Texas-Mexico: At the Border and Beyond

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Community for Children takes place in Texas's Lower Rio Grande Valley (LRGV) just across the border from Northern Mexico. The LRGV is one of the most medically underserved and impoverished areas in the U.S.

Major cities include Brownsville, Harlingen, and McAllen on the U.S. side. Poverty is a way of life for many of the children living on both sides of the border of Mexico and Texas. Many of these children are products of generations of families that have lived in the region. Others are recent immigrants.

This region of the state has the greatest percentage of children living in poverty and the greatest number without access to health care. The problems felt by these children are not merely the result of actions or inactions of those living in the area. The roots of these problems area tangled web of local, state, national and international problems. The Texas-Mexico border is representative of the symbiotic relationship of many joint-border nations of unequal wealth.

map of lower Rio Grande ValleyThe Texas-Mexico border provides a unique opportunity for pediatricians to be trained in the skills of community pediatrics, working in collaboration with public health experts, promotoras (lay health educators), migrant and refugee health experts, community activists, educators and parents implementing the guidelines, designed by the American Academy of Pediatricians and other organizations, for advocacy to address the factors that perpetuate the suffering of children. Didactic classes are primarily held at the University of Texas Rio Grande Valley School of Medicine in Harlingen.

Experiential learning will be through community-based field work, including home visits.

Program Objectives

  1. Educate participants on the UN Convention on the Rights of the Child, and its implications for health care providers working with children
  2. Educate participants on the social determinants of childhood disease and health in resource-poor regions with emphasis on the South Texas/Mexico border.
  3. Assist participants in developing skills to care for pediatric patients and their families when medical and social service resources are limited.
  4. Increase participants’ awareness of the root causes and personal impact of poverty and social injustices on health and deepen understanding of the challenges faced by families living in poverty.
  5. Prepare participants to be advocates for social justice to improve the health of children, families, and communities.
  6. Foster participants’ cultural and linguistic competence, with emphasis on South Texas/Mexico border issues.
  7. Foster a culture of compassion for self and for others.
  8. Provide individualized development guidance.

Patient Population

Community for Children-At the Border and Beyond begins at the junction of Texas’s Lower Rio Grande Valley (LRGV) and Northern Mexico. Major cities include Brownsville, Harlingen, and McAllen on the U.S. side. An estimated 340,691 children live in the LRGV, 36% of the total population. This figure does not include children who cross the border from Mexico into the LRGV.

In the LRGV, 95% of children are Latino, primarily of Mexican-origin. The percentage of children, ages 0-17, living below poverty is 48.5% (compared with 24.3% for Texas). Border county populations, including children, suffer higher rates of diseases such as Type 2 diabetes, asthma, tuberculosis, and hepatitis, yet are in one of the most medically underserved regions of the U.S. Here, the ratio of direct care physicians per population is 1:1,394 (compared to the Texas’ 1:606).

Sources

Border Kids Count, 2010, Anne E. Casey Foundation and Center for Public Policy Priorities; Texas State Department of Health Services’ Center for Health Statistics, Health Professionals Resource Center-2011; At the Cross Roads: US/Mexico Border Counties in Transition-US/Mexico Border Counties Coalition, 2005.

Background on the Lower Rio Grande Valley

Community for Children begins at the junction of Texas’ Lower Rio Grande Valley (LRGV) and Northern Mexico. Major cities include Brownsville, Harlingen, and McAllen on the U.S. Side. An estimated 435,584 children live in the LRGV, 33% of the total population.1 95% of children are Latino, primarily of Mexican-origin. The percentage of children, ages 0-17, living below poverty is 48% (compared with 25.8% for Texas).1 Fourteen percent of documented children are uninsured. Because they are less likely to have a regular source of care, these children are more likely to receive care in emergency rooms, community and migrant health centers, and other publicly funded health facilities. These public facilities, especially in border counties, are funded on one of the nation's lowest per capita property tax bases, severely limiting their ability to provide care. The lack of a stable, consistent source of care places these children at a high risk of illness. There is no public hospital in the LRGV.

Many LRGV children and their families live in colonias, unincorporated communities often lacking basic infrastructure such as electricity, running water, sewer service and paved roads. There are 1,500 colonias with a combined population of 300,000 along the LRGV border.2 Beginning in the 1950s, unregulated developers sold small lots in the LRGV floodplain with promises of utilities, sewers and paved roads that rarely materialized. Finally, in 1995, the Texas Legislature began requiring developers of new colonias to install electricity, water and sewer lines. Federal and state grants also helped bring utilities and paved roads to older colonias, though the task is far from complete. The continued lack of infrastructure exposes the population and surrounding communities to infectious diseases and public health hazards. The history of the colonias is filled with broken promises to buyers and contracts that leave many vulnerable to losing everything when they miss payments.3 Yet, colonia residents, the vast majority long-term, legal residents or U.S. citizens, persevere. 

U.S.-Mexico border communities are inherently tied together by history, culture, and socioeconomics. No other region of the U.S. has the same demands by outside factors as those suffered by U.S.-Mexico border counties. The ability to continually respond to population needs is a major challenge, multiplied by interactions with Mexico. 

Residents and students who participate in this elective will work with one of the most medically underserved populations in the United States where the ratio of population per direct care physician in the LRGV is 1:1,828 (compared to the Texas’ 1:584).4 There are 192 pediatricians in the LRGV (out of 3,565 pediatricians statewide) to serve an estimated 435,584 children, ages 0-18 (1:2,268).  

Sources 

  1. Border Kids Count, 2013, Anne E. Casey Foundation
  2. Karlin, M.. Latina leaders of Texas colonias help remake shantytowns into empowered communities. Truthout, April 22, 2012, Retrieved from http://truth-out.org/news/item/8638-empowering-the-texas-colonias-with-a...
  3. Eckholm, E Eckholm, E. (2007). Inside a jumble of poverty, Texans build a future. New York Times, August 27, 2007
  4. Texas State Department of Health Services’ Center for Health Statistics

Benefits

In addition to the opportunity to train in university and community settings with international public health experts, physicians, community leaders, promotoras (lay health educators), migrant and refugee health experts, community activists, and families on the border, there are benefits such as:

• Housing near the academic campus
• Personal attention and one-on-one guidance from faculty mentors
• Direct interaction with clinical faculty
• Tailored Spanish lessons
• Individualized development counseling
• 24-hour computer access to medical journals and reference -- even from home PC
• A journal for reflection and three textbooks are provided at no cost
• Easy access to South Padre Island National Seashore/Gulf of Mexico