Community for Children – Harlingen, Texas

Posted by Elizabeth Losada, MD (a third year Pediatric resident from Kaiser Permanente, Oakland while on a global health elective in Harlingen, Texas with Community for Children).

On 10/21/12 I flew to Harlingen, Texas with my colleague Preeti Dave to participate in the Community for Children elective for four weeks.  Many people have asked me why I would spend 4 weeks in Texas in the middle of my third year of residency.  The Community for Children rotation is a very special elective that was set up by Dr. Martha Griffin, a community pediatrician in Brownsville, Texas.  She wanted to design an experience that would give residents and medical students a chance to serve an entire community and to get back in touch with the ideals that brought us to medical school in the first place.  This is a true community pediatrics elective.  The goal is not to see tons of patients in a clinic every day, but to work on projects with community organizations that have an impact more broadly.  Since the program is an elective through the university of Texas, there is also a classroom component with Spanish instruction and lectures on a wide range of topics that are relevant to border health — environmental health, immigration, international health, child abuse, and others ( Community for Children Curriculum).

Let’s take one step back and have a basic geography lesson for those not familiar with Texas geography (myself included before coming here).  Get out a map of the U.S. and look all the way down at the furthest tip of Texas, right on the Mexican border.  There you will find 3 cities, Brownsville, Harlingen, and McAllen.  This is the area we will be working in during the elective.  This region is called the Rio Grande Valley and is one of the poorest and most medically under served areas of the country.  A great percentage of the region’s children live in poverty and lack health insurance.  The families that Preeti and I will be working with during on our community project live in colonias.  Colonias are unincorporated, rural settlements that exist in border communities in which poverty is a way of life.  Many of the colonias lack basic amenities that most of us take for granted in America, such as paved roads, electricity, indoor plumbing, and garbage collection.  The residents of the colonias are mostly families that have lived in the U.S. for generations, as well as some recent immigrants.

The main reason we chose to come to Texas as opposed to doing true international work abroad, is that there is so much need right here in our own country.  The same type of poverty and environmental issues exist here in Texas and in Mexico.  Just because the international border is present, does not mean that the conditions really change.  In the past participants in this elective have crossed the border to do work in Mexico.  Unfortunately, due to the increased violence in the border region due to the Mexican drug cartels, we are unable to do work in Mexico at this time.  However, our community work in the colonias will provide a very similar experience and plenty of time to improve our Spanish.

Getting to Texas took much of a day.  We left Oakland in the early afternoon and arrived in Harlingen around 9:30 pm.  Our flights were all on time, and we easily picked up a rental car with a free GPS upgrade at the airport.  Then we tried to find our apartment in UT housing, which was only a few miles from the airport.  We literally drove around and around for over an hour.  The roads here have names like Loop 499 South and Loop 499 North.  Apparently, the GPS unit had no idea where it was going either, or what the difference in all the loops was.  Finally, Google Maps on our Droid was able to get us close enough and we found the complex, which was set back from the road and hidden behind a dental office and a large fence.

Since we were still on California time we then hit the 24-hour Walmart and a nearly 24-hour grocery store to get some basic supplies.  Everything is definitely bigger in Texas.  The stores were the size of large stadiums.  We spent a couple of hours wandering around dazed and confused under the fluorescent lighting and amid the piles of processed foods and cheap household goods.  Then it was home to take a nap for a few hours before getting up early to begin.

This first week was designed to be an introduction to the border region and its issues.  This would get us ready for our community projects which will begin in depth during week 2.  Our first day was a whirlwind of lectures about the region and the issues that pediatricians and community workers face in this resource poor environment.

Here are a few of the more startling facts:

• over 60% of the adults in the region cannot read a simple newspaper article in Enligh or Spanish
• high school dropout rates approach 70-80% in some of the colonias
• nearly 60% of the population in the colonias are obese and over 40% have diabetes.

From a medical standpoint, the community is very under served   The number of people in the population per doctor is about twice the national average.  A lot of the medical care that is available targets the “Winter Texan” retiree population, which spends several months of the year here.  Access to pediatric sub-specialists is sorely lacking, with the nearest location in the U.S. with access to these services being San Antonio (over 4 hours away).
Later in the week we learned more about what defines a border community and about the issues that the community faces having an international border dividing it into two.  We took a drive along the border fence, which stretches for hundreds of miles along the Rio Grande River.  The wall costs about $5 million per mile to construct, and in some places it literally divides people’s property.  Their home might be on one side and their cattle and crops on the other.  Interestingly, the wall is not the actual border itself in many areas.  Each side of the wall is still in Texas.

Environmental health is also a huge issue on the border.  With the establishment of the maquiladoras, especially after NAFTA was signed in the early 90s, the region was exposed to the by-products of heavy industry.  In Brownsville and Matamoros, Mexico they saw a large cluster of babies with neural tube defects, which helped spark a lot of scientific research on the possible link between NTDs and environmental pollutants.

We also explored the issue of immigration, particularly how it relates to children.  Due to increasing violence from drug cartels and gangs, as well as severe poverty and lack of opportunity, there has been a large spike in unaccompanied minors traveling from Central America to try to cross the border into the U.S.  These children make harrowing journeys through Central America and Mexico, often riding on top of trains for thousands of miles.  Many are victims of violence and horrible conditions in their home countries, and may be assaulted, robbed, raped, and even killed on their journey.  There is a great documentary that we watched, called “Which Way Home,” that follows some of these teens as they ride the trains.  If these children are picked up by the border patrol, they are detained in U.S. custody while they await their immigration hearings.  Since they are not U.S. citizens, they are not provided with attorneys.  This means that even elementary age children will go to court alone.  We toured some of the detention facilities that house these children, and also met with legal group called ProBar that works to educate them on their rights and options.

One of the most inspiring moments of the week was our trip out to a rural community, Pharr, Texas, to meet with the women of a community group called ARISE.  ARISE works with low income families in the colonias and surrounding communities providing classes and other outreach on topics like obesity prevention, diabetes care, healthy lifestyles, English classes, driving test preparation, non-partisan voting information, and enrichment classes for children.  The group targets women as potential agents for change in the communities, and provide information which they can use to empower themselves and their families.  Many of the women we will be working with started in the organization as volunteers and were trained to be promotoras, who go out and educate other women in the community.

The women we met were incredible people who have clearly overcome many hardships in their own lives and are dedicated to helping other to do the same.  They were so nice and welcoming and literally embraced us as we came through the door to meet them.  Each time a new person entered the room our conversation stopped and we had another rounds of introductions and hugs.  It was a warmth I have rarely experienced elsewhere.  For the next 3 weeks we will be accompanying the promotoras as they give classes and make home visits.  They hope we can use our medical knowledge to provide more information to those who need it.  We hope to learn about what they do and to contribute in some way, possibly by assessing how we could provide better outreach on diabetes and obesity prevention in the community.  Whatever it may be, I can tell that we are going to have an amazing experience with the women of ARISE over the next several weeks.