Q&A: Southern Colorado doctor details immigration enforcement's impact on community health

PUEBLO, Colo. — Doctor Laura Stein has worked with documented and undocumented migrant farmworkers since she was a teenager in the 1980s, when she first met a group of migrant farmworkers picking cherries in Wisconsin. 

Stein’s experience in Wisconsin led her to serve migrant farmworkers when she graduated from her residency 1993 and started practicing family medicine. 

She eventually moved to southern Colorado and has worked as a family doctor in Pueblo for 30 years, practicing a wide scope of medicine in rural communities. 

In southern Colorado, documented and undocumented migrant farmworkers pick and sort the peppers and pumpkins that end up in Colorado grocery stores. These farmworkers carry out arduous, manual labor that can result in injuries, Stein said.

But since President Donald Trump took office, Stein has seen a decrease in patients — both documented and undocumented. This has ramifications for the health of everyone, Stein said. 

Stein said even documented workers are not usually aware of their rights to health care, and often fear seeking medical treatment if Spanish is their only language because of potential ICE enforcement. Stein said that concern is heightened following the Supreme Court’s decision to permit racial profiling during immigration stops. 

The latest data from TRAC, a nonprofit data center, shows ICE has detained about 60,000 people, up from 37,782 people who were detained before President Donald Trump took office in January. The increase in immigration enforcement and ICE raids has also led to a decrease in undocumented workers visiting Stein's free health clinics for fear of arrest, detention, and deportation, she said.

Stein’s conversation with Rocky Mountain PBS came at a time when many Republican politicians are incorrectly blaming the extended government shutdown on health care for undocumented people.

Laura Stein: I'm like five one and a half. At that time [1980], I just didn't have the height and the strength to do the large animal veterinary stuff, so I decided to go to medical school instead. 

And the migrant workers I worked with in Wisconsin worked for a guy who owned, like, a riding stable for tourists. And then as part of our jobs, we helped clean out the trailers that the migrant workers lived in, and we would be out in the cherry fields sometimes helping out with that stuff. So I got to know that population pretty well, and I know they were always like, super nice people and super hard working.

And so when I decided to go into medicine, I thought, well, this is the population I want to work with, like people who are moving from place to place, and they need health care.

LS: The first year [1998] we did the after-hours clinic, and we did have people show up, but they were just nervous because it was kind of like a known clinic. And some of them expressed that they were concerned that immigration would be waiting outside the door when they walked out. And the church is a sanctuary place.

So the next year, we switched it to where the church had their open house on Thursday evenings. So if they were worried about [ICE raids] … it made no sense to have a clinic where people weren't going to show up because they were afraid, right? So you kind of go where the people are.

But no, other than that. Even at my first job in Las Cruces, , we would go out into the fields and we would check people's blood pressures and we would do TB testing and so I was kind of used to going out and doing field work, like out in the field, treating people out where they were at so that that wasn't really new for me.

You just try to do more with less.

LS: Well, let me start with Trump's first administration. So, I mean, we used to routinely see, I would say 10, sometimes 14 patients in an afternoon, on those Thursdays. And after Trump got into office [in 2016] and ICE was cruising the streets, I mean, we would hardly see anybody.

And then even after Trump left office [in 2020], people had gotten out of the habit of coming, and they're so nervous. So even when Biden was in office, we never got our numbers really back up to that…. So I think just people are nervous in general.

With Trump's second term, I think what's new is, you know, we have these folks from Cuba and Venezuela, some from Peru, and they are on asylum visas where they actually get Medicaid, temporary Medicaid. And are able to work and things like that. And now recently they're [the Trump administration] revoking a lot of those.

And so people [who were previously granted asylum visas] are losing their jobs, they're losing their health care. They don't know where to go. They don't want to go back home. I mean, they left [their home countries] for a reason. 

So we're seeing examples of that happening where they had coverage and now they don't. They had a job and now they don't, which creates a lot of stress, which adds to whatever health problems they already have. 

So that's kind of the difference between the first term. The first term was just like ICE sweeps. The second term is ICE sweeps plus these visas being revoked.

LS: I mean my worry is that people are not getting any care.

That things are going to —  whatever issue they have — is going to progress to the point where they're going to end up in the emergency room. And then like, you could have avoided that. Or they don't know what kind of resources are available to them. 

We just had a guy. This [documented, migrant farmworker] guy came in, and he had been working for somebody up in Denver, like north of Denver, and on a horse. I don't know if he was on a ranch, but he came off the horse, and the horse kind of jumped over him. And to protect his face, he put his arm over his head. And the horse's hoof, the back of it probably, like, hit his wrist. 

And that was a month ago. Okay. The guy is actually a legal resident, but was afraid to go get health care or didn't realize he could get health care. So now the fracture has healed incorrectly and he can't move his wrist.

And so we got him an X-ray. And sure enough,  it's a fracture that didn't heal well and is actually affecting his wrist bones, which are really, that's kind of a dicey fracture to begin with. 

So now we're bringing him into our clinic here in town, Southern Colorado Family Medicine, because now he has Medicaid and we're going to get him over to the orthopedics, and he's probably going to need a surgery to fix what healed wrong, possibly get some mobility back in that wrist.

It's never going to be the same.