A CONCLUSION, A REFLECTION

I thoroughly enjoyed being a part of Border Beat. Through the articles and blogs of my classmates I learned about individuals and organizations that are a part of the United States - Mexico border as well as the unique culture of the border.

Throughout this semester, I updated and maintained this blog which focused on health organizations and healthcare issues related to the border. I hope that I was able to convey my genuine interest in this issue to anyone who read this blog. I also hope that the information, resources and links were useful to readers.

I met exceptional individuals involved with unique healthcare organizations. I learned that there are a lot of people and organizations that provide invaluable aid and support to the border communities.

Not only did I write on this blog but I also published articles about the border. These articles included; "A line in the sand: The history of the Arizona-Mexico border fence," "Something Worth Waiting For," and "Fighting Venom with a VIPER."

One of the most unique and beneficial aspects of this course was learning new multimedia skills. These included; how to upload, publish and edit articles, photos and audio online, how to set up a blog, how to create links with HTML, as well as the basics of programs like SoundSlides and Final Cut Pro.

Another great part of this course was the variety of topics that reported on and written about. This publication covered aspects of culture, lifestyle, people and news. Our reporters delved deeper into political and social issues as well as wrote fun articles about the diverse and interesting culture of the border.

I am very glad and grateful to have been a part of Border Beat. I have learned so much about the U.S. – Mexico border largely because of the individual perspective each person brought to this publication.

I hope that you have enjoyed reading my blog and learning about healthcare and the border. I hope that I’ve shown you that the healthcare issues we battle here in the United States are also battled along the border but often without the same vital resources. We may have shared symptoms, but there still isn’t a shared solution.

CHANGING THE STAGGERING STATISTICS OF LATINA TEEN PREGNANCY

Between 2005 and 2006 there was a 3 percent increase in teen birth rates, unfortunately Latinas have the highest teen birth and pregnancy rate of all racial and ethnic groups in the United States. Nearly 53 percent of Latinas get pregnant at least once before their 20th birthday.

These startling statistics are courtesy of The National Campaign to Prevent Teen and Unplanned Pregnancy. This organization has recently developed, The Latino Initiative.

The Latino Initiative’s mission is to reduce the persistently high teen pregnancy and birth rates and in doing so improve the lives and future prospects of children and families, according to the Latino Initiative’s Web site.

By why are these numbers so high for such a specific demographic?

Teen Pregnancy Rates by Race/Ethnicity, 1990-2004

Graph provided courtesy of The National Campaign to Prevent Teen and Unplanned Pregnancy, Latino Initiative.
The organization suggests four possibilities.

According to the organization, Latina teens commonly have sexual partners that are four or more years older. However, teens with older partners are less likely to use contraception and thus more likely to get pregnant, also according to the organization.

Another possibility for the high pregnancy rate is that Latino teens are also less likely to use contraception such as condoms, according to a 2008 presentation from the organization.

Sexually active teens who reported that they used a condom the last time they had sex

Graph provided courtesy of The National Campaign to Prevent Teen and Unplanned Pregnancy, Latino Initiative.
Other factors include acculturation, or adapting to another culture amidst generation and language barriers, as well as ineffective parent-teen communication. Roughly 75 percent of Latino teen boys and girls said that parents send varying messages to their sons and daughters about this issue, according to the organization.

The ultimate goal of this initiative is to decrease the rate of Latina teen pregnancy to only 2 out of 10 teens by 2015.

To reach this goal, the organization has outlined five steps; 1. Conduct an environmental scan, 2. Build capacity and partnerships with guidance of Latino Initiative Advisory Group, 3. Strengthen the research base for action, 4. Offer technical assistance and provide resources for parents, teens, and communities, 5. Reach out to key organizations and sectors, including policymakers, faith leaders, and media, also according to the presentation.

No teen wants to end up with this fate and every teen deserves to have a hopeful and meaningful future. Teens want to learn more information about methods of protection in order to ensure a successful future.

According to the organization, 84 percent of Latino teens report either graduating from college or a career is the most important goal for the future and 70 percent of teens want more information about abstinence and contraception.

But in order for this initiative to be successful, it requires effort from everyone in the community. The community needs to believe in the Latino youth and encourage them to be dedicated to their future as well as involve parents in the lives of their teens, according to the organization. It is also critical to appreciate the diversity of the Latino community and recognize that these statistics do not and cannot be applied to every individual.

This data is frightening. These young girls are only 15 years old to 19 years old.

This is a vital issue; not only are the futures of these teen girls at stake but so are the futures of these children.

