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.

"CULTURALLY-FOCUSED” HIV/AIDS RESOURCES ALONG THE BORDER

Resources, such as education and training are critical to those both battling and treating HIV/AIDS.

HIV or, human immunodeficiency virus, damages the cells of the immune system and weakens body’s ability to fight infections, according to the WebMD Web site. The most advanced stage of the virus is AIDS, acquired immune deficiency syndrome, according to WebMD. There is currently no cure for AIDS and it can be fatal.

This disease doesn’t discriminate against any person regardless of age, gender or even race. Therefore treatment, care and educational resources are essential for everyone affected by the disease.

Fortunately, the AIDS Education and Training Centers (AETC) National Resource Center is an organization that facilitates and manages the dissemination of these resources.

The mission of the AETC is, “to improve the quality of life of patients living with HIV/AIDS through the provision of high quality professional education and training,” according to the AETC Web site.

The AETC serves all 50 states, the District of Columbia, the Virgin Islands, Puerto Rico, and the six U.S.-affiliated Pacific Jurisdictions, according to the center’s Web site. The center offers training to physicians, nurses, pharmacists, oral health professionals and more. This training is based upon the needs of the community and involves both hands-on training and clinical consultation.

The center also has several special initiatives, such as the United States - Mexico Border AETC Steering Team (UMBAST).

The centers involved in UMBAST include; the Mountain-Plains AETC, New Mexico AETC, National Minority AETC, Pacific AETC, UCLA AETC, San Diego AETC, Texas/Oklahoma AETC, HRSA HIV/AIDS Bureau and the Arizona AETC, according to the Web site.

Though this coalition, these centers work together to share resources and provide care to those infected with HIV/AIDS and living on the border.

Because of their proximity to one another and the border, these centers face similar healthcare issues, said Carol Galper, principal investigator for the Arizona Aids Education Training Center.

The Arizona Aids Education Training Center provides, provide healthcare professionals the resources and skills to care for those living with HIV and AIDS.

The HIV/AIDS statistics in both Arizona and Mexico are alarming. I was unaware of the severity and extent of the disease in both regions. The AETC has created a map and table that illustrates an overview of HIV/AIDS in both Arizona and Mexico.

According to the AETC National Resource Center Web site, “In Arizona, which has a population of 5,307,331, the total number of reported cases of AIDS from 1981-2004 is 9,320; the total number of reported cases of people living with HIV is 5,178.”

Also, according to the center’s Web site, “Mexico reported 182,000 people living with HIV and 115,651 AIDS cases in 2007.”

UMBAST provides invaluable HIV/AIDS resources and is not overwhelmed by the size of both the area and the population of the U.S. – Mexico border.

The U.S. – Mexico border is a diverse region with unique healthcare challenges. However, through UMBAST healthcare providers can collaborate to provide specialized HIV/AIDS care and resources for communities along the border.

Click play to listen to Carol Galper, principal investigator for the Arizona AIDS Education Training Center explain the purpose of the Arizona center, the mission of UMBAST and the need for AIDS resources along the U.S. – Mexico border.

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More information:
“Managing Patients in the Border Region”
Who: This workshop is available to physicians, physician assistants, nurse practitioners, nurses, and other providers serving impacted patient populations in the region.
What: A 2-day symposium to discuss current testing, treatments and screening issues for
TB, STDs, HIV, Hepatitis C and substance abuse. Also, to examine these epidemics locally, further develop clinical interviewing skills, share testing and treatment directories in order to share local resources and referral networks.
Where: Rio Rico, Ariz.
When: Facilitated discussion for Physicians, Physician Assistants, Nurse Practitioners and Nurses only: Friday, June 12, 2009 12:00 pm - 2:30 pm RSVP required. Conference: Friday, June 12, 2009 3:30 pm - 8:30 pm (includes dinner) Saturday, June 13, 2009 8:00 am - 5:30 pm (includes breakfast and lunch)
The event is sponsored by: The Pacific AIDS Education & Training Center, California STD/HIV Prevention Training Center, Francis J. Curry National Tuberculosis Center/UCSF, Pacific Southwest Addiction Technology Transfer Center, US/Mexico Border Health Commission, Arizona Department of Health Services, Division of Public Health Services, Tuberculosis Control Section.

