E17: The deadly impact of immigration enforcement on public health

Immigration enforcement doesn’t just shape borders—it shapes health outcomes.

In this episode of Emerge in EM, Dr. Mohamed Hagahmed is joined by Dr. Italo Brown for a candid, clinician-to-clinician conversation about how immigration enforcement affects patient care, trust, and public health.

Originally recorded as a live Instagram discussion, this conversation was brought to the podcast because the issues raised were too important to disappear after a moment on social media. From emergency departments to outpatient clinics, fear of immigration enforcement is changing how and when patients seek care—often leading to delayed presentations, worse outcomes, and preventable harm.

Together, Dr. Hagahmed and Dr. Brown unpack:

• How fear of enforcement becomes a barrier to care
• What clinicians are seeing at the bedside when patients delay treatment
• Why immigration enforcement is a public health issue—not just a policy debate
• How trust, or lack of it, directly impacts health outcomes
• Practical steps healthcare workers and institutions can take to protect patients

This episode challenges the idea that healthcare is neutral in the face of fear and structural harm. It reframes immigration enforcement as a patient safety issue and calls on clinicians, health systems, and public health professionals to acknowledge their role in protecting access to care.

As the first episode of 2026, this conversation sets the tone for the year ahead—centering equity, courage, and accountability in emergency medicine and beyond.

Care without fear should never be controversial.

Transcript

Mohamed 0:00

Welcome back to EMERGE In EM, and welcome to 2026. Before we get into today's episode, I wanna take a moment to say thank you to everyone who's listened, shared episodes, sent messages, challenged ideas, and grown alongside this platform. Your engagement is a reason EMERGE In EM continues to exist. This community has always been about more than content. It's about conversation, reflection and pushing emergency medicine and healthcare more broadly to do better. Starting a new year felt like the right moment to hold space for a conversation that reflects those values. This episode is a little different. It began as an Instagram live, unplanned, timely, and rooted in what many of us are seeing in our clinical work right now. We were talking about immigration enforcement fear, and how those realities show up in emergency departments, clinics, and communities, often long before patients even reach us. As the conversation unfolded, it became clear that this wasn't something meant to disappear after 24 hours. The issues we were naming aren't temporary. They are structural. They affect patient safety, trust, and public health, and they deserve to be heard beyond a single moment on social media. That's why we decided to bring this conversation here. In this episode, I'm joined by Dr. Italo Brown from Stanford for a grounded clinician to clinician discussion about how immigration enforcement impacts healthcare delivery and what we can do individually and collectively to protect our patients. This is not a political debate, it's a patient safety conversation. It's a public health conversation. And it's a reminder that healthcare is not neutral when fear becomes a barrier to care. As we step into a new year, my hope is that EMERGE In EM continues to be a space where we don't shy away from hard conversations, especially when they matter for the people we serve. Thank you for being here. Thank you for listening. Let's get into it. Italo maybe you can give us introduction about you and what you do.'cause in my books, you don't need an introduction. But for those people that don't know you, great work. Let us know who you are.

Dr. Italo Brown 2:35

Oh man, you're far too kind. I'm Dr. Italo Brown on Instagram. I'm@gr8vision. I'm an emergency physician, assistant professor of emergency medicine at Stanford. I did fellowship in social emergency medicine, which is a field that essentially looks at social determinants of health and how they can change someone's engagement or interaction with the emergency department, what kind of resources they need, whether or not there are ways for us to prevent some of the illnesses, whether it's chronic illnesses or acute illnesses, and then we tackle some tough issues, things like dealing with substance use in the emergency department human trafficking in this case, things that are at the verge of social justice. So I'm happy to be here talking about this stuff with you, man.