By providing more information, resources and aid for this specific demographic, this organization has taken large strides to impede the rise in these statistics.

UNITED STATES - MEXICO BORDER HEALTH COMMISSION

Back in 1994, United States section of the Border Health Commission was established, but it wasn’t an entirely comprehensive border commission without the other half of the border.

July 24, 2000, an agreement was made between the U.S. and Mexico that established the United States-Mexico Border Health Commission (BHC) and in 2004, President George W. Bush signed an Executive Order that designated the BHC as a public international organization.

The U.S. – Mexico border houses a population of roughly 12 million people and more than 800,000 people legally, and thousands illegally, cross the border daily, according to the BHC Web site.

Many border communities are impoverished, have limited healthcare resources as well as poor access to healthcare, according to the Web site.

Whether it is for travel or medical care, U.S. and Mexican citizens can’t check their health problems at the border and thus enter the neighboring country as a potential health risk.

High population growth and constant migration, put further strain on the healthcare system of both countries. This strain can be dangerous to the dissemination of care and resources in an area desperate in need of proper healthcare.

Some of the biggest health threats at the border are chronic diseases like, diabetes, and hypertension, according to the Web site. Border communities also struggle with respiratory and gastrointestinal disease and as well as communicable diseases like, HIV/AIDS and tuberculosis, also according to the Web site.

A map of the Border Health Comission state outreach offices along the U.S. - Mexico Border.
The BHC’s mission is to provide international leadership to optimize the health and quality of life for those living along the border.

“The Commission was established after many years of many leaders on the border advocating for the establishment of a border health authority […] that would provide the necessary leadership to serve in a coordinating capacity to develop and advocate for specific binational actions and secure binational resources that would improve the health and quality of life on the border,” said Cecilia Rosales who was appointed to the to the U.S. section of the commission in 2006 and is also an associate professor at the UA’s Mel and Enid Zuckerman College of Public Health.

Until its creation, there was no method of addressing and improving the health of this region.

Through focusing on access to and promotion of healthcare as well as research and data collection at the border, the BHC facilitates identification of public health issues and encourages the collaboration of federal, state and local resources, according to the Web site.

In order to accomplish these goals the commission conducts public health need assessments along the border, provides support to public and nonprofit entities, aids in health promotion and disease prevention actives and has established a system of coordinated care.

The commission’s commitment to border communities is clearly illustrated through their extensive list of public health actions.

This includes; Healthy Border 2010, Border Binational Health Week, National Infant Immunization Week, Border Health Research, Pandemic/Avian Influenza Planning, Border Lead Issues, Border Tele-health, and the Border Health Information Platform.

Healthy Border 2010 is composed of aspects from Mexico’s National Health Indicators and the United States’ Healthy People 2010 programs. It establishes 10-year objectives for health promotion and disease prevention in the border region. This includes improving the quality of life, increasing the years of healthy life and eliminating health disparities.

Some of the focus areas of Healthy Border 2010 are; access to healthcare, cancer, diabetes, injury prevention and oral health.

National Infant Immunization Week is a collaboration between the Center for Disease Control and Prevention, the Pan American Health Organization, border agencies and community organizations. These groups work to coordinate activities along the border that promote immunizations and highlight the importance of protecting infants from vaccine-preventable diseases, according to the CDC Web site.

The United States section is led by the Secretary of Health and Human Services and the Mexico section is led by the Secretary of Health of Mexico. The commission is made-up of 26 members from the six Mexican and four U.S. border states.

The commission receives funding and support from the U.S. Department of Health and Human Services and the Mexican Secretaria de Salud.

The need for healthcare and health services at the border is blatantly obvious and unreasonably high. Fortunately, the Border Health Commission assemble a group of individuals who are genuinely concerned about the welfare of individuals living at the border and who are dedicated to improving the lives of those individuals.

"Up until the Commission was established and operationalized, the region did not have a sustainable process for addressing and improving the health of border residents," Rosales said. "The establishment of a Commission […] was needed to effectively address cross-cultural health disparate issues impacting border communities."

MONITORING THE SPREAD OF INFECTIOUS DISEASE AT THE BORDER

Infectious diseases, also known as contagious or communicable diseases, are a significant health threat chiefly because of their high probability of transmission and increased virulence, or ability to cause disease.

Infectious diseases are caused by organisms such as bacteria, viruses, parasites or fungi, according to the World Health Organization.

This health threat is intensified in border communities.

Fortunately, the Border Infectious Disease Surveillance (BIDS) Program was created in 1997 to combat this threat.

