Marcela Zhou Huang was born in Mexico and has lived in the United States since age 15. She graduated high school, earned a college degree and now is a medical student at UCLA. But Marcela is undocumented, and the possible end of DACA threatens her future.
When I was 7 years old and growing up in Mexico, a robber held me hostage and hushed my cry with a knife he pressed against my throat. Two years later, when I was 9 and developed a mass on my neck, a doctor told me that I had three months left to live. I am 27 now, and it has been more than a decade since I’ve seen my father and my sister. I don’t know when we will see each other again.
There has been much love and joy in my life, but also trying times. In many ways, I am fortunate to be alive. So when I woke up on the morning of September 5, 2017, to the news that the current administration would terminate the Deferred Action for Childhood Arrivals — DACA — program, I wasn’t terribly afraid.
I sent a text to everyone I knew who I thought might reach out to me that day. I told them not to worry, that I was turning off my phone and heading to the hospital for my clinical rotations. I wanted to stay fully present for my patients, and insulating myself from the life-changing announcement that now was dominating the news was the best way I knew how.
In a strange twist, the stress and fear that had engulfed my life since the 2016 presidential election subsided. Although my American dream and legal status in this country had a potential end date, I felt calm and composed. Suddenly, I had concrete answers and a clear path forward. Now it was time to work toward a solution for me and for the nearly 800,000 other DACA recipients like me.
According to the American Medical Association (AMA), there are an estimated 70-to-100 DACA recipients in training to become doctors nationwide, and more than 5,400 previously ineligible physicians could enter the health care system in the coming decades because of DACA. At the same time, there is a growing physician shortage in the U.S. In a letter to congressional leaders after the announcement to end DACA, the AMA noted the potential for “severe consequences” for many in the health care workforce, patients and the overall health care system. The AMA cited an independent study by the Association of American Medical Colleges that projected the total physician deficit to grow between 61,700 and 94,700 physicians by 2025. The AMA argued that DACA helps address these shortages and ensures patients access to care, saying, “Those with DACA status help contribute to a diverse and culturally responsive physician workforce, which benefits all patients.”
MY PARENTS EMIGRATED FROM CHINA TO MEXICO in the early 1980s, settling in the town of Mexicali, just south of the California border. My father Yin and my mother Hua worked in restaurant kitchens while they raised my older sister Claudia and me.
My parents always have been huge advocates for education, a path to progressing in life. They spent what little money we had on private schooling in Mexico, where my sister and I learned to speak and read and write in Spanish and English. When an opportunity arose to attend a better school in the U.S., my parents arranged for us to live with our uncle and his family across the border in Calexico, California. We took advanced classes, participated in extracurricular activities and made new friends. Claudia and I were very close. We shared the same room growing up in Mexico, and in the U.S. we even shared the same bed. We spent every day together, developing the type of bond that only sisters understand. That all changed in January 2007.
We had returned to Mexico to stay with our parents over the winter holidays. But while we were there, one or the other of my parents would drive us back across the border nearly every morning so that my sister could complete a school project. The one day I decided to stay at home with my mother was the day that everything went awry. Immigration officers stopped my father and sister at the border for a random secondary inspection and detained them for 12 hours. The officers revoked both my sister’s and father’s visas. Our family was in shock.
When they got home that night, tears and sobs shattered the somber silence at our dinner table. My sister had just started to receive college acceptance letters, including from UCLA and UC Berkeley. She would never be able to attend. My visa, however, still was valid. My parents sat me down and gave me, a 15-year-old whose world had just turned upside down, the most difficult choice of my life: stay in Mexico or return to school in the U.S. If I chose to return to school, I would not be able to see my father and sister again until their immigration status changed. I felt like I was thriving in school, and I wanted to get the most out of my academics, so I decided to go back to the U.S. I said goodbye to Claudia and my father. That was the last I have seen of them.
The average medical student in the U.S. graduates with almost $200,000 in debt. For most students, the availability of low-interest loans can help offset the high cost. DACA students, on the other hand, are not eligible for federal loans and must rely on scarce state and local resources or philanthropy. While private loans are available, interest rates often are high, and a U.S. citizen or permanent resident must act as a cosigner. For those who do earn a medical degree, residency training is required to obtain a medical license and practice in a given specialty. However, acceptance into residency training — which typically lasts three-to-six years — is difficult in many states outside of California that do not recognize DACA participation as sufficient for a medical license. This also raises the possibility that prospective employers may have doubts about whether or not to offer a qualified candidate a spot because, if they cannot fulfill their training, this could potentially waste medical education funds and leave spots vacant.
