After Trump’s immigration crackdown, a desert clinic tries to save lives without breaking the law

Eric Boodman, Stat, July 6, 2017

When the man walked in with fang marks on his leg, the volunteers knew the protocol: In the case of a rattlesnake bite, you call 911. But like all of the patients who end up here, his very presence in this desert clinic meant he had broken American law.

He’d been bitten sometime after he’d slipped across the southern border, while he was walking 12 miles through the arroyos and cactus-studded outcroppings in and around the Buenos Aires National Wildlife Refuge. He was hoping to reach his family in the United States; the last thing he wanted was for anyone to call the authorities.

That was the dilemma that greeted Dr. Norma Price when she picked up the phone. She is a retired physician who volunteers with a group called the Tucson Samaritans, and she doesn’t remember exactly where she took the call because she has dealt with hundreds and hundreds like it over the last 13 years. She has taken them at a salon called The Coyote Wore Sideburns. She’s abandoned her groceries at Safeway and Trader Joe’s to do consults in the parking lot, without the distraction of Muzak and other customers.

She even got one of these calls on Christmas day, while she was visiting her kids and grandkids in Atlanta. She excused herself to help volunteers deal with a woman who was having trouble breathing, after the coyote who was supposed to guide her across the desert had assaulted her instead. He had broken her ribs, and her lung had been punctured by a jagged edge of bone. She had been found, stranded and wheezing, far out in the middle of the desert, and she needed to go to the ICU.

But this man had walked into the No More Deaths (No Más Muertes) clinic himself after the snakebite, and was adamant he didn’t want anyone to call 911. The clinic volunteers asked Price what they should do. “I said, ‘Explain to him that, number one, he could lose his leg, and number two, he might die,’” Price recalled.

He still wasn’t convinced.

Price was used to difficult cases. She had spent 15 years as a medical oncologist, prescribing different chemo combinations for stubborn tumors, and then 12 years in urgent care. But now, she isn’t just battling injury and disease. She and her fellow volunteers are fighting US border policy and the Trump administration’s crackdown on illegal immigration. That means fighting against the very landscape in which they work: the expanse of desert that undocumented migrants try to cross on foot to avoid being caught by the U.S. Border Patrol. It’s a place where even the smallest ailments can turn life-threatening. Blisters look like third-degree burns. Stomach bugs make dehydration even worse. A sprained ankle can mean being left behind to die.

According to the Border Patrol, 6,915 corpses were found along the southwestern border between October 1998 and September 2016—and as Dr. Greg Hess, the chief medical examiner for Pima County, put it, “We know for sure that Border Patrol’s number is an underestimate.”

Small nonprofits like No More Deaths and the Samaritans try to keep those people alive. But for the volunteers, providing even the most basic services out here is a legal high-wire act. They’ve been arrested while driving migrants to the hospital (the felony charges were eventually dismissed). They’ve had run-ins with the Border Patrol. Fellow citizens accuse them of abetting illegal immigrants. They’ve been told that their patients should be left to die.

That climate has only grown more hostile under Trump, whose candidacy was endorsed early on by the union of Border Patrol agents, and who won the election with bitterly anti-immigrant rhetoric. These volunteers take care not to break the law—not to cross the line between permissible medical care and unlawful assistance to migrants—but it’s an unpredictable business.

The desert campsite clinic is tucked between hills of creosote bushes and spiny ocotillo, like a pot plantation hidden among rows of corn. Instead of peddling illegal wares, though, these retirees and fresh college graduates are doling out foot bandages and Imodium, clean water and Tylenol. It’s the stuff of your average American medicine cabinet. The Border Patrol has, in recent years, largely stayed out of the campsite clinic, but that tenuous arrangement—what Customs and Border Protection called, in a recent statement, a “positive working relationship”—may be falling apart.

In mid-June, during some of the most dangerous heat Arizona would see all year, the Border Patrol spotted four people who had illegally crossed into the U.S. Agents tracked the group over mountains and through dry streambeds, and saw that they entered the No More Deaths camp. The camp leaders, when asked, wouldn’t turn over these people whom they considered their patients. And so more than 15 armed agents waited for a search warrant and then stormed the camp, with a camera to film the arrests. They triumphantly broadcast clips on Twitter.

