MEZCOPH’s Border Health Service-Learning Institute - 2019
This year, BHSLI took place in the Arizona communities of Yuma, Somerton, and San Luis, as well as the Sonoran community of San Luis Rio Colorado. As students, we had the privilege of shadowing and working with the following community partners:
- The Regional Center for Border Health, Inc. acts as the Arizona Health Education Center for the Western region of the state (WAHEC). They generously hosted and guided us during our stay in Yuma.
- Yuma County Health District
- Cocopah Tribe
- Arizona Community Health Workers Association
- U.S. Customs and Border Protection – Yuma Station
- Secretaria de Salud, Sonora
- Campesinos sin Fronteras
- Casa del Migrante
- Instituto Nacional de Migración, Sonora
We would like to extend a heartfelt thank you to all of BHSLI’s community partners!
During its decade-long tenure, BHSLI has introduced students to the nuanced and challenging reality of health disparities along the U.S. – Mexico border. But even more importantly, BHSLI highlights the work that is being done to improve health outcomes in the Border Region. The course continues to inspire and challenge students like us to grow as health professionals, as we explore the role of public health advocacy in globalization, migration, and health. We hope this blog series will provide a glimpse into our experiences as BHSLI 2019 students!
– Micaela de la Rosa (MPA / MPH student in Public Health Policy and Management)
Day 1: Monday | Bienvenidos a la frontera [Welcome to the border]
By Micaela de la Rosa (MPA / MPH student in Health Policy & Management)
“The thing about the border is that it’s this combination of really high needs and amazing human resources and assets…If you can figure out how to pull on these assets you can make incredible things happen.”
– Jill Guernsey de Zapien, BHSLI 2019
Our first stop was a panel for healthcare providers at the Regional Center for Border Health Inc. (RCFBH) in Yuma, Arizona. Our panelists were Amanda Aguirre (President and CEO of RCFBH), Diana Gomez (Director of the Yuma County Public Health Services District), and David Rogers (Chief Executive Officer of Sunset Community Health Center). Several key discussion points really stood out for me:
- There are unique challenges associated with public health work along the U.S. – Mexico border.In Yuma County, these challenges include poverty, a lot of movement and exchange across the border, a largely mobile migrant/seasonal farm working community, and the fact that it is tricky to recruit and retain healthcare providers in a rural area.
Quilt depicting some of RCFBH’s many community partners. RCFBH Main Offices, Yuma, AZ. ►
- The complex problems presented by the border require creative solutions.
It’s been said that necessity is the mother of invention, and this is definitely true with border health work. It was so inspiring to hear about all the different ways that providers and public health organizations in Yuma are thinking outside the box to improve the health of the entire region. For example, RCFBH is tackling the shortage of rural healthcare providers through a “grow your own” approach; they have established a local non-profit College of Health Careers to offer nationally recognized certifications in a variety of healthcare professions. Similarly, the Sunset Community Health Center invests in extensive training for staff, and hires community health workers to help bridge the gap between providers and the families they serve.
- Collaboration and integration are key to improving community health.
When resources are scarce (and they usually are in the Border Region), stakeholders in Yuma County rely on partnerships to make ends meet. Whether this collaboration takes the form of integrated care models among providers, community partnerships to help students pay for their medical training, or cooperative humanitarian efforts to respond to increased numbers of asylum seekers at the U.S. – Mexico border, these partnerships allow organizations to share precious resources, people power, and expertise. Together, the organizations are able to cover more ground than they would ever be able to cover alone.
Our visit to RCFBH provided us with invaluable context and background information, and it gave us a sense of what “border health” really means in Yuma County. It was a great start to what would turn out to be a truly transformative week.
Day 2: Tuesday | Understanding underserved residents including farmworkers and the elderly through shared experiences and engagement
By Carlos Garrido, PhD (MPH student in Health Behavior Health Promotion) & Abby Welter (MPH student in Maternal and Child Health)
Community-based service learning has been used as one of the most powerful approaches to teach people through active learning-by-doing. Through engaging in activities planned for us by the Yuma County Health District (YCHD), the 2019 Border Health Service-Learning Institute (BHSLI) students experienced, first hand, the current projects and activities of the publicly funded local health district. YCHD was awarded a grant by the state to communicate with the public about the occurrence of heat alerts (advisories, watches, warnings), create local cooling centers for the needy and underserved, and provide education about sun safety to local residents and the elderly, in particular. As a result of these motives, we surveyed a group of local elderly residents at a senior center about their ability to receive weather alerts and about their knowledge of the new cooling centers in the area.