The program is a part of the Arizona Department of Health Services and was formed by the Center for Disease Control and Prevention, the Mexican Secretariat of Health and various border health officials.

"BIDS is a collaboration of federal, state and local public health authorities from both sides of the border to study infectious diseases. These collaborations are intended to improve knowledge gaps of known and emerging diseases along the border. They also improve the exchange of disease surveillance and epidemiological data [...]" said Orion McCotter, infectious disease surveillance epidemiologist for the Office of Border Health, in an e-mail.

The program works to establish an active, binational sentinel surveillance system, exchange disease incidence rates and risk factor information, enhance the public health infrastructure along the U.S. - Mexico border as well as improve binational communication and data exchange, said Robert Guerrero, office chief for the Office of Border Health, in an e-mail.

"There is no system to assess infectious diseases throughout the border as a unit. The large population movement across the border will allow for the disease to reach populations on both sides. The surveillance of infectious diseases by BIDS will allow detection of outbreaks and epidemics," McCotter said.

These agencies include nine clinical facilities in four geographically grouped cities along the border, Tiajuana–San
Diego, Nogales-Nogales, Las Cruces–Ciudad Juarez–El Paso, and Reynosa-McAllen.

The geographically widespread participation in the BIDS program allows participants to focus on a variety of diseases, McCotter said.

Within the BIDS program there is an executive committee and three subcommittees, epidemiology, laboratory and communications. There are nine “sentinel” site surveillance coordinators who are responsible for interviewing patients, completing data entry and also specimen shipping and tracking, according to a CDC report.

The increased participation and surveillance is critical because the proximity of border cities such as Nogales, Ariz. and Nogales, Sonora.

“From an epidemiological perspective, the border population must be considered as one, rather than different populations on two sides of a border, pathogens do not recognize the geopolitical boundaries established by human beings,” also according to the report.

Despite efforts to build walls and fences, as one of the busiest international portals, the constant migration of people across the border amplifies the spread of infectious pathogens. Thus, the BIDS program works to manage the transmission of these infectious diseases.

These diseases can be passed directly, from one person to another, or indirectly through some sort of vector, a mechanism for transporting disease, such as a mosquito.

There are several different types of infectious diseases including, the Avian Flu, leprosy, yellow fever, small pox and cholera.

BIDS past surveillance projects include, the West Nile virus, pediatric influenza, viral hepatitis (A, B, C, D and E), fever and rash syndromes such as, measles , rubella, dengue fever, typhus and ehrlichiosis, Guerrero said. The program’s current focus is Valley Fever, he added.

Past BIDS surveillance projects in Tucson have included, hospitalized pediatric influenza, hospitalized West Nile virus and Dengue Fever, Guerrero said.

This program demonstrates a collaboration of binational organizations as well as infectious disease surveillance strategies.

However, the program has encountered some obstacles along the way such as, language barriers, coordination of information as well as moving equipment, supplies and specimens, according to the report.

Man-made boundaries cannot contain disease-causing pathogens that spread rapidly, infect and can cause death.

"Infectious diseases are among the most critical health issues in the border region. Enhancing the network of surveillance for infectious diseases helps estimate distribution and spread of diseases," McCotter said. "The surveillance activities can also provide early detection of outbreaks. These efforts can lessen the morbidity and mortality of infectious diseases in border communities."

CONTROLLING THE RISE OF TUBERCULOSIS AT THE BORDER

A few weeks ago I came across a Morbidity and Mortality Weekly Report (MMWR) from the Center for Disease Control and Prevention (CDC) about tuberculosis and the United States – Mexico border.

This week I want to discuss that report, "Preventing and Controlling Tuberculosis Along the U.S. – Mexico Border," which was released in January 2001.

Along the roughly 2,000 mile stretch of the border, the number of tuberculosis or “TB” cases, including drug-resistant strains, has increased, according to the report. Accordingly, the incidence of TB for border counties was higher than the national TB rate.

In 1999, 3/4 of the total number of Mexican-born individuals living in the U.S. with TB were from the four states that border Mexico; California, Texas, Arizona and New Mexico-- there were 67 cases in Arizona, according to the report.

In the report the CDC lists five factors that contribute to the prevalence of TB in the border states. These include; Mexico’s overall higher TB rate, low socioeconomic status and limited access to healthcare in Mexico, frequent border crossing, language and sociocultural differences and lack of coordinated care from both sides of the border.

It is chiefly the constant flow of people across the border, either legally or illegally, that is responsible for the transfer of TB from countries south of the border into the U.S.

