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Mutual Assault : U.S., Mexico Join Hands and Funds to Fight the Spread of Tuberculosis

August 07, 1989|PATRICK McDONNELL and GREG JOHNSON | Times Staff Writers

TIJUANA — For the past five years, a San Ysidro health clinic and the Mexican government have used joint funds to operate a unique binational program that attempts to limit the spread of tuberculosis into the United States by treating patients in Baja California.

The effort involves the Baja California branch of the Mexican Secretariat of Health and the San Ysidro Health Center, a publicly funded, nonprofit clinic that operates out of the San Diego community of San Ysidro, just across the border from Tijuana. The center, bolstered with up to $200,000 annually in U.S. tuberculosis-control funds, provides the Mexican health agency with supplies and expertise.

While the incidence of tuberculosis--once a scourge of mankind, known alternately as consumption and the "great white plague"--has been reduced considerably in the United States and other Western nations, the far-reaching disease remains a serious problem in the developed world and a crucial health one in Mexico and much of the Third World.

Since 1984, the center and Mexican officials have quietly operated the joint program in an effort to thwart the spread of the contagious illness across the border, which is annually traversed by tens of millions of people, both legally and illegally.

The U.S. Department of Health and Human Services began funding the program after the San Ysidro clinic documented that area patients--many of whom maintain close family and social ties in Mexico--suffered from a higher incidence of TB than was evident elsewhere in the United States.

"Disease does not recognize frontiers," said Dr. Jesus Ontiveros, chief of the federal health department branch in Tijuana, a city of up to 1.5 million people.

"We have to work together, respecting the laws of each other's nations, in order to combat these problems," said Ontiveros, who has overall responsibility for the entire government tuberculosis treatment program here.

The international cooperation may seem natural and logical, but health experts say it is by far the largest such formal initiative involving direct treatment of patients with contagious diseases along the U.S.-Mexico border, which stretches for almost 2,000 miles and is a mecca for economic and political refugees from around the world.

Conflicting laws and guidelines, plus nationalistic sensitivities, often hamper coordination--facts that have led officials to be deliberately low-key about the TB effort. Health officials along the border have traditionally exchanged information about contagious diseases in both nations, but the TB initiative here is one-of-a-kind, officials said.

Joint treatment programs "are a politically sensitive issue, particularly for (officials) in Mexico City and Washington, D.C.," said Gabriel Arce, chief executive officer of San Ysidro Health Center.

Yet the need is clear. While ailments such as tuberculosis and Hansen's disease (leprosy) are more prevalent in Mexico, other problems--notably AIDS--have migrated south from the United States.

There is a hope that the TB program, which has attracted widespread attention in the border health community, could serve as a model for similar initiatives aimed at further combating the spread of TB and other infectious ailments along the border.

"If our goal is to wipe out TB, then it's essential that we do something like this," said Dr. Laurance Nickey, director of the El Paso City-County Health District in Texas, across the Rio Grande from Ciudad Juarez, Mexico. "There is a lack of understanding among the people who give out the money. . . . They assume that public health problems belong in one jurisdiction, whereas in our case, it's 1.8 million people (in two nations) who live in a valley where they share the same air, water and diseases."

Whether similar initiatives will evolve remains an open question.

"You don't often get a foreign government allowing you to march around treating their citizens," said Arleigh Sawyer, chief of primary care programs for the U.S. Department of Health and Human Services in San Francisco, which has allocated $200,000 to the joint program during the current fiscal year. "This program is unique."

In Baja, the program, which complements Mexico's own broad anti-TB effort, has been credited with considerable success in helping reduce TB rates and in cutting down on the mortality of patients. The disease has long been treatable with a variety of drugs.

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