Yuma County Health District is spearheading an initiative to help community members protect themselves from the extreme summer heat. ►
From my interviews with local elderly residents, I was surprised to learn that most do not know about emergency heat-related alerts or about the opening of local cooling centers. In fact, most people reported benefiting from learning about local cooling centers that provide drinking water and air conditioning during heat- oppressive days. In addition to providing education about protection from the sun and other local health-focused initiatives, surveying the local elderly population allowed me to learn directly about the unique needs of this fragile population in Yuma. For example, many survey- respondents indicated that a major challenge to healthy aging in Yuma is finding a qualified medical provider that has experience with dealing with the unique medical issues of the aging population. Many indicated that turnover is high among local doctors who are often in transit, which makes developing rapport greatly challenging.
Campesinos sin Fronteras
Today at a binational promotora dinner in San Luis Rio Colorado, our group had the privilege of learning about Campesinos Sin Fronteras from its founder, Emma Torres. Campesinos Sin Fronteras is based in Somerton, Arizona and works binationally to improve the access to health services for farmworkers and their families. The incredible and life-changing work that they provide would not be possible without its network of promotoras (also known as community health workers), which is a model that originally began in South America and was brought to Yuma County by University of Arizona professor Joel Meister and Jill Guernsey de Zapien in the early 1980's. Emma was recruited and hired to assist in the development and implementation of the first promotora-run program in Arizona, the "Comienzo Sano" Healthy Start prenatal education program in Somerton. (This eventually became a state-wide, lottery-funded program through the Arizona Department of Health Services.)
Emma’s roots to this organization run deep. She was born into a farm working family in Guanajuato, Mexico. Emma began working as a farmworker at 12 years old and dropped out of sixth grade. After seeing her husband die at too young of an age, likely from pesticide exposure on the job, she realized that she needed to help other farmworkers access healthcare in order to prevent serious ailments and early death like her husband. She began working as a promotora and WIC nutrition worker, while also going back to school and eventually receiving her MSW degree. As the executive director of Campesinos Sin Fronteras, Emma ensures that promotoras continue to work within an empowerment model, where they serve as advocates who best understand the challenges and strengths of their communities – making them the best-suited agents to facilitate the needs of their neighbors’ health and well-being.
Day 3: Wednesday | Casa del Migrante & Pastor Castro
By Jhenitza Raygoza (MPH student in Health Behavior Health Promotion) & Rodrigo Valenzuela-Cordova (MPH student in Health Behavior Health Promotion)
Migrants were gathered in family groups of two, three, and as many as a family of seven. Some families had children, and other migrants consisted of just a male traveler occupying the shelter. Casa del Migrante is recognized throughout San Luis Rio Colorado (SLRC), Sonora, Mexico as one of only two migrant shelters in town providing shelter, food, and water for guests to rest before seeking asylum in the United States or before their travels back to their origin location. The community of SLRC faces many disparities rural areas typically encounter, as an area that is already in need of resources for its local residents. Casa del Migrante is led by strong support as local residents donate their own resources and time, despite their existing needs.
Students helped serve breakfast for over eighty people at Casa del Migrante. San Luis Rio Colorado, Sonora, Mexico. August 7th 2019. ►
Discussions with guests led to a deeper understanding of the motivators of migration and a realization of the uncertainty that accompanied them on their trek across Mexico and the Sonoran Desert. The disturbing reality of violence, poverty, and family separation were common migration motivators guests shared with the BHSLI students.
On the other side of the border, canned and packaged foods flood the grounds of the Gethsemani Food Ministry, located in San Luis, Arizona. Pastor José Manuel Castro receives truckloads of donated food and hygiene kits from various partners throughout Arizona.
“Doing the Work of Jesus”. Pictured at Gethsemani Food Ministry. San Luis, Arizona. August 7th, 2019. ►
Migrants and community members from both sides of the border are then invited to partake in food drives of approximately 40,000 pounds at a minimum of twice a week, typically reaching 1 million pounds per month. As a faith-based organization, Pastor Castro offers spiritual guidance and a mini Bible as a means to help restore hope and address mental health, something he says many food banks overlook. Through the initiatives led by Casa del Migrante and Gethsemani Food Ministry, it is evident that community aid is an asset-form of advocacy addressing migrant health, local economic development, and migration on both sides of the border.
Day 4: Thursday | Regional Center for Border Health
By Lisa Floran (MPH student in Health Behavior Health Promotion) & Stephanie Serrano (MPH student in Maternal and Child Health)
How do health, economic development, migration, and advocacy intersect at the U.S.- Mexico border? This question guided our work with individuals, faith-based groups, government agencies, and nonprofits during MEZCOPH’s 2019 Border Health Service Learning Institute in Somerton, Arizona and San Luis Rio Colorado, Mexico.
