The Borderline
  La Linea Fronteriza
Houston Institute for Culture 

The Borderline
Health Issues
The Future
As soon as I started seeing the people I took
a deep breath to keep from crying. That was
only going to make them feel worse. I just
held in everything and treated them.

- Jackie Urbano UH pharmacy student

Medical Missions Deliver Care
Pharmacy Students Make a Difference in Medical Mission Effort
By Mark Lacy

When fourth-year pharmacy student Jackie Urbano learned of her assignment to the trash dump in the Mexican border city of Reynosa, she could not imagine the health issues and poverty she would face.

Less than 24 hours after Urbano received her itinerary in an email from Barbara Tatum, a clinical assistant professor in the UH College of Pharmacy, two vehicles in tandem rolled west on a neatly manicured highway lined with palm trees between the South Texas cities of Harlingen and McAllen, on their way to the international bridge. They crossed the Rio Grande and continued driving toward the afternoon sun on a narrow Mexican highway. Following the course of the river nearly two kilometers, the vehicles turned right onto an unpaved road into the trash dump. In the lead car, Bill Jacoby, a retired Methodist minister, honked his car horn and announced, "¡Clinica! ¡Clinica! ¡Andalé! ¡Andalé!"

Following in a minivan down the uneven gravel path into the trash dump was Yong Han, a Texas Children's Hospital emergency medicine physician, with his medical team. Jackie Urbano sat silent in the back of the van.

As indigent families gathered around the vehicles to see the medical team, Urbano was nearly overcome by her emotions. "Making that turn, I could feel my heart pounding. As soon as I started seeing the people I took a deep breath to keep from crying. That was only going to make them feel worse. I just held in everything and treated them. I was in shock the whole time."

Houses in the trash dump offer precarious shelter from the elements and are even less suited for medical service. The team handled patient in-take, diagnosis and treatment while standing around the vehicles. Mothers held their children up for the doctor to diagnose. Urbano was quickly initiated into the role of pharmacist as Dr. Han sought her advice on treatment options for ailments and diseases. She frantically sorted through pharmaceutical supplies in the van to provide for the patients' needs.

Dr. Yong Han
Yong Han, being observed by volunteers from the University of Houston College of Pharmacy, treats patients in Colonia Los Patos near Reynosa, Tamaulipas.
Local people call the trash dump Colonia Los Patos, or "The Ducks," for its founder's love of ducks. Children play in the river and wave at U.S. border patrol boats that cruise up and down this stretch of the 1,254-mile international boundary between Texas and Mexico. Many of the children look out across the divide and imagine that everyone in the United States is rich.

Like many colonias in the Lower Rio Grande Valley, Los Patos doesn't have running water or electricity. Many residents of the trash dump settled on the former city landfill when they were unable to find work in the maquiladoras (assembly factories) that operate on the Mexican side of the border. Most of the residents collect trash for minimal pay using horse-drawn carts to bring the industrial and household refuse back to their homes to sort and resell. Many homes are built with recycled materials, such as abundant shipping pallets. Heat distorts the midday sky and radiates into homes that are only cooled by air circulating through shabby, porous construction.

After seeing many of the 35 families that live in the trash dump, the team hurriedly left to spend the remainder of the day helping two other medical teams in El Chorizo, a colonia in Rio Bravo, about 16 kilometers east of Reynosa.

Earlier that day, four pharmacy students arrived with medical teams in El Chorizo, where the government allows squatters to build homes on the railroad corridor. During the six-hour van ride from Houston to the border, students inventoried medications and prepared vitamin supplements. The nervous passengers crossed the border into a world of need for which their cumulative experiences had not prepared them.

They began unloading medical supplies at Lynn Jacoby's clinic in Rio Bravo, while more than 100 patients waited in the heat for medical care. As members of the team began registration of the patients outside the clinic, two doctors divided the front room with a sheet. The students organized the pharmacy and glucose testing station in a kitchen under the supervision of professor Barbara Tatum and Janis Parsley, a regional director of development for the University of Houston and a graduate of the UH College of Pharmacy. Patients passed through continuously for more than six hours.

Sarah Singh, a fourth-year student in the College of Pharmacy, felt the urgent need to help, saying, "I was overwhelmed, but I knew it was my purpose to be there."

The pharmacy students quickly implemented processes to test blood pressure and glucose levels. They found more than 25 percent of the adult patients had glucose levels over 140, for which they administered a diabetes protocol under Tatum's and Parsley's supervision.

Sarah Singh
University of Houston pharmacy student Sarah Singh checks a patient's blood pressure in one of the colonias served by the medical mission team in Mexico.
The students quickly realized the serious disparity of medical services for the poor in Mexico when Dr. Han was summoned to a nearby house to treat a woman with an ectopic pregnancy that had ruptured. Without the financial resources for treatment in a local hospital, the woman would have likely died.

The experience was invaluable for Arshunda Washington, a first-year pharmacy student, who plans to work with underserved communities during her career. She marveled at the desperate situation, "For them to wait three months while they are sick with no place to go shouldn't happen in this day and age. We still have places in the world where you only receive health care when people take time out of their lives and leave their luxuries to come and help. If what we are doing is the best that can be done, then I'm all for more medical missions."

In the relative peace and quiet of an orphanage in Reynosa, the team's quarters for the night, the medical mission volunteers reflected on their first day and on the first-time efforts of pharmacy students. Han and Parsley, the mission organizers, were thrilled by the work of the students.

