Warning! Some Priests Do Talk And Write This Way!

“We’re starting to forget 2020 now.
How can we commit to ending the systemic inequalities 
that have led to so many deaths in these [1918 and 2020] pandemics?”
Historian Beatrix Hoffman

We’re really not sure how to begin this.

So, warnings:

To the pearl clutchers who (unimaginably) actually believe priests should not speak or write like this: Wait until next week.

To the bigots: This is a warning!

To those who dare to read through: We’ve got a Scrabble-winning word for you – “necropolitics.”

On May 1, I underwent major surgery. All went well, until it didn’t. I began hemorrhaging and, after they closed me up, was sent directly to the Intensive Care Unit – Do Not Pass Go; Do Not Collect Two-hundred Dollars – for five days.

Only a week later did I really understand my situation. At my previously scheduled annual physical, my General Practitioner walked it and, from behind his face mask, began: “Thank Dr. Andy. My immediate thought when he called at three or four o’clock in the afternoon was ‘Skipper is died!’ but his first words were ‘Skipper will be fine.’ When we get calls like that it usually means our patient has died.”

Then he got serious!

Almost touching thumb and forefinger, he declared in a voice I hadn’t heard in our 40-plus year relationship, “Skipper, you were less than an eyelash hair width away from bleeding to death.”

I remember in the ICU praying often for so many folks, especially for two young men, with whom I have not finished our shared journeys and recalling that I had made promises to do invocations at two events a friend was planning ten days hence. (Keeping promises is important to me.)

But mostly I remember that I shat my bed at least six times in one night.

And I remember that every one of the nurses who cleaned me and changed my bed linens and to whom I apologized over and over was gentle, patient, reassuring, accepting and repeatedly insisted there was no need to apologize as they treated me with respect and kindness. 

More importantly, I realized that every one of those men and women had an accent that sometimes shouted, sometimes whispered “English is not my first language. I’m from a family of immigrants.” 

Young women in their mid-twenties from across Central America and Venezuela; a man in his fifties who was probably once a physician in Cuba; two guys in their late twenties or early thirties – one carried himself like a career military medic and could easily push out eight or ten 250-pound bench presses. 

They left me prayerfully grateful and praying for our nation’s newest waves of immigrants. They and/or their children will be our next generation of healthcare providers – from surgeons and nurses to the healthcare aides who change our sheets and clean our asses when we’ve shat ourselves. 

On January 3, 2024, Rice University’s Baker Institute for Public Policy released “Understanding the Role of Immigrants in the US Health Sector: Employment Trends from 2007-2021.”

Despite being written in the aftermath of the COVID-19 pandemic and before all the implications of that crisis could be fully understood, the report’s opening paragraphs are rattling: 

“Health care professionals were widely praised for their work on the front lines of the COVID-19 pandemic. But the U.S. health care sector faces longstanding challenges that undermine its capacity to respond to future health threats and provide critical care. These challenges include an aging population, worker shortages, and the underrepresentation of minorities, a problem that has important implications for health care delivery. Meanwhile, policymakers have the difficult task of simultaneously expanding health care access, improving health care quality, and reducing costs without compromising compassionate care.

“Immigrants and the U.S. immigration system offer a potential solution to the sector’s challenges….”

Using Bureau of Labor Statistics figures, the report notes a drop of more than 400,000 – from 1,918,172 to 1,512,752 - workers involved in nursing and residential care facilities between 2013 and 2021. These are facilities providing care for patients who require more than in-home care by trained medical professions, such as therapists, and doctors, who are available around the clock. They are facilities used for short-term stays after hospitalization, surgery, or injury, with patients staying in skilled care settings to heal and gain strength before returning home. Immigrants represented more than 18% of workers in this subset in 2021.

Consider:

“The COVID-19 pandemic has taken the lives of more than 6.5 million people around the world. Despite containing only 4.25% of the global population, the United States has accounted for 16% of those deaths — more than 1 million. There was significantly higher mortality among younger Americans than in comparable nations. But it's not as if this country hadn’t been warned. A century ago, the U.S. saw about 675,000 deaths due to the ‘Spanish Flu.’”
Isabella Backman. “Nurses and Essential Workers: The ‘Sacrificial Lambs’ of US Pandemics of 1918 and 2020.” Yale School of Medicine, November 8, 2022.

Yale Associate Editor Backman cited the work of Northern Illinois University professor of History Beatrix Hoffman, Ph.D., who described “Necropolitics” as the power to determine who lives and who dies. Professor Hoffman noted America’s willingness to sacrifice its “essential workers” – especially nurses and low wage workers – in the death counts of the 1918 and 2020 pandemics: “I can’t find a better word [necropolitics] to capture what was happening and what is still havening in the politics of COVID.”

Historian Backman looked back at America’s response to the 1918 Spanish Flu pandemic and noted: 

“[T]he Red Cross mobilized 21,000 nurses to various domestic army camps, and as many as half would fall ill themselves. While the organization advised the public against sleeping in the same room as an individual with influenza, nurses were frequently in overcrowded, poorly ventilated rooms with highly infectious patients. They were 50% more likely to die than doctors were.”

Hoffman observed:

“In pandemic history, nurses’ deaths are either erased or mentioned in passing. And when they are remembered, the deaths of health care workers in the influenza pandemic have been valorized as wartime sacrifice, but not as an occupational hazard.”

