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).

OUR SECOND WEEK….

…..in the Rio Grande Valley actually started with some recreation.  This area has some great things to offer in the way of wildlife and outdoor activities.  We visited the Brownsville Zoo, which is one of the top 10 zoos in the country.  The zoo was quite nice with open air exhibits featuring a very diverse range of animals from around the world.  One of the highlights was getting to feed giraffes some small branches.  This area is also known for its birding, and this time of year is a fantastic time for seeing the migratory birds as they make their way down to Mexico and Central America for the winter.  We took a great hike in the Laguna Atascosa National Wildlife Refuge.  It is known as an ocelot refuge and a home for alligators.  Unfortunately, we did not see either of these cool species.  But we did see a wide variety of colorful birds around the lake and surrounding marshes.

Finally, we took a sunset dolphin cruise out of South Padre Island and were amazed to see groups of dolphins swimming and jumping in front of our boat for several minutes at a time!  They are quite playful and majestic animals.  None of the pictures we took, in which we were lucky to catch a sliver of the dolphins, can do the experience justice.  We also were given a tour of the Port of Brownsville and Port Isabel. Unfortunately, the shrimping industry, which used to be huge here, has been decimated by high fuel prices among other things.  This explains why I have been eating flash frozen shrimp from the Pacific Northwest while here.

We started our work with the women of ARISE by attending a ‘grupo de salud’ with a promotora in the Milpas colonia.  The groups are held in the homes of women in the community and meet weekly.  Women attend the group to develop a support network and to obtain information about healthy eating and lifestyle changes.  The promotoras have been trained to weigh the women, and to check their blood pressure and blood glucose.  Over 3 month cycles the values are tracked and the women can see the progress that they are making.  Often guest speakers, such as nurses from the local universities, will come and give a talk on a health topic to the group.  The women will also go for a walk together and prepare a healthy meal, like chicken salad.

Our first day we really did not do much.  We chatted a bit with the women in Spanish about their children and grandchildren.  But we did not discuss health topics with them. The plan had been that we would be interviewing the women about obesity and diabetes in children in the community, and determining what interventions we might be able to make to help with prevention.

After the group was over, we returned to the ARISE center for lunch.  There were 2 nuns visiting the center as well.  One was from Albany, NY, and the other was from Mexico.  The Mexican nun sat with us and grilled us in Spanish about our backgrounds, training, and experience in Texas so far.  We also learned a bit about her work in Chiapas, where she was trained in herbal medicine by indigenous leaders, and her time spent as a healer in other parts of rural Mexico.  She was quite an interesting lady.  After lunch it seemed that the women did not know what to do with us.  They assigned a local college student volunteer, who spoke English, to give us a tour of the center.  Since it is a small building, this was over rather quickly.  The student was not doing her work because she felt obligated to entertain us.  So we finally excused ourselves for the day.  Overall, we were a bit confused by our first day since it felt like we had just been shadowing and not working on the project we had been asked to do.  We clarified with Dr. Griffin that we were indeed supposed to be conducting interviews and not doing, as she put it, “medical tourism.”

The next day we traveled to another ARISE location, which serves the South Tower colonia.  Unfortunately, the ‘grupo de salud’ that usually met at the center had been canceled.  But many of the women had shown up and we were able to sit down and interview them.  Several themes quickly emerged.  All of the women felt that obesity and diabetes were huge problems in their community, especially obesity in children.  Lack of exercise was a huge contributing factor.  Due to dangerous dogs that roamed the streets, speeding cars, and high crime rates, there is no safe place for their children to play.  Other than gym class at school, they have very few outlets for physical activity.  Diet also was a big problem, with many families lacking access to fresh produce due to lack of transportation to get to grocery stores.

The visiting sisters then returned for lunch again, and gave presentation on projects they felt would benefit the community.  The sister from Albany showed the women how to do deep breathing for relaxation and some simple massage techniques.  Our friend visiting from Mexico had a project in which people could learn to build herb gardens from old tired  herbs that could be used medicinally and then be grown.

After lunch we made a home visit to a mother who uses many of ARISE’s services for her children.  She lived in an extremely impoverished area of the colonia where the house were in very poor repair.  We smelled raw sewage and saw a group of pitbulls chasing after cars in the street.  Dirty, feral kittens were running around her yard and her toddler was happily chasing them. For her kids, basic access to pediatric care is very difficult.  She had no car and had difficulty getting rides.  Her husband worked 12+ hour days in the fields, and might be able to drive the children after work.  But then she would need to access clinics late at night or early in the morning.  Her son had recently been stung by a bee and had anaphylaxis.  Luckily, she was able to get him medical attention, but was worried about not being able to pay the bill for the ED visit.

We left the home visit feeling incredibly saddened and angered by the severe poverty this family lived in and the obstacles they faced in having their basic needs met.  The pitbulls in the street put an actual image on the problem them women had described earlier.  And we noted that feral cats also appeared to be a big issue as well.  Perhaps doing a project on how the community could deal with the stray dog (and cat) problem would have a big impact on these families.

The rest of the week was spent at a conference on child abuse.  It was well done, but really depressing.  By Friday afternoon we were ready to escape to San Antonio for a weekend in a larger city.