Cross Borders Committee
Members
Frederick Bw’Ombongi, MHA
Janel Curry
Lynette Johnson, RNC, BSN, MSA
*Valerie Reed
Spectrum Health
Calvin College
Spectrum Health
Michigan Department of Community Health
*Committee chair
Objectives

Draft collaborative plans that describe how non-U.S. leaders can ensure health care access is
equitable for citizens and the public.

Draft collaborative plans that allow U.S. and non-U.S. health workers to cross borders
appropriately to work.

Draft a plan to ensure cross-border access has supplies to meet demand.

Ensure that any plans developed as a result of grant activities mesh with existing cross-border
agreements.
Assumptions
1) Federal / tribal agencies control their respective borders and border access.
2) Region 6 cannot make international border agreements, but the region can make recommendations
based on the objectives in the grant proposal and agreements currently developed.
Background
Why this work is needed – Diseases do not respect political boundaries, especially in this time of frequent
national and international travel, trade, and educational opportunities. Seamless delivery of health care
during a pandemic is essential to ensure the health and safety of the public and will require collaboration
by all jurisdictional entities.
Preconceived notions – Many jurisdictions, their respective public health agencies and their own unique
preparedness plans will be involved for the successful implementation of the framework proposed by this
committee. Their willingness to review and align portions of their preparedness plans will allow a seamless
response during a pandemic. Even though Region 6 has no direct interstate or international borders, this
framework, or portions thereof, can be incorporated into the pandemic planning of the region as needed.
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Committee Characteristics
o
Frederick Bw’Ombongi – Manager of Translation and Interpreting Services at Spectrum
Health, Grand Rapids, MI. His experience includes coordinating preventive health for
refugees and immigrants in Kent County, currently responsible for the overall language
access strategy for Spectrum Health.
o
Janel Curry – Dean for Research and Scholarship at Calvin College, Grand Rapids, MI.
She has a Ph.D. in geography. She has spent extensive time in England, Canada, New
Zealand, and Hong Kong.
o
Lynette Johnson – Neonatal Outreach Coordinator, Helen DeVos Children’s Hospital,
Grand Rapids, MI. She has 17 years in the Air Force, which has given her extensive
experience in disaster response training, and has experience in risk management at
Spectrum Health. Spends time in regional outreach activities.
o
Valerie Reed – Laboratory Coordinator –Bioterrorism Preparedness Program at the
Michigan Department of Community Health, Bureau of Laboratories; Lansing, MI;
experience in clinical laboratory preparedness planning activities for the Great Lakes
Border Health Initiative.
The Process
How we approached the objectives
o
The committee first had to define the use of the term border. Region 6 does not have
state-to-state borders or international borders, per se, but does have regional and tribal
nation borders, an international port of entry, foreign travelers and visitors. The committee
then discussed how to focus the activities of their work to determine the appropriate
relevance – region, state, tribal or federal. Discussions continually returned to a regional
level then broadened in scope. Requirements for inclusion in the framework were then
determined by review and discussion of local, national, tribal and international documents
and plans.
o
Existing agreements were reviewed, and from there templates were developed that could
be used to assess similarities and differences of jurisdictions. The information gleaned
from these assessments can be used for the development of agreements which take place
amongst neighboring entities—across international boundaries and between tribes and
county health agencies
.
Tough Decisions
o
Making the grant-defined cross border activities relevant to this region presented a
challenge. The committee had to determine what would make this activity relevant to
neighboring jurisdictions or entities and then focus on what would make this a useful tool to
ensure equitable health care that would be available to the larger community, irrespective
of jurisdictional boundaries.
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The Conclusion
Final Objectives
o
o
o
Identify resources to assist in comparing jurisdictions or entities.
Develop a cross-border activities framework that can be utilized to ensure health care
access is equitable to all residents.
Ensure plans mesh with existing cross-border agreements.
Infectious diseases are not bound by geographic or political borders. These boundaries are often invisible
to the citizens who cross them. Supported by federal funding, these jurisdictions have developed
pandemic preparedness plans to ensure the health and safety of their citizens. If these individual plans
were activated without a cohesive response across neighboring jurisdictional boundaries, complications,
inequitable care, confusion and social unrest could ensue. Therefore, it is essential that neighboring
jurisdictions develop a seamless, collaborative response.
To assist jurisdictions and entities in the development of this consistent response across their boundaries,
a series of activities should be undertaken so that a broad understanding can be established of what each
jurisdiction has planned and what each can offer to the coordinated response. The following
recommendations were developed to assist in these endeavors:
Recommendation Number 1: Each entity should go through the process of determining its potential
borders and proactively develop agreements/Memorandums of Understanding (MOU) with cross-border
counterparts in the event of an influenza pandemic.
Existing documents/resources, processes, and models to enhance the development of such agreements
have been identified (see References). Consistent plans, developed prior to such an event, will provide
equitable health care. The development of such agreements or MOUs is essentially a communication
strategy as well, developing working relationships in and of themselves. Cross-border collaborations exist
and are implemented at the local level. Thus a framework is provided for these intermediate areas of
cross-border coordination.