Additional Information: RSVP is required. For more information or an application, please contact Joel Peisinger at (310) 794-2932 or send an email to jpeisinger@mednet.ucla.edu

ILLEGAL IMMIGRATION AND THE U.S. HEALTHCARE SYSTEM

The past five weeks I have focused on individual organizations that provide care along or across the United States – Mexico border.

This week, rather than focusing on a particular organization, I decided to take a much broader approach and explore the effects of illegal immigration on the United States healthcare system.

Illegal immigrants in the United States are in a sort of healthcare purgatory. They aren’t legally a part of the U.S. but they’ve abandoned their native country.

So when emergency strikes, which country’s healthcare system is responsible for their care? Who provides the care? Who pays for the care?

Illegal immigrants typically don’t travel with their health insurance card, let alone have any kind of health insurance.

Since hospital emergency rooms typically cannot deny medical care to any person, regardless of their legal status, emergency waiting rooms are nearly bursting at the seams trying to accommodate both U.S. citizens and illegal immigrants.

This increase in patients creates increased strain on doctors and could ultimately impact the quality of their care.



According to this video, in 2000, hospital emergency rooms along the border spent nearly $119,000,000 in unreimbursed care for illegal immigrants.

I was shocked by the statistics presented in this clip -- millions of tax-payer dollars spent on the healthcare of illegal immigrants.

I can understand the unfairness of this situation-- it isn’t fair to be forced to pay for a stranger’s needs. But it also isn’t moral to shut the doors and ignore someone in need.

According to the clip below, some Phoenix, Ariz. hospitals have reached their breaking point on this issue.



When I began watching this clip and saw the graphic “deporting patients” I was stunned. Once I watched the entire clip, I realized the hospitals weren’t acting with morally unjust motives. These hospitals have provided more than adequate care to illegal immigrants but ultimately, the costs outweighed any humanitarian effort.

Hospitals are million-dollar, life-saving businesses and cannot financially devote all of their resources to an outlet without any financial return.

We should never put a price tag on a person’s life but if the hospital goes under, no one can benefit from the medical care.

With the election of our new president, Barack Obama our healthcare system could see a dramatic transformation.



But this transformation is still not drastic enough to include illegal immigrants.



In this clip, I think President Obama makes a great point by recognizing that our healthcare resources are severely limited and must be applied to U.S. citizens before anyone else.

I agree with the president; before we can fix anyone else, we need to fix ourselves. It doesn’t help anyone to continue with a depleted healthcare system.

Even though both U.S. citizens and illegal immigrants have contributed to the current state of our healthcare system, this reform will be funded through the wallets of U.S. citizens and not the wallets of illegal immigrants. Thus, I think it is fair to focus on ourselves first.

More information:

• Read a chart that explains the various healthcare options around the world
• Listen to President Barak Obama's views on healthcare
• Read President Barack Obama and Vice President Joe Biden's healthcare plan

ANTIVENOMS FOR BORDER BITES AND STINGS

No matter which side of the border you get stung by a scorpion or bitten by a snake, the potentially fatal venom is unbearably inescapable and immediate medical treatment is crucial.

Fortunately, The University of Arizona's college of medicine is home to the VIPER Institute, which stands for, Venom Immunochemistry, Pharmacology and Emergency Response.

VIPER researchers study, “venom injuries” through the genealogy, or family tree, of venomous creatures to develop treatments such as antivenoms, said Dr. Leslie Boyer, founding director of the VIPER Institute.

Currently the group is working with a firm in Mexico, Instituto Bioclon, to develop an antivenom for scorpion stings known in the United States as Anascorp and in Mexico as Alacramyn.

“The work that I’m doing probably could not be done by either country alone. What the United States has to offer with our difficult [Food and Drug Administration] is the standard of proof, to say a drug is effective is very high,” Boyer said.

Dr. Leslie Boyer holding a snake. Photo courtesy of Margaret Hartshorn, senior photographer for Biomedical Communications at The University of Arizona, college of medicine.

VIPER consists of more than 125 national and international scientists and clinicians from all different fields and includes the doctors who participate in the clinical studies that test the potential antivenoms.

The FDA has never approved an antivenom for scorpion stings even though there are roughly 250 scorpion sting cases in Arizona and 250,000 cases in Mexico each year, Boyer said.

VIPER also collaborates with Dr. Alejandro Alagon from Mexico’s Instituto de Biotecnología, or Biotechnology Institute, in Cuernavaca, Morelos Mexico and is a part of the La Universidad Nacional Autónoma De México.

