The States of Texas, New Mexico and Chihuahua share a common border between Mexico and the United States in the central area.
There are three international border crossing points between Chihuahua and New Mexico: Puerto Palomas-Columbus, San Geronimo-Santa Teresa, and Antelope Wells. Between Chihuahua and Texas there is one border crossing point between Ojinaga and Presidio and the other between Juarez and El Paso.
The latter has a peculiarity because three States and three communities from two countries share their borders: Ciudad Juarez, Chihuahua, El Paso, Texas and Sunland Park, New Mexico. Although Sunland Park does not have a formal crossing point, Sunland Park and Las Cruces, New Mexico constitute an integral part of this large binational metropolis.
Considerable interaction takes place in the border region between Chihuahua-New Mexico-Texas. There are two natural migratory corridors that cross their territories: one called Paso del Norte which includes Ciudad Juarez, El Paso and Las Cruces; and the other goes from Nuevo Casas Grandes to Silver City through Columbus-Palomas. According to Lorey, (United States-Mexico Border Statistics since 1900. Edited by David E. Lorey. UCLA, Los Angeles, CA. 1990), between 1980 and 1982, there were an average of 364,929 South to North border crossings per year in Columbus, and in El Paso more than 43 million border crossings. More recent information indicates that there were 61 million border crossings in El Paso (South to North) in 1993 (U.S. Immigration and Naturalization Service. Yearbook 1993. Washington, D.C.).
In general, population movement poses an important challenge for health officials. It becomes even more complex when it is movement between countries, since identification and control of diseases or health damaging events becomes more difficult. There are multiple reasons for this, but among the most important are the following:
- People arriving to a new community and do not know where public health services are located, thus it becomes difficult for them to seek health care.
- Many people who cross the border constantly do not trust health care providers of the neighboring country.
- Interpersonal communication is not adequate between patients and health providers.
- Transculturation implies exportation and importation of diseases and high-risk behaviors.
- Patients have contacts on both sides of the border, thus making medical and epidemiological follow up very difficult.
Mexico and the United States share a common border of over 2,000 miles long involving 10 states from both countries. Six States are on the Mexican side and four on the U.S. side of the border. There are many peculiar border features, but among the most important is the enormous population movement that takes place in this area. For instance, there were over four hundred million crossings from south to north. This represents one and one half times the total population of the United States and 4.3 times the total population of Mexico.
The border region between the States of New Mexico, Texas and Chihuahua is approximately 275 miles long. The main binational community is located in the area where these three States meet. This community is formed by Ciudad Juarez, Chihuahua, Mexico; Sunland Park, New Mexico; and El Paso, Texas. The City of Las Cruces, New Mexico is located 35 miles north of the border, and is considered an integral part of this "community" due to various factors such as trade, education and family ties.
This common region is the second most heavily populated area along the US-Mexico border with an estimated population of two million. Each year more than 80 million people cross the border through the three border crossing points located between El Paso and Ciudad Juarez. Approximately 32 million motor vehicles and over 2.1 million cargo units and goods account for about $19.4 million annually (Diario de Juarez).
People who cross from one side to the other of the border between the two countries carry with them disease agents that can endanger the health of humans and animals. This situation concerns the health officials from New Mexico, Texas and Chihuahua, since their reporting systems of events involving health risks are not fast nor permanent, and control activities generally do not include the border area of the neighbor country.
For the General Division of Health Services of the State of Chihuahua and for the Texas and New Mexico Departments of Health, the health of the people of their common border population is a priority, therefore different binational health activities have been carried out for some time.
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In August 1996, the General Division of Health Services of the State of Chihuahua, headed by Dr. Eduardo Rico, and the New Mexico Department of Health headed by Mr. Alex Valdez met to study the main common health issues and to establish a Bi-State Health Agenda. Bi-State health issues that were addressed at that meeting were:
- Project Mirror (Proyecto Espejo): A binational project on detection and treatment of sexually transmitted diseases in Nuevo Casas Grandes, Palomas and Columbus.
- "Our Kids" Project (Proyecto Nuestros Niños). Immunization promotion program which included Ciudad Juarez, El Paso and Las Cruces.
- Mobile Bi-State Health Brigades: A primary health care project for migrant population of Nuevo Casas Grandes/Southern New Mexico.
- A binational study of the prevalence of Hantavirus in the Chihuahua-New Mexico border.
- Binational Border Health Information System: Binational project to promote exchange of health and epidemiological surveillance information among the three States.
Dr. Julio Garcia-Garcia, General Director of the Chihuahua State Health Services, ratified these issues in December 1996 (now called General Health Division).
During 1997, binational activities between the three states were primarily to consolidate a Memorandum of Understanding (MOU) about the Border Binational Health Information System. State, regional, and local representatives from Chihuahua, New Mexico and Texas signed the MOU in Las Cruces on November 21, 1997. At this meeting, representatives of the federal governments on U.S. and Mexico, through their respective International Health Directors signed the Memorandum as "Honorary Witnesses".
During 1998, the activities described in the MOU (Article II) were started. In order to comply with the activities described in item a) and d) of the above-mentioned Article, a binational technical working group was formed. Its first task was the preparation of this document, which had to do with the cooperation and operation procedures of the group.
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