A Special Gift
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.
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.
oavila@tribune.com
maramirez@tribune.com
[Edited on 2-17-2009 by CaboRon]
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