Inside a tiny prairie town relying on immigrants for hospital work

Hettinger, North Dakota (CNN) — “Do you like McDonald’s?”

That was the first question Marichu Castillo Villamiel was asked when she applied for a job at a hospital in Hettinger, North Dakota, a tiny town of about 1,100 people and only one grocery store.

It was the interviewer’s way of checking if the Filipina ultrasound technician would be OK working so far from home in a place without much of an immigrant community.

“Yes, I’m willing,” Marichu remembered she said about a move to Hettinger, though she added, “I don’t like McDonald’s much because I can make my own burger.”

Marichu got the job and is one of 19 foreign workers at West River Hospital, which serves residents of Montana and South Dakota, as well as the locals.

CNN spent a month in Hettinger to examine the impact of immigrant workers and how they were viewed in a rural part of the country that mostly voted for President Donald Trump. The documentary, “30 Days Inside: Hospitals and the Immigrant Workforce,” reveals life in the community just as it was getting more foreign workers for a vital local resource – teachers in schools.

Marichu welcomed us into the home she shares with her partner, Eric, and her three daughters who arrived from the Philippines six months ago.

She had waited until the snow melted at the end of the bitter prairie winter to bring her girls to America, hoping that at least the temperatures would feel familiar.

“Because this is my dream,” she said about wanting to come to the US to work. “Yes, Hettinger is a home. If I got a chance to live in the United States, a good opportunity, why not?”

“I can help people here, yes, I can stay,” she said.

Marichu came to the US on an H-1B visa for skilled foreign workers to fill vacancies for three years, generally renewable for a further three years. It’s a program West River Health Services has used to recruit people from the Philippines as nurses and lab technologists, looking to fill posts, one of which has been open for over a decade.

But the Trump administration’s clampdown on legal immigration has created uncertainty – as well as the targeting of illegal migrants that fill the headlines. There’s a new proposed $103,000 fee for H-1B visas, though many hospitals have an exemption.

“It is something we expect to potentially affect us in the future as it continually changes,” said Alyson Kornele, the CEO of West River Health Services. “We never know what’s going to happen.”

West River is facing issues familiar to many rural hospitals across the country, with worker shortages exacerbated by young people moving away. The hospital is 2½ hours from the nearest big city, Bismarck, North Dakota, where immigrants fly in and are picked up by hospital staff for the drive down to Hettinger.

“All rural areas are experiencing population loss,” said Dr. Cathy Houle, a family physician at West River Health Services. “We’re seeing, increasingly, it’s difficult to recruit and retain people to work in the medical field.”

If the hospital is happy to have its staff from the Philippines, it seems that the town is too. The recruits told us they felt welcome in Hettinger, where the vast majority of the population is White and native-born. We saw that too, with friendly waves from people around town as we walked to places like Pastime, a steakhouse bar run for more than four generations by one Hettinger family.

Embedded in the community

As Marichu got her kids ready for their first day of school, we met three Filipino teachers who’d arrived the week before — more immigrants filling more public service roles.

They all cried when talking about leaving loved ones behind and when school ended, we saw them talk to their families on cell phones in the cafeteria. Chickens roosted in the background of one of the video calls, it was sunrise in the Philippines.

“One of my students (told) me, thank you for coming here, you left your daughter in the Philippines just for us,” said Zaira Chinte, a second-grade teacher in Hettinger. “I’m so touched with that because they see our effort as a teacher coming here.”

The school hosted a get-together to welcome the teachers to the community. Marichu and other Filipinos brought home-cooked meals as families chatted and parents met their students’ new teachers.

We hadn’t known what we would find when we ourselves had arrived in North Dakota, and Marichu ended up being one of our guides too.

We ate with her and the school community discussing the upcoming academic year, and on our first day filming at the hospital we saw Marichu with Mayra and Hugo, who were getting an ultrasound for their fourth child. Three weeks later, we were there again when Mayra gave birth to Emmanuel on one of the busiest days in the ER on Labor Day weekend.

Dr. Houle delivered Mayra’s baby as just one of her duties during a 72-hour on-call shift at the hospital.

“It’s really a privilege to be part of that,” Dr. Houle said. “Especially with a family that’s nice and welcoming as they are.”

Away from the camera

In the course of filming 30 days, we learned how to spend time with the town’s families and when not to pick up a camera — to give them space and simply to hang out as Marichu hosted a karaoke night, for instance.

When we were filming, we held our shots longer than we would for a traditional news report to be able to share more of what we were seeing and to capture intimate moments we were privileged to witness.

We did our own shifts in the hospital ER, waiting for events to unfold. We attended scheduled events, like surgeries, where we met patients who invited us to their homes to talk about the immigrant workforce and the community.

Leona Freymiller spoke with us at her home 45 minutes away from the hospital where she has had two surgeries, talking about her children who moved to Minnesota to live in a city.

She also addressed the immigrants working at the hospital, acknowledging, “there’s some people that don’t think they should be here,” though she thought they should be welcomed.

And even though she’d had surgery the day before, she took us to White Butte, the highest point in North Dakota, to show us what this place has to offer.

Far beyond the vastness of the scenery, the hike helped shape our understanding of the people who live in and near Hettinger and those they allow into their lives.

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