Mohamed 3:17

I'm happy you joining me and of course, for those of you who don't know me, my name is Mohamed Hagahmed. I'm an emergency medicine physician as well as an EMS physician here at the Pitt University of Pittsburgh. I know is not the California like weather right now. It's cold, it's snowy. It's it's depressing. So thank you for keeping up the heat with me, brother. I appreciate you

Dr. Italo Brown 3:37

A totally different experience on this end.

Mohamed 3:42

that's why I'm wearing this is, it's so cold in my office right now, but I think before we start any discussion, it's good to set some ground rules. And when I thought about this, the initial intention was not to make it political, so this is not a political discussion. This is a discussion about public health, humanity, and how we can deliver the best care possible to our patients. And, Italo, I'm gonna pick on your brain for a lot of these issues and a lot of these concepts that we're seeing, but the issue is clear, right? Immigration enforcement impacts healthcare. So I'm gonna just share some data and I want you to give me a public health frame to these data that I'm gonna, that I'm gonna share with you. And I'll be honest with you, man, it's been, I tell you, like when I was looking for data for Reliable data, I had to find different sources and just tells you exactly, there is no centralized agency. Where you can get data about injuries, about barriers, about problems related to immigration enforcement and healthcare. So I had to pull different resources that I'm gonna share with the audience when we've done recording. And these are the following data. So since 2024, between 150,000 to 200,000 people were arrested by ICE. And that number went up in 2025. By late 2025, only about three in 10 people who were arrested by ICE had any criminal conviction. So seven outta 10 had none. And then when I looked at the government data showed that only a small minority that's like less than one in 10 individuals, less than one in 10 individuals in ICE detention have violent convictions. So most of these people have either no conviction at all or maybe some minor immigration related offenses. So just give us. It's a public health lens into these data. What do you, what are you thinking right now as a clinician and a scientist?

Dr. Italo Brown 5:54

It is a concerning thing to know that you know the type of people who are being pursued by ICE typically are nonviolent. They don't have these criminal records that are being stated. And so it's hard not to look at it as somewhat of a political issue. And what we know is that in emergency medicine, people will come in for a variety of different reasons. And even those individuals who are being, who are essentially seeking asylum come into us often in a variety of different states. And our goal is to, again, give care no matter what state that they, whatever like condition they're in whether they are. Actively, undocumented, whether there is ice pursuing them or their family members, if they have heart failure and they need to be treated, we have to treat those patients. And there's a onus on us to do i'm reading some more data here. It says as of mid-December 2025, there are about 68,000 people in ICE detention centers. So 78% increase over mid-December to 2024, like you stated. I think that what we're hearing is compounded medical issues that are occurring not only in these de detention centers, but people who are trying to avoid being brought into those detention centers. So they come to us in extremis, in sicker states, and we know that they're, if they do come in the first place going to be a little bit more medically complex and socially complex.

Mohamed 7:15

so you broke down a lot of things, right? You just, the topic of delayed medical care, fear. Trust, which is to me a big word. We have to rely on patients trust in us, that they trust us in the care that we deliver to them, and they're gonna be safe in our environment. And Italo, I tell you, a lot of people think of emergency medicine as is a sexiest specialty, right? Is trauma. Resuscitation, the hypotensive, the one in getting shot, the one in getting stabbed. But truthfully, the majority of patients that you and I see are actually patients that suffer from some form of a public health barrier. And I remember one of my mentors in medical school told me emergency medicine is like the mirror of society.

Dr. Italo Brown 7:59

Facts.

Mohamed 8:01

If. Your society is breaking down, the sequela will come down to your department. The sequela will come down to your EMS systems. And as an EMS clinician medical director, I see this all the time. So how can we, let's say the topic of fear, right? How does that impact care?