In a No More Deaths statement on Facebook, the group pointed to the Trump administration’s more aggressive enforcement of immigration laws, and a founder of the group called the raid “a direct attack on humanitarian aid.” He said the event was a violation of the Border Patrol’s agreement to respect the camp as a medical facility.

But Daniel Hernandez, a spokesman for the agency, told STAT that “the only agreement that was made was a verbal one, to continue the dialogue.” He added, “I’m not sure about the legality of practicing clandestine medicine in the desert. There is a hospital 40 minutes from the camp. If the patient is in distress, our priority is not to keep them in the field—in 115-degree weather, in a tent. That’s unethical and it’s inhumane.”

The volunteers worry that migrants like the patient with the rattlesnake bite will no longer feel safe entering the camp. He knew that treatment at a hospital would almost certainly come with a deportation order—and so, like many migrants desperate to escape violence or poverty or both, he played a miserable game of chicken.

Price instructed the volunteers to find a Magic Marker or Sharpie. Every few minutes, they were to draw a line around the man’s leg at the upper limit of the swelling. That way, they could approximate how far the venom had traveled into his body. They might not be able to stop it, but at least they would know how bad things were getting. Eventually, as the migrant watched the damage inching up his leg, he agreed to have the volunteers call 911.

He was taken to a Tucson hospital, more than 60 miles away, and the next day, Price drove from her house to see how he was doing. From the nurses’ station, she could see the patient’s doorway. But there was a Border Patrol agent inside the room, keeping guard. He told the nurse not to let Price in.

In early April, Trump boasted that his administration in “just a matter of weeks … has brought record reductions in illegal immigration.”

The number of people apprehended or turned away at the southwestern border has indeed dropped dramatically in the past few months, according to Customs and Border Protection. But even in places where there is already a border wall, some migrants are still crossing—and the measures that were supposed to keep them out of the U.S. are, at least for some, creating medical emergencies within the U.S. instead.

In Nogales—a city cut in half by a tall rusted barrier along the border—local EMTs have their own name for some of the patients who still try to cross there.

“They’re called jumpers,” said Capt. Gilbert Escobar of the Nogales Fire and Medical Department, on the Arizona side. “What we’re seeing right now is a lot of broken legs, lower extremity injuries, fractured ankles. And we have come across one death: the person who went up and over came down face first.”

Still, the most deadly places are the deserted ones, into which migrants have been funneled for decades. As the Border Patrol laid out in a strategic plan for 1994 and beyond, “absolute sealing of the border is unrealistic.” Instead, the first step was to control more populated migration routes, like San Diego and El Paso.

“Mountains, deserts … and valleys form natural barriers to passage,” the plan said. “Illegal entrants crossing through uninhabited expanses of land and sea along the border can find themselves in mortal danger.”

Between the tightening security in border towns and the threat of these wild places, the thinking went, migrants would be deterred, and fewer of them would try to cross the border illegally. It was the early precursor to Trump’s border wall. Yet it turned out to be a drug that makes you sicker than the condition it was supposed to treat. The nastier side effects involved corpses in the desert.

In Arizona’s Pima, Santa Cruz, and Cochise counties, the cadavers end up in the body cooler at the medical examiner’s office in Tucson, where they wait for a pathologist to dissect them and label them as UBC—undocumented border crossers. “We have averaged 170 a year from 2002 through the end of 2016,” said Hess, Pima County’s chief medical examiner.

Even as the number of migrants goes down, that pattern of deaths doesn’t seem to have changed much since Trump’s inauguration. By early July, 82 corpses of desert-walkers had come through the examining rooms in Tucson since January.

“It looks like we’ll be about average for what we have had over the past few years,” he said. Many of the corpses could have been more than eight months old: they were nothing but bones, sun-bleached and picked at by coyotes. But others still had ligamentous attachments, a sign they’d been there 90 days or less. Yet others still had flesh clinging to them—relics of migrants who’d died only a few weeks before.

