Travel ban could keep doctors from needy rural Oregon towns

There aren’t enough doctors to treat rural Oregonians already. Trump’s travel ban could make that worse. 

Update June 26, 2017: The Supreme Court partially reinstated the travel ban, barring most new immigrants and all refugees from Iran, Libya, Somalia, Sudan, Syria and Yemen from entering the U.S.

The ban now excludes current visa and green card holders. New applicants who have close family in the U.S., or who want to study or work, can also travel to America. The Supreme Court will hear the case in early fall. 

When Donald Trump was elected president of the United States, Dr. Haifa Jaedi didn’t mind. The Libyan citizen, who is a pediatrician in Grants Pass, said she was glad Trump was elected over Clinton.

“I think the interfering of Hillary Clinton in Libya made our country worse,” she said, in reference to Clinton’s decision to support opposition leaders instead of the Qadaffi regime, which lead to the destabilization the country faces today. “I’m not allowed to vote, but if I was allowed to vote I would have voted for Trump.”

Dr. Jaedi never expected what happened next. Trump issued an executive order for a travel ban, temporarily stopping citizens of seven primarily Muslim countries from traveling to the United States.

The ban was halted but on March 6, Trump issued a revised travel ban that keeps refugees from Libya, Syria, Yemen, Somalia, Sudan and Iran from traveling to the U.S. for at least 120 days. People just looking to visit America from those six countries are barred from traveling for at least 90 days.

The new ban starts March 16. Trump says it will keep terrorists out of the country and give the government time to develop “extreme vetting” procedures.

Also caught in the travel ban are people such as Dr. Jaedi; doctors who work in the country using visas and are critical to the health of America’s rural communities.

Dr. Jaedi is safe, since she already has a valid visa as of March 6 – one of the changes Trump made in the revised ban. But the new ban still excludes doctors who want to work in the U.S. and haven’t gotten their visas yet.

That could gut hospitals and clinics in rural communities, including many underserved areas of Oregon.

Why foreign doctors matter

Foreign doctors disproportionately staff needy rural hospitals in Oregon and U.S.

 

One in four doctors working in the U.S. is from a foreign country, and they disproportionately serve rural hospitals and clinics. That’s because the popular J-1 visa that brings many of them here stipulates they must work in an “underserved” area for three years after their medical residency, before they are allowed to apply for permanent citizenship. 

The program helps the doctors participating in it, but it has a far wider benefit for America’s rural communities, which have a difficult time finding doctors who want to relocate to small towns.

The countries named in Trump’s travel ban contribute significantly to America’s staff of physicians. There are about 13,500 doctors from those six countries who work in American hospitals, according to the physician recruiting company The Medicus Firm. Iran contributes the most, with 8,884 medical doctors.

 

 

In Oregon, 320 foreign doctors have been placed in hospitals and clinics, according to state data. Fifteen of those are from the countries named in Trump’s latest travel ban.

Fifteen doctors may not seem like a lot, but in Oregon losing even one doctor could threaten the health of some rural communities that are already struggling.

There are 104 rural service areas in the state – places farther than 10 miles from a population center with more than 40,000 people. Half of those areas have “unmet healthcare needs” – there aren’t enough doctors or hospitals to treat people. Some rural places are as far as an hour and 45 minutes away from the nearest hospital.

Others, such as Sherman, Gillam and Columbia counties, have no rural hospitals. Sherman and Gillam counties don’t even have rural physicians, according to 2015 data from the Oregon Office of Rural Health

People are 23 percent more likely to die in rural areas than urban centers overall. In Reedsport, Brookings, Florence and Yachats, the mortality rate is twice what it is statewide. 

Losing physicians could also mean hospitals and clinics could be forced to shutter.

“Without foreign doctors, a lot of these rural places would simply close down,” said Dr. Mahmoud Shoib, an internist from Raqqa, Syria who worked at PeaceHealth Southwest Medical Center in Vancouver before taking a job as a traveling physician in northern California this February.  “There are simply not enough medical doctors graduated by U.S. schools to fill that gap and even with the international medical graduates, the gap is still there. If you’re someone who just got out of medical school, your first choice is probably not going to be going somewhere in rural Pennsylvania.”

Shoib would know – his first residency program was in Johnstown, Pennsylvania. It’s an isolated community of 20,000 people in Appalachia, one and a half hours from Pittsburgh and four hours from Philadelphia. The town is best known for a string of deadly floods and its population has declined in recent years.

“Most of our program was filled with international medical graduates. Probably one out of 30 was someone who was trained in the U.S. Almost everybody else was trained outside of the U.S. and that goes pretty much for most rural residency programs and hospitals,” he said.

Mahmoud explains the math behind that statement:

“Basically, there are 25,000 residency positions in the United States,” he said. “Medical schools in the U.S. graduate probably around 17,000 medical students each year, so that leaves a gap of about 8,000 medical residency spots that end up being filled by international medical graduates.”

