 46:12
  SPEAKER_01: It's just a matter of time that some of these outbreaks will happen with when you put all these conditions together.
• 46:19
  SPEAKER_01: So so, in summary, Vanessa, I think this is an issue, I think it's a moral issue, it's it's a public health issue uh that goes beyond just the medical interest of infection control and antibiotics antimicrobial sourcery.
• 46:34
  SPEAKER_01: They're obviously very important, you know.
• 46:36
  SPEAKER_01: But I think we can address this at a higher level.
• 46:40
  SPEAKER_01: And I think that's what I would say.
• 46:42
  SPEAKER_01: Um the most important thing to share is to protect people at a higher level and preventing these cruelty in the first place.
• 46:54
  SPEAKER_00: Finally, looking ahead, what are the biggest opportunities to strengthen infection prevention and antimicrobial stewardship in ICE facilities?
• 47:03
  SPEAKER_00: What lessons can help your epidemiologists and stewardship leaders apply from other congregate care settings to ICE facilities?
• 47:12
  SPEAKER_01: Yeah, no, I think you know, I think that I talked about this briefly.
• 47:18
  SPEAKER_01: My my way to answer this question is is there's some things that we cannot really prevent uh or we cannot really impact directly, you know, such as the the social forces that brought people to to be biologically vulnerable to these infections or this structural vulnerability that they being carrying before their migratory journey, during their migratory journey, and then arriving in this case to the US and being detained.
• 47:49
  SPEAKER_01: So those things are also important to address at a higher level, but there's not much I would say we can do at this point, but we we should not lose sight of that too.
• 48:01
  SPEAKER_01: But specifically, what I've learned or lessons learned or best practices that I could summarize, Vanessa, would be that you need a higher um level political will to support these efforts.
• 48:18
  SPEAKER_01: Um working with the medical officers in detention facilities to develop formally or informal protocols to protect people, ensure that they receive the vaccinations, vaccine-preventable diseases, uh, addressing some of these uh uh populations being undervaccinated, you know, trying to improve their vaccination rates, uh, improve food practices in these facilities so that you prevent some of these potential foodborne outbreaks, uh, improve sanitation levels, improve ventilation, improve distribution of the population in these facilities so that there's not major overcrowding, I think is important.
• 49:07
  SPEAKER_01: But I think that the most important lesson that I could think of um is is the teamwork.
• 49:13
  SPEAKER_01: You know, I think the teamwork that goes beyond the medical officers, the nurses, nurse practitioners, um psychologists, psychiatrists, um, social workers, um, and physicians that we, you know, that may be inside and outside, uh, providing care or providing some advice to these facilities.
• 49:37
  SPEAKER_01: But I think it's also working with with the other um, I would say, stakeholders in in these efforts, and that includes um the advocacy groups, the uh human rights groups, the civil rights groups, the immigration attorneys, to ensure that some of these protocols are enforced.
• 49:59
  SPEAKER_01: Um I would say that the teamwork, um, in my experience, particularly as I mentioned during the COVID-19 pandemic, is that we we can do very little if we do do it on our own.
• 50:12
  SPEAKER_01: But if we work as a team and we write letters, we uh go to congresspeople, we try to increase the accountability within the centers.
• 50:23
  SPEAKER_01: Uh, it's very important.
• 50:24
  SPEAKER_01: Those that that to me is the most important lesson.
• 50:27
  SPEAKER_01: That a way to improve strengthen infection control practices, anti-paracorial suit with a main goal of safety for the for the people in detention, um, is that it starts with that.
• 50:44
  SPEAKER_01: I think it starts with with teamwork.
• 50:47
  SPEAKER_01: Um, and really not just saying that to sound interesting or to sound humane or compassionate, but that to me is the most important thing.
• 50:59
  SPEAKER_01: And that just brings me again to think about we we need more kindness, you know.
• 51:04
  SPEAKER_01: I think we need more kindness um among all of us and with the communities and understanding people's struggles.
• 51:12
  SPEAKER_01: Uh, because at the end of the day, many of these infections can be prevented.
• 51:15
  SPEAKER_01: Uh, many of these outbreaks, um we can increase the safety of the of the people in terms of infectious diseases um in these facilities by preventing detention in the first place.
• 51:28
  SPEAKER_01: But if we can prevent that, then at least make sure that they're safe from these outbreaks.
• 51:34
  SPEAKER_01: Um, to the best possible ways we can do by by addressing improving accountability within the centers to adhere to these protocols or the protocols that may be in place in some of them and not in place in others.
• 51:50
  SPEAKER_01: So that those are the things I can think of, uh, Vanessa.
• 51:53
  SPEAKER_01: And I know it sounds very uh idealistic, but I think we should not lose that idealism of trying to be be better, be be kind to each other in some way, and uh improve um you know the safety of others as the Shea goal.
• 52:14
  SPEAKER_00: What a beautiful and inspiring conclusion.
• 52:17
  SPEAKER_00: Thank you very much, Dr.
• 52:18
  SPEAKER_00: Franco Predes, for sharing your perspectives and experiences.
• 52:22
  SPEAKER_00: This was an educational and deeply enriching lesson, and your trailblazing work and advocacy are so appreciated.
• 52:29
  SPEAKER_00: This concludes this episode of the Shea Podcast.
• 52:32
  SPEAKER_00: Thank you, listeners, for tuning in.