The campsite clinic is hardly the only response to these deaths. Like conifers whose seeds are spread by wildfire, nonprofits tend to spring up in the wake of disaster, and a whole network has taken root on the Arizona-Sonora border to prevent these migrants from dying or vanishing.

Humane Borders sets up 55-gallon tanks of water in the desert and brings donated medical supplies to the Mexican government’s desert rescue workers, who are often so underfunded they can’t afford even bandages and ointments. No More Deaths helps migrants make free calls to their home countries, so their families know where they are. Samaritans go visit migrants in detention, many of whom spend months behind bars for simply presenting themselves at the border to seek asylum. The Kino Border Initiative operates shelters on the Mexican side of Nogales to care for those who have just been deported.

The nonprofits can only do so much. On a recent day in a Nogales shelter called the Comedor, a 34-year-old migrant named Elisabeth Hernandez Reyes told a volunteer nurse, “I have pain in my bones.” She had just been deported, after trying to cross the desert for the sixth time. “All morning yesterday we were crawling on our knees, so that the cameras wouldn’t see us,” she explained. There was little that the nurse could offer besides Tylenol and skin salve. She handed other migrants pills for diarrhea, allergy pills, and pills to help with symptoms of the common cold and the flu.

Treatment in the desert clinic is similar—but the tension is higher. That’s where some of the most heated standoffs with the authorities have taken place, and its very presence is a testament to how long this spate of deaths has continued.

It began as little more than a place to refuel, a dip in the desert where volunteers could eat, sleep, and strategize before they went out looking for migrants again.

Many of the volunteers had already been going on water drops for a few years, but by 2004, enough migrants were dying in the desert that some decided to stay there around the clock, at least in the hottest, deadliest months. It would save them the hour and a half drive from Tucson, and those three hours could instead be spent saving lives.

On the outskirts of Arivaca—Price calls it a town of “hippies and cowboys,” where roadrunners strut across backyards like pigeons in Times Square—there was a children’s author who had helped the migrants she’d met on her property. She agreed to let the volunteers camp on her land.

They slept in the beds of pickup trucks and in sleeping bags under the open sky. At night, after they had been out dropping off water and looking for migrants in distress, they sat in their campsite and shared where they’d been and what they’d seen. But they didn’t know what to say: To them, all the places were nameless. There might be a dry riverbed—a wash—where they met many migrants, but they didn’t know what to call it, or exactly how to get back there the next day. “They would say, ‘We were in Dead Cow Wash,’ because there was a dead cow at the edge of the wash, or ‘Dead Suburban Wash,’ because there was an old Suburban, or ‘Pine Tree Wash,’” recalled Deborah McCullough, one of the volunteers who had been there that first summer.

They were like ambulance drivers trying to navigate a city without a GPS or map. McCullough’s husband, Ed, had spent his career teaching urban geology at the University of Arizona, driving through the mountains around Tucson, charting sites prone to debris flows and landslides and rock-falls and floods. He knew that the dirt-rutted roads around their campsite all had names or numbers—they’d been used by miners harvesting copper, silver, and gold, and by ranchers eking nutrients out of the scrub. And he knew his group could prevent more deaths if they had an idea as to where the migrants actually were.

“We discovered there was a trail system,” he said, “and we decided to map that system.” One of his primary tools was his white Ford F-250, which doubled as the couple’s bedroom: They’d sleep in it at night, and during the day he’d drive the adjacent roads, getting out to walk the trails he came across, clicking the button on a handheld GPS to record his coordinates every 50 to 100 feet. Meanwhile, other volunteers set out from the camp to distribute water and look for migrants in distress.

The name No More Deaths was as much a prediction as it was a wish. “I thought two, three years, and this problem would be done,” Deborah McCullough said.

After all, hundreds of corpses were turning up within commuting distance of manicured lawns, glittering hospitals, sprawling malls, gastropubs serving mesclun greens and mezcal cocktails. As Juanita Molina, the executive director of Humane Borders, said, “It is the equivalent of having a plane crash happening every year in Tucson.” The volunteers expected some sort of comprehensive immigration reform that would stop the deaths—and allow them to stop camping in the desert.

