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UNITED STATES PUBLIC HEALTH SERVICE HISPANIC OFFICERS ADVISORY
COMMITTEE 1 6 S E P T E M B E R 2 0 1 4
H O A C R E C O M M E N D A T I O N S F O R U C H U M A N I T A R I A N R E S P O N S E
HISPANIC OFFICERS ADVISORY COMMITTEE (HOAC)
Mission: • To promote professional development and advocate for the
recognition of contributions made by Hispanic Officers in the U.S. Public Health Service (USPHS).
------------------------------------------------------------------------------ • HOAC provides advice and consultation to the Office of the
Surgeon General (OSG) and the Minority Officers Liaison Council (MOLC) on issues relating to the professional practice and the personal activities of civil service and commissioned personnel. HOAC also provides advisory assistance to agencies and program leaders of the USPHS and to non-USPHS programs that routinely use USPHS personnel.
AGENDA 1200-1205 CDR Avilés-Mendoza: Welcomes 1205-1210 RADM Elizondo and CAPT Beck 1210-1225 LT Santiago: Cultural Briefing
1225-1250 LCDR Lybarger: USPHS Response to UC 1250-1325 CAPT Aizvera: Moderate the discussion 1325-1330 CDR Avilés-Mendoza
HISPANIC OFFICERS ADVISORY COMMITTEE AND UC HUMANITARIAN RESPONSE
• HOAC and the Unaccompanied Children (UC) Humanitarian Response • Ad-hoc meeting with OFRD Leadership at the COA
Symposium in North Carolina (11 June 2014) • HOAC Emergency Meeting, 16 June 2014, established the
HOAC Ad-Hoc Subcommittee for the UC Deployment • Multiple HOAC and UC Deployment Subcommittee meetings
discussing lessons observed from deployed HOAC Officers the UC response (months of June and July)
• HOAC recommendations transmitted to OSG through MOLC on 24 July 2014
• August and September 2014: ongoing conversations and activities for the implementation of some of the HOAC recommendations
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B Y : L T Y V O N N E M . S A N T I A G O
A BRIEF HISTORY OF THE SOCIAL, POLITICAL & ECONOMIC STATUS OF 3
CENTRAL AMERICAN COUNTRIES
REPUBLIC OF EL SALVADOR
• El Salvador (The Savior) • The smallest and most densely populated country in
Central America • Capital – San Salvador • Ethnic Groups - Mestizo 86.3%, white 12.7%,
Amerindian 1% (2007 census); Mestizo culture dominates heavy in both Native American Indigenous and European Spanish influences
• Languages – Spanish (official); Nahua (Amerindians)
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HISTORY OF POLITICAL UNREST
• On September 15, 1821achieved independence from Spain
• Current President Salvador Sanchez Ceren elected in June 1, 2014
• 1930s Insurrection of the campesinos (farmers), rural poor led by Agustin Farabundo Marti; 30, 000 killed by the army (La Matanza)
• For the next 50 years every President was a military officer
• 1960s as a result of the Revolution in Cuba U.S. formed the “Alliance for Progress”
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EL SALVADOR
• Death squads assassinated all who opposed government • During the 1970s elections were sabotaged • Monsignor Oscar Romero organized mass demonstration; he
was later assassinated • Full scale Civil War ensued • 1980s U.S. viewed the Salvadoran military government as a
barrier to communism in Central America • Reagan increased aid to the military • 70,000 people died as the government in El Salvador tried to
repress dissent • The country’s infrastructure crumbled
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EL SALVADOR
• UN helped end civil war in 1992 • Most Salvadorans think the situation is not much
better now • Half of the population is unemployed • Poverty and proliferation of guns have led to high
suicide rates • Lack of environmental protection laws have led to
pollution, trash and sewage
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EL SALVADOR
• Two most daunting challenges: economic development & growth
• Coffee is the major source of income (95% of it is exported but of the income made only 2% control the wealth); Season only lasts 6-8 weeks leading to such high unemployment
• 20% of population lives abroad – provides support to country
• Problem of the maras (gangs)
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REPUBLIC OF GUATEMALA
• Guatemala means Place of many trees • Capital – Guatemala City • Climate: Tropical • Mayan civilization; 59% of population is Ladino,
Mestizo and European descendants called Criollo. The indigenous community makes up 40% including the following Amerindian populations K’iche, Kaqchikel, Mam and Q’eqchi
• Spanish is the main language; 93% of population speaks it but there are also 21 Mayan languages
• Most Guatemalans speak 2 to 5 different languages
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GUATEMALA
• 50 – 60% of the population is Catholic • Fastest growth in population in 20th century • Divided into 22 departments (regions) and 335
municipalities • Won independence from Spain on September 15, 1821 • Struggles in health and development; there is much
disparity between Western Medicine and traditional care
• Current President Otto Fernando Perez Molina • Civil war lasted 36 years for the same reasons as in El
Salvador
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GUATEMALA
• One of the poorest countries in Latin America • The distribution of income remains highly unequal
with the richest 20% of the population accounting for more than 51% of Guatemala's overall consumption.