Through this collaboration, biochemistry students from the Biotechnology Institute and pharmacy and medicine students from the UA exchange research and learn from one another’s resources.

“By doing all of that together, we’re offering training opportunities for students that you couldn’t get in either country and we are developing drugs in a better way than you could in either country,” Boyer said.

This collaboration is partially funded through CONACYT, which is akin to the U.S. National Science Foundation, Boyer said.

CONACYT funds research and education at Mexican universities and has several collaborative programs at the UA, including the VIPER Institute. CONACYT indirectly funds the VIPER institute by financing the UA researchers’ travel expenses to Mexico to conduct this research.

VIPER is also developing a rattlesnake antivenom and researching the most cost-effective and overall efficient manner to deliver antivenoms to hospitals and patients.

The group began as an informal partner to the Arizona Poison Center in 2004 and in 2007 was granted institute status by the Arizona Board of Regents. It is funded through state and federal grants, including grants from the FDA and the companies that produce the antivenoms.

CARE FOR CAMPESINOS

Various Farmworkers. Photo courtesy of campesinossinfronteras.org.

Campesinos toil in the dark hours of early morning and into Arizona’s mid-day blistering heat.

A major struggle for these seasonal farmworkers is accessing proper healthcare. The work environment coupled with the health risks of the Hispanic race, create an unhealthy situation in desperate need of care.

But there is a glimmer of hope, Campesinos Sin Fronteras, a non-profit organization dedicated to providing health, housing and social services as well as advocacy for migrant workers and their families. The organization, established in 1997, also aids low to moderate income individuals in Yuma, Ariz. and rural communities like, Somerton, Ariz. and San Luis, Ariz.

"Most of them do not have access to medical services because they can’t afford health insurance,” said Hilda Lopez, executive assistant for the organization. “We go out and promote healthy lifestyles or we do health fairs where we give free medical services.”

Farmworkers typically suffer from stress and bone and joint problems from the demanding physical labor, she added.

“Because of the situation that they work in and because most of them don’t speak English, that creates a lot of stress for them and stress brings along a lot of other health issues,” Lopez said.

Campesinos spend hours laboring in the fields; a trade foreign to the average American. Despite the imbalance of labor, there is an even greater imbalance in access to vital healthcare.

Campesinos Sin Fronteras offers several programs to combat this disparity.

The Campesinos Diabetes Management Program assists individuals or the family of an individual afflicted with type 2 diabetes, Lopez said. It provides education about care and self management.

A volunteer with the The Campesinos Diabetes Management Program. Photo courtesy of campesinossinfronteras.org.

The organization also offers preventative programs such as, Alma, Corazon y Vida, or Soul, Heart and Life, which encourages healthy lifestyles choices to prevent cardiovascular disease.

Campesinos Sin Fronteras also offers housing services like, the Home Ownership Counseling Program which provides information and assistance to low-income, first-time home buyers.

This organization could not operate without the, “Promotores.” Promotores are employees and volunteers who serve as the link between the community and the resources.

A volunteer with Alma, Corazon y Vida. Photo courtesy of campesinossinfronteras.org.

These individuals are fluent in Spanish and work in community centers, churches, schools and even the fields to improve the health status of the community and eliminate health disparities.

The need for health care among campesinos, migrants and individuals living along the border is often ignored.
Campesinos Sin Fronteras fills in the gap between what is deserved and what is given.

Campesinos Sin Fronteras works with various community organizations, faith-based groups and local governments to provide care for more than 10,000 people each year, according to their Web site. The organization is funded through various state and federal grants.

HEALING ON THE LINE

Some Mexican citizens are willing to risk their life for a chance in the United States, battling Arizona's unforgiving summer sun and the callous landscape of the Sonoran Desert.

In the past 15 years, roughly 5,000 dead migrant bodies have been discovered along the United States-Mexico border, said Walt Staton, a volunteer with No More Deaths.

In 2004, No More Deaths, also known as No Más Muertes, was created to prevent death and suffering along the border and provide humanitarian aid to migrants crossing the border.

Volunteers find shade under a tarp at the Arivaca Camp tent, one of the migrant aid stations. Photo courtesy of NoMoreDeaths.org.

“What we’re trying to do is recognize that these are human beings, these are families, moms and dads and kids that are trying to figure out a way to make it in the world and we want to support that,” Staton said.

