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How Trump's refugee ban hurts health care in places that voted for him

How much is your community served by doctors trained in one of the banned countries?

In early 2001, an Iranian family fled their home and landed in Texas as political refugees.

The mother, who went to medical school in Iran, passed her boards in the US and now works as a psychiatrist; she largely serves children in poverty. Her son, just 15 when they moved here, is now in his last year of residency; he extends the lives of people with cancer. They both work with underserved populations.

So a few weeks ago, when President Donald Trump signed the first executive order temporarily banning people from seven Muslim-majority countries — including Iran — they were shocked.

"How come we are the enemies?" the mother asked.

Physicians who trained in these seven countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — provide care to a large number of Americans, especially those in areas where domestically trained physicians typically don’t want to work. "This is a population that I enjoy working with. I see ourselves as very useful for the community," the mother told me. (She and her son asked me to withhold their names.)

When the courts struck down the first executive order, she said she was glad to be living in a democracy. “Now, we appreciate democracy more,” she said.

But on Monday, Trump signed a revised executive order — and it affects six of those countries. (Iraq was taken off the list.)

It’s been difficult to precisely measure how much various communities in the US are served by doctors trained from these banned countries. So a handful of researchers gathered data from Doximity, an online networking site for doctors, and shared it with me. The team included the University of Chicago’s Peter Ganong; Harvard University’s Mitra Akhtari, Matthew Basilico, Valentin Bolotnyy, John Coglianese, Jonathan Roth, Adrienne Sabety, and Heather Sarsons; and Massachusetts Institute of Technology’s Otis Reid and Michael Stepner.

They analyzed the seven countries the first order affected, and this is what they found:

(View an interactive version of the map here.)

This map shows more than 8,000 physicians who trained in those seven countries. The researchers estimate that these doctors provide 16 million appointments a year. If you exclude doctors trained in Iraq, that’s still more than 7,000 doctors who treated 14 million appointments a year.

What’s most fascinating, though, is where these doctors tend to be concentrated.

Red America relies on these doctors

A disproportionate number of communities that favored Trump during the election rely heavily on these foreign-trained physicians. This includes swaths of areas in the Rust Belt, Midwest, and Deep South.

"The irony of it is: We work in a red state, so the majority of our patients probably voted for Trump," the son said. Just the other day, he said a patient told him she wanted an “American” doctor.

This is partially by design.

The US has a shortage of physicians who want to practice in rural and underserved areas. So as my colleagues Julia Belluz and Sarah Frostenson point out, the US grants visas to foreign doctors if they agree to work in these areas for three years after their residency. These are often in rural and industrial areas that tend to vote Republican.

But Trump's first executive order, which was shot down by the courts, may have already done damage.

The Boston Globe reports that the immigration order puts hospitals in a tough position when ranking which students they want to accept into their residency programs. Med school graduates from these six countries may be barred from coming to the US, so hospital administrators may rank them lower on their list of preferred candidates.

A common ground with other Trump targets: trauma

The mother in our story, who works in El Paso, now provides psychiatric services for many Hispanic children.

She said that recently she has seen many children who are worried that Trump's anti-immigrant policies means their families will be deported. This is the first time kids are coming into her sessions talking about politics — and crying.

But because she's experienced trauma, she says it's helped her care for these children.

"I have lived through the Iran and Iraq wars," she said. "And definitely the understanding I have from living in a war zone helps me understand their trauma much more than someone who hasn't."

“...even if they voted to keep you and your people out”

The family now has citizenship, and much of their fear has subsided since they first arrived just months before 9/11.

The son, who was a teenager at the time, said, "We were really scared what was going to happen to us. We were scare we would be deported for whatever reason. That would've been deadly for us."

He remembers a constant sense of fear — barely understanding English; President George W. Bush giving a speech and saying Iran was part of the "axis of evil"; taking a bus to a college visit, only to be pulled off the bus by Border Patrol and threatened with deportation.

Now, though, he says America is his country, and he's sad for America.

So I asked him: Has he ever thought about whether someone he’s caring for supports the ban?

"As a doctor, you show up to work every day and treat your patients the same," he said, "even if they voted to keep you and your people out of the country. That's your job as a physician. You're supposed to be like that.”