“TB is brought into the United States from Mexico and Central America in three ways: a) persons with active TB disease move northward across the border; b) persons with latent TB infection experience active disease after arrival in the United States; or c) U.S. residents touring Mexico, including immigrants, acquire TB disease after returning to the United States,” according to the report.

Table courtesy of the Center for Disease Control, Morbidity and Mortality Weekly Report

The threat is amplified by the approximately 1 million people who cross the border cross the border daily and the 2.7 million individuals who illegally live in the U.S.

Many binational patients do not seek diagnosis, let alone continued care because they fear the potential repercussions of a TB diagnosis-- loss of housing, employment, income or even legal action for living in the country illegally. Not only that, but there are minimal resources for illegal immigrants in the U.S. healthcare system.

In order to combat the growing threat of TB, the CDC created the, TB Along the U.S. – Mexico Border Work Group. The report outlines the work group’s four focus areas; surveillance needs, case management and therapy completion, performance indicators and program evaluation, and research needs.

“Ultimately, lowering TB rates in the border area and reducing racial and ethnic disparities of TB disease depends on identifying and treating infected persons on both sides of the border until patients are cured. Therefore, TB prevention and control efforts along the U.S. – Mexico border require the cooperation of local, state, and national TB control programs in both countries […],” according to the report.

Surveillance includes communication and collaboration of U.S. and Mexican healthcare providers as well as establishing an electronic registry of binational TB cases. The CDC also notes the need for surveillance for immigrants with TB who are in Immigration and Naturalization Service (INS) custody. Medical staff and local health departments are not often notified when these individuals are released.

An increase in surveillance would greatly aid in the control of TB. Surveillance extends beyond simply recording the number of patients; it also includes monitoring the quality of their treatment and their progress.

Prompt diagnosis, careful observation of treatment, commitment to treatment and evaluation of healthcare contacts are all aspects of the case management and therapy completion focus area.

In order to accomplish all of these aspects, the CDC suggests screening populations that are at a higher risk for TB; including, HIV patients, medically underserved individuals, and immigrants that have lived in the U.S. for less than five years.

Performance indicators and program evaluation involves sharing laboratory and surveillance data between countries as well as healthcare providers increasing their own cultural awareness.

Discrepancies in coordinated care create confusion among both healthcare providers and patients and can negatively impact critical treatment.

The final focus area of the work group is research needs, which involves identifying strategies to eliminate TB at the border. This also includes researching all aspects of individual TB cases from diagnosis to treatment completion.

Combined, these four focus areas attempt to improve documentation, diagnosis and treatment of TB. They also illustrate the great need for coordination and collaboration between the U.S. and Mexico in both the clinical and human setting.

A key control of this work is funding. However, the report states that counties along the border are among the poorest economically in the U.S. and that about one third of border families live at or below the poverty line.

In an ideal world, the need would outweigh the costs and programs would be implemented to combat TB.

Likewise, the costs should not outweigh the risks. A lack of programs could lead to a lack of treatment and put the lives of U.S. citizens at risk.

Even though this data is somewhat dated, the disease has not been eliminated and thus the cases discussed in the report probably still exist today.

The air that is shared across the border is unavoidable but has become increasingly hazardous. Hopefully the alarming data presented in this report will encourage more aid in eliminating and controlling TB.

More Information:
CDC resources for tuberculosis
Read about the 2008 trends in tuberculosis
Read about the fight against drug-resistant tuberculosis

RESEARCHING WOMEN’S HEALTH AT THE BORDER

The Transborder Consortium for Gender and Health at the United Sates – Mexico Border perfectly illustrates how collaborations across border lines can enhance research and strengthen understanding.
The Consortium was designed to develop the diversity of women in the southwest through research that examined, health, education, economics, women’s history and more, said Dr. Janice Monk, co-director of the Consortium and research social scientist emeritus.

In the beginning stages of the Consortium, research was mainly conducted on the U.S. side of the border.

However, Monk met a researcher from El Colegio de la Frontera Norte in Tijuana, Baja California, Mexico who was trying to create a women’s studies program. Through this chance encounter, the Consortium expanded across the border.

Dr. Janice Monk, co-director of the Consortium. Courtesy of the SIROW Web site.

Following that, researchers from The University of Arizona, including Monk, and El Colegio de la Frontera Norte met twice, once in Tijuana and once in Tucson, to discuss areas of common interest, Monk said. Another researcher from El Colegio de Sonora in Hermosillo, Sonora, Mexico was invited to attend the second meeting and join the collaboration.

The areas of common interest turned out to be economics and health. The focus was further narrowed to health, specifically cervical and uterine cancer.