Dr. Italo Brown 8:19

I think that fear for we see how fear is for individuals who are not in this current situation, right? Where their concern of being treated or mistreated. For example, we talk about L-G-B-T-Q communities that are worried that they'll be stigmatized when they come into the emergency department. We talk about elderly individuals who are afraid that when they come there, they may not. Encounter some technological issue that affects their ability to get accurate, adequate care. We talk about communities of color who have been marginalized for a long period of time and have experienced very poor health outcomes when they come to the emergency department. And these are communities that might already have documentation status confirmed. And so imagine in the. Additional layer to that right? Where that fear of going there and potentially divulging information that makes you particularly vulnerable to ICE and being sought after. That is running rampant right now. And I've literally heard family members, I. Talk about Hey, they got a patient they ask, send someone who is documented first to ask, is it okay for this person to come and really scout out the hospital or the emergency department prior to even showing up? And so it's like very. Unnerving to hear that a patient or a potential patient is at home or wherever they're dwelling. Dealing with this medical issue that's only getting worse because they are worried that the moment they present, they're gonna be taken away in handcuffs.

Mohamed 9:44

So that's what looks like to us in a department, right? So we see delayed in care, delayed treatment for infections, people that need dialysis, people that need, care for their heart failure with exacerbations. Can you tell me more about what can we do as clinicians? And this is some, this is one of the questions that popped up and someone asked, like, how can we make them trust us that no matter who you are, what your immigration status is, we are gonna give you the best care possible in our department.

Dr. Italo Brown 10:16

that's a very layered question and I like it. I think one first step is realizing that clinicians, whatever you are, if you are a nurse practitioner or pa, if you are, trainee, like a resident medical student. You have to do your best to educate yourselves upon the issues and know what's actively happening in your county, what's happening at the state level. And I say that because you should know how ICE is being deployed. A lot of this stuff is available or accessible information. The second thing is, what are your hospital protocols in place? If you work in the administration level or you are interfacing with hospital leadership, you can ask directly, what are the policies for this? Do they have to demonstrate a cause? Do they have to show badges or some sort of like identification that they are ICE? What is our duty to protect those patients? To get crystal clear on that especially if you're in a position where you can. Easily be swayed. So I'll give you a quick example. Medical students versus an attending. If I'm ICE and I walk into the emergency department and I'm like, Hey, do you know where you know Joe Garcia is? And I'm talking directly to a medical student, I might feel compelled to give him information simply because this is an officer in front of me as opposed to an attending who will be like, I can't give you patient information. I don't know what you're asking for, but you might have to check with registration in the front or go through the protocols that exist simply because I don't feel that threat the same way as somebody who might be in a different station or work as a different member in the team. So you really need to be clear on those policies. And then lastly, I think that I do, I go above and beyond to make sure that patients hear me say you're safe. You're here, we're gonna treat you. There's no funny business. You can't expect that you don't have to expect that we're going to like, relinquish your information without your consent. Like going back over those core tenets and then saying this. With an interpreter if you need to. I like an in-person interpreter so that I can have a physical presence there, giving that information to the patient or having it in writing so they can physically see it, take it, walk away with it. So these are things that we can do that are low hanging fruit, in my opinion, to establish that trust and to create a safe en environment for our patients.

Mohamed 12:39

Yeah, and I can't emphasize that point enough, realizing the power dynamic. You said medical student, resident, fellow maybe versus an attending. Because that power dynamic is different. And also knowing the policies in your hospital. And I'll tell you, like for example, in our institution, we received a clear email saying that we as clinicians don't have to interact with ICE officials. We don't have to give any information. That is not related to the care. So basically if I see or, got the chance to run into a, an ice official asking me questions, I'm like, you know what? This is the enforcement person you need to talk to. Not me. I, my main sole responsibility is to take care of that patient in front of me. And I can, you mentioned something about like power dynamics.'cause I can see how can that maybe change patient care, right? Because. The, maybe the intention is you know what, just wrap that wound and just get him discharged as quickly as possible, right? It can bias your care instead of them maybe getting, needing to be admitted for chest pain evaluation or needing to be given IV antibiotics, things like that, right? So don't be

Dr. Italo Brown 13:47

points you just raised.

