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Dr. Catalina Amaral practices medicine in Matamoros and teaches biology in Brownsville.

PHARR, RGV – A border nurse says she would like to kick start a conversation through the pages of the Rio Grande Guardian about creating a framework that would allow patients to obtain healthcare on both sides of the Texas-Mexico border.

Martha Williams, a registered nurse who lives in Pharr and works in Weslaco, said under the framework she has in mind, clinics would be electronically connected on either side of the Rio Grande, with physicians and nurses able to work on either side of the river.

“At the moment, there is no reciprocity for healthcare between the two countries. I have always wondered why we can have a free trade zone and yet have not investigated the idea of a free health zone. That would allow us to set up networks of clinics all along the border,” Williams said.

According to the Centers for Disease Control and Prevention, the U.S. and Mexico are two countries with different health systems, who share populations and many health issues. “Both countries may be viewed as a single epidemiologic region, especially the geographic area where both countries meet: the United States-Mexico border region,” the CDC says.

A physician who likes the idea of a “free border health zone” is Dr. Catalina Amaral, who practices medicine at the International Medicine Center in Matamoros, Mexico, and teaches anatomy and physiology at Texas Southmost College in Brownsville.

Asked about Williams’ idea, Amaral told the Rio Grande Guardian: “That would be fantastic. I would be open to that. I can see where that could happen.” Asked what the advantage would be, Amaral said: “The cost. As physicians in Mexico, our system is very cost-efficient. For example, one of our workers here (at Texas Southmost College) got injured and she happens to live in Mexico. She had an x-ray, she had a cast put on with a little shoe and she was given a prescription, all for less than $100. That was in Matamoros. Here it would have cost her over $1,000.”

Amaral said the “knowledge and preparedness” of medical doctors in Mexico is “excellent.” She said in Mexico there is more of a clinical approach taken. “We do not use as much technology. We still use technology, MRI, CT Scans, Pet scans, but many times we see our patients. We actually examine them and touch them and talk to them. In the United States, people say, oh, the doctor did not even touch me today. Oh, and the bill, it is like, $300 or $500. And people are like, what?”

Amaral added: “I like the idea of an area where people can have a choice and we can have doctors from the United States and Mexico working together and seeing patients and making it cost-efficient. I would say, hey, Obama, what about this, we can offer this and it can be a choice. Patients can have a choice in doctors and Mexico could start to work with doctors here in the U.S. It would be fantastic. It is a great idea. It is another option, let us look at it.”

Williams moved to the Rio Grande Valley in 1990 to help launch an epilepsy clinic at the old migrant clinic on Ferguson in Pharr. She was working on a small grant as part of Pan American University’s South Texas Border Health Office.  She has been in the community health field ever since.

Asked if patients could come back and forth freely for treatment under her “free border zone” idea, Williams said: “Absolutely, with proper documentation and screening. You would get a pass to come here and see the doctor.” Asked how the clinics on either side the border would be linked, Williams said: “Electronic medical records are not a big problem. You get the right system in place and the record belongs to the clinic and it can be accessed from anywhere as long as it is on your computer. Those are the kinds of issues you would have to discuss, HIPAA, all of that. It is a federal requirement. If there was a free health zone, HIPAA would obviously apply. We would have to respect the patient’s privacy, of course.”

Asked why a “free health zone” would be advantageous, Williams said: “It would improve the education of healthcare providers, because you would have public health people there, rural public health, we have the Texas A&M School of Rural Public Health, right here in McAllen. We would involve nursing students, laboratory, radiology, public health, rural public health; all of the statisticians, the medical epidemiologists, all of those people can look at the impact of living on the border and what it does to people. Healthcare right here is very much different to what it is like in San Antonio. Our population is very transient.”

Williams said the Valley’s new medical school could have an important part to play. “We would link the clinics to the medical schools. We would have access to medical schools, nursing schools, dental schools, all up and down the border so that establishing a free health zone, we could treat folks and offer some kind of reciprocity to physicians to come here and train, for our physicians to go there, so that patients could be seen and treated.”

Another thing that needs to happen, Williams said, is having the infrastructure in place to do mass health screenings. She said this was lacking when thousands of women and children from Central American crossed into South Texas last summer.

“We have absolutely no place to screen these folks in any kind of large numbers. I volunteered at Sacred Heart last year. We had just a little rudimentary clinic that was staffed by volunteer nurses and doctors, we saw children that had low grade fever, diarrhea, dehydration, insect bites, things like that. But, there was no screening of any of these folks. Either that day or the next day they were put on a bus to places unknown throughout the United States, with absolutely no screening, no health history; no documentation of any sort. We need to be prepared for something like that to happen again. We were not prepared but all of a sudden there were literally hundreds of people every single day. We were there for about six weeks in June and July of last year. There were hundreds of people every single day coming through that one center.”

Williams said she started thinking again about a “free border health zone” after a conversation with the incoming mayor of Pharr, Dr. Ambrosio Hernandez. The two met by chance at the Moonbeams coffee shop in Pharr when Hernandez was having coffee with Pharr City Manager Fred Sandoval.

“Dr. Hernandez is looking at access to care, particularly in the southern part of Pharr. There seems to be a lack of primary healthcare in that area. Certainly, there are no free-standing, ambulatory care centers like the Hidalgo County clinics. I think Dr. Hernandez wants to do his research to see what exactly available in that area and then see how best the needs of that community can be met.”

Williams said an ambulatory care center is crucial for the south side of Pharr because such centers are entrances into the healthcare system. “At least they are a place for people to be screened. That becomes their patient center medical home. From there they can be referred to some sub-specialties. The Driscoll clinics are subspecialties. They feed into Driscoll in Corpus Christi. Those are in-take centers and they are free-standing. I do not know the availability of ambulatory care centers anywhere south of Business 83.”

Williams said she was encouraged by the conversation with Hernandez.

“I am excited that we have a medical doctor sitting as the mayor of Pharr. He will bring, I hope, a public health perspective and a broad based perspective on the health of his community. It goes way past having hike and bike trails and sidewalks and clean drinking water,” Williams said.

“Dr. Hernandez sounded real interested. We talked a lot about literacy, to me that is a public health issue – workplace literacy, financial literacy, health literacy. You cannot educate people about their health if they cannot read and write or they don’t know how to use a computer and to advocate for themselves.”

Williams added: “My whole thing is promoting community health and that is what I talked to Dr. Hernandez about. Anything that promotes the health of the community is something he as the mayor of Pharr and as a physician should be very much aware of and very much on top of because the lack of hike and bike trails, the lack of primary healthcare, the influx of immigrants that we had last summer, the impact they have had on our schools, that all impacts public health. It impacts community health. And it is not just a lack of hospital beds. A lot of these people are up walking around. If they do not need healthcare now, they will, eventually.”