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