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NY medical students study border health in Nogales

In this March 30, 2012 photo, Dr. Tanya Henry of the pediatrics department at MCHC and first-year med student Amrita Karambelkar go over a patient’s history before entering the examination room in Nogalas, Ariz.
In this March 30, 2012 photo, Dr. Tanya Henry of the pediatrics department at MCHC and first-year med student Amrita Karambelkar go over a patient’s history before entering the examination room in Nogalas, Ariz.
Manuel C. Coppola, Nogales International, Associated Press

NOGALES, Ariz. — Rather than a destination, Nogales is often seen as a town one has to go through on the way to Mexico from the United States, or vice versa. In simply passing through, many people ignore the economic, cultural and social characteristics that make this place unique.

But a dozen students from Mount Sinai School of Medicine in New York spent their spring break in Santa Cruz County last week specifically to observe health needs on the border while simultaneously learning about its culture and challenges - at least as much as they could in one week.

Mariposa Community Health Center, Carondelet Holy Cross Hospital and the Pimeria Alta Historical Society joined the Southeast Area Health Education Center and Mount Sinai as part of the Medical Students Making Impacts (MSMI) program. The student-run program is dedicated to educating current and future medical professionals about global health by working in underserved communities.

"We're from a huge hospital in an urban area," said Amrita Karambelkar, a med student from Burlington, Mass. "This is a fantastic opportunity and privilege to learn about rural medicine."

In the big city, there are numerous medical specialists to address the multiple needs of patients, Karambelkar noted. "Here, you don't have that. Physicians here must have a broader knowledge base to make good decisions to ultimately make referrals to Tucson or across the border."

Circumstances to which border residents may have become jaded, Karambelkar and her fellow students found curious and unique, such as the practice of ambulance crews transferring patients between Mexico and the United States at the border.

"This is an eye opener not just for the students, but also for the people we talk to about their rural services that are quite unique and that the community should be proud of," said Dr. Rainier Soriano, who along with Dr. John Ripp joined the group as faculty members since it began visiting Nogales four years ago.

MSMI students used to visit such places as the Dominican Republic and Belize, Soriano said, but shifted gears after a medical student who served during the summer with SEAHEC went back to Mount Sinai to share his experience. "We realized you don't have to go outside of the United States to learn about rural health and global health," he said. "In Nogales, students are exposed to both."

"We realize, too, that whether in Nogales, with its limited resources or Mount Sinai where resources are plentiful, the goal remains the same and that is to provide outstanding and quality care," Soriano said.

He sees immigration as unavoidably intertwined with health care on the border. "You cannot work to improve one without working on the other," he said. Local health-care professionals are bound ethically to provide services despite the circumstances, which may mean an inability to cover costs or "the reality that Border Patrol will be taking the patient back to Mexico."

On the subject of immigration, the group met with Teresa Leal of the Pimeria Alta Historical Museum who also works as an advocate for women and the poor. They learned about how some people and organizations on the border work outside the parameters of government to help migrants, who many times are deported into Mexico with broken limbs, blisters, diabetes issues and even depression.

"Panchito," for example, is an emergency medical technician who was trained extensively and worked in Phoenix. But as he was lining up his immigration documents, his wife, a U.S. citizen, divorced him and allegedly reported him to U.S. immigration officials.

"So Panchito was deported and now walks around with his backpack and volunteers his services to these people," Leal said. "It's his way of coping with the depression of having been separated from his family and the life he left behind."

There are other organizations too that are working against a rising tide of anti-immigrant sentiment, Leal said. "I knew the students would be dealing with mainstream groups and I thought I could provide them with insight as to some of the ongoing efforts outside the box because people have the right to service with dignity and grace" that may not be available to them through conventional sources.

Among other activities, the students put their services to use at the Mexican Consulate's "Ventanilla de Salud" and at the Nogales Senior Center, providing health-screening to more than 90 people, said Erin Sol of SEAHEC, who coordinated the visit.

Dr. Eladio Pereira, medical director for Mariposa, said that while the visit was a short one, it was impacting. During the screenings they identified several people with high blood pressure who were unaware of their condition and referred them to the clinic.

Karambelkar, the student from Massachusetts, said it won't end there. The plan is to have Mariposa clinic follow up with plan of care. Then later, the students are to contact the patients as well to reinforce the importance of following through.

"It's a privilege to work with these first-year medical students from such a prestigious school," Pereira said. "The learning is mutual as they explore Santa Cruz County, its people and the delivered health care."

He hopes the visit inspires the students to go into primary vs. specialty care. "Hopefully one day, some of them may decide to come back and work here."

Information from: Nogales International,