Border Health: Meeting the Challenge

A Hunt School of Nursing student performs a blood pressure screening on a woman at a health fair

In the wake of the coronavirus pandemic, the existence of Texas Tech University Health Sciences Center El Paso has never been more important. Even before El Paso’s first COVID-19 case was reported in March, our university was preparing for the many roles it’s now serving during the worst public health crisis in a century.

We’re fulfilling our role as a source of expertise by providing accurate information about the disease – and how to protect ourselves from it – to our Borderland residents, in English and Spanish. We’re on the front line, treating the sick as we educate culturally competent physicians, nurses, (and soon, dentists), many of whom will remain in El Paso and the surrounding region to practice. We’re adding to the ever-growing body of research on COVID-19 by sharing our insights with the world as we learn more about the disease.

In essence, we’re fulfilling our mission of improving the lives of people in our majority-Hispanic community and beyond by addressing the unique challenges of public health along the U.S.-Mexico border. This issue of TTUHSC El Paso Alumni & Friends offers a broad overview of university initiatives that are helping to reduce – and hopefully someday eliminate – health disparities in border communities.

 

Hispanics and the Future of Texas

Dr. Wendy Woodall performs a dental exam on a man at a health fair.

Border health is particularly salient for Texas, where Hispanics are predicted to become the state’s largest population group before 2022, according to the state demographer. As a group, Hispanics face a number of troubling chronic health issues, including obesity and high blood pressure. Hispanics are also more likely to die from diabetes and chronic liver disease than non-Hispanic whites.

A TTUHSC El Paso student hands a bag of essential items to a man at a health fair.In El Paso, obesity remains a growing and troubling trend, as the condition often leads to a cascade of health problems, including Type 2 diabetes, hypertension, heart disease and certain cancers. The percentage of obese adult El Paso residents grew from 23% in 2004 to 29% in 2016, according to the County Health Rankings & Roadmaps program. Lifestyle plays a major role in these chronic diseases, hence the need for TTUHSC El Paso’s health education and outreach programs.

 

Pandemic Exposes Racial/Ethnic Disparities

A TTUHSC El Paso student and two middle school students dressed in surgical gowns and masks work on a hands-on project. As COVID-19 surges through the U.S., researchers are beginning to comb through race and ethnicity data connected to the disease. Their findings show that communities of color suffer disproportionately from the virus. Health issues such as obesity, diabetes and heart disease are factors behind the disparity, but so are the social realities of Hispanic, Black and Native American communities. These groups are more likely to work essential jobs that put them at high risk for viral exposure. They’re also more likely to come home to multi-generational households and spread the virus to vulnerable family members.

COVID-19 has further laid bare racial and ethnic health disparities, and the disease threatens to turn back the public health progress we’ve made in our border communities. The faculty, students and public health workers of our health sciences center are needed more than ever. We invite you to read on to learn more about how TTUHSC El Paso is meeting the border health challenge.

 

Going the Extra Mile

TTUHSC El Paso Care Van brings health care and health education to underserved communities

Four students from the Foster School of Medicine stand in front of the TTUHSC El Paso Mobile Care Van in Sparks.

A challenging – but very real – aspect of life on the U.S.-Mexico border is the existence of colonias, neighborhoods outside city limits that lack basic infrastructure due to socioeconomic factors. In El Paso County, and across the southern border of Texas and Southern New Mexico, thousands of people live in colonias, and many go without basic public transportation, adequate health care, and in some cases, necessities like electricity and running water.

Thanks to the Foster School of Medicine’s Student Run Clinic (MSRC), and other initiatives led by faculty and students at Texas Tech University Health Sciences Center El Paso, residents from colonias in El Paso County can be seen by a health care professional and screened for diseases like breast cancer and cervical cancer. It is often the only health care they receive because of a lack of insurance, transportation or money needed to see physicians in the city.

In fall 2019, TTUHSC El Paso was given even more means of providing preventive and primary care to underserved communities thanks to the gift of a mobile health unit. The Caring for Children Foundation of Texas generously donated the full-time, exclusive use of a Care Van, which is being used by the MSRC and several departments within TTUHSC El Paso. The Hunt School of Dental Medicine’s future clinic also plans to use the van to bring dental care to colonia residents.

A man cares for a child and her mother during an immunization clinic in Sparks.The Caring for Children Foundation of Texas, sponsored by Blue Cross and Blue Shield of Texas, pays all costs associated with the van, including insurance, maintenance, tolls and gas.

Mobile clinic services include early childhood vaccinations in partnership with Immunize El Paso; blood pressure, blood sugar and cholesterol screenings; and basic wellness and dental health assessments, as well as education for all family members. Some of the communities and colonias served by the mobile clinic are located in the Montana Vista and Sparks areas just outside El Paso city limits.

The Care Van didn’t take long to hit the road, and visits began early this year. A vaccination clinic in January kicked off the first stop in the Agua Dulce community. Agua Dulce is a low-income, rural area in Far East El Paso, and many of its residents are uninsured. The van also made a stop in two areas of Southwest Texas, Alpine and Van Horn, to provide services associated with TTUHSC El Paso’s epilepsy outreach clinic, led by the Department of Neurology.

While promoting the university’s mission of improving the lives of people in our own community, the Care Van also allows TTUHSC El Paso to focus on the unique health care needs of border and rural populations well beyond El Paso.

