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Burned migrants on a grueling road to recovery

FATEFUL CROSSING / Second of two parts

October 07, 2008|Marjorie Miller | times staff writer

SAN DIEGO — They arrived by ambulance every half-hour, their blistering wounds caked in soot and mud. In the hospital trauma bay, doctors examined their scorched backs and limbs, black in the sterile, white light. They smelled of burnt flesh.

Nurses removed clothing. In went the breathing tubes and catheters, the intravenous liquids. Blood and X-rays were taken. Some patients were rushed from emergency to intensive care to make room for others.

"They just kept coming; it was challenging to keep up," said Dr. Bruce Potenza, director of the UC San Diego Regional Burn Center. "The burns were covered with all sorts of debris, their faces, . . . their noses, every part of them. . . . You couldn't tell what was burned because everything looked burned."

The men and women had been caught in last October's Harris fire after illegally crossing the border from Mexico. Most of them didn't speak English, so medical and hospital staff doubled as translators.

Of the eight people who died in the fast-moving blaze, seven were illegal immigrants. Sixteen migrants were admitted to the burn center, and all but one needed surgery. Moises Ramirez, 34, a laborer on his way to work in Oregon, was among the most seriously injured, conscious but dazed, with burns to his face, hands, arms and back.

Nicolas Beltran and his sister Maria Guadalupe had gone south to attend their father's funeral and were on their way back to San Diego County when the fire overtook them. At the hospital, Beltran, 24, looked to be the more severely injured of the two, with burns over 40% of his body and face. Doctors quickly decided to put him into a coma to spare him the unbearable pain.

The first time Rosa Beltran, the sister of Nicolas and Guadalupe, saw her brother, she recoiled in disbelief. "The burns on his face. . . . I told the nurse this is not my brother," she said.

Guadalupe's injuries were less apparent. She was burned over two-thirds of her back, but the worst problem for the 29-year-old mother of four was her lungs, badly damaged from breathing smoke laced with particles and toxic gases. "And then there's the actual heat of the smoke," Potenza said. She was burned inside and out.


Angry at the treatment

Word spread quickly that undocumented immigrants were among the hospital's burn patients, and angry callers telephoned the emergency room to protest against providing free care to people who were in the United States illegally.

In keeping with federal law, said Potenza, director of the burn center, "the hospital will treat anybody who requires emergency medical services."

Potenza is a Midwesterner by background, a surgeon by profession. He worked around the clock treating burn victims last October, stopping only to evacuate his own house, which was under threat from a second fire. He speaks carefully, knowing that illegal immigration is a politically charged issue. An estimated 12 million undocumented immigrants live in the United States, and their health emergencies pose a burden to hospitals. He knows many people were enraged that the victims were treated rather than deported. "Their injuries give them something of a pass," he said. "But it's a huge price to pay."

For Moises Ramirez, the price was angry second- and third-degree burns. He needed skin grafts, but the soot and dirt from the fire made that difficult. "We could never get their wounds completely clean," Potenza recalled.

Second-degree burns affect the epidermis, or outer layer of skin, and may go deeper into the dermis. Third-degree, or "full thickness," burns destroy the dermis as well as the epidermis, plus hair follicles, sweat glands and pain receptors, and prevent the growth of new skin.

Doctors put a sterile cover over Ramirez's wounds to allow them to begin healing. Once the risk of infection had lessened, they returned to the operating room with an instrument like a cheese slicer to take skin from Ramirez's stomach and legs and place it over burned areas on his arms and hands.

A native of the Mexican state of Jalisco, Ramirez had come north to make money for a new start with a new woman back home. His girlfriend had left her husband and children to be with Ramirez, who was separated from his own wife and three children. They agreed that he would take a job alongside his brother in Oregon for a year or two to save for a house, furniture and perhaps a tractor or cars to work as taxis. This was a second try for both of them, and they were determined to make a life together as soon as he returned.

Ramirez knew he was lucky to be alive. The "coyote" guiding him into the United States had died in the fire, and another man in the group had lost several fingers.

Still, the struggle to heal was sometimes overwhelming. The physical therapists were taskmasters. Again and again, they had him clench and unclench his fist, stretching the new skin over his hands.

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