Mohamed 13:49

Don't be swayed by what they tell you because. That person need to be deported or arrested as soon as possible. I think we run into these issues even before ice, right? You and I, we know this from prisoners come to the ED all the time Hey, I just wanna get a clearance. I wanna get a, an alcohol level, something like that. And just get him

Dr. Italo Brown 14:07

Do me a

Mohamed 14:08

soon as possible.

Dr. Italo Brown 14:09

me a solid,

Mohamed 14:10

Gimme a number. You do miss solid.

Dr. Italo Brown 14:11

No,

Mohamed 14:12

It gets, that gets me all the time because it biases me. And as we work in busy emergency departments, so we have a lot of patients that need care. So sometimes it can be, we can be easily swayed, we can be easily biased by the situation because, hey, I don't wanna deal with that person anymore. Just get him outta here. Let me just deal with the other person. So do you have any experiences, regarding that? Any tips points?

Dr. Italo Brown 14:36

There, when I was in residency, I think I was a second year. And, as a second year resident, you move a little differently. You feel like you do better at patient management than you did as an intern, but you're still not familiar with all of the ins and outs of the department, like these logistical things or workflow things. And I had a senior at the time, his name was Calvin Sun, really cool dude from New York like a straight New York based mentality all the time. And Calvin, I had a patient and he saw some guys with some I'm thinking this is standard law enforcement. He walks up to me and he's dude, that's fucking ICE. And I'm like, at the time I have no clue. I'm coming from Nashville, Tennessee. The hell you mean that's ICE. And he was like, listen, if they ask you information. Lie. I said, what? I said, what? He was like, lie, I don't care what happens, just lie. And I said, all right dude. And sure enough, they walked, they made a lap around the department, then they stopped at the desk and they were like, it is such and such here. I was like, I don't know the patient that you're talking about. You gotta go check in at the front desk outside, da. And Calvin sent somebody to show them outside. And I just remember that was like. I thought nothing of it after the day, I was just like, I'm following what my seniors said. But that began like the first real uncomfortable interaction that I had in a hospital with someone who presented as law enforcement. And I wanna make sure I draw a clear distinction like will engage law enforcement in the presence of law enforcement is something that's almost inherent to most hospitals now. Like you're gonna at some point experience. Law enforcement being present. But ICE is different because they are coming with the clear like goal of identifying somebody and there is a clear course of action once they identify them. As opposed to like law enforcement, which may show up to ask questions. There may not be any type of detaining occurring. And in many cases they don't actually have an action that they can do right then and there. They can give a citation, give a court date, they can apprehend somebody. Or if they come in, they can already be apprehended. But very seldom do you see somebody come in and yeah, I'm gonna take this dude as soon as he's discharged away to a detention center. So things that I, and I know I was long-winded to give that story, but to your initial question, like I think that a part of it is mentally roleplaying, what you're gonna do when they physically walk up to you, or when you physically encounter somebody who you don't really understand what their intent is that is something that you can practice, you can try on for size. And I think that for most folks, there is a more senior person in the department who can share with you resources or tell you exactly how they've previously responded to these types of things.

Mohamed 17:32

And again, just to emphasize the point and bring it all back again just for people to realize. You don't really have to interact with ICE. You have a legal person in your department. You have a legal person in your hospital that can have that conversation with them.'cause your sole purpose is to take care of these patients. You are there to provide unbiased care to their needs without getting influenced or biased by whatever they tell you or tell you. Staffing. And this is also the other thing too, because I feel like. One point. We don't also get biased by just ICE, but also get biased by the staff. Some people tell you like, you know what? They're here brought in by ICE. Just quick eval. Maybe they need an x-ray and discharge,

Dr. Italo Brown 18:16

I thought you were gonna go there first. You gotta talk more about that. I think that's a significant issue.

Mohamed 18:22

Tell me more.

