Fall 2008 Semester Summary - by Bryan Monier

It has been an exciting and productive semester for Frontera with the addition of 5 new MSII leaders who have each brought boundless enthusiasm and a unique vision and perspective to the organization. The new leaders for the year are Arielle Perez, Cristina Ippolitio, Dave Shahani, Kristi Pogue, and Bryan Monier. Under their guidance Frontera has been able to increase the number of trips the organization has taken allowing more students to become involved and more patients to be reached. One of our biggest goals for this year has been to make Frontera more of a campus wide organization that provides opportunities for students from all of the different schools at UTHSCSA and not just the medical school as it has in the past. We have succeeded in this respect by bringing along nursing students, physician’s assistants students, dental students, and medical students on our trips. The addition of these other students has helped foster a collaborative environment on all of our trips where students from different schools are able to share their knowledge and experiences in a collected effort to provide the best care possible. We have received overwhelmingly positive feedback about joining these students together because it better reflects the type of environment we will be working with in the future with a mix of healthcare workers from all fields and backgrounds.

The addition of students from the other UTHSCSA schools has increased the demand for spots on Frontera trips and in response we have been able to take more trips down to the border. In the fall semester we took four trips total with two trips working in Robstown and the other two in Laredo. These trips have focused on bringing health care and health education to the underserved populations living in the colonias of these areas. Frontera provided basic health screenings and physical exams along with referral information for those with more serious medical needs. Several participants on the 2nd Robstown trip were given the opportunity to visit the colonias and provide care on these home visits to those who were unable to make it to the health fair at the church. This was a wonderful experience that brought a very real portrayal and demonstration of the difficulties facing the people living in these areas. We are hoping to expand these home visits and make them a permanent addition to our Robstown trips. In Laredo we expanded our services by providing not only physical exams but immunizations and sex education as well. All of the kids who come to see us for their sports physicals are now also given a sex education and healthy lifestyle presentation that focuses on encouraging safe sex practices and positive life choices like exercising and eating right.

Each of these trips provided not only healthcare to the underserved populations of these areas but also provided a great teaching and learning environment for the students involved. First year nursing, PA, and medical students are paired with second and third year students who are able to pass on the knowledge and experience they have gained to create a collaborative environment that provides care and encourages teamwork.

In the spirit of building lasting awareness and fostering group efforts several Frontera leaders were given the opportunity to attend the National Summit of Clinicians for Healthcare Justice in Washington D.C. from Oct. 23-25. Arielle Perez, Cristina Ippolito, and Bryan Monier were given the privilege to meet and listen to some of the leading primary healthcare doctors and workers in the country. We were inspired by their tireless efforts to bring healthcare and opportunities to those who need it most, and we gained great insight into how they have overcome various obstacles on the road to providing care.

We are looking forward to a successful spring that will build on the steps we have taken this fall to create a campus wide organization that can provide better healthcare and education to the underserved areas of the Texas border. We would like to thank everyone at the Center for Humanities and Ethics for their contributions to making this a successful organization and to all of the students and doctors who offer their time and energy to attend our trips.

Robstown - February 17, 2008 by Anne Cioletti

This weekend, a rather large group of medical students of all years made a trip south to Robstown for a health fair. This being my third trip to the area, I was impressed with how much it has grown over the two and a half years. I still remember the first trip we made: we set up a few tables in a small church associated with one of the many colonias, and when the “patients” did not come to us, Mr. Lopez took us to see the colonia, getting a firsthand look at the shocking and unfathomable living conditions. At that time, we only had students eager to help, physicians willing to guide us and site in need of health care access (as well as much more). This was what we hoped would be the beginning of a new commitment that would continue to grow...

And grow it did! As we embarked for Robstown on Saturday afternoon, thirteen students and one eager pre-med undergrad from Baylor piled into three vans for the trek south. Arriving Saturday evening, we checked in our hotel and then met Dr. Smith and family at a local Vietnamese restaurant. There we had a chance to continue the fellowship and catch up with Dr Smith. After dinner, we returned to the hotel to get a restful night for a big Sunday.

The next morning, we packed the vans back up and headed off to a nearby church of which we would set up the health fair in the associated gym where we were joined by Dr Berggren and Jeannie who drove up from Harlingen. At this fair, we offered blood pressure and glucose screenings as well as a general history and physical (as we had the first time), but there was also many more outlets to offer the patients: Christus Spohn was present to allow access to a health care community if needed; AmeriGroup and sCHIP set up for insurance information; Humana came to offer free glucometers and additional information; flu and pneumococcal vaccines were offered to those who needed them; and rapid HIV screening per the new CDC protocol to screen everyone over 13 years old as well as additional testing for high risk individuals. We split into pairs, often a first-year with someone older, and began seeing patients of all ages, ranging from the second to ninth decades.

