Border Health: Tijuana

Each morning begins with an 18-mile drive, a 0.5 mile walk across the border, and an Uber ride to the Tijuana General Hospital where I will see patients for the day.  In the process I cross the busiest border in the world which also has the largest income disparity in the world.  Additionally, this border currently has been embroiled in political turmoil throughout my rotation. Migrant asylum requests from Central America have dramatically increased for which President Trump has responded with a public threat to the close this vital border.

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To say the least, the daily politics surrounding the border have been tumultuous and anxiety provoking.  When President Trump threatened to close the border one week ago, he gave a week timeline for which he could close the boarder at any time.  What would a border closure mean?  What time would it most likely happen?  Would I be able to predict a day before hand or would it happen suddenly for which I would end up stuck away from my 9-month child? How long could this last?  Thankfully, it never did.  But I have come to realize the daily anxiety that this border crossing holds on those who traverse it.  It is unpredictable.  One day there is no line and the next day it is over an hour.  Never sure if I would be able to return home across the border, I found myself checking US news hourly searching for new information or border rumors.

My medical experience has been one that demonstrates the similarities within the medical community even when there are vast differences in resource availability.  I have found the doctors, residents, and medical students with whom I work to carry the same passion and professionalism as found with my colleagues in the states as they care for their patients.  Yet, the differences in resources remains a defining factor in how patients are able to maintain their health and recover.   I have been routinely surprised at the condition of patients when they present to our TB clinic or infectious disease unit as they are much sicker than what I am accustomed to.  In only a single rotation I have seen patients with severe multiple drug resistant TB, an uncal herniation, multiple cases of ring enhancing lesions of the brain, bacterial meningitis, miliary TB, and many cases of permanent lung collapse due to TB.  I have grown to recognize those with severe TB as they appear in our clinic, thin, cold, and struggling to walk.  All of the patients we see in TB clinic have drug resistance and their chest x rays never resemble the subtle TB findings to which I had seen previously.  Instead it shows destruction, collapse, effusions, tracheal deviation, and multiple cavitations.  I feel some solace knowing that these patients have finally made it to our care team and that the medication will be paid for by the government.  But I am continually surprised at the toll these diseases have taken on the patients by the time they reach our care.  I am practicing 30 miles from my home but many times it feels much, much further.

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