Combating visas endangers these rural doctors

How Trump's travel ban hits this doctor in South Dakota

How Trump's travel ban hits this doctor in South Dakota

In his pediatric practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal up to 10 patients daily. He has known some of them since they were born. He still treats others after they finish high school.

"I treat these children for type 1 diabetes, thyroid problems, thyroid cancer, puberty, and adrenal gland disease," he said.

Al Nofal's expertise is crucial. He is one of only five full-time pediatric endocrinologists in a 150,000 square mile area that covers both South and North Dakota.

Like most of rural America, it is a region with a shortage of doctors.

"We are very happy to have Dr. Al Nofal here. We cannot afford to lose someone with his specialization," said Cindy Morrison, chief marketing officer of Sanford Health, a nonprofit health system based in Sioux Falls, which operates 300 Hospitals and clinics in predominantly rural communities.

Related: Visa ban could make doctor shortage worse in rural America

Still, Sanford Health can lose Al Nofal and several other doctors who are vital to its health network.

Dr. nofal patient
Dr. Alaa Al Nofal [here with a patient] is composed of only five pediatric endocrinologists in South and North Dakota.

Al Nofal is a Syrian citizen and has implemented a special staff development program in Sioux Falls called Conrad 30 (Visa Waiver). This eliminates the requirement that doctors who complete their stay with a J-1 exchange visa must return to their country of origin for two years before applying for another American visa. The Conrad 30 waiver allows him to stay in the United States for a maximum of three years as long as he is committed to practicing in an area where there is a shortage of doctors.

After President Donald Trump issued a temporary immigration ban prohibiting people from seven predominantly Muslim countries – including Syria – from entering the United States, Al Nofal is uncertain about his future in America.

"We agree that more needs to be done to protect the country, but this arrangement will have a negative impact on doctors from these countries who are urgently needed across America," said Al Nofal. "You may no longer want to practice in the United States." The lawsuit is currently in limbo after a federal appeals court temporarily suspended the ban.

See also: Trump angry after the court upheld the travel ban

In the past 15 years, the Conrad 30 has been exempted from the visa requirement has smuggled 15,000 foreign doctors into under-served communities.

In total, Sanford Health has 75 visa-exempt physicians, and seven of them are from countries listed in the Implementing Regulation. "If we lost Dr. Al Nofal and our other J-1 doctors, we would not be able to close critical gaps in rural family access to health care," said Morrison of Sanford Health.

And the ban could also damage the pipeline of new doctors. The Conrad 30 visa waiver program is powered by non-immigration J-1 medical school graduates who are US residents.

South Dakota Rural
Cows in a field just outside of Sioux Falls.

More than 6,000 overseas trainees participate in U.S. residency programs each year through J-1 visas. Around 1,000 of these trainees come from countries affected by the ban, according to the American Association of Medical Colleges. J-1 visa holders who were outside the country at the time the ban came into force were not allowed to enter the U.S. and could not start or finish school while the ban was in effect.

The State Department told CNNMoney that the government could issue J-1 visas to people from one of the restricted countries if it was "of national interest" but would not confirm whether there was a shortage of doctors qualify for such a consideration.

"The stress and concern that the short-term executive order creates could have long-term effects as fewer physicians choose state-run training programs, and consequently the lack of providers willing to practice in underserved and rural areas, enlarge, "said Dr. Larry Dial, Vice Dean of Clinical Affairs at Marshall University Medical School in Huntington, West Virginia.

Related: Obamacare affects this city in Alaska with only one doctor's office

Al Nofal attended the medical school in Damascus, the capital of Syria, and graduated from the University of Texas on a J-1 visa. He went on a scholarship to the Mayo Clinic and then applied for a J-1 waiver, which took him to Sioux Falls.

Nineteen months after his three-year engagement, Al Nofal either treats directly or serves as Consult an average of more than 400 pediatric patients per month.

He sees most of his patients at the Sanford Children's Specialty Clinic in Sioux Falls, where families often make appointments for hours. Once a month he flies on a small plane to see patients in a clinic in Aberdeen, which is approximately 300 kilometers away.

Sanford children
Many Dr. Al Nofal spend hours with him at the Sanford Children's Hospital in Sioux Falls.
Aberdeen hospital
Dr. flies once a month Nofal to Aberdeen, S.D. Seeing patients in an outreach clinic.

"It's not easy to be a doctor in this environment," said Al Nofal, referring to the long hours and famous cold winters in South Dakota. "But as a doctor, I am trained to help people under all circumstances and I am proud of it."

This is one of the reasons why Al Nofal and his American wife Alyssa struggled to accept the visa ban,

"I have a 10 month old baby and I cannot go to Syria now. My family in Syria cannot come here," he said. "Now my family can no longer meet their first grandson."

"I know if we go I probably can never come back," he said. He doesn't want to travel anywhere in the country now. "I'm afraid of how I'm treated," he said. He is also afraid of being stopped at the airport – even if he is traveling to another country.

Related: Trump Travel Ban and What You Need to Know

Almatmed Abdelsalam of Benghazi, Libya, had planned to practice as a family doctor in Macon, Georgia as part of the visa waiver program after completing his studies at the University of Central Florida Medical School in July.

Everything went smoothly. Abdelsalam, who treats hospital patients and veterans, applied for a visa waiver and was accepted. He signed an employment contract with Magna Care, which provides doctors for three hospitals in the Macon area, and he had started looking for houses to relocate with his wife and two young children over the summer.

almatmed abdelsalam
Dr. Almatmed Adbelsalam with his family.

But there was one last step. For its application for J-1 exemption to be completed, it must be approved by the State Department and the United States Department of Citizenship and Immigration.

"The executive order was in the middle of this process and stopped my application to the State Department," he said.

As he is a Libyan citizen (Libya is also subject to a visa ban), Abdelsalam fears the result.

"The Macon hospital desperately needs doctors. Even though they hired me, I'm not sure how long they can wait for me," he said.

"Nobody can say that it is necessary to protect the country, but we should also keep the country healthy," he said. "Doctors like me, trained in some of the best schools in the United States, are an asset, not an obligation."

CNNMoney (New York) First published on February 10, 2017: 7:47 p.m. ET