AS A TRILINGUAL TEENAGER WHO LIVED IN MEXICO AND THE U.S., I often struggled with how to identify. I never wanted my mom to speak Chinese to me in public in Mexico as I tried to blend in with my Spanish-speaking friends and classmates. Now Border Patrol agents and immigration officers were my neighbors in the U.S., and their presence made the potential for discovery and deportation a constant threat.
I lived in disguise for many years, learning to protect my identity by assimilating as an Americanized Chinese. I also had the privilege of looking a certain way, and I didn’t fit the typical picture of what some might think of as an “undocumented” person. No one suspected that a little Asian-looking, English-speaking girl who worked hard to become valedictorian of her high school class might lack the proper paperwork.
But some things were beyond my control. Shortly after I finished high school, I was walking down the street one day when a dog charged and bit my foot. When I checked in at an urgent-care facility, the woman at the front desk asked if I knew the owner of the dog. I told her I did not. She continued to press for details and insisted the clinic would file a police report about the incident. Until then, I had no idea that something as unremarkable as a dog bite might trigger the undesired attention of law enforcement officials. When I started to walk out after telling the receptionist that I lacked identification, she understood my hesitation. Thankfully, I received the care I needed and continued to live my life.
A 2014 study in Public Health Reports found that racial and ethnic minorities are at a disproportionate risk of being uninsured and lacking access to care, as well as experiencing worse health outcomes from preventable and treatable conditions. DACA students, meanwhile, often are bilingual and come from diverse cultural backgrounds, making it easier for them to relate to the challenges of these communities. Because of their experiences, medical students from underrepresented minority backgrounds are more likely to work in underserved areas, according to a study of 20,000 U.S. medical students published in the journal JAMA in 2008. That study also showed that Caucasian students at more racially diverse medical schools rated themselves better prepared to care for racial and ethnic minority patients than students at less diverse schools.
UNDERSTANDING THE VALUE OF ACCESS TO QUALITY HEALTH CARE was instilled in me at an early age. When I was 9 and developed a mass on my neck, my family set off on a hunt for answers, traveling up to eight hours from home to seek help. Uninsured and unable to get comprehensive medical care, I experienced the burdens as a helpless patient limited by financial barriers.
We sought care from a dermatologist, who referred us to an ear, nose and throat specialist. We lacked insurance and were charged for every visit and every lab draw. My mother didn’t speak Spanish well, so I was left to communicate with the doctor. During one examination, the doctor told me that if the mass turned white, I would have three months to live. Years later, I had a biopsy performed in the U.S. that confirmed it was nothing to fear, and eventually I had the mass drained. The small scar on my neck serves as a visible reminder of the inadequate medical care and poor communication that highlighted the nightmare my family faced.
These experiences taught me invaluable lessons that have shaped my ideas about what constitutes quality medical care. I learned the importance of doctor-patient communication and the value of a patient understanding his or her health status, regardless of the treatment availability or diagnosis. My experience as an uninsured and low-income immigrant showed me the health disparities that come in the wake of financial hardship and sparked my desire to help bridge the gap for the underserved.
The David Geffen School of Medicine at UCLA, along with the broader University of California system, has been committed to providing the most qualified students an opportunity to pursue their dreams, regardless of their immigration status. Kelsey C. Martin, MD, PhD, dean of the David Geffen School of Medicine at UCLA, and Clarence Braddock III, MD, MPH, vice dean for education, are among those who have taken strong public stances supporting DACA recipients. In an article published last year in U.S. News & World Report, they wrote: “These students are here not because of their DACA status, but because they are exceptionally qualified intellectually and because of their genuine desire to care for, and heal, the sick.” Drs. Martin and Braddock noted how the David Geffen School of Medicine at UCLA has become one of the most competitive medical schools in the country, with more than 14,000 applicants vying for 175 spots. “To achieve one of those spots is a monumental and arduous feat, all the more so for DACA students whose future — unlike other medical students — has been ever shrouded in doubt,” they wrote.
