The preventable death of Jean Carlos Martinez Rivero

It is impossible to describe the loss that parents experience with the death of their child. As doctors at a large children’s hospital in Chicago, my colleagues and I work tirelessly to spare parents this pain. We see some of the most complex pediatric cases in the state and help patients with progressive disease transition comfortably. However, there is nothing more devastating to a pediatrician than the preventable death of an otherwise healthy child.

On December 17, 2023, 5-year-old Jean Carlos Martinez Rivero, a migrant who had arrived in Chicago just days earlier, died at Comer Children’s Hospital. At the time of his death, he was residing in a rehabilitated warehouse for migrant families in Pilsen housing. 2,300 people. Initial reports indicated that Jean Carlos had prolonged diarrhea, bleeding and a fever. By a press release from the mayor’s office on February 17, 2024, it was confirmed that Jean Carlos Cause of death it was secondary to invasive sepsis Streptococcus pyogenes. From my perspective as a pediatrician, this boy’s death was not an accident, but secondary to the many inequities he faced as a recent immigrant.

In medicine, we seek not only to control symptoms, but to determine the underlying cause of diseases in order to treat them effectively. When we see a patient, we consider their background and circumstances, identifying socioeconomic barriers to care: the factors outside of a disease that prevent the patient from getting the care they need. Barriers could be monetary (inability to pay for services), geographic (lack of transportation to care facilities), or even cultural (medical mistrust and language barriers). All three probably contributed to the death of Jean Carlos.

Children from low-income families, regardless of immigration status, can receive Medicaid benefits in Illinois under the All Kids Program. Depending on household income, families may still have to pay insurance premiums and co-pays for medical visits. While I am not sure of Jean Carlos’ insurance status, there is a good chance that he was unable to obtain health insurance during his short time in Chicago. A 2015 to study of Iraqi refugees in Texas noted that the language barrier and complexity of Medicaid renewal were among the most cited barriers to obtaining medical care.

Initial reports noted that Jean Carlos’ family asked shelter staff to leave them alone when they asked about his health. The family may have been concerned about the financial cost of taking him to the hospital or distrusted the medical staff’s ability to care for him. In 2023 to study found that immigrant children are 4 to 16 percent less likely to visit a doctor than their nonimmigrant counterparts. Teams of volunteers like the Mobile health team for migrants they regularly visit shelters to administer care and provide vaccinations, but their resources are scarce.

The overcrowded and unsanitary conditions in the Pilsen shelter made Jean Carlos’ situation even worse. There are numerous reports of rampant viral infections, dirty bathrooms and spoiled food in shelters. These conditions and low vaccination rates contributed to the highest increase in chickenpox cases Chicago has seen since 2005; the Chicago Department of Public Health identified 400 cases of chicken pox in the city as of January 2023. Anecdotally, we often see homeless children visiting the emergency department with viral gastroenteritis. These stomach bugs can cause profuse diarrhea and vomiting, which can lead to dangerous, life-threatening dehydration if not treated properly. Since August 2022, Chicago has received more 26,000 migrants, which complicates an already serious housing crisis. Today, 68,000 Chicagoans are experiencing homelessness, many of whom are migrants. However, the city of Chicago only allocates 77 million dollars to homelessness starting in fiscal year 2024, orders of magnitude lower than other major cities like Los Angeles and New York.

While all of these factors shaped the end of Jean Carlos’ life, my colleagues and I believe that negative sentiment toward refugees created these crises in the first place. Public services are strained beyond their breaking points in sanctuary cities like Chicago as Gov. Greg Abbott (R-Texas) transports migrants by the thousands. These children are seen as political statements rather than innocent human beings fleeing countries in conflict. The death of Jean Carlos is not an isolated incident, another tragic example is the death of 3-year-old Colombian refugee Jismary Alejandra Barboza Gonzlez, who death of bacterial pneumonia while riding a bus from Texas to Chicago. She was sick when she got on the bus, but she never received medical attention in Texas.

I propose the immediate mobilization of more funds to address the homelessness crisis in Chicago. A proposed solution is the Bring Chicago home move that aims to restructure the real estate transfer tax for homes sold for more than $1 million, creating at least $100 million in additional revenue annually. Unfortunately, the Bring Chicago Homes proposal did not pass this year, but I urge Chicagoans to be on the lookout for similar policies in the future. In addition, a state-funded unit of health professionals dedicated to primary care screening, vaccination and shelter hygiene should be formed in conjunction with the city’s many hospital systems.

Until more systemic changes can be implemented, I urge students, like those at the University of Chicago, to volunteer at migrant vaccination clinics. These initiatives are even more integral to the health of migrants cases of measles they have shot in the shelters. Both healthcare professionals and people without healthcare experience can volunteer Chicago Medical Reserve Corps, the mobile health team for migrantsand the Chicago Refugee Coalition. Finally, educating peers, teachers and administrators about the plight of migrant children is equally imperative. Only through vocal and public advocacy will organizations like the University of Chicago feel motivated to mobilize the right teams and resources to make an appreciable impact on this public health emergency.

Unfortunately, the truth is that these tragedies will only end when politicians stop seeing migrants as pawns and start treating them as people deserving of compassion and care.

Pranshu Bhardwaj, MD is a resident physician (Pediatrics) in Chicago, IL