Dr. Italo Brown 18:23

No I just think that the way that you will truncate a workup or pursue a workup because of additional insight that may be not necessary at all. It is alright, this guy, like you said, might come in with chest pain. You're like, Hey, this dude has a high heart score. His risk factors are there. He has a cardiac history that's like. It makes him the ideal candidate for admission for maybe a stress echo or something like that. And then you learn okay, you know this guy being pursued by ICE, and you're like, alright, maybe I gotta discharge him so that he can get away from the hospital. Or maybe there's physically the presence of ICE there, and you're like, all right, I really don't know what to do. If you planned on admitting this guy when you first heard him without any other information, then you should admit that man. And I think that's how I would pursue it. There are only very certain situations, certain circumstances, where I would say, all right, I would do something different based upon information that someone gave me,

Mohamed 19:19

And I think that applies to a lot of aspects in emergency medicine, right? Getting biased by the pain level of the person with sickle cell disease, getting biased by the whatever, the severity of the wounds or obesity or body odor, things like that can bias all of the time. And I'm telling you, man, I will never forget this story again. The story of this person's was faking a seizure? And. I was like, oh yeah, they're sure you know this person. Oh yeah, I've seen him. They always come to the ED all the time, sometimes three days a week. They just always taking a seizure, trying to get some pain meds, and I'm like, okay, I didn't get that head ct. And guess what? Get the head CT and they had an intraparenchymal hemorrhage. Intraparenchymal hemorrhage. Again, like it's so easy for us to be swayed at this level of chronically busy, tired, exhausted, hungry. So we have to be aware of those issues. And that's something that you and I know we talk a lot about, but I think a lot of our audience also are aware of this now. But let me just kinda shift gear a little bit. For that person who tells you, you know what, I'm a law abiding US citizen. I don't care. Things need to be done for these people who don't obey the law. They, they need to pay somehow. This thing is not going to affect me. Absolutely. I'm getting no impact from what's happening right now in Minnesota from what's happening now in various states of this country. So how can counteract this argument? It's not impacting me at all.

Dr. Italo Brown 20:46

So to take it out of, there's a couple ways that you can count. I would say speak directly against that argument, or rather debate that argument. One is. I think you can take it out of the context of something political and say you do realize that this patient who is not, who's avoiding care is eventually going to come in, and that will change the way that we respond because we'll have sicker patients. And so when you come in for a routine visit or whatnot, you might not, your wait time can be longer or extended because we're dealing with that or. Imagine patients who are in high volume, high concentration areas like a detention center, and the amount of communicable diseases that emerge because of that, and them coming in, especially in something like the flu season, again, adds additional strain to an already stressed medical system that changes the way that you experience the healthcare ecosystem. I think that the cost of care in general, first off, there's all types of funding shifts, not only from a federal standpoint, but a state-based standpoint. When you start talking about an agency that's acting in a way that seems to be poorly regulated sometimes. Almost all the time, in my opinion, unlawfully. And so the things that are being put in place are stuff that you will eventually pay for. So these are the things I tell folks, like it doesn't even have to be a political conversation. This is a dollars and cents conversation. This is a live and not a live conversation.

Mohamed 22:18

And guess what? If you have a 60 something year old grandparent, if you have an elderly person you care for at home, if you yourself have chronic illnesses that make your immune system, less strong, right? You have an immunosuppressed condition and then you have this. Massive number of people that cannot trust us. Again, the word is trust and they cannot be seen by their primary care physicians. And they come to the ER, chronically ill and then have acute exacerbations, and they have, oh, guess what? I did not get my TB prophylaxis medication because I was concerned that I might get pulled over by ice or I might be deported. So now you have a massive surge of TB cases. So yes, it impacts you eventually, like you said, influenza, all these infectious diseases that can, can go rapid in your communities because of this issue. And I tell you what, like as an EMS clinician, this issue specifically worries me the most, right? Because people rely on EMS as the safety net for the community. You call 9 1 1 and you expect help. That's the way it works. Has been working for years. Right now, I don't trust anybody in uniform, right? So you call 9 1 1. Maybe police shows up for some reason. Maybe two paramedics that have law enforcement background. Maybe they're wearing a uniform that looks like their local police. People don't know this, right? Immigrants don't know this what EMS supposed to look like. So you know what? I'm not gonna call anybody that looks like an officer to me, so I'm gonna wait. That shortness of breath might get worse. Have a saddle PE,I die at home, or have a massive heart attack. So that concerns me the most is like, how many of these poor individuals gonna be deterred by using the safety net when they most need?

