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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 3

After the child abuse conference, we headed back to Harlingen to quickly hit the gym and pack up for the long drive to San Antonio for the weekend. We’ve been pretty good so far about going to the gym at least 3-4 times each week, Elizabeth of course a little more so than me. When we headed out on our long drive, it was definitely getting dark.  We had heard the drive was a bit treacherous, in part due to truck drivers that drove slowly and a little oddly. Overall, it was true, in part due to construction, and random left turns people could make across the highway that one had to watch out for. We wanted to keep working on our Spanish, so we had a Spanish language station on and tried to give each other directions in Spanish. We kept waiting for the border patrol check point to come on our path. I know it sounds strange, we’ve told you guys that we weren’t leaving the continental United States for this trip (and honestly we haven’t), but apparently a lot of the South Texas border is regarded as a fluid area. So the checkpoints are farther north, I guess to keep illegal immigrants in the Rio GrandeValley and from getting into the rest of Texas. Apparently that has been an issue, where an infant is airlifted to a medical center further north, and the parents can’t go to the hospital because they fear deportation at the border patrol check point. Anyways, back to the drive. The check point finally arrived. We jokingly decided it was fine Elizabeth forgot her passport in the apartment, if they were going to ask documents of anyone, it would be me. As we drove up, there was a large dog (we really can’t get away from dogs in Texas apparently), probably the drug sniffing kind. He had not interest in our car and was tugging strongly towards the car behind us. The agent just asked us if we were American citizens, and in our best American English (yes, we switched back to conversing in English and turned off the radio as we waited in line), we told him we are in fact citizens, and he let us continue onward.

The rest of the drive was not that exciting. It was dark, and we kept seeing dark shapes on the side of the road, which we couldn’t decide if there were that many tires or if some were armadillos. Along the way, we told each other stories in Spanish. It was actually fun, and we both stayed awake for the 4 hour drive. We stopped halfway in Corpus Christi, and decided there’s a little more ethnic diversity there. We arrived at the hotel in San Antonio pretty late at night, and were informed that the hotel was full, so the room they gave us was all we would get. The next day, we explored the city with Elizabeth’s friend from college. She took us to a farmer’s market. It satisfied our need for fresh vegetables and Elizabeth’s for some gluten-free items. It was also nearby a part of the river-walk that wasn’t so touristy. We went to a gluten-free bakery for brunch, which was also great, though we may have over-eaten. On the way to the Alamo, a bee stung Elizabeth (I’m telling you, the bees are crazy here). She got ice for her finger from a very nice shaved ice vendor. The Alamo was interesting, although clearly presenting a one-sided view of history. Next we saw a toursity part of the riverwalk and later went to dinner at an awesome place called The Cove. It’s part dive, part carwash, part laundromat, and part playground. The food was great, as me the vegetarian and the two gluten-free people had several options each. Sunday we headed back to Harlingen with the food we had collected.

Monday we started working on the subjunctive in Spanish class. It was a special request amongst many of us, and the Spanish teacher had noted we weren’t that good with using the subjunctive appropriately in our presentations. Afterwards, we went to the third site, ARISE Muñiz. We have been getting better at the interviewing and handling a group, although we’re still working on redirecting the group. Obesity and diabetes are big issues again. Main points seemed to be again the access to fresh vegetables without “chemicals”, lack of safety outdoors due to roaming dogs and cars driving too fast, and kids only wanting to eat certain foods.  Many of the participants have worked in or have family members that work in “labor”, meaning in the fields harvesting crops. They reported that they used to be able to take some of the harvest home to their families and some of it would appear in local markets. Now they could lose their jobs if they’re found with any of the crops, which are shipped off in large trucks. Also, the soil in the area isn’t good for growing a sustainable garden in their own yards; apparently the big farmers bring in special soil, etc to grow their crops. They also complained about paying what they thought were hospital bills for surgeries, etc, and years later having collections agencies after them for apparently unpaid hospital bills plus lots of interest. Many of them still trust having their medical care in Mexico when safe to cross the border to do so.

We went on a great home visit this morning as well. We interviewed a great-grandmother, and she told us about her family, and how they came to have the home they have now. Apparently they used to rent land, and pay exorbitant prices for the water and electricity bills to the owner. The family did not earn much as laborers, and it was hard to get ahead. One of her sons was deported for breaking a window, but at the time she couldn’t be watching him all the time because she always had to work in the fields with everyone else to feed the family. Recently, Proyecto Azteca, formed by local community groups, has helped them and many other families (about 35-60 homes per year on their website) own their own land and build their own homes. Señora Tere reported that they had helped them secure land with a low-interest loan, and helped with the building of the home, which seems to surpass code. The program sounds a lot like Habitat for Humanity for those familiar with that, in that the family helped build their own home. Now, she reports they pay less for their water bill and not much more for electricity despite now having air-conditioning. Proyecto Azteca even put a ramp up to the front door so that when Señora Tere is no longer able to walk, she can still gain access to her home. She even has an amazing oven to bake bread, grows some vegetables, and had gallos and gallinas (roosters and hens) running around the yard with a few well-behaved dogs keeping an eye on the proceedings. She even pointed out a few of the other homes in the area built by Proyecto Azteca. They are sturdy, built above ground likely to avoid flooding common in this area. Señora Tere was wearing a “Best Grandma” T-shirt, but had never known what it said until we translated it for her to Spanish.