But the deaths continued. Coordinate by coordinate, Ed McCullough’s maps changed, the first data points growing into green tendrils that represented over 3,000 miles of trails. Slowly, the camp became less and less transient. Some of their water had come from the nearby home of a pink-bandana-wearing, gun-toting Vietnam vet—but eventually the nonprofit put in its own water pump. The camp was mostly for volunteers—but they eventually set up a MASH-style tent, where migrants could receive treatment. They only staffed the place in the summer—until February 2008, when they found the cold remains of a 14-year-old girl.

The nonprofit held a mass for her out in the desert—her aunt came, but her mother couldn’t take the risk, because she, too, was undocumented—and began to schedule volunteers to be at the clinic year-round. They are still there through the scorching foresummer, when migrants die of heatstroke and dehydration, and the monsoon summer, when migrants come in with the skin on their feet sloughing off from the constant moisture, and through the winter, when migrants are killed by the cold.

The camp, rudimentary though it still is, now has a trailer for an office, where the more serious medications are kept. It has a stash of donated clothes and shoes. It has paths, marked by painted stones, leading to and from tents and toward the bathroom. A hand-washing sink rests on six upside-down milk crates, replete with orange liquid soap and a cracked mirror. And a shiny white dome tent has become the clinic, with beds, and tall shelves for medical supplies.

Those are just a few of the signs that there are still migrants coming through the desert, and that some are still dying. You can find others in the McCulloughs’ living room, in the hills west of Tucson, where Deborah has mounted some of the thousands of objects that migrants have left behind in the desert, from which she creates exhibits, at once an art project and a wake-up call. She makes earrings out of the metal of their discarded food cans. There are shoes that have been slit to make room for swollen toes. There are water bottles painted black so that they won’t reflect the Border Patrol’s nighttime searchlights. There’s carpeting that was used to cover footwear, so that no footprints will be left in the sand. Bibles. Amulets. A Spanish translation of “The Secret.” Lost blister packs of birth control pills, taken along because migrant women knew they’d likely be raped along the way.

And if you walk across the house, into Ed’s study, and look at the maps showing every spot where a corpse has been found, the whole region glows a pixelated red.

When she first moved to Tucson in 1998, Price never imagined she’d be treating those at risk of becoming red dots on a death map. She didn’t think she’d be practicing much at all, let alone within confines set out by the Border Patrol.

She was retired. She did yoga. She hiked. She sat on her porch, watching pyrrhuloxias and quails and gnatcatchers, listening for poorwills after dark. She volunteered at the Arizona-Sonora Desert Museum, tracking spiny-tailed iguanas as they skittered through the sand and rock.

The work that has replaced her lizard-watching and her sparrow-banding is sometimes, oddly, not so different. On an uncharacteristically cool day in May, the 75-year-old set off—braces on her knees and walking sticks in her hands—through a dry riverbed arced with cottonwoods, up a scrabbly hill of burnt-looking rocks, and out into hills of cholla cactus and mesquite. With her was Sarah Roberts, a registered nurse, who, like Price, provides medical counsel to the volunteers at the camp, and an 82-year-old retired professor of social work named Lois Martin. They were here, accompanied by a first-time volunteer, to hike one of the migrant trails, check for usage, and leave out fresh gallon jugs of water.

This was some of the most important medicine that they could provide. “Everybody is dehydrated to a certain point—you just can’t carry enough water,” said Roberts. “Usually it’s five to 10 days that you’re walking continuously through the desert. There isn’t any water out here, except in some areas there are cattle tanks, and of course the water there is very contaminated.”

It might have looked and sounded like an outdoors club—with trail mix and geological finds, home-baked muffins and plant sightings—but even this work came with complications. A few years ago, a hidden camera had captured a Border Patrol agent kicking a gallon-jug of water, sending the liquid into the arid earth. The sector chiefs had subsequently agreed that their team wouldn’t tamper with humanitarian groups’ supplies, but volunteers were still vigilant.

Anti-immigration citizen groups say they monitor the water drops too, and sometimes drink the water themselves or give it to their dogs. They argue the government is complicit in “human smuggling” by tolerating humanitarian aid. “You wouldn’t have to build a wall, a fence, or anything else,” said Tim Foley, founder of a group called Arizona Border Recon, which patrols in military-style fatigues, with weapons, and has been labeled “extremist” by a watchdog organization.