Parsley was instrumental in bringing UH College of Pharmacy students into the process of serving the colonias. She first heard about the heroic effort of Dr. Yong Han through the Sugar Land Christ United Methodist Church newsletter. In 2002, Han had taken it upon himself to bring care to the many poor people his wife discovered during Vacation Bible School in Rio Bravo and was able to treat 200 patients in four days. The church financially supported the medical missions he established, but Han needed additional help.

"I was the first pharmacist to join the team," says Parsley, who went on her first trip in April 2003. "I knew immediately that having pharmacists on the team could expand and improve the services provided by the mission team. I was also confident that I could identify corporations who would donate the products we would need."

Parsley, who worked at the UH College of Pharmacy for eight years, knew that this was the perfect clinical service learning opportunity for pharmacy students. She contacted Tatum, who is the advisor for the pharmacy student organization Christian Pharmacists Fellowship International (CPFI), for help recruiting the students.

"We are so blessed that our students wanted to serve on the team," says Tatum. "And this was the perfect opportunity for CPFI members to use their talents in a meaningful way."

The medical team was faced with a grueling day ahead in Reynosa, in which they would visit three colonias on the fringes of the growing industrial city. The medical mission would function in small churches serving communities on distant dusty roads that run off the map. The students prepared to spend the day from sunrise to sunset seeing the majority of the more than 400 patients treated during the mission's two-day effort.

On early trips, the doctors selected the drug product to be dispensed, but with the participation of the pharmacy students on the team, the doctors simply write a diagnosis or drug category, and the pharmacy team members select the product based on availability. "This has made our process efficient and our doctors more productive," boasts Parsley. "It allows the doctors to spend more time with the patients and our students use the knowledge they have learned in the classroom in real-life situations."

On day two the students thoroughly tested the improvements to the team's medical effort, making it possible for the mission to serve more patients than ever before by splitting into two groups at the colonias Emaus and Reynosa Diaz, and then reconnoitering at the Iglesia Vida Nueva to perfect the process by performing glucose tests in advance of the doctors' diagnosis.

While working under the shell of a new church being built at Vida Nueva, doctors and pharmacists identified a life-threatening lymphangitis infection (blood poisoning) and began an anti-biotic treatment. Singh reported, "To save two lives in two days was touching for me."

Supervising the treatment, Dr. Han explained, "The pharmacy students are practicing what they are taught."

Improved patient records help the pharmacists adequately prepare for future missions and follow up on patients with chronic diseases. Han and Parsley developed protocols (treatment plans) for diabetes, the leading cause of death in Mexico, and hypertension. Diabetes treatment began in March 2004, and hypertension treatment began in June 2004. UH College of Pharmacy student volunteers serve an integral role in providing these services to patients.

Each patient is given a diabetes and/or hypertension card with their test results and advised to bring the card whenever they see a health care professional.

Organizers at Vida Nueva have become proactive in the health care needs of the community by offering breakfast for children each morning before school and dispensing vitamins supplied by the medical team.

Bellita Espinoza, pastor at Vida Nueva, proudly explained, "The kids take their vitamins daily while they are having breakfast and they know that they are suppose to do the same at home. At first we saw kids with many spots (skin conditions) who were very thin, but now they are much better. They are more active. In less than a year we've noticed great improvement."

Many of the families who have come to reside in the surrounding area have migrated from the central Mexican states of Oaxaca, Veracruz and Tabasco. While they are slightly more prosperous than those in other colonias, health care is still beyond their means. Men usually work in construction and women often work as housekeepers or find jobs in the maquiladoras that operate near their community. It's a precarious existence as jobs are expected to increase on both sides of the border, only to be outpaced by unemployment and population growth.

Bill Jacoby sums up what tragic news stories about undocumented workers' deaths and State of Texas statistics reveal about migrants from southern Mexico and Central America, "They are still coming in from the south, looking for jobs and trying to get a better life by being near the United States."

Local community advocates, like Bill and Lynn Jacoby, and organizers of the medical missions are seeking solutions to meet the growing needs of the poor in Mexico's industrialized northern cities. University volunteers have enhanced the services of the medical team by incorporating students and faculty of the College of Optometry into the effort.

While the Jacobys have raised money for many of the kids' tuition over the past two years, health care providers are ensuring they are able to be successful in school. University optometrists on their first mission in June 2004 assessed a rate of one in ten refractive vision problems in children. Glasses were provided to the children during the Christ United Methodist Church's Vacation Bible School in July to help the kids prepare for school. Dr. Norman Bailey, clinical professor at UH College of Optometry noted, "Without learning, it is difficult to move out of impoverished conditions."

Jacoby confirmed, "Education is the future of these people, especially the young people. If we can get them to go to school, they will have a much better chance for a better life than their parents do right now."

The doctors, pharmacists and translators, as well as optometrists who are now part of the effort, believe health will be a major factor to improve the quality of lives of our Texas neighbors. An organizer in her community, Pastor Bellita Espinoza is always thankful for the volunteer work of the medical team, saying, "For us it's very important when the medical missions come here because they bring pediatricians and specialists to check the eyes. The mothers are happy because they get milk for their babies. Since it's usually too expensive for them, many kids aren't feed as well as they should be."

Singh expressed the value of the university volunteers' service in Mexico, saying, "They were appreciative that we came all the way from Houston to check on them. It offers them hope more than anything else. For the young ones it gives them motivation to aspire for better things, the hope for a future really."