 

Healing Hands

Volunteer physicians see beyond borders when caring for vulnerable populations 

As a Texas border city, El Paso has been at the forefront of a humanitarian crisis that began in 2018. Though border migration has long been an aspect of life in the Paso del Norte region, all eyes were on Southwest Texas as the number of U.S. Border Patrol apprehensions rose dramatically throughout 2018 and 2019.

Volunteer residents from TTUHSC El Paso work in a hospitality center that houses asylum-seekers.Seeking asylum, and fleeing extreme poverty and violence, immigrants from countries including Mexico, Honduras, El Salvador and Guatemala arrived in the United States in droves with hopes of finding safety and refuge.

In 2019, the U.S. Border Patrol reported 851,508 apprehensions – an eye-opening climb from the 396,579 apprehensions reported in 2018. Following processing, U.S. Customs and Immigration Enforcement released many of these asylum-seekers to nonprofit, volunteer-run shelters throughout El Paso. Their journey from one country to another, however, meant that health care services were critical, especially for children.

With nowhere else to turn, the immigrants relied on services provided by volunteer physicians, both in El Paso and from across the country.

Blanca Garcia, M.D., a Texas Tech Physicians of El Paso pediatrician and assistant professor in TTUHSC El Paso’s Department of Pediatrics, is among several physicians who have volunteered regularly since the end of 2018. Dr. Garcia works primarily with hospitality centers run by Annunciation House, a local nonprofit that houses asylum-seekers.

She remembers the first time she volunteered to help children in the shelters.

“One Friday night in October 2018, I received a text about a group of approximately 80 migrants, which included many families with small children, who had been released in front of the Greyhound station downtown,” Dr. Garcia said. “The group was organized by local police to walk approximately a mile to a nearby parochial center, which was being transformed into an emergency shelter. There were sick kids in the group, and the call came for anyone available to come see them.

“Many TTP El Paso pediatricians and pediatric residents came in that day and spent the evening triaging and treating the sick children. I was one of them, and I have been volunteering and helping to organize medical volunteers for this cause ever since.”

Dr. Garcia said she and fellow volunteer physicians mostly treat common childhood illnesses, including acute gastroenteritis – characterized by diarrhea and vomiting — as well as colds and other viral illnesses.

In 2019, the U.S. Department of Homeland Security implemented the Migrant Protection Protocols, which sharply reduced the number of asylum-seekers released to local shelters. The protocols require asylum-seekers to remain in Mexico while they await immigration hearings in the U.S.

Since then, Dr. Garcia and other volunteer physicians are called in on an as-needed basis – but it doesn’t change the important, behind-the-scenes work of physicians who see no borders when it comes to health care.

“Many of the children we see have endured tremendous physical and psychological stressors. Difficult travel histories, poor nutritional status, environmental exposures and toxic stress make them high risk for complication from common childhood conditions,” Dr. Garcia said. “Not only do these families have limited resources, but they are also limited by fear.”

Though they are just one stop in their patients’ journeys to better lives, volunteer physicians like Dr. Garcia and the faculty at TTUHSC El Paso are a reflection of selflessness and compassion, lending helping hands to all in the community that surrounds them.

 

Education Without Borders

Curriculum at TTUHSC El Paso prepares students and residents for challenging work in border regions

Future physicians at the Foster School of Medicine not only learn medical Spanish as a requirement, but are offered electives geared specifically toward becoming a doctor in border communities.

During their Family Medicine course, fourth-year students at the Foster School of Medicine can take the Border Health Spanish Immersion elective, which provides the opportunity to work with residents in Presidio, Texas, while improving their Spanish skills. Additionally, students engage with the border community while understanding challenges faced by patients and providers regarding access to primary care.

Opportunities to learn more about border health are also extended to TTUHSC El Paso residents. The Department of Pediatrics has implemented a border health curriculum for all pediatric residents, especially those interested in better understanding underserved Hispanic populations on the border.

In the beginning, Norbert Donias, M.D., a first-year pediatric resident at TTUHSC El Paso, thought the course was just about helping people in the community who didn't have access to health care resources.

"What I experienced was more eye-opening than that," Dr. Donias said. "I saw how scared these populations can be, not having access to health care – how they live in constant fear. I saw that many don’t know what their resources are and it affects them greatly."
Dr. Donias said the experience has affected how he will interact with patients in the future. For him, it's not just about providing health care, but learning about the daily lives of those in underserved communities and how a lack of resources could be affecting their health.

A group of TTUHSC El Paso residents stand in front of a wall with a mural that says “Esperanza.”

According to Lisa Ayoub-Rodriguez, M.D., assistant professor in the Department of Pediatrics, part of the curriculum in Fall 2019 and Spring 2020 included visiting several sites throughout El Paso, including the Annunciation House migrant hospitality centers, the El Paso Federal Immigration Court, and U.S. Customs and Border Protection. Residents also visited with local immigration attorneys and several other community experts.

During the elective course, residents worked with community partners, including Project Vida, to provide supervised medical care in El Paso colonias. The goal of the elective is to build a strong foundation of understanding of the border population, which will allow physicians to become advocates for the underserved.

Dr. Ayoub-Rodriguez’s goal is to make the course available to residents in other departments in the future, expanding their knowledge of border communities, and border medicine, even further.

No matter where TTUHSC El Paso residents resume their careers, the university’s mission of training compassionate, culturally competent doctors prepares them to care for diverse communities both on the border and across the United States.