The clinic's lobby is usually packed with waiting patients, but on a recent Monday morning there were plenty of empty chairs. The only people killing time were three generations from the same family: a 9-year-old girl, her 53-year-old father and her 76-year-old grandfather.

Since January, quieter days have been the new normal for this Borrego Health clinic, which stands among farm fields near the community of Oasis west of the Salton Sea. Many patients just don't show up for appointments or they cancel without rescheduling. Instead of 60 or 70 patients a day, medical assistant Norma Diaz said the clinic is seeing closer to 40.

The likely explanation comes from the concerns people who do show up tell their doctors.

"Patients aren't coming in because they're basically afraid of immigration (authorities)," Diaz said. "They're afraid of being taken from their families."

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Other health and social-service providers in the largely Latino eastern Coachella Valley say they are seeing the same thing: A decline in numbers that coincides with President Donald Trump taking office in January and a perceived crackdown on illegal immigration.

It's not just doctor visits creating angst. Clinic staff said patients say they hesitate to run out to the grocery store or post office. Even a legal resident may fear where an interaction with federal immigration agents could lead, they said.

Borrego Health has seen similar drops at another clinic in nearby Coachella and a mobile clinic providing mammograms. At Coachella Valley Volunteers in Medicine, a free clinic for low-income people in nearby Indio, patient visits were down almost 17 percent in January and nearly 13 percent in February.

"It's disheartening," said Executive Director Doug Morin. "I can't imagine the fear they are experiencing just on a daily basis."

More than half of the clinic's patients have a chronic medical condition like diabetes that requires regular monitoring. The clinic doesn't ask about patients' citizenship or immigration status, but Morin estimated that about 20 percent are undocumented.

It's not happened recently, but Morin said the clinic has taken calls from people saying they are with US Immigration and Customs Enforcement and asking when a specific patient was scheduled for an appointment. Privacy laws mean the clinic cannot pass along such information, he said.

Coachella Valley Volunteers in Medicine is upping its spending on promotion and outreach in an effort to help combat the decline in patientsand assure them of their safety. The clinic has started placing fliers in the lobby with legal information about immigration and dealing with law enforcement.

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Trump's hard talk

There appears to be no evidence of heightened immigration enforcement in this area about 100 miles from the US-Mexico border, although sightings of ICE vehicles are not uncommon. Some medical providers said they've seen no changes because of immigration concerns. A spokeswoman for Clinicas de Salud del Pueblo said the network of clinics has not seen a decline in patients. Emergency visits to JFK Memorial Hospital in Indio appear to be unaffected, a hospital spokesman said.

Still, the perception is out there. Alberto Ruiz, who drives a shuttle for Borrego Health five days a week, said part of his job has become reassuring patients that he's not seen immigration officials while traveling his route.

Aldo Valdovinos, the man waiting recently in the Borrego clinic with his daughter and father, said many immigrants, legal and illegal, make valuable contributions to the US economy in industries like construction. A legal resident who does maintenance work for a golf course, Valdovinos didn't think people should be overly concerned.

But his father, Francisco, said in Spanish that people have reasons to be a little afraid.

Trump used blistering anti-immigrant language in his campaign. His promise of building a border wall and vows of tougher enforcement of existing laws has helped keep immigration issues in the news. ICE officers arresting people at courthouses in California led to a public fight between the chief justice of the state Supreme Court and the Trump administration. And on April 11, US Attorney General Jeff Sessions said while speaking in Arizona that the administration was amping up efforts to deal with illegal immigration.

State Assemblyman Eduardo Garcia of Coachella said he's heard what the political climate has apparently done to health clinics.

"I don't think it requires any thorough analysis of why that would be the case," Garcia said of the drop in patients. In addition to the harm the added stress could be having on people, Garcia worried about the economic hit businesses might take as people fear leaving their homes.

FIND Food Bank has received calls from people asking how to un-enroll in federal food assistance — not because they were undocumented but because someone in their family was, said Lisa Houston, FIND's CEO.

FIND's distribution program includes visits to the impoverished mobile home parks of the eastern Coachella Valley. Houston said immigration officers have shown up near those events before, and since late last year attendance at some smaller food distribution events has been down by as much as 40 percent.

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She said media attention on immigration raids has put the issue at the top of people's minds and led to rumors stirring up fear. "All it takes is someone to say, 'I saw an ICE car,' and then it grows like wildfire," she said.

A Canadian citizen, Houston worked for three years to get her green card making her a permanent US resident. The legal immigration system is complex, she said, and that makes people fearful of interacting with it.

"Let's not talk about the undocumented. Let's talk about what does it take to go through the process" to be here legally, she said.

Health reporter Barrett Newkirk can be reached at (760)778-4767, barrett.newkirk@desertsun.com, or on Twitter @barrettnewkirk.