• More than half of the population is below the national poverty line, and 13% of the population lives in extreme poverty. Poverty among indigenous groups, which make up more than 40% of the population, averages 73%, with 22% of the indigenous population living in extreme poverty.
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GUATEMALA
• Major transit country for cocaine and heroin; in 2005, cultivated 100 hectares of opium poppy after reemerging as a potential source of opium in 2004; potential production of less than 1 metric ton of pure heroin; marijuana cultivation for mostly domestic consumption
• Proximity to Mexico makes Guatemala a major staging area for drugs (particularly for cocaine); money laundering is a serious problem; corruption is a major problem
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REPUBLIC OF HONDURAS
• Honduras means depths • Capital – Tegucigalpa • Was once part of the Kingdom of Guatemala and
the First Mexican Empire • Languages: Spanish, Honduran Sign Language,
Creole English, Miskito, Sumu, Pech • 97% are Catholic • Gained independence from Spain on September
15, 1821 • Current President Juan Orlando Hernandez
Alvarado 15
HONDURAS
• Honduras is one of the poorest countries in Latin America and has the world's highest murder rate. More than half of the population lives in poverty and per capita income is one of the lowest in the region. Poverty rates are higher among rural and indigenous people and in the south, west, and along the eastern border than in the north and central areas where most of Honduras' industries and infrastructure are concentrated.
• The increased productivity needed to break Honduras' persistent high poverty rate depends, in part, on further improvements in educational attainment. Although primary-school enrollment is near 100%, educational quality is poor, the drop-out rate and grade repetition remain high, and teacher and school accountability is low.
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HONDURAS
• After two and a half decades of mostly military rule, a freely elected civilian government came to power in 1982.
• During the 1980s, Honduras proved a haven for anti-Sandinista contras fighting the Marxist Nicaraguan Government and an ally to Salvadoran Government forces fighting leftist guerrillas.
• The country was devastated by Hurricane Mitch in 1998, which killed about 5,600 people and caused approximately $2 billion in damage. Since then, the economy has slowly rebounded.
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HONDURAS
• In 2008 flooding destroyed half the country’s roads • In 2009 a Constitutional Crisis culminated in the
transfer of power from the President to the Head of Congress
• International Community outraged; declared a coup d’etat
• President Manual Zelaya attempted to hold a non-binding referendum
• Army arrested him
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HONDURAS
• Honduras has the highest rate of intentional homicide in the world.
• Honduras is a source and transit country for men, women, and children subjected to sex trafficking and forced labor.
• Honduran women and girls, and, to a lesser extent, women and girls from neighboring countries, are forced into prostitution in urban and tourist centers.
• Honduran women and girls are also exploited in sex trafficking in other countries in the region, including Mexico, Guatemala, El Salvador, and the US; Honduran adults and children are subjected to forced labor in Guatemala, Mexico, and the US and domestically in agriculture and domestic service; gangs coerce some young men to transport drugs or be hit men.
