Community for Children – Harlingen, Texas

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

Week 2

This first weekend we decided to start exploring the Rio GrandeValley. Luckily for us northern Californians, it was unseasonably “cool” (low 70s Fahrenheit) We went to the Brownsville Zoo on Saturday, apparently one of the top 10 zoos in the United States. It did not disappoint. We fed the giraffes (talk about big tongues!), and had a good time watching some of the more active primates. When we sat down to eat in a “human” eating area, there was a male peacock hanging around. I have to say, he was a more entertaining scavenger than the usual pigeons and seagulls. Afterwards, we went to a Dia de los Muertos street fair in downtown Brownsville. On the way, we found a coffee shop called “El Hueso de Fraile”, which seemed like a very hip local hangout, complete with local artwork and a live band in the evenings. The fair was small but full of arts and foods, and we realized that we were only a block from the border crossing between Brownsville and Matamoros, Mexico. Sunday we went to Laguna Atascosa, a wildlife refuge. We did not see the famed ocelots except in an exhibit, but we saw plenty of birds, butterflies, and ants. We went on 2.5 mile walk, which really exhibited the local flora. There was also a nice drive where we stopped to take pictures and could see tall buildings of South Padre Island in the distance.

Monday I gave a little presentation in Spanish class on diabetes (Elizabeth had done hers last week). ARISE was celebrating its 25^th anniversary and had cancelled its meetings for the day, so we had the day to ourselves. Elizabeth and I headed down to South Padre Island. We eventually found the beach, which was nice, white sand just like the pictures and video you see of South Padre Island, just without all the spring-breakers thankfully. On the way back to the car, we were walking on a well-marked path that was unfortunately between flower bushes, and I was stung by a bee on the toe. So instead of going to a bird sanctuary, we went to CVS for some first aid supplies. In the end, I was doing alright, so we went on a sunset dolphin watch as planned. It was great, apparently the dolphins were in a good mood, because they came to play in front of our boat a few times. The tour boat operators of Breakaway were good about pointing out local landmarks and going over the history as we passed by certain areas.

Tuesday after Spanish class we went to our first Health Class (or Clase de Salud) at the Las Milpas site of ARISE. The class is in a volunteer’s home, and they were all happy to meet us. Entertainingly, I was “outed”. One of the attendees figured out I am not Mexican, but “una Hindu” as she put it, and everyone else gathered around to study my features. Some suspected I was not Latina, based on my eyes or nose, but most people had initially decided that I was of Mexican descent (or mixed) and just had not learned Spanish as a native language. The real shocker was when blond haired Elizabeth reported she’s half Colombian. Eventually the ladies decided Colombians are fairer than others, and her “Anglo” blood was stronger in her features. When we casually began interviewing this group, the ladies really had their act together, they knew what to do for diabetes, how to prevent diabetes, reported (and showed pictures of) children and grandchildren with normal BMIs who exercise regularly and willingly eat vegetables. So Elizabeth and I were not sure how our project would go, since we hadn’t yet really found a need. We lunched at ARISE, and returned in the evening to observe an English class for kids. Our presence made the college-aged teacher nervous, and I think I messed up a game about seasons. We decided to stick to the Salud classes from now on.

We talked with Marsha about our project, because based on the first day, we didn’t think that our original plan of a survey of the women about diabetes specifically would yield much new information. Marsha recommended keeping it open ended, and asking about what was missing in the community, and what could local pediatricians do to help. Wednesday we went to the SouthTower location for ARISE. I wanted to get back in the car when I saw some loose dogs start lining up, but we walked on into Arise. Two loose pitbulls on the street ferociously barked as we passed by. The Salud class had been cancelled, so the class coordinator had brought in women for us to interview. This was a little more formal than the day before. We had some trouble redirecting an interviewee, but overall we did gain good information about the needs of the community. They reported children often have access to nutritious food including fresh vegetables if the parents provide it, but around the pre-teen years, they start demanding unhealthy food. Also, adults assume kids exercise at school, and at home the kids play out on the patio but aren’t allowed onto the street due to fear of dog bites from the loose dogs and cars driving without regard for children. They didn’t know of any regular after-school sports, dance, or other exercise activities in the area available to their school-aged kids.

We also did a home visit. Driving through the neighborhood helped us to understand that the colonia around the SouthTowers site was not as successful yet as the Las Milpas colonia. There were also more loose dogs and ferrel cats. The home visit was a good experience. This mom told us about having difficulty accessing medical care because she does not drive, so if a neighbor can’t take her or her children to the appointment, she has to cancel the appointment, even for preventative care. If the appointments were in the evenings or weekends, her husband could drive her there. Groceries are an issue too, and she echoed what women had earlier in the day, that if someone can’t drive to HEB (the local supermarket chain), the local food marts mostly have junk food. While we sat talking to her on the porch, some dogs chased a car driving down the road. Some of the ideas we started formulating after these visits included a nutrition class for the 8-12 year olds, and organized sports, dance, and other activities in a safe environment for children and teenagers.

Thursday and Friday we attended the second and third days of a Child Abuse Conference held on South Padre Island. Although it was a worthwhile experience and I learned a lot, I do not deny it was difficult at times to watch and listen to the talks. Friday morning was a moving story of 3 siblings locked in a bathroom for at least 9 months that had been in the news a few years before, and the medical and legal aspects of the case from the doctor and lawyers involved with the case. The daughter reported sexual abuse immediately when the officers arrived, so the children were taken to a location appropriate for that. When they mentioned how skinny the kids were, we and other MDs  immediately thought of refeeding syndrome, but I never thought about whether first responders would know about what to do with starved children. So they started consuming high calorie foods immediately and were soon vomiting before they went to the ER. Thankfully the stepfather was found guilty and the mother pleaded guilty, and now the kids overall are doing well. Dr Griffin joined us at lunch, so we were all able to check in with her about our projects. It was nice to hear that we all were facing obstacles and Dr Griffin was helping us all through it. She suggested we try to work on the dog problem, to collect data on dog bites by calling local ERs, and researching other aspects of that issue. Given the time we have, it makes sense to try to focus on a definable aspect of the obstacles related to health.