“At that meeting we discussed what were health issues that we thought we could address that were important to women on both sides of the border, especially Mexican-American women on this side and that would not be so contentious that they might make collaboration difficult,” Monk said.

These diseases were also the highest cause of death for mid-life women in Mexico at the time and are a key health issue for Mexican-American women in the U.S., she said.

Researchers studied all aspects of these diseases from transmission to the implications of gender on the issue.

“Whether women get self care and think their own health is important is also a gender-power issue. Whether they think they are important, if they can afford it or even value getting care for themselves as opposed to looking after their families or their husbands-- not thinking that they should go to doctor for gynecological exams unless their pregnant,” Monk said.

The Consortium embarked with a “multi-pronged" approach; research, outreach and education.

The outreach was designed to disseminate their research and build ties with community members, community health agencies and “promotoras,” she said. It included workshops and presentations every year.

The Consortium also granted three to four mini grants twice a year to various community health agencies on both side of the border and to graduate students for research.

In 2004, the Consortium created a bilingual Web site, "Women’s Health on the Border", Monk said. The Web site provides information on women’s health issues at the border and links to local and regional health programs and clinics.

The Transborder Consortium is a part of the UA’s Southwest Institute for Research on Women (SIROW).

The collaboration lasted from 1993 - 2005 and is no longer actively researching projects, Monk said. After roughly five years, El Colegio de la Frontera Norte left the collaboration, she added.

The Consortium was primarily funded through grants provided by the Ford Foundation in New York and in Mexico City.

TRANSLATING ENVIRONMENTAL SCIENCE FOR BOTH SIDES OF THE BORDER

It’s important to conduct scientific research along the United States – Mexico border but it’s equally, if not more important, to effectively disseminate that research to both sides of the border.

For the U.S.-Mexico Binational Center for Environmental Sciences and Toxicology at The University of Arizona, Denise Moreno provides the connection between research and the community.

As the program coordinator for the center, Moreno focuses on community outreach and science information education, according to a release from the UA College of Pharmacy.

“Environmental contaminants and health issues linked with them do not adhere to political boundaries, in other words, they do not need a green card to cross the border,” Moreno said in an e-mail.

Denise Moreno, program coordinator of the Binational Center. Courtesy of, Denise Moreno.

The purpose of the center is to highlight common environmental contamination problems and correlating public health issues along the border, she said. The center also strives to increase public awareness of the risks associated with the hazardous contaminants that occur in border regions, she added.

The center’s many research projects have spurred collaborations with universities and organizations on both sides of the border. These collaborations include; the Instituto Nacional de Salud Pública, the Centro de Investigación Científica y de Estudios Avanzados del Instituto Politécnico Nacional, the Universidad Juárez del Estado de Durango and more.

Their current research projects include; phytostabilization and phytoremediation of mine tailings, characterization, natural attenuation and bioremediation of landfill leachate plumes, arsenic and health and studying the long-term effects of heavy metals on children’s health.

Metal exposure, specifically arsenic and lead, via dust and chlorinated solvent exposure via groundwater are major health issues at the border, Moreno said.

In addition to the research projects, the center also focuses on outreach to border communities, environmental science workshops for graduate students, professionals and faculty, Spanish language information sheets and online textbooks.

The center offers short term (3-6 months) and long-term (1-3 years) fellowships to Mexican graduate students whose studies focus on environmental science, environmental engineering or environmental toxicology, Moreno said.

Moreno’s background as a native of Nogales, Ariz. significantly strengthened her interest in border health issues.

She was a part of her high school’s Science Club and implemented a health survey concerning the cancer/lupus clusters that were prevalent in her hometown. Through this early exposure to environmental science, Moreno recognized the significance of the collaboration between researchers and individuals impacted by the research.

“After becoming aware of the environmental and health impacts prevalent not only in my hometown but the entire border and how my community had become a sort of laboratory, I realized the importance of giving back information/education to the citizens impacted,” Moreno said.

There is a constant collaboration between the world of research and the world of ordinary citizens. The research conducted by environmental scientists can drastically impact communities but the voices of those communities can dictate the boundaries of that research.

Fortunately for organizations like the U.S.-Mexico Binational Center, individuals like Denise Moreno serve as the crucial link in this collaboration.

“I want the border to be viewed in terms of people instead of potential research projects that can be implemented,” Moreno said.

More Information:
Read the online Spanish language textbook, "Toxicología Ambiental: Evaluación de Riesgos y Restauración Ambiental." The textbook is fully translated and is provided as a part of the Binational Center's outreach activities.