Dr. Italo Brown 24:18

There's another layer to this that we don't often talk about, which is our pediatric cases. So I think about the families that are coming up with game plans on how to protect other members of the family who might be undocumented. And that includes like telling them to take different routes to school avoiding the grocery store. And so now you've got children. Who might have nutrition issues as a function of the parents not going getting adequate food sources or who may encounter new types of built environment dangers because of the fact that their typical routine is disrupted or to simply deciding to take a child to a well-child visit or get that immunization or vaccination schedule. Done as it's recommended by your pediatric societies. Like all of that now has a significant ripple through it because the people who care for them, the people who care for grandparents are now in the cross hair, so to speak. So you will see those extremes also experience different health outcomes as a function of something that's targeting a specific population.

Mohamed 25:27

And I'll tell you, as someone who practiced medicine. Texas in San Antonio, in the midst, in the heights of COVID, and I was like, what is going on? Like three, four people from the same household, just acutely ill needing to be ventilated and intubated, needing to be admitted to the ICU, and you wonder, that healthy 17-year-old from the same household who initially got COVID and now the grandma. Who has COPD type two diabetes, chronic kidney disease, all these things now getting the worst severe of COVID, right? And now they come acutely Ill, like I saw this is not just an isolated issue, this is a community-wide issue. This is a public health issue. So this is what I have with this point where like, when people tell me this is a, don't make it political. No. Just stick with EMS, stick with resuscitation, stick with like critical care. Don't make this political. But the problem is this is indeed resuscitation. This is the sick one's gonna come to see us and the sick ones most likely might not make it right. And this is what the data shows us. And I think this is as to from, a public health scientist or a public health scientist, I think we need to do more work in collecting data because I feel like. And even to this day, like even when people are not convinced by data anymore, we still have the responsibility to show that what's happening right now is gonna impact their own health.

Dr. Italo Brown 26:53

True.

Mohamed 26:54

If someone comes to you is okay. If Talo, I like what you're saying, Mohamed, I like what you're saying. I, I'm convinced now. What can I do as an individual? Let's say, what can I do as a paramedic, as a nurse, as a physician from an advocacy standpoint?