Step #1: Local entities identify all relevant cross-border counterparts.
Note: The legal counsel for any jurisdiction should review the foreign diplomats in the jurisdiction
and make a statement on the ramifications on how they are affected by the plans.

Step #2: Local entities identify which agreements/MOUs presently exist.

Step #3: Evaluate agreements where they do exist and assess if they are sufficient. If not, or if no
agreement exists, work through the process recommended below for the development of such an
agreement with cross border counterparts.
In formulating and implementing such plans and programs the counterparts should follow this general
outline for process:
A. Determine all those potential emergencies the counterparts might jointly suffer in the case of a
pandemic.
B. Initiate a process to review the counterparts’ individual emergency plans and develop a plan that
will determine the mechanism for the cooperation.
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C. Develop procedures to fill any identified gaps and to resolve any identified inconsistencies or
overlaps in existing or developed plans.
D. Assist in warning communities adjacent to or crossing the counterpart’s boundary.
E. Protect and ensure delivery of services, medicines, water, food, energy and fuel, search and
rescue and critical lifeline equipment services and resources (both human and material resources)
to the extent authorized by law.
F. Inventory and agree upon the procedures for the entities to loan or deliver material resources and
assure human resources have border crossing access, keeping in mind the procedures for
reimbursement or forgiveness after the emergency has passed.
To assist in the process of assessing/comparing each organization and to ensure a consistent and
equitable response the following templates can be used. Consider these tools to guide your evaluations as
you begin this process. These can be modified to meet the needs of your jurisdictional or entity
assessments; make them usable tools for your jurisdiction:
Template 1 Template 2 Template 3 Template 4 -
Entity Characteristics
Entity Influenza Plan Triggers
Entity Mitigation Responses
Entity Communication Comparative
As an outcome of this process of assessment, comparisons, and gap analysis utilizing these tools, develop
a collaborative MOU, if needed, to support your collaborative response. Refer to the References section
for many examples of MOUs and on-line links to other useful tools to assist in the development
Recommendation Number 2: Develop a communication strategy that incorporates all cross-border
entities or jurisdictions in the region; including identified universities, colleges, and business travelers that
engage in extensive international travel or involve foreign nationals.

Inter-institutional communication is needed to ensure consistency in response by these entities.

Communication between those coordinating responses and these entities is needed because of
the extent of international travel related to these institutions.

Identify key contacts related to these institutions.
Recommendation Number 3: Maintain a central Web site for the region with links to other sites where
essential contacts, information, etc. are deposited and updated regularly.
The purpose of this Web site would be to provide quick access to essential information in one place,
including key contacts. Additional links for relevant information should also be included. For this region it
would include the following links:
Great Lakes Border Health Initiative – Tools for Border Health
Located under the “Important Documents, Best Practices & Helpful Resources” are documents
such as the Data Sharing Agreement, the Infectious Disease Emergency Communication Guideline and
various memorandums of understanding.
www.michigan.gov/borderhealth


State of Michigan Tribal Regions and contacts
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For a listing of federally recognized tribes in Michigan with links to the Web site for each of the 12
tribes go to www.michigan.gov, then search using “federally recognized tribes.”
For a visual map of tribal locations in the state:
www.bjmi.us/maps/1996-mi-tribes.html

Michigan Public Health Preparedness Regional Maps
http://www.michigan.gov/mdch/0,1607,7-132-2945_21919_23628---,00.html

Center for Disease Control – Public Health Law Program – Mutual Aid
This site was created to assist U.S. state and local governments, Tribes, Canadian provinces, First
Nations, and Mexican states in sharing information, data, supplies, resources, equipment, or
personnel for the purpose of protecting the public’s health. Resources, which can be accessed
here, include a menu of suggested provisions for Mutual Aid agreements and an inventory of
agreements and resources.
www2a.cdc.gov/phlp/mutualaid/index.asp

