A 78-year-old priest who has been in immigration detention in Aurora for almost a year continues to present symptoms of respiratory illness with no improvement in his condition.
Edward Nalwamba, a citizen of Uganda who has lived in Colorado for more than two decades, has been in U.S. Immigration and Customs Enforcement detention since September. For months now, he has presented respiratory symptoms that a medical provider who reviewed his case said could be indications of tuberculosis.
His symptoms include coughing, chest pain, a runny nose, a scratchy throat and voice, headaches, dizziness and general fatigue, according to Joy Athanasiou, one of Nalwamba’s immigration attorneys. Nalwamba has become extremely malnourished and is now wheelchair-bound. He fell in early August and has nearly fallen on multiple other occasions, she said.
“I’m very worried about my clients’ health,” Athanasiou said. “He still has ongoing symptoms that are not improving.”
In messages to a friend that Newsline reviewed, Nalwamba said his chest gives him trouble now even absent coughing, while previously he experienced pain only when he coughed.
“My chest pain is still on and when I cough I get a sharp pain in the head,” Nalwamba said. “I really don’t know what’s happening to my body. These people have tinkered with my health so much.”
“Brother, I cough until I feel my chest will burst,” he said to his friend. “I need prayer. Sleep well, and blessings to you.”
Cough medicine is the most common treatment medical providers at the Aurora ICE facility, operated by private prison company The GEO Group, have provided Nalwamba, Athanasiou said. He has received a chest X-ray, and a doctor has listened to his lungs with a stethoscope, but she said he received no additional testing for respiratory conditions even as he continues to present symptoms and complain of pain.
“They keep giving him very minimal treatment, like cough medicine, but not really doing any more aggressive treatment, testing, anything,” Athanasiou said. “He gets no treatment for a couple of weeks, and then finally ends up getting a nurse appointment, then it’s kind of the same routine.”
Nalwamba stayed in the U.S. after his visa expired in 2002 because colleagues in Uganda expressed fear that his life would be in danger, since government agents were looking for him. He has unsuccessfully applied for political asylum and has remained in the U.S. He retired two years ago after working as a priest in Greenwood Village for about 15 years.
Katherine Soo, a physician assistant based in Massachusetts, connected with Nalwamba’s attorneys and immediately became concerned that he could have TB when she learned of his symptoms. She reviewed his full medical file, and found a positive skin test for TB right after ICE took him into custody in September. At that point, she said, he underwent a series of chest X-rays, and they came back clear at the time. He likely had latent TB, which means he can’t spread the disease, but the bacteria was likely in his system and he is more at risk to becoming sick with TB, she said.
“But he has subsequently developed symptoms,” Soo said. “My biggest concern is, we think he probably has latent tuberculosis. It’s known that people who have latent tuberculosis are more likely to develop active tuberculosis if they’ve been exposed to somebody else with tuberculosis.”
In another message to a friend, Nalwamba said, “I don’t feel safe here. They respond only to pressure from my lawyers to do anything for me.”
Testing for TB
Tuberculosis is a bacterial infection. A person with active TB disease, which can be deadly, can spread the disease. A person with a latent infection can’t, but they can develop the disease at any point. Hope Shuler, a spokesperson for the Colorado Department of Public Health and Environment’s Division of Disease Control and Public Health Response, said it’s essential that someone with latent TB seek treatment so they do not develop the disease.
The Aurora ICE facility already had a confirmed active TB case, so there is potential for exposure within the facility, Soo said. Public health officials have been unable to properly investigate the case as GEO did not respond to a request for information and access.
Colorado law requires public health agencies to investigate confirmed active TB cases. Adams County health officials became aware of one laboratory-confirmed case and issued a public health order on June 25 to require compliance from GEO. CDPHE issued a public health order Thursday directing GEO to cooperate with public health officials.
Brother, I cough until I feel my chest will burst ... I need prayer. Sleep well, and blessings to you.
– Edward Nalwamba, a priest who has lived in Colorado for more than two decades, in a message to a friend from ICE detention
Immigration advocates believe there has been more than one case, and an unnamed person detained in the facility told The Guardian that at least 12 people have tested positive for the disease.
Skin and blood tests show if someone has the TB bacteria present in their system, but not whether they actively have the disease, according to Shuler.
A person with positive skin or blood tests would then get a chest X-ray to check for lung damage if they have a chronic cough. Then, the “gold standard” test is a sputum culture, Shuler said. A provider will collect a sample of sputum, a thick type of mucus found in the lungs, and lab technicians will review the sample for the bacteria that causes TB. That process can take a week or more, but Shuler said nucleic acid amplification tests can also determine the presence of TB within hours.
