Nurses know that symptoms are indications of a deeper problem. A mother crying over bus tickets is a symptom.

“It was just the last straw for her,” said Maria Rojas, RN and a Registered Nurse Response Network (RNRN) volunteer who recently spent three days at Casa Alitas, a Catholic Community Services shelter in Tucson, Ariz., providing medical care to migrant families and asylum seekers recently released from federal detention. Rojas found the woman sobbing outside the shelter office.

The mother said she fled her home in Guatemala where gang violence, fueled in part by more than a century of U.S. intervention, is rampant. She said gang members wanted to recruit her 16-year-old son. Her husband offered to take his place in the gang, if only they would leave the boy alone. He was a good student, and his family wanted a better life for him. The gang responded swiftly, murdering the father.

On the last leg of her journey in Mexico, the mother said she sat behind the bus driver as he snorted cocaine to try to stay awake to drive. But despite the drugs, he kept drifting off. She would shake him awake to keep him from crashing.

When she learned at the shelter that she and her family would need to make a three-day Greyhound bus trip as the next leg of their journey in the United States, she broke down. “To us, riding a bus is no big thing,” said Rojas, but this woman was terrified for the safety of her family. To assure her, Rojas showed the woman photos of the outside and inside of a bus, and explained that drivers were required to change and take breaks. As Rojas wrote down where the family would get off and transfer buses, the mother relaxed and began preparing for the trip.

The Guatemalan mother Rojas found sobbing was one of hundreds of patients that RNRN registered nurse volunteers have listened to, treated, and cared for both physically and mentally as the border crisis has unfolded. Since the crackdown on migrants and asylum seekers began last year on our Southwest borders, National Nurses United (NNU) RNs have been protesting in solidarity with local communities, speaking out, and standing up to help care for those impacted by this humanitarian and public health crisis. Since late February, RNRN, a disaster-relief project of the California Nurses Foundation and NNU, has deployed more than seven two-to-three-person teams of mostly Spanish-speaking nurses and nurse practitioners to staff the Tucson shelter every weekend, 24 hours a day, and will continue to do so through May.

“Working with RNRN has been an amazing gift,” said Teresa Cavendish, director of operations for the Casa Alitas program. “The compassion, the understanding, and the empathy of the nurses, accompanied with the consistent, high-quality, round-the-clock nursing care they provide when they are with us, is more than we ever expected.”

RNRN deployments often profoundly change a nurse’s outlook on their work, said Cathy Kennedy, a registered nurse in Sacramento who is an NNU vice president and made the initial trip to Tucson to evaluate the need for nursing care. “It changes the nurses’ perspectives on health care, and society and humanity,” said Kennedy, who volunteered in Puerto Rico following Hurricane Maria. “They come back a different person. I came back a different person.”

Nurses can certainly attest to that transformation. Their migrant patients’ health conditions revealed so much about their arduous escapes from their home countries, and the poor conditions under which they were kept while in federal detention. RNRN nurses who returned from Tucson said many patients show signs of PTSD, trauma, dehydration, and exhaustion, as well as cold and flu symptoms. Nurses have treated migrants for a variety of illnesses, including sprained ankles, broken bones, chicken pox, colds, viruses, and respiratory illnesses. The RNs also identified more serious conditions that needed hospital-level care.

Simply put, migrants were not housed, fed, and treated humanely in federal detention. For Mallory Carrellas, a registered nurse from Baltimore and RNRN volunteer in Tucson, a torn strip of mylar sheet used to tie back a young girl’s ponytail raised serious questions about the treatment migrants face in detention. Why did they have to give up their hair ties and shoes laces? Why were they left without enough clothing to keep warm, and given just a thin mylar sheet as bedding? Video of detention facilities released in June 2018 by the Customs and Border Patrol show the concrete cages where migrants and asylum seekers are held. These rooms are reportedly so cold that they are referred to by migrants as hierela, the Spanish word for icebox.

“My understanding [from talking to the patients] is when you go into detention, you take off your clothes, and you can only wear one layer in, so everyone picks a jacket, but then you don’t have an underlayer to hold the warmth in, so everyone said it was very cold,” said Carrellas.

“Every single person comes in [the shelter] with some kind of a cold, runny nose, sore throat,” said Jessica Rose, a Tucson-area nurse who has gone on two RNRN border deployments. “Every single person is sick. I mean seriously, why?”

Migrants said they were often not able to take care of basic hygiene needs, such as getting diapers for their children and showering which, in some cases, exacerbated skin rashes and infected wounds. Nurses at the shelter are now seeing cases of chicken pox every week, and they worry about the spread of diseases within the detention facilities. When infectious diseases are present, not being able to meet basic hygienic needs becomes a very serious public health risk.

Nurses said they were shocked to discover the poor nutrition their patients suffered; many migrants families and asylum seekers were dehydrated and given very little food or water while in detention. Some migrants said they were offered uncooked frozen burritos once a day, but they were not warmed, just left out on a table to thaw. Other told the nurses they were given one or two crackers per person a day, and that parents would give children their own rations. “They are clearly hungry,” said Carrellas. “It was heartbreaking.”

Rose, who lives in the area, said Tucson’s tap water tastes bad and is often murky and full of debris. The nurses were told that clean, drinkable water was hard to come by in detention. One mother with a small child said she had asked for bottled water to mix formula, but was denied. “That is cruel,” said Rose. “Why would you do that to any human?”

Nurses were not surprised to learn from their patients that they received little or substandard medical care while in detention.

