Thread: Health departments fight tuberculosis on both sides of the U

Health departments fight tuberculosis on both sides of the U.S. border with Mexico


Mexican immigrants often contract the disease before entering U.S. bringing it north to cities like Chicago, officials say
By Oscar Avila and Margaret Ramirez | Tribune reporters
1:41 AM CST, February 16, 2009
REYNOSA, Mexico — A ragged-looking man takes deep breaths as a doctor listens through a stethoscope for a stubborn killer. Her verdict is good news. The medication seems to be containing his tuberculosis.

The bad news is that doctors can't keep him in this clinic a few miles from the U.S. border, just as TB patients were quarantined decades ago. They can't even keep their patient in Mexico to make sure he takes his pills and doesn't spread the contagious illness north to cities like Chicago.

So the disease festers among a population that migrates back and forth between Mexico and the U.S., even as—on a wider scale—public health officials have made great strides in defeating one of the scourges of the early 20th Century.

In the rugged terrain along the Rio Grande, this mobile population has forced public health officials to take a binational approach to the deadly respiratory disease. Texas is even taking the unusual step of sending medicines into Mexico that are paid for by American taxpayers.



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Immigration issues Doctors want to take on tuberculosis at the border before patients migrate northward into the U.S. If they don't properly treat TB patients from the start, the disease can morph into a multidrug-resistant variety that costs 10 times more to treat.

"It is a devastating experience to watch people suffering from this disease every day, especially when there are measures to ease their suffering," said Dr. Magin Pereda, a Mexican state health official who oversees the TB program in Reynosa.

Through screening and timely drug therapy, tuberculosis cases have plummeted in the U.S., Mexico and around the world. The Centers for Disease Control and Prevention reported 13,299 cases nationwide in 2007, half the number of 1993.

But that positive trend has not reached the border, a crossroads for many patients.

The state of Tamaulipas saw TB cases rise 10 percent since 2007. The south Texas city of McAllen has TB rates nearly three times higher than the national average.

In Illinois, Mexican immigrants make up 18 percent of cases, a much higher rate than their 6 percent share of the overall population.

Those demographics mean public health has become entwined with the emotional issue of illegal Immigration. Activists and commentators raise the specter of disease to argue that the U.S. should better enforce its borders.

In a book that reached best-seller lists, conservative commentator Pat Buchanan wrote that the re-emergence of tuberculosis, malaria and "rarities of the Third World" such as dengue fever were "high among the costs of Immigration."

Many of Reynosa's cases involve Mexicans living there while planning a crossing into the U.S. Others are Mexicans who have been deported and are waiting to return to their hometowns.

Still others are living the reality that the Rio Grande Valley has known for generations: that this is one community. Many locals work in Texas and live in Mexico, or vice versa. They have relatives on both sides of the border.

As part of the binational initiative that began in the 1990s, Texas health officials exchange information with Mexican counterparts about patients they know are crossing the border so they can continue directly observed therapy—home visits in which they watch patients take their pills.

Even with that renewed attention, a troubling trend began emerging in recent years. Mexicans were developing a multidrug-resistant variation because they were not properly following the initial round of therapy.

Short on more advanced drugs, dozens were migrating northward and checking into Texas hospitals, said Dr. Brian Smith, regional director of the Texas Department of State Health Services in the border city of Harlingen.

Those patients lacked insurance, and their treatment was costing up to $250,000 each.

As a last resort, Texas officials enrolled many of those patients in their binational program and offered to send medication to Mexico if patients would stay there.

Smith acknowledged that the program could be controversial but said the several hundred thousand dollars Texas spent on the drug treatment actually saved millions in uninsured care.

"Whatever your opinion is on undocumented Immigration, we have to focus ourselves on public health," Smith said. "And if we don't treat TB the right way, society pays."

Dr. William Clapp, director of Chicago's tuberculosis program, echoed worries that TB treatment would fuel "xenophobia" against immigrants.

According to the Chicago Department of Public Health, immigrants made up 51 percent of Chicago's 258 TB cases in 2007, the first time foreign-born cases made up a majority. The largest share of those cases was from Mexico.

Immigrants are at risk because many come from countries where the disease is still fairly prevalent. Many carry the disease in a latent form that is triggered after arriving in the U.S., exacerbated by other ailments such as diabetes or by a weakened immune system related to their high workloads and low access to medical care.

In 2007, the last year for which data are available, only one of Chicago's TB cases was confirmed to be of multidrug-resistant. Clapp called the spread of that form of TB "the worst-case scenario" because of the health risks and the expense of treating it.


http://www.chicagotribune.com/news/nati ... 9052.story

San Diego had to put up the money to treat Tijuana's raw sewage. US taxpayers have to put up the money for the border fence, not the other way around. Are there any other cross border expenses we are going to be footing?

This is disgusting! Why does Mexico have no dignity to take care of their own population? We buy enough drugs from them and hire enough of their population that send remittances for them to be rich. Why is it always the responsibility of the US taxpayer to take care of those illegally here with who knows what disease the illegal swarm brings. A few mill for a border fence and increased border patrol sounds real cheap, with over 47 mill of the US population uninsured because they have lost their jobs or never got it in the first place (like me.)
Now I need another blood pressure pill, and think the Mexican government will help me out?

Okay, I am not a regular smoker and was never a heavy smoker by any means. About two years ago I smoked for the last time. Last year I went to the dentist for a normal check-up and he saw a medium-sized black circle on the skin inside my cheek. He thought I had just bitten my cheek. It was still there when I've been back both times for my latest two teeth cleanings. I am so scared of cancer. Is there any possibility of getting cancer? Thanks for you great opinion in advance.
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Alcohol Rehab

nancybr: Please visit your regular doctor and express your concerns. Don't rely solely on your dentist to make a diagnosis. At least a second opinion will give you peace of mind.

This is costing taxpayers up to $250,000 PER illegal? This is ridiculous!

My favorite comment on the article: TB? Shouldn't Dr Clapp be treating STDs?

Welcome to Alipac nancybr

Welcome to Alipac nancybr...thanks for joining in!!