More than 3,600 health care workers lost their lives during the first year of the COVID-19 pandemic in the US; nurses and support staff where at significantly greater risk of infections and deaths and health care workers in nursing homes, often paid less and more likely to be immigrants or people of color, were twice as likely to die as someone who worked in a hospital.

History just keeps repeating itself:

Backman notes that COVID-19, like the Spanish Flu, did not kill rich and poor alike. Rather, workers of lower socioeconomic status were at greater risk of dying.

On April 7, 2023, Jeanne Batalov, a Senior Policy Analyst for the Migration Policy Institute reported:

“Immigrant professionals have long played an important role in the U.S. health-care workforce and make up disproportionate shares of both certain high- and low-skilled health-care workers. For instance, the foreign born accounted for 26 percent of the 987,000 physicians and surgeons practicing in the United States in 2021 and almost 40 percent of the 559,000 home health aides.”

While it’s easy (and sometimes advantageous in vote-getting) for some politicians and rightwing political parties to target immigrants, consider this report from the Migration Policy Institute (April 7, 2023): 

“Health-care jobs fall into two broad categories: health-care practitioners and technical occupations (accounting for about 10 million workers in 2021), and health-care support occupations (5.2 million). Health-care support occupations are expected to grow by 18 percent between 2021 and 2031, the fastest of the 22 broad occupational groups analyzed by [Bureau of Labor Statistics]. The number of health-care practitioners and technical occupations is projected to increase by about 9 percent, while overall U.S. employment is expected to grow by 5 percent.

“Several factors explain these upward projections. The aging and longer life expectancy of the U.S. population is driving the demand for care and treatment of chronic illnesses. So is the aging and retirement of current health-care workers and those who teach in medical and nursing schools. For example, about 18 percent of physicians, surgeons, and registered nurses are within ten years of expected retirement (meaning they were between ages 55 and 64) as of 2021. The lengthy time needed to acquire education and on-the-job training in health-care occupations makes it harder to switch between professions in response to new job opportunities, while professional licenses often restrict geographic mobility and, for those trained internationally, access to the profession…

“Immigrant professionals have long played an important role in the U.S. health-care workforce and make up disproportionate shares of both certain high- and low-skilled health-care workers. For instance, the foreign born accounted for 26 percent of the 987,000 physicians and surgeons practicing in the United States in 2021 and almost 40 percent of the 559,000 home health aides….”

On February 23, 2023, The Association of American Medical Colleges reported:

“In 2021, approximately 1 in 5 active U.S. physicians were born and attended medical school outside the United States or Canada. Known as non-U.S. international medical graduates (non-U.S. IMGs) to distinguish them from Americans who attend medical school abroad, they totaled more than 203,500 physicians in 2021. Since 2004, their numbers have increased by more than 30%.

“Some of these doctors arrive as refugees or as spouses of U.S. citizens and then decide to apply for a residency slot. But most start the residency application process during medical school back home or soon afterward.”

The authors of the January 2024 Rice University research paper noted:

“Despite the growing number of physicians and surgeons, (…) a study by Markit [merged with S&P Global in 2022] (2021) estimates that the United States may face a shortage of 37,800 to 124,000 physicians by 2034, with deficits in both primary and specialty care. Meanwhile, the percentage of immigrant physicians consistently ranged from 26% to 28% between 2007 and 2019; in 2021, it reached a low of 26.47%.”

The U.S. is facing a chronic shortage of health care providers due to an aging population, the growing demand for health care services, and the retirement of baby boomers. The shortage has resulted in various adverse consequences, such as longer patient wait times, reduced access to care, and increased costs. Rural areas and hospitals that cater to low-income patients are particularly affected by this shortage.

To address the health care worker shortage, the American Hospital Association (2021) suggests implementing strategies such as increasing pay and benefits for health care workers, expanding training programs, and recruiting foreign workers: 

“Immigrants help alleviate the current shortage of health care professionals through multiple avenues…  First, immigrants are more likely than native-born Americans to work in health care…. Second, immigrants appear more inclined to pursue high-demand health care occupations like nursing and home health care. In 2017, for example, immigrants comprised 27.5% of all registered nurses in the United States, while representing only 16.4% of the general workforce. Third, immigrants are more likely to work in rural areas, where health care worker shortages are prevalent. In 2017, immigrants represented 22.4% of all health care workers in rural areas, compared to 18.2% in urban areas (AHA 2021).

“In 2016, out of the 974,449 doctors practicing in the United States, around 25% (approximately 247,449) were foreign-trained. Among these foreign-trained doctors, 59% specialized in primary care fields, and 30% practiced in medically underserved areas. By comparison, U.S.-trained doctors accounted for 45% and 21%, respectively, in those categories (American Immigration Council 2018). This evidence suggests that roughly one-quarter of all practicing physicians opt to work in primary care fields, particularly in underserved communities, and that immigrant doctors are more likely to do so.”

At least one group of politicians has designated 2024 “the year to get votes by hating on the immigrant.” Put honestly, I never expected to come “less than an eyelash hair width away from bleeding to death” on May 1. I will forever be grateful for the immigrant nurses and healthcare workers who cleaned my ass and changed my bedlinens every time I shat myself through the next five days.

Think about that the next time a politician tries to get your vote by hating immigrants. 

Maybe even ask “Who will clean me up…?”

And yes! Priests do talk and write that way.