Four masses and over sixty people later (much more than our initial 20ish patients during the first trip!), we looked back on the day. There was a steady flow of people throughout the day, discussing everything from general health questions to coordinating soon follow-up. A couple of students even had the opportunity to go on home visits with Dr Campos, in order to bring medical care to those unable to come to the fair. Needless to say, each trip adds added access for care and education as well as opportunities for more students to learn and participate! I can only imagine what more will be added in the trips to come both to Robstown and Laredo! Keep up the good work and great vision!

Anne Cioletti, MSIV

Nov. 30 - Dec. 1 trip to Laredo by Tina Oak, MSII

I must first begin by saying that it was with a bit of irony that I went into planning for this last trip to Laredo. During my period of involvement with Frontera, the opportunity to go on a Laredo trip always passed me by. So, I had some trepidation as I enticed students and physicians to go on this trip that was still a mystery to me. Any questions that came up regarding the trip were deferred to Joe Peters, the other Laredo trip planner.

On the week of the impending trip, Dr. Richard Usatine met with our team to go over the sports physical exam, as that was the main exam Mercy Ministries asked us to perform for their young patients. Dr. Usatine went over the signs of hypertrophic cardiomyopathy (cause of Sudden Death in healthy athletes), Marfan’s Syndrome, scoliosis, and so on. For us second-years, it felt like a refreshing review of previous modules; for the first-years, I can only imagine their wonder and bewilderment. At least, that’s how I recall my feelings when I went on a Frontera trip as an MSI, pondering over what “HTN” and “CAD” on the HPI form could possibly mean. But that was part of the learning process for the medical students on this trip: MSI’s gained knowledge and skills beyond their fellow classmates, and MSII’s finally felt for once like they knew something and could be teachers.

We embarked on our trip on a drizzly, gray Friday afternoon. When we reached Laredo, we spent the night in dorm rooms at the Texas A&M International University. (Interestingly, TAMIU has a healthy population of deer and javelina roaming their campus.) The festivities of the night included excellent Mexican dining at a nearby restaurant and an exciting game of Rook taught by Shannon Toews (MSII).

The next morning, we arrived at Mercy Ministries at 8:00 AM with Starbucks coffee in hand, where the sisters warmly greeted us and whisked us to a back room for orientation. Sister Rosemary, a spunky, tall, gray-haired woman, gave us words of encouragement and reminded us of our purpose for being there. My impression of the ladies at Mercy Ministries was that of a group who cared so much for their community and were working tirelessly to improve their lives. They ensured us that they were careful to draw in a needy segment of the population to the clinic that day, because there were certainly people who would have come for free health care that did not necessarily need it.

The students paired off and went into six clinic rooms, and we went straight to work. Over the course of the day, we saw in total 50-something young patients who needed sports physicals and normal physicals. They were patient to wait in a full waiting room for who knows how long as we tried to serve them best by offering thorough exams. Dr. Berggren and Dr. Usatine were on hand to clear patients and examine any unusual findings. They began to count how many overweight and obese (BMI > 30) patients they saw with acanthosis nigricans (a dark pigmentation on the back of the neck that could be indicative of diabetes mellitus). The numbers were high, especially worrisome since the patients were young and many were athletes.

We ended the clinic at 1:30 PM, tired but satisfied over a day’s hard work. Before returning home, we had lunch at another Mexican restaurant for the last time. Needless to say, many were stricken with food coma and exhaustion on the drive home. Special thanks to the tireless drivers who delivered us safely back to the parking lot of UTHSCSA.

Overall, the trip was a huge success – the students were professional and hard-working, the doctors were constantly teaching, the patients were excellent, and the Sisters at Mercy Ministries were shining examples of what we can only hope we may one day become. For while we may congratulate ourselves for taking the day off from studying to help others, people like Sister Rosemary commit to this work day in and day out with perseverance I can hardly fathom.

-Tina Oak, MSII

August 10-11 trip to Robstown - by Tira Chaicha

I first have to say that our fearless leaders for the trip this weekend to Robstown did an awesome job. Joe and Jess did a great job with the organization and making things run smoothly. Also Daisy drove all the way from Harlingen to come help - what a trooper! This is a long post, but I listed some highlights at the bottom.

We first had a pre-departure meeting with Dr. Campbell who spoke of what to look for regarding physicals and was trying to promote EKGs as our next project. He spoke extensively about making sure we listened to the heart sounds and lung sounds and to "watch, teach, and do one" for the male genital exam.

I think for future trips, we should also get someone who will physically SHOW us what to do and what to specifically look for ( i.e. HOCM murmur increases with vasalva and standing, etc.)

