I read the recent reporting on Some Public Health Service officers deployed in detention centers suffer ‘moral distress with a mixture of recognition and concern. I spent three years working inside that system, first as a Health Services Administrator at an immigration detention facility, and later as Chief of Field Operations overseeing all health services across the United States of America. I also served as a commissioned officer in the U.S. Public Health Service because I believed, and still believe, in its mission to serve the poor, the underserved, and the most vulnerable.
During my tenure, advocacy groups often criticized those of us working within immigration detention. They assumed that participation itself implied indifference or harm. That assumption does not reflect the reality I witnessed daily. Many Public Health Service officers worked under extraordinarily difficult circumstances with a clear ethical commitment to patient care. We were not policy-makers; we were clinicians and public health professionals trying to reduce suffering where it already existed.
Concrete practices mattered. We implemented telemedicine systems in 1998 to ensure access to specialty care. This included mental health services. We did this long before such models became routine elsewhere. Individuals received comprehensive history and physical examinations within seven days of arrival. This care is often more thorough than what many Americans receive in the community today. When people were released, we worked to connect them with community organizations, ensure continuity of medications, and reduce the risk of care disruption.
That commitment extended beyond U.S. borders. I participated in a deployment to Guatemala during a mass migration event involving individuals from China. Even with limited resources, we conducted full physical examinations. We performed tuberculosis screenings and provided treatment to those in need. The human cost of migration was unmistakable. It was one of the saddest times in my PHS career and the one when I felt least able to help. I still remember riding on a bus to the airport. I watched the Guatemalan countryside pass by. A woman quietly remarked that she wished these people could escape to China. Her statement captured both despair and moral complexity.
Bearing Witness and Doing Good
I am also a Buddhist priest, and my understanding of this work is shaped by the Buddhist commitments to Bearing Witness and Doing Good. Bearing witness requires entering places of suffering without turning away, without denial, and without premature judgment. Doing good is not abstract moral purity; it is the daily, imperfect act of alleviating suffering where one stands.
A teaching that has deeply informed my understanding of care partnership comes from Chodō, who spoke of Jizō Bodhisattva, the bodhisattva who vows to enter the hell realms and not abandon those trapped there. Jizō does not wait for the world to be just before offering care. He does not ask who is deserving. He goes where suffering is greatest and remains present. For me, immigration detention often functioned as a kind of hell realm, not because of the individuals working within it, but because of the profound isolation, fear, and loss experienced by those confined there.
Much of our work was precisely this: staying present, providing care, and refusing abandonment in a place many preferred not to see. That, to me, is care partnership, not rescue, not endorsement of the system, but accompaniment within it.
If we are serious about justice and human dignity, we must be able to hold two truths at once: that immigration detention raises profound moral concerns, and that compassionate, competent health professionals inside those facilities have worked, often quietly and imperfectly, to bear witness and do good in the midst of suffering.