“It is important that public health is involved in assessing people suspected of having TB disease to help ensure the person is connected to healthcare and is receiving the appropriate tests, imaging, and treatment if indicated,” Shuler said. “If a person is diagnosed with TB disease, public health works with the patient to identify who they spent time with to perform a contact investigation with the goal of identifying and preventing any further disease transmission.”
In some cases, a vaccination to prevent TB can result in a positive skin test, but Shuler said they are typically administered to newborns in parts of the world where the disease is common, and the likelihood of a positive test from the vaccine “fades over time.”
Nalwamba received a skin test and X-rays, but Soo said he has not gone through any of what she would consider the next steps to rule out TB. She said she would “strongly urge” sputum culture testing for him.
“As a healthcare provider, what I see is a public health risk, but then also a patient who is not receiving adequate workup for symptoms that he has,” Soo said.
If someone within the facility has active TB, Soo said, it puts at risk everybody else in the facility — including other detainees, staff and visitors.
In a statement, an unnamed spokesperson for ICE said detainees are provided three meals a day, water, clothing, bedding, showers, soap and toiletries. ICE also said it is a “longstanding practice to provide comprehensive medical care” to anyone in ICE custody.
“This includes medical, dental, and mental health services as available, and access to medical appointments and 24-hour emergency care,” the statement said. “For many illegal aliens this is the best healthcare they have received their entire lives.”
“ICE follows all applicable health and safety guidelines, including those outlined in the U.S. Department of State’s travel advisories, when conducting removal operations,” the statement continued.
Other medical concerns
Nalwamba’s medical records also show multiple indicators for the potential of prostate cancer, according to Athanasiou, and he has not seen a specialist. That includes an enlarged prostate and elevated prostate-specific antigen levels. ICE is providing “the absolute minimal” amount of treatment so they can say they provided treatment, Athanasiou said, while “allowing this 78-year-old, very ill individual to languish.”
She has heard stories of many other detainees who are extremely ill, and some getting deported while they are sick. Nalwamba first got sick after he shared a room with another sick detainee for five days, Athanasiou said. That person got deported, and Nalwamba told Athanasiou that “the person was so ill that he was shocked that they would deport him in that condition.”
“There’s no effort to keep ill people away from healthy people,” Athanasiou said.
Miriam Ordoñez Rodriguez, who works with the American Friends Service Committee, said her organization has heard from people who have been released and who are still detained that those in custody in Aurora are frequently denied thorough testing for TB. Most of the detainees have learned about TB in the facility from the news or their loved ones, not from GEO, she said.
“The only way we will know what’s happening inside with accuracy is if healthcare experts go in,” Ordoñez Rodriguez said.
People in detention begin to panic and don’t know what to do because they are denied adequate and proper healthcare and don’t receive information from GEO, Ordoñez Rodriguez said. Those who do receive any care only receive it after advocacy from their lawyers or members of Congress, she said.
“We believe that the testing that’s being done is to appease, so they can say that they did testing, but … they’re not using the most accurate (test). They are using the cheapest, the fastest,” Ordoñez Rodriguez said.
Dr. Maureen Daly, a retired public health physician volunteering with the Shutdown GEO Coalition, said public health experts who specialize in TB must investigate the confirmed case. What she’s heard about the conditions inside the ICE facility — such as overcrowding, poor nutrition, shut down air conditioning, and other generally unsanitary conditions — can make the transmission of TB worse, Daly said.
“Public health needs to get in there. That’s the only way we’re going to know,” Daly said. “They need to go in and talk to the detained people, not talk to GEO staff.”
Pressured to leave country
Nalwamba’s lawyers filed a habeas corpus petition — a legal mechanism that challenges wrongful detention — earlier this year, but ICE told the judge it scheduled his deportation for June 30, so the judge denied the motion to release him. Athanasiou said they filed a new habeas petition Wednesday, since ICE has continued to hold Nalwamba in its Aurora detention facility.
ICE has also repeatedly pressured Nalwamba to agree to be deported, according to Athanasiou. She said it’s something ICE does “all the time” with detainees, and officials “use very manipulative” tactics.
“Every single time, they tell him he’s being released. They told me that he was being released … and then they get him in the area where they do the processing for release, and then they’re trying to talk him into signing away his rights and agreeing to be deported,” Athanasiou said.
ICE said “it is categorically false that ICE would pressure someone to self-deport.” The unnamed spokesperson said Nalwamba will remain in ICE custody until he is removed from the U.S.
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