Many migrants told nurses they had their medications confiscated at the border. “This mother had a son who was 15 and a daughter who was 8. The son had a history of asthma, so she had an albuterol inhaler and his other medications, all labeled with his name,” said Kennedy. “The mother said that when they were getting ready to cross the border, the border patrol agent took the medications and threw them in the garbage.”

Kennedy said she and the others rushed to make sure the teen had an inhaler before leaving to meet the family’s sponsors, but then they learned the same border agent had taken the 8-year-old girl’s seizure medication. “We were all very upset. To throw away medication — that to me is inhumane.”

Other migrants said they could keep their medications, but they were not allowed to take them while in detention. One woman suffered from hyperthyroid and hypertension and was forced to go without her daily medication for days while she was in federal custody. “It was mind boggling to me,” said Carrellas. “She has the medication, she needs the medication, why can’t she take the medication?”

Earlier this month, Dr. Anna Landau, a family medicine doctor who worked with the RNRN volunteers at Casa Alitas, shared with the New York Times her concerns about the medical care migrants are receiving in federal custody.

“They’re not treated as if their health and well-being is valued on any level,” said Landau in the article. “How do you send people who are clearly hurting, clearly in pain and suffering, how do you just move them through as if they’re just another number, as opposed to an actual human being?”

Carellas said it appears some people get at least a cursory medical screening while in federal custody, but others did not even get that. She noted one bus that came from a San Diego detention center had several very sick children on board, including one with chickenpox, and two small children with fevers over 105 degrees.

“Mom was just holding vigil over the 6-year-old. I was really worried about him having a seizure,” said Carellas. “We set alarms every three hours to give them fever medication around the clock because they were really sick.”

Perhaps more troubling was what Rose heard from one Guatemalan mother who came to the shelter complaining of severe stomach pains. The woman said she had pleaded to get medical care during the five days she was held in detention, but her complaints were ignored. The medical team at the shelter was alarmed by her condition and sent her to the hospital where she had emergency surgery to have her infected gall bladder removed. Left untreated, an infected gall bladder can lead to a number of serious complications, including death.

“It is very upsetting,” said Rose. “How can you just ignore somebody? [These detention staff] are not medical providers. You just have to err on the side of the caution if someone is hurt.”

Finally, Rose said migrant after migrant shared with her stories of humiliation and verbal abuse at the hands of federal agents. One man who had suffered flesh wounds to his leg and head after being shot at the border, presumably by gang members, said he was taunted by agents. “He said the officer told him, ‘Well, the only problem I see here is that it didn’t go right through your brain,’ and then [the officer] started laughing,” said Rose. “[The officers] kept saying it was so unfortunate that he had become their problem instead of dying.”

The concerns RNRN volunteers shared are not new, they are the subject of a pending 2015 lawsuit charging conditions in federal detention are “inhumane and punitive.” In recent days, U.S. Customs and Border Protection Commissioner Kevin McAleenan acknowledged that detention facilities are overwhelmed. “The danger of violent assault on that journey, the potential for a tragic incident in the crossing or in overwhelmed CBP facilities, or in transportation networks, is clear and present,” he told reporters.

Hundreds of migrants are being held under the Paso Del Norte Bridge in El Paso, near the site of @CBP Commissioner McAleenan’s press conference. pic.twitter.com/FeHWauFD53

— Bob Moore (@BobMooreNews) March 27, 2019

Kennedy said hearing the migrants’ stories made her ashamed of how the United States is treating families seeking asylum. “The migrants and asylum seekers are being treated as though they are animals and it is really hard to understand. It doesn’t make any sense to me,” she said.

Carrellas said she also struggles to make sense of how migrants are being treated. “At the end of the day we are all immigrants, and this is not the way we would have wanted to be received,” she said.

In stark contrast to what they experienced under federal detention, Carrellas said she was grateful for the opportunity to show migrants and asylum seekers that there are people in the United States who are caring and supportive and ready to welcome them as they deserved to be welcomed.

“It was really powerful because you made a huge difference,” said Carellas. “They would come in really shell shocked. But then the kids especially would start to open up and they would be hugging you and riding their bikes around and being kids, and that felt good.”

Rojas agreed, saying, “It is just a blessing I have health and knowledge to help others and make their lives a little bit better and that is why I went into nursing, just being there to hold their hand and listen, that is how I get fulfillment.”

Rojas and her fellow RNRN volunteers all said they are committed to sharing stories from the migrants they met to educate their communities about the dire circumstances families are escaping. Carrellas noted many people may be unaware that generations of self-serving U.S. economic foreign policies helped create the conditions under which Latin American residents are fleeing their home countries.

One family told Rojas they had a lumber business and had to leave because gang members threatened to kidnap their daughter when the family couldn’t pay off the gang. To show they were serious, the gang shot and killed two young men who were behind on their payments and dragged their bodies in front of the lumber store.

“[The mother] told me, ‘We took nothing, just the money in our pockets and left like thieves in the middle of the night,’” said Rojas. “I am telling you, to look at these people, the sounds of their voices, the anguish on their faces, you can’t make that up.”

“How bad does it have to be for a mother or father with a small child to endure 45 days of travel?” said Rose. “They feel that they can’t stay there complacent, and die of hunger or crime. They have to try and do something, and they do it.”

Rose said it is important that people know that migrants she spoke to came to the United States with a plan. They had sponsors to take them in and often jobs lined up. “They are all driven by hope,” she said. “Literally, that is the last thing they have.”