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).

Week 3 – CfC

We started the week in Edinburgh with a grupo de salud at the ARISE center.  The ladies in the group ranged in age and were all mothers and grandmothers.  Just as had happened in past groups, the ladies started peppering us with questions about the health of their own children once they found out we were pediatricians.  For many of the mothers we have met, access to basic pediatric services is very lacking.  If their children were born in the United States, they qualify for programs like Medicaid and CHIP (A Texas program for children’s healthcare).  But if the children were not born in the U.S. and are undocumented, they do not qualify for these programs.  Many families are blended, with some children who were brought into the country by their parents and others who were born here.  In these families the mothers face a difficult situation in which some of their children can see a pediatrician and the others cannot.

As in the other groups, the women brought up multiple issues that impact the health of the children in their communities, including obesity, lack of exercise, and dangers in the streets – ie, dogs, gangs.  Challenges getting to grocery stores lead to poor access to produce and other healthier foods.   School lunches that include foods like chicken nuggets, pizza and nachos were also cited as barriers to health y eating.  This group was very talkative had gave us a lot of ideas for programs that could benefit their families, such as nutrition classes for elementary aged children, supervised after school exercise programs, and more efforts to get dangerous dogs out of the streets.

The following day was November 6, Election Day.  We drive out to Pharr, Texas to attend the grupo de salud and were greeted with a march to get out the vote at the ARISE center.  Dozens of women in yellow shirts, which read “mi voto=mi voz,” were marching the street, chanting, and carrying signs.  The media was there taking pictures and filming the march for the evening news here and in Mexico.  We were beckoned to join the march and walked with the ladies to the nearest polling station several blocks away.  It was so inspiring to see these women, some of whom are not even able to vote in this country, working to turn out their community.  From the honks of the cars driving by, it was clear the efforts were appreciated.

We left the vote early to go and meet with the grupo de salud.  There was a visiting nurse from a local university who was teaching the ladies about signs of diabetes to watch out for.  We chatted and did some interviews with some of the ladies about their health concerns for the community.  The energy that morning was very good as everyone was excited about the election.  After the grupo ended we headed back to the center to have lunch.

Unfortunately, our mood and luck were drastically changed on the way to lunch.  We had pulled up to park on the street near the center when our car was hit by an elderly man driving a large, old truck.  He was attempting to turn into his driveway, turned short, hit our car on the front left side, and ripped the bumper off our rental car.  Luckily, no one was hurt.  This set of a course of events that would take over the rest of the day and cause us to miss all of the election results and excitement.

The situation was very tense because the man was very angry, cursing in Spanish, saying he had no insurance, and refused to let us fully assess the damage to the cars.  Once the director of the center came out and started to speak with him, things went a bit more smoothly.  However, since we were in a rental car we needed to call the police and file insurance claims.  In the end the police came, cited the man, and re-attached the bumper to our car so that we could drive to the airport to get a new rental car.  Multiple people thanked us later for having the police come since the man had hit other cars outside the ARISE center in the past.

I think the accident caused both of us to hit a low point in the experience in Texas.  We were now emotionally exhausted, homesick, and feeling frustrated about the whole situation.  The next day we did not have any visits scheduled with ARISE and instead took a tour of several local pediatric practices.  Dr. Marsha Griffin, the head of our CfC program, works at a federally qualified health center in Brownsville.  The clinic was in a gorgeous new building that also housed multiple other medical specialties and supporting departments.  We met the clinic director, who has been involved in community activism for decades.  She gave us an overview of the clinic’s unique promotora program, which trains volunteers to do health outreach and promotion work within their own communities.  The model is very effective, as we have seen when working with the promotoras at ARISE.  Not only does it give community members access to health information and basic health maintenance (blood pressure checks, weight check, etc), but it also empowers the volunteers to become leaders in their own communities.  Later in the day we visited Harlingen Pediatric Associates, a private practice that sees a mix of privately and publically insured patients.  The clinic was very efficient and moved the patients in and out very quickly.  Everyone working there had a clear sense of their duties and worked together to keep everything flowing.  It was interesting to see a small independent practice since it is a model that is not very common in the Bay Area anymore.

We wrapped up the week by spending 2 days with a former state senator from El Paso, Eliot Shapleigh, and his wife, Joyce Feinberg, who had a long career with the Y doing AIDS work in Africa.  They were both very interesting people, and Eliot inspired all of us to get involved in public service.  He had a very good way of breaking down what needs to get done to make change politically – get a diverse group of people together in a room and get them to outline their vision for the future.  In the cases where he has seen it happen, people usually come to most of the same conclusions and can then work together to form a plan to accomplish the vision.  We also met with Dr. Rose Gowan, an Ob-Gyn in the community who got elected to the Brownsville City Commission.  She is using the experience she had in her clinic, while working with patient on obesity issues, to push for changes that will make the city more healthy – bike lanes, sidewalks, hiking trails.  It was nice to see how changes can be made on a local and state level to positively impact the lives of many people.  And it was good for us to end the week on such an inspirational note.