For many migrants their exhausting journey is thwarted by the United States Border Patrol. Within 24 hours of being caught, they are fingerprinted, identified and deported back to Mexico, Staton said.

But just past the portal of entry in Nogales, Sonora, Agua Prieta, Sonora and Naco, Sonora are the No More Death’s migrant aid centers. These centers provide basic health care for cuts, scratches and dehydration as well provide food, water and clothing.

“They come to us in just as bad if not worse condition then even when they were picked up in the desert,” Staton said.

A volunteer wraps the foot of someone at a migrant aid center.
Photo courtesy of NoMoreDeaths.org

If a migrant arrives in a more serious condition, such as diabetic shock, volunteers will transport him or her to a hospital. The volunteer will stay with the migrant and act as an advocate for him or her at the hospital.

“These migrant centers give people a chance to rest and relax and think about if they want to cross again or if they want to go home, if they want to go home we can get them bus tickets and things like that to get back,” Staton said.

No More Deaths works with the Mexican Consulate, the Mexican Red Cross and various faith-based and community organizations and operates entirely through donations.

Staton said doctors and nurses often volunteer at the migrant aid centers, but no matter their profession, these volunteers are saving the lives of migrants by attending to their physical and mental health.

Volunteers at the migrant aid centers also monitor the border patrol’s treatment of migrants.

In 2008, No More Deaths wrote a report as part of their advocacy for change in border policies. The report,"Crossing the Line", documented the border patrol’s abuses of migrants’ human rights.

As long as there is a division between nations and principles, the work of No More Deaths will be essential for those who fall in between the division.

Volunteers raise a flag with a green cross, a symbol of aid in Latin America. Photo courtesy of NoMoreDeaths.org.

“Immediately we’re […] assessing where the need is the greatest and where we are the most effective,” Staton said. “The ultimate future is to put ourselves out of business.”

A MOTHER'S SEARCH FOR HOPE

When Jenny Culver Hill’s son, Walter Ben, was diagnosed with autism, her search for answers was tirelessly echoed by the phrase, “There’s nothing we can do for your son.”

Since autism isn’t specific to any one family, let alone one culture, Culver Hill decided that help shouldn’t be either.

In 1998, she created Angel's Purse, an organization that provides practical assistance for families battling autism, particularly those who cannot afford the care and resources.

Based in her Nogales, Ariz. home, Angel’s Purse provides translations of autism information and resources into Spanish, a lending library of books and videos on autism and personal development, nutritional supplements and the Sensory Learning Program.

These nutritional supplements are provided at no cost. For the first five years, Culver Hill purchased all of the supplements, until manufacturers like Kirkman Laboratories and Nordic Naturals began donating supplements, she said.

“I’ve had kids who have turned around completely to the point where the doctor says, ‘Oh, I must’ve made a mistake, this child does not have autism,’” said Culver Hill, director of Angel’s Purse. “That’s pretty exciting. I’m a volunteer but the payoff is when the kids get better.”

The Sensory Learning Program is a 12-day intervention that “re-wires the hard drive” through a combination of motion, light and sound therapies, Culver Hill said. This program typically costs $2,600 but she offers it in her home free of charge.

“Imagine a big traffic jam and a detour because the new neuropathways that are formed are like detours around big traffic jams in their brain,” she said.

Angel’s Purse also hosts conferences every other year and has hosted two international conferences on Autism in Spanish.

Artwork by Walter Ben Hill. Cruella De Vil's car (top), The Little Engine that Could (Middle), and a tractor from Thomas the Tank Engine.

Culver Hill’s dedication to this cause has not gone unnoticed.

Ten years ago she discovered a group across the border called, “Venciendo al Autismo” or Defeat Autism. The group was created three years ago and is comprised of parents who have utilized the services of Angel's Purse since its creation.

Aside from the support of her family and a recently-hired assistant, Culver Hill manages Angel’s Purse on her own.

The organization operates entirely through donations but has been awarded grants from the Santa Cruz Community Foundation and has received $500 from the Nogales Masonic Lodge No. 11 for the past three years.

Culver Hill plans to focus on writing her book, “Wally B. Well,” about her experiences as a mother with an autistic child.

Culver Hill ignored the doctors’ hopeless prognosis for her son and created Angel’s Purse to find the answers that families on both sides of the border were searching for.

“I think there’s a social stigma about autism no matter where you live. I think parents are becoming more assertive in advocating for their kids because there’s a big problem that’s not being addressed,” Culver Hill said.