Once international doctors are in America, they often get solicitations from rural hospitals even after they find a job.

Dr. Jaedi said she gets 15 to 20 emails a day from recruiters, trying to hire her away from her pediatric clinic to come work elsewhere.

“If they have a hard time recruiting a worker who was a J-1 worker who is obligated to be working in an underserved area, I don’t imagine it would be easy for them to get a [doctor with a] green card or a U.S. citizen. I think a lot of areas would be left without doctors,” she said. “People would probably have to travel hours to get service.”

Dr. Jaedi said at her Grants Pass clinic, she sees people who travel as far as two and a half hours from the Southern Oregon coast. Even in Medford, which is the closest urban area to Grants Pass, there are dozens of international doctors. Without them, the small city’s hospitals would be gutted.

“If all these doctors disappear and are made to leave the country, it will be a really big shortage in the underserved areas,” she said. “I don’t know how they’re going to work that out. They must have made that plan before they made the decision with the travel ban, right?”

Revising the travel ban

Foreign doctors suggest changes to Trump's travel ban

 

President Trump recently released his revised travel ban, but Dr. Jaedi and Dr. Shoib have suggestions on how they would edit it.

There have been no reports that anyone from the countries named in Trump’s travel ban has committed an act of terrorism on U.S. soil, but Dr. Jaedi said she understands the president’s intention behind the ban.

 “He needed to protect his borders,” she said. “But the way it was done was the wrong way.”

Dr. Jaedi said extreme vetting has been in place for years. She has a one-entry visa, which means every time she goes back to Libya she has to re-apply at an embassy.

In 2013, she traveled back with her husband and two children, now ages 9 and 12. They went to the closest U.S. embassy, in Morocco. She and her children received visas but her husband had to wait eight months before his went through. It was a gut-wrenching time, as Dr. Jaedi was finishing her last year of residency in New York and her husband didn’t know if he would ever be allowed to re-enter the U.S.

 “We never broke the law of immigration or any other law in the U.S. and still, he had to go through a very, very intense vetting. He was just here [in America], he left to see his family, and he wasn’t allowed to reenter with his family,” she said. “With the new restrictions it’s even worse. Before, we would think twice before going [to Libya]. Now we think a hundred times. You’re probably not going to come back.”


Dr. Haifa Jaedi discusses the visa process for foreign doctors and what happened when her husband tried to re-apply for a visa

Dr. Jaedi said Trump shouldn’t focus on refugees or workers; instead, he should scrutinize tourists. Because Libya and other countries named in the ban are unstable, passports are easy to obtain, she said. That makes travel easier for terrorists posing as tourists.

“If I were to rewrite it, I wouldn’t erase it. But you can protect your border other ways. People that are working here are not harmful,” she said. “But there should be extreme restrictions on tourism. I would just look at that. Why are they coming here?” 

Shoib said he doesn’t think the ban actually protects Americans from terrorism.

“A blanket travel ban is not going to serve anybody and I don’t think it will help keep this country safe. I think it will actually make things worse,” he said. “I’ve been through the immigration process, almost every one of my friends have been. It’s the most screened, toughest immigration process you could go through. I don’t know what Trump means by extreme vetting but we’re already going through that.”

Waiting for what's next

Travel ban keeps doctors' families in limbo

 

Shoib, who has a green card, said the ban makes him hesitant to travel and he worries if he leaves the U.S., a law could be enacted that would keep him from reentering the country.

He’s more worried about his parents, who have asylum but not a green card.

“Thank God they got asylum before Trump became president. But because they are on asylum state that means they can’t leave the country until they get a green card – which, after all these decisions, is up in the air,” he said.

Shoib’s brother, who is a dentist, has applied for asylum but hasn’t heard anything from immigration officials. His three sisters are still in Syria and have all but given up trying to leave the country.


Mahmoud Shoib talked to KGW via Skype about the visa issues his family faces

For Dr. Jaedi, she said she hopes to stay in Grants Pass long-term. But she worries what will happen if her husband’s 90-year-old father becomes critically ill. If the family goes back to see him before he dies, they may not be allowed to re-enter the U.S.

“I have friends whose fathers and mothers died in Libya, and they just cried here for days and months and never went back to see them,” she said. “It’s a hard decision because you’re going out and losing your future and there’s nothing you can do.”

For now, she and her family are enjoying rural life in Grants Pass. There are a few hurdles they encounter as a Muslim family – they travel to Beaverton or Portland to stock up on Halal meat, and there’s no mosque close by – but the community has welcomed the family, Dr. Jaedi loves her clinic, and her girls quickly settled into life in the quiet southern Oregon community.

“It’s more calm,” she said. “The kids like the school they’re in. We have outdoor activities here to get engaged in. They can do anything that they want, instead of being restricted in an apartment in New York. I think we’re starting to think about staying here.” 

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