I FOUND MY PASSION FOR MEDICINE WHEN I WORKED AT A FREE CLINIC while an undergraduate student at the University of California, San Diego. The work gave me a sense of purpose and motivation to do the most that I can for the community. Yet I had mixed emotions in the lead-up to graduation. Despite the fact that I was about to receive a degree in human biology from a top-10 public university, my legal status made it challenging to apply to medical school or pursue a career path of my choice. I felt like I had put my family and myself through too much to do some other job that did not merit all of the sacrifices we had made.
But then, on June 15, 2012, the day before graduation, President Obama announced DACA. The policy, established by the Department of Homeland Security, made it possible for young undocumented immigrants like me to pursue our dreams. It was an amazing experience to walk across the stage at graduation knowing that there was this possibility that I could study and work in my chosen field. I also could finally get a driver’s license, open a bank account and apply for a credit card — simple things that are a rite of passage for most young people but major milestones for someone who never before had access to them.
I earned acceptance into the PRIME Program at the David Geffen School of Medicine at UCLA, where I hope to graduate in 2020. As part of the program, I will spend next year at Harvard University working toward a master’s degree in public health, with an emphasis on health policy. I eventually hope to practice internal medicine in underserved communities. While the academic challenges are great, I know they are within my control. Other things about my life are not.
Recent years have posed constant threats to the continued presence of many immigrants in this country, including myself. There are days I go to bed wondering if I will be forced out of the country that I love and call home. I know there are some people who would rather see me deported. I try to listen to their point of view and understand why they feel the way they do, because this discussion is not just about people like me. I feel that we all are contributing to this country in different ways. Similarly, I do not feel that I ought to be put on a pedestal as a model person who should be allowed to stay in the U.S. simply because I am educated, multilingual and working to become a health care provider. There are millions of others who are contributing in different ways and who too often are not a part of this discussion.
I frequently wonder: What do we define as being worthy to be in the U.S.? Why are some people unworthy? And who defines who is and who is not worthy? What kind of standards are we setting? Because here’s the thing — I wouldn’t be who I am without my parents, two immigrants who are quite the opposite of me, who are uneducated, who work in kitchens and who don’t really speak English or Spanish. Their horizons were limited by many factors, but they were able to raise me and my sister — who now is pursuing an environmental sciences career in Canada — to be educated and motivated and caring young adults. Parents and families like mine often are lost in the noise of the immigration discussion. I am actively seeking these difficult conversations, trying to give a voice to those who are socioeconomically disempowered.
While the future of DACA is held up in court proceedings, UCLA has developed infrastructure to support the estimated 600-to-700 undocumented students on campus. The Chancellor’s Advisory Council on Immigration Policy created DACA-renewal workshops and distributed educational materials should immigration enforcement occur at UCLA. The council also recommended additional psychological and legal services and reached out to campus police and other groups. At the David Geffen School of Medicine at UCLA, faculty and administration have continued to lend support to DACA recipients. Additionally, the UCLA medical student group UndocuMed has brought the campus community together to advocate for undocumented medical students. The group’s mission is to support medical students by increasing funds, such as loans and scholarships; educating students and faculty about how immigration status affects students, patients, providers and the greater community; and advocating for policy changes that lead to sustainable solutions for undocumented students pursuing careers in medicine.
FIGURING OUT WHAT TO DO IF I COULD NOT COMPLETE MEDICAL SCHOOL and become a practicing physician in the U.S. is perhaps something I should plan for, but I’m hopeful that the situation won’t get to that point. Many of us stuck in the political limbo of the immigration debate have been through a lot already and have survived. I went through college without financial aid. My family exhausted savings and borrowed money. I know many others who have had their own unique journey filled with obstacles. I think the resilience of the community has taught us that even if things don’t work out at that moment, another opportunity will open up. We just have to be ready for it. Maybe I won’t have the chance to be a practicing physician, but I know I can do something else with my medical knowledge.
I’ve been told plenty of times that I’m not Chinese enough, I’m not Mexican enough and I am not American enough. Everyone tries to categorize me as one or the other. As I’ve gotten older, I’ve come to appreciate being able to identify with multiple cultures. I’ve learned to not allow people to define me and to accept myself for who I am and what I can be. I’m proud of where I come from, and I’m excited about the positive differences I can make in this country, my home.
Marcela Zhou Huang is a third-year student in the David Geffen School of Medicine at UCLA/UCLA PRIME program. She is on track to receive her MD and MPH degrees in 2020. Antonio Gonzalez is research and news editor of U Magazine and a former writer for the Associated Press