Dr. Italo Brown 27:11

I think we have to continue to. Like champion the message that you're not like powerless, you're not at affect to all of these changes. You are someone who has considerable social capital and equity inside of the healthcare ecosystem. And so your voice matters. And that may require organization that may require having some longer nights where you're troubleshooting your role in this I found, I find that. There are some already existing things that people do. For example, if you're a nurse and you're part of a nursing union, and I know union for a lot of people is a volatile or potentially inflammatory word. My point is that those same associations that help argue for, collective bargaining that help give you benefits, can also help you, in terms of your stance on whether or not the patients you care for are at increased risk of death or disease. And so I think that tapping into them and seeing what actions are already being planned is an easy thing for a person who's in a union to do, or at a institution where there is a union. If you are not, and you do not have that particular capacity, almost every department has a committee that is actively following this issue. Join the committee. Never turn down that opportunity to do free work. And so that free work may be something as simple as printing out cards that tell someone how to know their rights. That could be checking in with security to see like how many times in the past month, like what does the data say in terms of the number of inquiries and seeing like what have we done from a response standpoint, going to again. After hour meetings or in the middle of the shift meetings where this information is being disseminated, and then taking that and becoming a megaphone to your colleagues, to your other coworkers and team members about what's happening. What I like to do. If you are an educator in your academician, you can use this as the opportunity to teach through the lens of your academic sphere. So if you want to do a bedside teaching about like how to care for patients that are socially complex, and this can be one of those case studies, that to me is of high value.'cause now you're getting multiple phases of learner. You're getting a med student. A resident or an intern, you're getting whoever else is listening in the care team, that interdisciplinary care team, I think that's important. And then my number one social emergency medicine thing is talk to the people who know it best. You need to have case management and social workers that are like your best friends who can tell you like, this is what we're gauging and fielding because nine times outta 10, that patient is not gonna directly divulge. To you that they are in this circumstance, they're gonna divulge it in that quiet conversation.'cause sometimes social workers and case managers have more time to really ask grueling que not grueling questions, but like exploratory questions where these details somewhat come to the surface and they feel safer often because again. A lot of case managers and social workers aren't walking in, in scrubs, walking in white coats, don't have the visible signs of authority. Not saying that they aren't of authority, but they give a different impression, and it lands in a way that often patients feel like they can divulge more to them safely.

Mohamed 30:36

And one of the biggest advantages of emergency medicine, you and I know, is that we are part of the community. We are the face of medicine when people see us in the hospital. So it's good to be out there, be engaged with your local, settlement centers, refugee centers, educate patients and about Hey, if you call 9 1 1, nobody's gonna arrest you, they will take care of you from a medical standpoint. They're not gonna take you to an ICE detention facility. They will take you to the hospital. A lot of people don't know that EMS clinicians wear uniforms. This is their identity. They have a stethoscope, they wanna take care of you, and they genuinely care about you. Education, you mentioned education. Talk about these issues to EMS clinicians, to nurses. Be part of the, be part of the committee, like you said in the hospital. And also reach out to your bosses. The chair needs to hear that because if they hear you, my employee does care about this stuff, then they want to support you and my experience, like most people wanna support you. Because at the end of the day, they care about patients because patients do come to the institutions, and pay for healthcare. So they do care about these issues. It just, you have to make it clear that it's not about politics, it's about patient care. And that's what we, started this, the first place. So I appreciate you, Atallo. Is there anything else you want to add to this conversation?

Dr. Italo Brown 31:56

One point I was gonna say is that hospitals, they, you may encounter a hospital that is somewhat soft on the issue. I think that the current events have forced a lot of hospitals to reconsider their positions in a way that I think is more positive because. It used to be this amorphous thing a year ago is when I was first in conversations at our hospital about, the presence of ice, right? So we were coming off the heels of an election and there were these announcements that all of a sudden they're gonna be, deploying ICE into different communities. And I remember immediately our social emergency medicine team got in alignment with multiple stakeholders at the hospital, and we were having active conversations around it. And although we felt like we might have been behind the eight ball, we were actually ahead of the game. But I share that to say that some hospitals at once, I mean at some point may have been like, Hey, we just put up some signage or whatnot. But now you're hearing that, in the process, there are additional collateral damage. And so I think that it becoming a public health nightmare as well as becoming a PR nightmare at the same time is the motivation that hospitals are moving with now. Okay, so this can get really bad. Really quickly, and you're looking at an active case study in Minneapolis where you have active protests and social activity or rather nonviolent approaches to showing resistance. And so now it's not just about. Like how do we protect and take care of the patient who is directly in the cross hairs, but how do we protect the community as they practice civil disobedience in a very respectful manner? And possibly those patients can be the ones that are documented who are coming from these actions. And we have to be able to deal with capacity as well.

Mohamed 33:50

I really appreciate that because that's definitely brings another light into the issue and. I appreciate you man. This has been good and I was looking at all the questions. I think I was able to,

Dr. Italo Brown 34:03

You hit a lot of these, man.

