Health Frontiers in
Tijuana
An academic
community partnership
Prevencasa-UCSDUABC
Initiative Driven by UCSD Medical Students
Course Objectives
• Explore and address the challenges of community
medicine and public health involving marginalized
populations of Tijuana
• Participate in HFiT clinic activities, working alongside
Mexican physicians, Prevencasa staff, and UABC
medical students
The population
• IV drug users
• Female sex workers
• Deportees
Drug use in Mexico
• Mexico produces 30% of all heroin and 70-90% of
the methamphetamine entering the U.S.
• Highest consumption of illicit drugs in Mexico is in
Baja California
• Tijuana has ~21,000 drug users, and ~6000 IDUs
• In Mexico overall, men were 13 X more likely than
women to have ever used an illicit drug; in Tijuana
the ratio is 6:1
Bucardo et al, 2005
Female Sex Workers
• Prostitution is quasi legal in Mexico
• Up to 9000 FSWs in Tijuana alone
• Many women/girls from
southern Mexico/
Central America
• Multiple venues: street,
bars, massage parlors, hotels
• Sex ‘tourism’ is common
Deportees
• In 2009, 465,295 people were deported, 118,712 from San
Diego County (Department of Homeland Security Yearbook,
2009)
• Deportees are often delivered by US Customs and Border
Protection Patrol Agents to Mexican migration officials at
deportation stations, two which are located in Tijuana
• Deportees are uniquely at
risk because they often lack
economic resources after
deportation
• In one study, only one-sixth
of deportees had received
medical care in the last 6
months (Brouwer, 2009)
The Canal
Course
components
• Classes- two hour weekly
Sessions
• Clinic visits in Tijuana
• Health Education Talk
• Binational Social Service Referrals
Didactic Classes
• Understand differences between the US and
Mexican Health Systems
• Learn about different programs for marginalized
populations
• Identify health and social issues involving
marginalized populations
• Learn about selected Global Health Issues
• Participate in a binational community center
• Electronic Medical Record Training
Class Schedule
Time
Location
2 hrs.
2 hrs.
UCSD
Prevencasa
2 hrs.
Topic
Course launch and Introduction
Course requirements and outline
Scheduling
Universal precautions/ Safety
Student safety and travel requirements for Tijuana
Mexico (Check list)
Question answer panel with (repeat) students
Medical history/ SOAP Notes/
Confidentiality/Safety
Physical Exam
Cultural competency
Substance abuse in the Zona Norte, Tijuana.
Congenital syphilis in Tijuana General Hospital
Class Schedule, cont
Time
Location
Infection Control in health care settings in the US and
Mexico
Case studies: TB outbreak at Tijuana General Hospital
2 hrs.
UCSD
Prevencasa
2 hrs.
2 hrs.
Topic
Health care and health policy in Mexico
Legal aspects of clinical practice in Mexico
Case studies
Provider cultural competency
Social resources in Mexico
The Binational patient
Class Schedule, cont
Time
Location
Marginalized populations
• Deportees
• Female Sex Workers
• IV drug users
2 hrs.
2 hrs.
UCSD
Prevencasa
4 hrs.
2 hrs.
Topic
Cross-border collaboration between clinician-researchers for
better patient outcomes: Case studies.
Community as a teacher
Community health
Wrap up/ Case studies/ Lessons learned/ Look to the future
Health Frontiers in Tijuana Clinic
• Patient care will be under the supervision of
Mexican licensed physicians
• Teams of two students
o
o
o
o
First/second year + third/fourth year (UCSD and UABC)
Present cases to physicians
Work on social and medical referrals
Maintain and update the medical records
• Case discussions with fellow students will take place
at the end of the clinic day
Electronic Medical Record
Health Education
• With a partner, the students will prepare a health
education talk on a community health topic of their
choice
• Possible topics include nutrition, HIV/AIDs risk and
prevention, substance use, self defense, domestic
violence, etc.
• These presentations will be
presented to clinic patients
Social Resources Referral
• Social resource referrals are an essential part of the
clinic’s activities
• Students will help create and maintain referrals for
social services
• Information will be collected in Mexico and the US
• Telecommunication techonology is available to
complete this task from San Diego
Basic Laboratory
Future Directions
• Expanding to other community clinic
locations
• Rotating at Tijuana General
• Involvement of residents
• Mobile Clinic
• Other collaborations
Questions?