Trip to medical clinics on border brings classroom lessons to life

Trip
to medical clinics on border brings classroom lessons to life
…………………………………………………………………

BY B.J. ALMOND
Rice News Staff

Rice sociology
student Kendall Moseley was caught off-guard when she took
a field trip to the health-care clinics at the Texas-Mexico
border between Harlingen and Matamoros.

“I expected
a poverty-stricken, spiritless medical team swamped with
depressing circumstances,” she said.

What she found
was “remarkably positive and optimistic” personnel,
despite their having to work in clinics where an X-ray machine
is considered a luxury and where laboratories have less
equipment than some of the facilities at Rice.

Moseley was one
of 23 students in the Sociology 399 class who ventured out
to Harlingen and Matamoros Feb. 28. The class, Immigration
and Public Health, includes students at Rice and The University
of Texas School of Public Health at Houston.

Katharine Donato,
Rice associate professor of sociology, planned the field
trip to supplement the lessons she has been teaching in
the classroom. “I wanted to bring to life what the
students had been reading about and make it real for them,”
she said.

Donato felt
that the South Texas border would be an ideal place to observe
the health-care issues posed by migration, so she used the
Department of Soc-iology’s Walter Hall Fund to cover
plane and bus fare for the trip. Accompanied by Donato and
Associate Professor of Sociology Michael Emerson, the class
flew into Harlingen and then chartered a bus to the Texas
Department of Health’s (TDH) Region 11 headquarters,
where they learned more about the United States’ and
Mexico’s joint effort to lower the rate of tuberculosis.

TB, an infectious
disease of the lungs, is more common at the border, where
it is easily transmitted. In the early 1990s, TB rates were
higher at the border than elsewhere in the United States
or Mexico. Physicians were not always treating TB in the
same way, and different tests were being used to diagnose
the disease on opposite sides of the border. Health officials
were particularly concerned about drug-resistant TB, and
as a result, they received funding for a binational TB project
from the Centers for Disease Control and Prevention.

Domingo Na-varro,
TDH program manager for the TB Elimination Project, told
the Rice and UT students about the binational project. The
United States wanted to get Mexican clinics to improve compliance
rates for the standard four-drug therapy treatment for TB
and to use direct observational therapy, because an estimated
40 percent of TB cases in Mexico were not treated in their
entirety. U.S. physicians also wanted Mexican clinics to
use an X-ray and blood test to confirm the disease rather
than only clinical observation of a cough and a positive
sputum smear test.

Other TB-related
issues were explained to the class, including the difficulty
of treating patients who have developed resistance to multiple
drugs, the differences in the cost of medication and how
treatment is paid for in the two countries and provisions
to alert physicians across the border when a patient with
TB may be in transit.

Donato said
the binational TB project appears to be successful, because
the rate of TB in Harlingen’s region 11 has dropped
to 150 cases in 2000 from 400 in 1992.

Other health
concerns at the border include sexually transmitted diseases
and diabetes. Because diabetes is more common in Mexicans
and the prevalence of the disease is higher among residents
at the border than in the United States and Mexico, health
officials along the border have started a joint effort similar
to the TB Elimination Project to address the problem.

Students on
the field trip were able to view the TB clinic at the Harlingen
facility and then cross over to Matamoros to observe its
clinic. Donato noted that the class was particularly alarmed
by an X-ray that showed only one lung in a patient whose
other lung had been ravaged by TB.

Seeing such a
dramatic case can make an impression on students and help
them realize the magnitude of the problem confronting public
health officials, Donato said.

She learned
the value of field trips while spending two years as a member
of the Binational Study on Migration Between Mexico and
U.S. To help develop a document that will guide immigration
policy for the 21st century, Donato and the 19 other members
of the study (10 each from the United States and Mexico)
visited such places in Mexico as Mexico City, Guadalajara
and Oaxaca. They also visited the barrios of Chicago to
meet immigrants and see their problems firsthand.

Donato was grateful
that the health officials in Harlingen and Matamoros were
so accommodating of her request to bring students there.
Domingo told her his hope is that some of the students might
return after graduating to share their expertise and work
to solve the public health challenges.

Moseley said
the experience had an impact on her education and career.

“As an
aspiring doctor, headed to Baylor College of Medicine next
year, I know I am in for pages and pages of diagrams, articles
about health policy and maybe a medical Spanish class or
two,” she said. “But it was not until our trip
to the border that I realized how important it is that I
absorb each fact and figure that I will forever see regarding
health care and apply them to real people.”