Mohamed 34:05

We were able to

Dr. Italo Brown 34:05

I just wanted to check with you man. Are there things, take home messages.'cause again, thank you for holding this space for us to discuss it, but you have multiple layers of insight around this. Everything from personal insight to professional insights, and I just wanted to make sure we gave you adequate time in the floor to express that.

Mohamed 34:25

No, I appreciate you for asking because a lot of people don't know this, but I am an immigrant. I was born in East Africa. I came here as a refugee. I was on TPS, so temporary protected status, and then I got my green card, I got my citizenship. So I am a naturalized US citizen, and. I'll tell you, like when I first came here, I felt lost in the system. There's so many things, and when people tell me, it's like, why don't these people just follow the law? Why don't these people just fill in the paperwork and do what needs to be done? But I'll tell people this. It's like it's at such a convoluting system. Me being college educated, I speak multiple languages, three languages and I still had issues and problems navigate the system to try to be legal, right? So imagine, you grew up not able to speak English, maybe English is not your first language, like myself, and you try to navigate this complicated system on your own. So I always have grace, when people tell me. I tried, I couldn't, maybe I didn't have money because every application has a fee with it, right? Every application is like$500, seven$50, and this is, you have to renew and make sure you don't miss the deadline. So yes, it's a complicated application process. But yes, everybody, and absolutely, I fully agree, everybody should follow the law to be a law abiding citizen and be part of this community. And being at this position like you and I as attending physicians in a big academic institution, I feel empowered to speak up about these issues because it's always one thing if you like, Hey, you know what, I'm just gonna do my thing. Shut up. I'm an immigrant. I don't wanna be targeted. I don't want people to come after me. So it's one thing you can do that, which is fine, absolutely fine if that's your the battle you wanna fight. Sure. Take care of your family, take care of yourself. But if it's like, if one life can be impacted by this, then I think it's worth it for me. If one single life that can, I can prevent, maybe a heart attack, I can prevent maybe someone to be ventilated, intubated, or even come to the ICU because they waited so long, or avoided or fear or lack of trust, then to me, that's worth it, right? Because at the end of the day, you go to a shift. You work, what, eight, 12 hours maybe in a shift. You take care of what? 17, 18, 20 patients you leave? What is your impact? It's the things that you do,Italo, that create the most amount of impact that we do that. That's why I encourage people always speak up about these issues because you and I, in a day, in a shift, maybe 20 people, that's our impact, in a week. I don't know, 40 patients, but if we can ensure that actually these people can be, maybe feel safe to talk about these things and feel safe to trust us in the care that we deliver to them so that the family member can seek primary care, they can have access to interpretation. I think that's all worth it for me. And thank you for bringing that up, and I appreciate you. For your insight. And I always, man, I'm, I admire your work, and I also appreciate the audience for those questions that you brought up. And this is just, this is not just one thing. This is a dynamic issue. We will continue to speak up about these things and write up about it, teach about it, and hopefully we can make this place a better place for all of us, right? This is why I love this country. I'm a proud citizen. I love the people here. They support me. I support me. And this is part of us being productive, piece of the community. And I think this is why I'm gonna stop digressing, but this is why we do this.

Dr. Italo Brown 37:55

No, we got some good comments in the chat. People who are appreciative of this dialogue today, many saying thank thanking you for hosting this and for having the courage to speak about these things. So I just want to, like I said, I salute you and honestly, this is. Unconventional for a lot of clinicians to engage in this type of discussion on a platform that can be this accessible. And I think that we are living proof that you can walk in truth and in confidence and feel that you are on the right side of history by having a stance on this issue.

Mohamed 38:31

I appreciate Italo, you're my brother, man. I love you and thank you to our audience for engaging and I hope this was as enlightening, as empowering as we intended to be initially. And hopefully we can continue this conversation, make this place better. So thank you so much, Italo. Again, thank you all. Appreciate you all. Peace.