For undocumented students, a community to help them build health careers

When Denisse Rojas entered college, her path to becoming a doctor started with a lot of uncertainty — and loneliness.

While her peers were able to get a driver’s license, passports to study abroad, and financial aid to help pay for school, Rojas’ undocumented status — where no official record of her being in the U.S. existed — meant that she was also shut out from getting government-issued documents and benefiting from federal programs.

“The number one thing I was feeling was that I was the only person in that situation, and that everyone else was living in a different world or reality,” Rojas said.

Born in Mexico City, she immigrated to the U.S. in the early ’90s along with her parents and two older siblings before she was even a year old. All she knows is that her family crossed the border from Mexico somewhere into California before settling in the city of Fremont. “We don’t really talk much about it in my family,” Rojas, now a first-year emergency medicine resident at Boston Medical Center, said.

Much like the adults who brought them here, “childhood arrivals” like Rojas often find themselves in limbo. Without the proper visa documentation, basic things like getting a government ID, health insurance or, in many cases, a job become difficult tasks. And the path to a better life — which is often the reason why people immigrate in the first place — becomes that much harder to walk.

Things changed for Rojas after the expansion of the Obama-era policy known as Deferred Action for Childhood Arrivals, or DACA, in 2014. Being a DACA recipient meant Rojas could get a credit card and a government ID — and belatedly celebrate her 21st birthday. It also meant that her dream to become a doctor could be more easily realized.

Even before Rojas was accepted into the DACA program, she and two other co-founders, who were also undocumented, had launched the group Pre-Health Dreamers, named after a policy during the George W. Bush administration that granted unauthorized immigrants — especially minors — temporary residency and the right to work. Their hope: to guide those with an interest in health professions through the challenging process of applying, securing funding, and succeeding in their chosen fields.

“People shouldn’t be going through these challenges alone,” Rojas said of the inspiration behind the group. “Not only is it easier when we work together, but you can thrive as a community.”

Since 2012, Pre-Health Dreamers (PHD) has supported over 1,500 students. The organization has an eight-month program for helping undocumented students through the graduate school application process, and 60 students from 16 U.S. states participated in the most recent iteration of this program that ended in May this year. PHD also offers one-on-one advising and professional training for students and educators alike.

While nearly 70% of those who have come through the organization are medical students, PhD also works with public health professionals and those interested in other health careers, including nursing, physical therapy, and pharmacy. The vast majority comes from low-income backgrounds and identifies as Latinx or Hispanic. The most recent training cohort included people originally from Mexico, Honduras, Haiti, and the Philippines.

In June, Rojas and another co-founder, New Latthivongskorn, won this year’s Vilcek-Gold Award for Humanism in Healthcare for their work on PHD. The group “shines a spotlight on outstanding immigrant healthcare professionals and celebrates the positive impact that accessible and humanistic care has on public health,” the announcement for the award said.

STAT spoke with Rojas to learn more about PHD and the community it has built. This interview has been lightly edited and condensed for clarity.

How did being an unauthorized immigrant impact your life?

I’m really fortunate that California has progressive legislation that allows undocumented students to pay in-state tuition at public universities. So, when I was admitted to University of California, Berkeley, I was able to afford it by working as a waitress. I didn’t get financial aid from the school.

I remember applying to a premed summer internship program when other people were getting these opportunities to boost their resumes. I applied and got rejected — someone on the selection committee told me they couldn’t accept me because of my immigration status. My peers went off and did study abroad programs and had opportunities to delve into global health, and I couldn’t.

Was there stigma attached to being undocumented?

There was this time in my junior or senior year when I started to ask for help and went to a premed adviser and explained my situation. This person took me to an office in way back and closed the door before they had me explain more about what I was looking for, and all I was looking for was help. I hadn’t been feeling ashamed [about my undocumented status] and had it in my head that if I just asked for help, I would get it. But this reinforced that maybe I should be ashamed and my status isn’t something to publicly talk about.

How did being a DACA recipient change that?

I got it in 2014 and DACA completely changed the conversation [I had previously been having]. Before I couldn’t even see an R-rated movie because I didn’t have an ID. I dreaded my 21st birthday because I knew I couldn’t show an ID. Apart from that, with DACA, there was now a pathway to employment and long-term training. I was accepted to medical school in 2015, and went to Icahn School of Medicine in New York City, and graduated [earlier this summer].

How did the idea for Pre-health Dreamers come about?

I met New and Angel [Ku], the other co-founders of the group, at a scholarship banquet for undocumented students in the Bay Area. I was so surprised that there was an organization that is dedicated to supporting people like me. Meeting New and Angel, I felt like we had similar goals and experiences. I think the idea was to connect people who have our similar barriers and who were undocumented.

What does it mean to be a Pre-health Dreamer?

We started with the idea of connecting other individuals like ourselves and we frankly didn’t think there were that many. It was a bare-bones effort. We had a Google form that was also pretty bare. And we started presenting at premedical conferences about who we were. We have infrastructure now, including an executive director and project coordinator.

One of my favorite parts is crowdsourcing knowledge. People ask questions like about needing to take out loans for medical school and have no idea who to go to. A lot of people who have gone through it can offer advice. We also have a program called the Peer Engagement and Enrichment Program. It’s for people who are ready to apply to graduate school, they’re paired with a mentor, and there’s support throughout the year, from writing a personal statement to financing your education and also how to advocate for yourself and how to tell your story as an undocumented immigrant.

People can be a bit concerned about sounding like everyone else and just like all the premed students at their school. We have to remind people they’re unique, have a lot to contribute and to be authentic about telling their story.

How has being an undocumented immigrant helped you be a better care provider?

[In medical school], I was working with a patient who is undocumented and she didn’t have insurance in order to have medical care. It was really important that she had outpatient follow-up because of the medications she was on, and needed to be monitored. So, I called one of the free health care centers in New York City, and was able to get her in. I grew up with that kind of safety net and went to free health clinics, so I was savvy about navigating that system.

Last month, a judge struck down the constitutionality of DACA. It protects current recipients, including you, but what about other Pre-Health Dreamers?

This isn’t the first time the program has been under threat. It’s been a huge roller coaster since the program was initially struck down in 2017, and there was a lot of hope after the Supreme Court said it would uphold it in 2020. I feel really lucky that I [am protected] and have been able to renew it, as it gives me some level of safety.

When DACA was first rescinded in 2017, there was a wave of concern as it stalled a lot of applications and folks rethinking graduate school plans. It’s presenting new challenges now, such as if folks are going to get as many residency interviews if program directors feel DACA is under threat. Our hope is that they will continue.

What does it mean to have won the Vilcek-Gold Award for Humanism in Healthcare?

It brought tears to my eyes when they specifically chose New and I because they saw so much value in the work that we were doing. It was really a surprise when we were told that they wanted to speak to us. We joined a Zoom conference, and saw that Richard [Levin] and Jan Vilcek were on the call [and it slowly dawned on me]. New and I are getting $10,000 each, but I have loans and expenses, so there’s plenty of places that money could go.

I really hope it inspires young people to really go for issues that they care about. I used to be discouraged when I was the youngest person in the room, but we [won] this without being doctors. And it was because we believed in ourselves that we kept pushing each other forward.