We met at 4 p.m. in front of the libary on Saturday and left around 4:15, but didn't get to Robstown until about 7:00. One of our fealress leaders really enjoys traveling and he decided to take us on a tour of I-37 and its foliage as we were looking for a water closet. For people going on the next trip: look for the Three Rivers exit, as that is where you will find a Valero on the right side of the highway going towards Robstown. We ended up going to the exit after that and stopping at a historical post office where the country folk hang out. There was only one ladies and one men's room, so it served its purpose.

Once we arrived to Robstown we checked into the Best Western, which is very nicely surrounded by farm land, the highway, and a BBQ restaurant. The hotel was nice and clean with a pool, small gym, wireless connection, and breakfast. Other than our shower knob coming off, we had no issues with, at least, our room.

Later on Friday night, we headed to the church to make an announcement during whatever activity they were having that night. Jess invited everyone to come to the health fair where there would be vaccinations for kids (all for $10), glucose and BP checks, sports physicals, audiologists, and social workers to sign people up for Medicare/ Medicaid/CHIP - and that everything was free.

We had dinner at the Cotten's BBQ next door - this is a CASH only (no checks or credit cards) and a very laid back place with waiter who wore a bowtie and a vest. They serve only 4 kinds of meat that come as a sandwich or laid out on a paper plate (the plate is a sheet of wax paper). And for the herbivores, there is a salad available and potato salad and beans. The food was a little expensive for the quality we got, in my opinion. ($125 to feed 14 of us).

We got up at 5:30 on Saturday morning, had breakfast at the hotel, and headed off to St. Anthony's Catholic church on the corner of Dunn and Tex Mex Rd. We were greeted by a 100ft tall cut-out of the Virgin Mary at the entrance to the parish (which was a gym before). We set up four tables for BP/glucose/health screening and two areas were partitioned off for the sports physicals. In the other areas of the gym were the audiologist, social workers, and vaccinations. There was plenty of room in the gym, plus it was airconditioned. There was a "registration" table for people to pick up the health sheets and fill out their name, age, address, PCP, etc. Jess also went to make an announcement at a second church that is also associated with St. Anthonys - this really helped get more people coming to the fair as it was very slow early on.

The ladies from Catholic Charities came as well and brought us food as usual. Mr. Lopez is still active in the community and expressed his appreciation. Dr. Smith treated us to Friday and Saturday's dinner and is as optomistic as ever about our group. Dr. Campos helped out at the fair and recommended that at the the next fair we have more tables set up so that the patients couldn't hear each other ( i.e. be "HIPAA compliant"). Father Williams was also nice enough to make some of the announcements about the fair as well.

Highlights during the fair/trip:
- a few people were able to sign up for CHIP
- one of the MS4s heard a kid with PVCs and got him follow up
- we saw 100 patients!!! (some of you might remember that time when we had 23pts at Tierra Grande)
- Dr. Campos (who practices in CC) will fax over the health sheets to the patients' doctors (if they listed one) if there were pertinent findings
- comments were made that this was the best organized fair they had every been to; a pt said that they had never had their illness explained to them before until the fair
- effort to provide follow-up care for patients was the best I have experienced on a Corpus trip (with social workers and Dr. Campos)
- next time the table should be spaced further apart so patients don't hear each other

I don't know if this flies for a post-trip blog but the main thing about this trip is it has gotten better with every trip. Kudos to the current board members on continuing to carry and strengthening the
tradition of Frontera.

Peace out,
Tira

(Photos contributed by Johanna Preston)

Laredo, May 19, 2007 - Linda Pham

This trip to Laredo was awesome. We ate some great food and had a really great time providing a service to middle and high school boys.

Early Saturday morning, Dr. Fred Campbell met with us to discuss the sports physical and to answer our questions. Arriving at Mercy Ministry at 8 am, Sister Rosemary gave us a brief history of the Mercy Ministry as well as the purpose of our services that day. The local Rotary Club had donated its time and money to pay for the sport physicals that the young men needed but were unable to pay for. The Rotary Club members helped direct traffic as we student doctors set up at different stations – vitals, eye exam, and complete physical exam. Nurses Martha and Ana Laura were the resident health care staff helping us throughout the day.

Emma Rodriguez checks the weight of a patient.

Linda Pham examines the ear canal of a patient

Joseph Peters examines a patient's eyes

It was such a busy and vibrant atmosphere, and we were able to see 58 patients and complete their physicals by 1:30pm. Most of the patients were healthy overall, and we did hear some heart murmurs and had to refer some patients for further observation and treatment.

Everything went really smoothly and we were so happy to be able to help all of the young men in their athletic endeavors. We even had Amanda from the Center of Medical Humanities and Ethics to take pictures of all the student doctors in action. The student doctors on the trip had a great time bonding with each other and eating great food from Laredo, TX. Great job everyone!

Linda Pham

(Photos contributed by Amanda Evrard)

Frontera de Salud

Welcome to the blog for Frontera de Salud!

Here Frontera members will post personal reviews of each trip and activity.