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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 4 – Community for Children
Our last week was a whirlwind of activity. I made a brief but fun and wonderful trip home over our third weekend. We hit the ground Monday morning with the ladies of ARISE South Tower. When we arrived, there was a large group of women participating in a crafts class. They were using magazines to cut out pictures to make collages. The theme of the collages was relationships, in particular the characteristics of healthy relationships. Themes of equality, good communication, and healthy boundaries were discussed.

Several women took breaks from their crafting to come and speak with us about health issues in their communities. At this point, we were getting much better at conducting our interviews. It was nice to realize how much my Spanish had improved, and also to recognize that we were much better at keeping the interviews on track by re-directing the discussions as needed.

One lady’s story was really striking. She had no health insurance and did not qualify for any government programs. In the past she had gone to Mexico for management of her diabetes. She’d had diabetes for about 12 years, and over the last several years her sugars had gotten increasingly out of control. However, with the escalation in border violence she was unable to get to Mexico to see a doctor or to buy medications there. Medications were too expensive in the U.S. She had been waiting months for an intake appointment at a local, low-income clinic. Meanwhile, her sugars were routinely above 300 and she was taking random diabetes pills that relatives sent from Mexico. She was starting to have visual changes and numbness in her hands. It seemed that likely her disease had progressed and she needed insulin to control her sugars. She desperately needed a clinic appointment. We both wished we could have done more to help her. All we could do was urge her to be persistent at following up with the clinic to get seen.

Another woman in the group then shared a very sad story of another women in the community who had died from uncontrolled diabetes in her 20’s, leaving behind a young daughter. She had routinely been getting hypoglycemic episodes during which her daughter would wake up in the night to check on her and find her unconscious. The little girl would then call 911 and the woman would be treated in the ED and released. One morning the girl woke up to find her mother dead. We were saddened and outraged by this story.

We left ARISE after the interviews so that we could get home and work on the many presentations we had to prepare as our rotation came to a close. That night I prepared a talk on dog bites and the problem of dangerous dogs in the community to give to the ladies in the health groups at ARISE. It was a bit of a challenge to prepare a Powerpoint presentation in Spanish, but I also felt accomplished that I was able to do it.

Over the next 2 days I gave my talk to two different groupos de salud. At both groups the talk inspired a lot of conversation among the ladies about the dangerous dogs in the community. We learned about a particular intersection at which children were threatened by menacing pitbulls while waiting for the school bus. One lady told a story of a neighbor’s pitbull jumping over the fence, killing her dog, and her fear that one of her children would be mauled next. Another talked of having to have a family dog put down after it bit her son several times. We handed out some resources for community and government organizations that could be of assistance with the removal of dangerous dogs and that offer low-cost spay and neuter services. We also presented the idea that the women involve their community PTA with helping to deal with the threatening dogs at the school bus stops.
Our project concluded rather ironically with a dangerous dog encounter. As we left the ARISE center for the last time, a pack of wild dogs was roaming the streets, growling at all of the dogs in nearby yards. These dogs were muscular—pitbulls, boxers, and a tiny Chihuahua bringing up the rear. For awhile we could not safely get to our car. A group of high school students on a mission trip were painting the center and wanted to go out and see the dogs. We warned them not to. These are not the type of dogs to play with.

The last 2 days of the week were spent wrapping up with the other CfC participants. On Thursday we had some lectures on global health and had a nice lunch hearing about the experiences of a PICU doctor who has done trips all over the world. On the last day we all gathered at Marsha and Mike’s home and gave presentations on our projects. It was really interesting to learn about what the others had been doing for 4 weeks. Their work ranged from teaching health classes to undocumented, unaccompanied minors in immigration detention to designing biking initiatives for the city of Brownsville. The scope of the projects illustrated how multifaceted community health truly is.

Afterwards, we all shared personal reflections on the experience. There was singing, poetry, and letters to government officials. We had all been deeply impacted by this experience and the wonderful people we met along the way. Despite the hardships, from the language barriers to the car accident, the work we did was some of the most inspiring that I have done during residency. It was amazing to be so welcomed into a community and to be able to learn so much about the lives of the women we worked with. Seeing such poverty within our own country gave us all perspective on how fortunate we are. There is still so much work to be done, and I hope to return someday.

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