Tuesday started out great. After Spanish class, we went to the Las Milpas site for ARISE, and found at least 50 people starting a march from the site down the street, replete with reporters from American and Mexican news channels, newspaper reporters, etc. Tuesday was election day as you may have guessed, and they were marching to remind people the importance of voting. We were supposed to find someone to direct us to the Salud class, but incorrectly assumed that it must be cancelled for the class. So when someone invited us to join the march, we did. It was empowering, they walked several blocks down to a polling station. Ramona, the coordinator of civic involvement, realized we were there, and told us that Nasaria and the rest of the ladies in the health group were waiting for us. So we headed back to that house from last week, and again met many of the same women again, this time with more direct questions for them. There was a nurse from UT PanAmerican (aka PanAm) that had been talking about diabetes to the group. So we skipped formalities since everyone else knew us, and started quickly interviewing people individually or in small groups. Most people reported similar information, that HEB or Junior’s was their access to fresh vegetables, if they didn’t have a car, a neighbor could take them since the public transportation system in the area is essentially nonexistent or at least not accessible or useful to most. There was discussion again about the dogs and drivers not heeding children, especially on the weekends.

We headed back to the Las Milpas site for lunch with the big group, and that’s when things took a turn for the worse. We parked across the street from the site, completely legally in the spot, when an 89 year old uninsured driver without his glasses decided to make a tight right turn in to his driveway and hit our front left bumper. But he didn’t stop. He just kept turning, and pulled the left side of our bumper out. He then parked in his driveway, and came out yelling at us as if it was our fault for existing. Ramona appeared, and helped mediate the situation. She calmly told him that he had hit at least 4 of their parked vehicles before, which he tried to deny. His stepson, however, confirmed he had been hitting parked vehicles, and was even followed recently by the police for weaving on the street. The Pharr Police came right away, found him at fault and issued him citations, but we still spent the rest of the day dealing with insurance companies and our car rental company, instead of working on our projects. We felt bad we couldn’t do home visits, but there was just so much to do (and still is). The only positive aspects of this incident is that hopefully this man will be off the road now that his license was taken away from him, which will prevent him from hitting a child and possibly killing them. Also, we saw a bit of McAllen on the way to the airport to trade in our car, including some grandiose mansions with mega security. Later we realized that we had both been bitten several times by bugs, likely mosquitos.

Wednesday through Friday we had various visits with all the participants of CFC. We visited Dr. Griffin’s office at BrownsvilleCommunityHealthCenter, a federally qualified health center, and learned about how it worked. It was a beautiful new building, but my cell phone service provider decided I was in Mexico and therefore roaming (again, I promise all of you we’ve stayed in the United States). We also visited a private pediatric clinic where Dr. Fisch works in Harlingen. It was good to hear about all the things people have to think about in terms of efficiency and economy when running their own practice. Thursday and Friday we met with Senator Eliot Shapleigh, former Texas state senator from El Paso, Texas, and his accomplished wife Joyce Feinberg. It was a great experience, and he really got into how a community works towards improvements in their health, such as giving people options other than the payday advance companies that charge 1150% interest on payday loans (yes, I did mean 1150%, or paying back more than $3400 for a $300 loan), how to start a medical school in the area and how that can help jobs and the economy, and overall how to address problems in the community. We went to another federally qualified health center, Su Clinica in Brownsville and met with Dr. Rose Gowen, an Ob/gyn there as well as Brownsville’s current city commissioner. She talked about her work, such as convincing the city bike lanes and sidewalks were needed and helpful to the community. We also crossed the border wall again (but were still in the United States). We went to a preserve called Sabal Palm Sanctuary and learned about the native plants and animals, as well as took a little walk. Thankfully that had free deet and deet-free bug spray to use. Thursday evening there was a dinner party with Senator Shapleigh and many like-minded people from the Brownsville Community. Friday we went to a meeting in Mercedes of several community groups working together to provide affordable housing amongst other issues. We saw Ramona and Esperanza from ARISE there! It was a great surprise. These past few days have been great to see how much people can do when they work together, and that it is a frustrating process many times, with special interests and bureaucracy obstructing the way to positive changes in the community. Elizabeth and I have been making calls these past few days, trying to catch up from the day lost on Tuesday. We’ve been gathering information from hospitals on dog bites seen in the local ERs and on laws and resources available in the community. We’re hoping it all comes together next week.

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