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L C D R E L I Z A B E T H L Y B A R G E R , U S P H S
USPHS DEPLOYMENTS IN SUPPORT OF CBP/ACF UNACCOMPANIED CHILDREN
RESPONSE 2014
THE BASICS
• Unaccompanied children come to US to: • Find work • Escape poverty, gangs, violence, and / or prostitution • Reunite with family
• Come to US, and then: • apprehended by Customs and Border Protection (CBP) as
or after they cross the border • Moved into Administration for Children and Families (ACF)
custody • Until reunited with family • Until immigration hearing
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A VULNERABLE POPULATION
• The smuggling routes are not safe for children. Children are often times exposed to dangerous circumstances, including exploitation, disease, human tragedy, and in some instances death while in the hands of human smugglers. We continue to rely on the support of our international partner to help locate, disrupt, and dismantle these transnational criminal smuggling networks.
• Immigrant children who make the long and often dangerous journey to the US alone represent some of the most vulnerable individuals who interact with our immigration system.
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FLORES V. RENO, 1985
• 1985 lawsuit challenged the Immigration and Naturalization Service’s (“INS”) policies governing: • apprehended unaccompanied and undocumented children’s
release, • as well as the conditions of confinement of those who were not
released • Based on 1984 INS Policy to not release children to
anyone other than a parent or legal guardian • Extenuating circumstances made it very difficult for
many children’s release
• The law prohibits DHS from immediately deporting these children if they are not from either Canada or Mexico and requires DHS to turn them over to HHS supervision within 72 hours of taking them into custody.
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CHILDREN APPREHENDED BY CBP
• From 2000-2011 there was roughly 5-7,000 children per year
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CHILDREN’S DEMOGRAPHICS
• Majority males • 15-17 years old
• Increasing number of females • Intergenerational: girls under 18 yo with their own children
• 25% under 12 years old • Primarily from:
• Guatemala • El Salvador • Honduras
• Come to US to: • Find work • Escape poverty, gangs, violence, and / or prostitution • Reunite with family
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WHAT HAPPENS TO KIDS NOW?
1 •Children are apprehended by Customs and Border
Protection (CBP) upon crossing the border
2 •Placed in temporary holding facilities for up to 72 hours
3 •Processed and turned over to Administration for Children
and Families (ACF) / Office of Refugee Resettlement (ORR)
4 •ORR then places these children into residential facilities
5 •Children are reunited with family
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ORR RESIDENTIAL FACILITIES
• Permanent • Miscellaneous locations around the US
• Temporary
• Joint Base San Antonio (Lackland AFB) • Naval Base Ventura • FT Sill
• Medical evaluation, behavioral health, education • Case management to connect with family member
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WHAT ROLES HAVE USPHS OFFICERS PLAYED?
• Conducted medical screening missions • Assisted CBP officers in CPB facilities • Screening children as they’ve been apprehended • RDFs 1– 4 were deployed over 6 rotations
• In Nogales and McAllen • Augmented by Tier III assets
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WHAT ROLES HAVE USPHS OFFICERS PLAYED?
• Assisted ACF with case management • Nogales, McAllen, misc DoD facilities • Contacting family members
• HOAC support • Behavioral health screenings
• MHT-2, 3, 5 • Potential temporary site evaluations
• APHT-2 and 3
• Augmented ACF leadership at ACF HQ • Washington, DC
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WHAT ROLES HAVE USPHS OFFICERS PLAYED?