US Customs and Border Patrol - Locate port of entry on land, sea, or air.
This provides a searchable database to locate/identify all ports of entry by state and US territory.
Included in these links are lists that contains pertinent information specific to that port of entry.
http://www.cbp.gov/xp/cgov/toolbox/contacts/ports/
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Supporting Documents
Template 1
Entity Characteristics
Jurisdiction
Population
Number
of
Schools
Number of
Colleges/Univ.
Other
identified
items
Other
identified
items
List each entity that will be
assessed in this column
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Template 2
Entity Influenza Plan Triggers
Triggers
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
A compiled list of triggers
that would activate a
jurisdiction’s Pandemic
Plan would be listed in this
column
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Template 3
Mitigation
Response
Isolation
Entity Mitigation Responses
Enter Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter a brief description
of jurisdiction’s planned
response
Quarantine
School Closure
or Dismissal
Daycare
Closure
University
Closure
Banning of
Public
Gatherings
Traffic
Limitation
Border Closure
Non-Essential
Business
Closure
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Template 4
Entity Communication Comparative
Communication
Method
Phone
Enter Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter
Jurisdiction
Enter a brief
description of
jurisdiction’s planned
response
800MgHz
Language
Services
Public
Notification
Jurisdiction
Notification
Regional
Notification
Other
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References

Michigan Pandemic Influenza Community Health Plan version 3.5 (June 2008)
o http://www.michigan.gov/documents/mdch/MDCH_Pandemic_Influenza_v_3.1_final_draft_
060107_2__198392_7.pdf

Michigan Emergency Management Assistance Compact (MEMAC) (10-8-2004)
o http://www.michigan.gov/documents/MEMACFINAL7-3-03_69499_7.pdf

INTERIM Pandemic Influenza Emergency Response Appendix 2 of the Hazard Specific
Appendices, New Mexico Department of Health, Emergency Operations Plan
o http://www.health.state.nm.us/flu/providers/Master%20Pandemic%20Influenza%20Append
icies%2010March2006%20FINAL1.pdf

Great Lakes Border Health Initiative Web site
o www.michigan.gov/borderheatlh

Great Lakes Border Health Initiative Public Health Data Sharing Agreement (February 2009)
o http://www.michigan.gov/documents/mdch/2007-06-21__DATA_SHARING_AGREEMENT_202933_7.pdf

Great Lakes Border Health Initiative; Infectious Disease Emergency Communications Guide.
(February 2009)
o http://www.michigan.gov/documents/mdch/GLBHI_INF_DIS_EMER_COMM_GUIDELINE_
255878_7.pdf

Great Lakes Border Health Initiative; Reportable Disease Directory (March 2009)
o http://www.michigan.gov/documents/mdch/REPORTABLE_DISEASE_DIRECTORY_2558
83_7.pdf

MOU Between Ashland County Health Department and Bad River Health Services
o http://www.michigan.gov/documents/mdch/SAMPLE_TRIBAL_MOU_219758_7.pdf

Bay Journal Web site “Michigan Indian Tribe Locations (1996)”
o www.bjmi.us/maps/1996-mi-tribes.html

Development of Public Health Memorandums of Understanding - a How-to Guide CDC Public
Health Law Program
o http://www.michigan.gov/documents/mdch/CDC_Model_MOU_Templates_219756_7.pdf

Pacific Northwest Emergency Management Arrangement (PNEMA) Implementing Procedures(720-05 Revision)
o http://www2a.cdc.gov/phlp/docs/PNEMA.pdf

A Memorandum of Understanding Public Health Emergencies (6-20-2006)
o http://www2a.cdc.gov/phlp/docs/WA_BC_Public_Health_Emergencies.pdf
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
Declaration Among the Department of Health and Human Services of the United States of
America, the Department of Health of Canada, the Public Health Agency of Canada, and the
Ministry of Health of the United Mexican States. (11-1- 2007)
o http://www2a.cdc.gov/phlp/docs/SPP_Tripartite_Declaration.pdf

Arizona and Sonora Declaration of Cooperation (12-5-2008)
o http://www2a.cdc.gov/phlp/docs/20081209155422662.pdf

Michigan Department of Community Health – Flu Web site
o www.michigan.gov/flu

Great Lakes Pandemic Influenza Coordinators Workshop December 4, 2008 Detroit, MI Report
Summary. (Not released electronically as of this date)

Agreement Between the Government of the United States of America and the Government of
Canada on Emergency Management Cooperation. December 12, 2008 (Not released electronically
as of this date)
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