The desert poses its own challenges. If volunteers left the water jugs on the ground or in the crook of a mesquite, ravens would perch nearby and peck through the plastic. Instead, the bottles had to be hung from trees at an angle to keep the birds from getting a grip on them, so they wouldn’t be “ravenized.”

The group came to the spot where they would be leaving most of the water. Every drop had been drunk since Martin had tied up these bottles with the help of a group of nuns. Now, there was something gruesome about them hanging empty from the branches on white cords, swaying in the wind.

“OK, we need good messages on all the bottles,” said Martin, pulling Sharpies and full gallon jugs out of her pack.

They drew hearts and flowers onto the plastic, writing phrases like “Agua Pura” and “Buena Suerte.” It wasn’t just decoration: Migrants in the camp had told the volunteers that they’d been warned by coyotes not to drink the water left out in the desert, because it might be a trap—either poisoned, or put there so that the authorities could nab migrants as they drank. But, Martin recalled, they knew that the Border Patrol wouldn’t have been drawing daisies and hearts, and figured the water was safe.

In the 1970s, Martin had been a social worker in the South Bronx. “That was the hardest job I ever had,” she said. “I was working with pregnant teenaged girls who were homeless and on drugs. … You got some of them into counseling, if you were lucky. Sometimes you managed to get them hooked up with some food, or a place to stay if you were lucky. And sometimes you just hope that they realized that somebody did care.”

That was all she could hope for many of the migrants as well. She remembered coming across three Guatemalans who’d been apprehended on this very trail. Martin offered them some water, and the Border Patrol agent who was leading them was willing to let them drink—“they aren’t always”—and she noticed that he didn’t have any water either. He drank, too.

There had been nine migrants in total, but they had scattered when a helicopter began circling above them. “The BP said, ‘We were able to apprehend three of them, so there were six more of them someplace up there’”—she gestured up toward the arid hills. “The thing is that Border Patrol wasn’t doing anything about these six more people out in the desert,” Martin went on. Her own group couldn’t go looking for them—they’d already been hiking for hours—and so they called the campsite clinic to send out a search party. But they didn’t come across any migrants.

Now, Price is worried that migrants who are lost without food or water will be too afraid to seek help at the camp, because word will have spread of the Border Patrol’s arrests there. She worries that more people will die.

She knows that one of those arrested last month was a felon—a drug smuggler—and she doesn’t want to promote the entry of convicts into the country, but she doesn’t want them, or anyone, to die in the desert. Her priority is that no one dies in the desert.

“The Border Patrol made the statement that they didn’t think it was good medical care to be out in that heat but a lot of the people that are treated there would not seek medical care for fear of apprehension,” she said. “Medical observation in that facility is better than no medical observation at all.”

When they arrive, their vitals are taken, their feet washed, their blisters drained, their diabetes prescriptions refilled, their blood sugar checked. The migrants usually stay for just a little bit, allowing their feet to recover. They might stop by the shrine on the edge of camp, where the Virgin of Guadalupe presides over half-burnt candles and rusted horseshoes. Most leave before they are fully healed, anxious to get wherever they are going, to settle in a place where they might be able to work, or where they don’t have to worry about extortion or murder.

They might wait for someone else, so they can travel on in a group, or they might leave alone, simply walking out of the camp the way they came in, through the wash, stepping between gray clumps of grass and prickly pears, and heading northward.

In spite of the arrests, volunteers will keep working at the camp. Price will continue doing consults by phone. She recently got a call while she was in the dentist’s office, and another while she was behind the wheel.

“I was just driving down the street when I got a call from No More Deaths camp,” Price said in a text message, the week before the arrests. “I ask her to let me call her back after I pulled over. (I don’t like to talk when I’m driving). Patient had terrible diarrhea after drinking dirty cattle tank water. I gave volunteer medical directions and told volunteer the most important thing is to keep patient hydrated.”

Then, she put her car in gear, steered back onto the road, and continued on her way.