• Assisted ASPR Logistics at NRCC
• Augmented DCCPR/RDOG staff
• Behavioral Health Screenings • On-site for children • On-site for USPHS personnel and CBP staff • Follow-up from MHTs
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USPHS IMPACT
• Approximately 350 officers deployed • 15May2014 - 01Aug2014
• Nation-wide impact and support to the Federal Government • Supported over 15 distinct missions
• Assisted in screening and moving thousands of children from CBP to ACF, and further onto their families or other appropriate facilities
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HOAC RECOMMENDATIONS TO THE UC HUMANITARIAN RESPONSE
I. Recommendations to UC responses applicable to other USPHS deployments requiring cultural and linguistic preparedness
II. Recommendations Specific to Hispanic Officers in future UC humanitarian responses
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HOAC RECOMMENDATION: PRE-DEPLOYMENT ASSESSMENT
OF CULTURAL AND LINGUISTICALLY CAPABILITIES
The Office of the Surgeon General to consider assessing the cultural and linguistic training needs of the USPHS personnel deployed to the UC missions. • The proposed HOAC survey could assist the OSG in
assessing the cultural and linguistic needs of Officers would help better prepare Officers for future deployments providing services to underserved populations with limited English proficiency.
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HOAC RECOMMENDATION: PARTNER WITH PUBLIC HEALTH STAKEHOLDERS TO OBTAIN
RESOURCES FOR ASSESSING AND IMPROVE THE LEVEL OF SPANISH AND CULTURAL PROFICIENCY AMONGST COMMISSIONED OFFICERS
• OSG to consider partnering with Federal Agencies and Departments (Centers for Disease Control and Prevention, Department of Defense, Department of Homeland Security. others) to obtain resources for assessing the level of Spanish proficiency amongst Commissioned Officers.
• OSG to consider partnering with HHS- Office of Minority Health
(OMH) to assess the need and ultimately the value of making National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS) courses as a requirement for deployment readiness; emphasizing the added value of a Bicultural/Bilingual Officers.
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HOAC RECOMMENDATION: PROVIDE A PRE-DEPLOYMENT BRIEFING ENHANCING THE CULTURAL PREPAREDNESS OF COMMISSIONED
OFFICERS
• OSG to consider partnering with OMH and Office of Global Affairs to develop a quick guide to provide to Officers to learn more about the underserved communities in the UC response.
• Develop a pre-deployment brief for Officers with information covering the cultural and linguistic differences between natives from Honduras, Guatemala, El Salvador and other countries where the UC are native.
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HOAC RECOMMENDATION: ADDRESS THE LINGUISTIC NEEDS OF THE UC, PARENTS AND
GUARDIANS
Issue: Officers deployed assigned to help ACF with the Reunification of Parents/Guardians and children here in the U.S. noted significant delays in processing whether by DHS-Border Patrol or ACF of those who spoke indigenous languages. Recommendation: OSG to consider advising Federal Agencies in charge of the UC humanitarian missions to partner with local faith base organizations as well advocacy groups in the community to assist with identifying interpreters who speak the indigenous languages of Central America.
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HOAC RECOMMENDATION: PROVIDE A PRE-DEPLOYMENT BRIEFING ENHANCING
THE CULTURAL PREPAREDNESS OF HISPANIC COMMISSIONED OFFICERS
Issue: Many of the Hispanic Officers who were deployed reported the mental challenge of the missions due to the connection with the underserved populations of similar ethnic heritage. Recommendation: If UC missions will continue, OSG to consider developing a pre-deployment briefing allowing Officers to speak with Mental Health Professionals regarding the mission as it is culturally sensitive to some of our Officers and may have a greater mental health impact. The purpose of the pre-deployment briefing is to better prepare USPHS Officers for the US missions
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ACKNOWLEDGEMENTS • LT Yvonne Santiago • LCDR Elizabeth Lybarger • LT Jorge Muñiz Ortiz • LCDR Michelle Sandoval • LCDR Elizabeth Garza • LCDR Dolores Addison • LCDR Luz Rivera • CDR Guillermo Avilés-Mendoza • CDR Edgardo Alicea • CAPT Ana Maria Osorio • CAPT Laura Aponte • CAPT Beverly Daindridge • CAPT Mercedes Benitez-McCrary • CAPT Jeasmine Aizvera • CAPT Dan Beck • RADM Epi Elizondo
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¡Gracias! Questions/Comments?
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