The Regional Center for Border Health’s mission is to improve quality of life for people residing along the border with accessible, quality, and affordable healthcare.
We spent one day learning more about a key nonprofit partner operating on the U.S. side – the Regional Center for Border Health (RCFBH). RCFBH is unique in that it develops and implements programs that both address specific, local health needs and also create new opportunities for participants. For example, in 2007, RCFBH established the College of Health Careers, a licensed allied health-training center with accelerated education for nurse assistants, pharmacy technicians, medical coding specialists, and more. The program has graduated hundreds of healthcare professionals to date, many of whom stay in the Yuma area and strengthen the rural health workforce. In this way, the College concurrently addresses healthcare capacity and, by providing a path to well-paying jobs, economic development.
RCFBH also uses integrated care and payment models that reduce barriers for the area’s most vulnerable populations. Given that many people near the border lack access to U.S. health insurance, RCFBH established CAPAZ-Mex, a medical discount program that helps uninsured and underinsured individuals receive care on both sides of the border. And while services at all RCFBH sites are ultimately provided to anyone regardless of ability to pay or citizenship status, these flexible options make continuous care through RCFBH’s walk-in clinics, urgent care services, and family behavioral health support more accessible, especially for transient populations like migrant farmworkers.
In many ways, advocacy is inherent in RCBFH’s work, due in no small part to the organization’s leadership. Since 1991, Amanda Aguirrehas served as President and CEO, bringing skills that allow RCBFH to be a voice for the community and build a stronger, collaborative network on both sides of the border. Ms. Aguirre was also the area’s first Hispanic and the first female Arizona State Representative, serving there and as an Arizona State Senator from 2003-2010. Her understanding of policy, activism, and the political process have undoubtedly helped RCFBH further its mission at a systemic level and ensure its success in a sometimes-shaky fiscal environment.
RCFBH’s network continues to grow and find new ways to improve services for the border community – in fact, they recently broke ground on a comprehensive new medical mallto serve the area. In true RCFBH fashion, the mall will elevate healthcare services and the local economy: notable features will include a cancer treatment clinic, drive-through pharmacy, and emergency helipad, and the project is set to create about 200 permanent jobs for local workers. We look forward to the mall’s launch in 2020 and seeing how RCFBH continues to use its innovative strategies to strengthen the health, economy, and quality of life for the border region.
Day 5: Friday | Secretaria de Salud
By Hannah Scott (MPH student in Public Health Policy and Management) & Serena Bailey (MPH student in Maternal and Child Health)
We visited the Secretaria de Salud in San Luis Rio Colorado. This health center is comprised of primary care services such as reproductive health, immunizations, outbreak surveillance and chronic care management. Each student had the opportunity to shadow healthcare professionals from the clinic. We shadowed nurses who are responsible for maintaining immunization records for children under the age of eight.
Under Construction: new neighborhood on the outskirts of San Luis Rio Colorado, Sonora, Mexico. ►
On a daily basis the nurses go door to door looking for children to ensure they are up to date on the immunizations. Those who aren’t, are vaccinated on the spot. The nurses map out the community to keep track of where the children live. It was very powerful to see their hands-on approach to healthcare up close. The clinic has an integrated approach to healthcare that is in contrast to what we have in the United States. Their focus was on the patient and meeting them where they are. They reduced barriers for patients by having a flexible walk in clinic, and also traveling to some patient’s homes.
We visited a museum that showcased the Cocopah Indian Tribe. The Cocopah have lived around the Colorado River and Delta area for centuries. The Cocopah reservation was established in 1917, where currently around 1,000 members live. The reservation is located 13 miles south of Yuma. While people who identify as Hispanic or Latino are often the priority population here in Yuma County, our community partners acknowledged the importance of recognizing the Cocopah as stewards of this land since time immemorial.
BHSLI 2019 students, instructors, and RCFBH hosts outside the Cocopah Museum in Yuma, AZ. ►
Additionally, the Regional Center for Border Health and the Yuma County Health District both mentioned ongoing collaborations with the Cocopah Indian Tribe. The museum showed insight into the tribe’s origin and history. We left with questions about the struggles that the tribe may have had and continue to face.
Finally, many thanks to this year’s teaching team!
- Katherine (Kate) Ellingson, PhD
Assistant Professor, Epidemiology and Biostatistics, MEZCOPH
- Abby Lohr, MPH
Doctoral Student, Health Behavior Health Promotion, MEZCOPH
- Mario Trejo, MPH
Doctoral Student, Epidemiology, MEZCOPH
- Jill Guernsey de Zapien
Director, Border and Binational Public Health Collaborative Research, MEZCOPH
- Robert Guerrero, MBA
Chief, Office of Border Health, AZ Department of Health Services