Frontera NorteSur July & August 2001

Even people with only a casual knowledge of the problems that Mexico and the US face at the border realize that cultural differences, issues of sovereignty and national pride, and financial realities combine to make progress on shared problems difficult if not sometimes almost impossible. Immigration, law-enforcement, environment and other issues are being dealt with slowly with different levels of success on various parts of the border. While it is necessary and important to regularly examine the problems that have been hard to resolve, it is also instructive to look at how programs often succeed quite well on the border.

Last month Frontera NorteSur examined the success of PROBEA (Proyecto Bio-regional de Educación Ambiental), a binational, bioregional environmental education program that has succeeded in part because of its members' persistence and continued opened mindedness. This month, as part of its examination of tuberculosis (TB) on the border, Frontera NorteSur looks at Project Juntos, a binational TB treatment program that was first proposed in 1983 and finally started in 1991. In addition to the persistence and good bilateral ties it took to get Project Juntos (Project Together) started, the El Paso-Ciudad Juárez partnership can also contribute its success in treating TB to the fact that it is organized so that nationality and finances do not impede treatment of the disease.

TB treated anywhere--nationality not a barrier

According to program director Fernando González, who has been with Project Juntos for six years, the organization treats people wherever is best for them. González gave the example of a Cd. Juárez man whose TB was diagnosed while he was visiting his daughter in Austin, Texas. The man began treatment for the disease in San Antonio but returned to finish his treatment in Cd. Juárez once he was no longer contagious. Similarly, a US citizen that works in El Paso but lives in Cd. Juárez could seek treatment on the Mexican side of the border.

Project Juntos also provides outreach or home visits which are done by the organization's driver, vehicle and two nurses. While in 1993 Project Juntos was checking for the disease an average of 2.6 people that had had contact with one of its TB patients, by 2001 the program was testing 5 people for TB for each patient that it treated. People that have had contact with one of Project Juntos' TB patients have access to clinical exams, PPD tests (the TB skin prick test) and X-rays.

The program is also guided by people on both sides of the border as Project Juntos has a binational clinical committee that meets once a month to discuss the TB cases of people with associated conditions such as diabetes and HIV. Project Juntos provides direct support to these people and helps them find necessary secondary medications like insulin and HIV drugs.

"We are contributing," says González. In the past nine years Project Juntos has treated 721 patients, more than 80% of whom are cured, according to González. What's even more encouraging is that the number of new cases of the disease is down even as more people arrive to Cd. Juárez from some of Mexico's poorest areas.

Resources should not be a barrier

Another important aspect of Project Juntos is that anyone in Cd. Juárez and El Paso can access TB control and prevention services. When in 1995 it became apparent that it was hard for people to get treated if they had to go one central spot in Cd. Juárez for TB testing, Project Juntos helped the Servicio de Salud de Chihuahua decentralize its operation. Now people can be treated in any of a number of primary health clinics throughout Cd. Juárez. To make sure that the necessary infrastructure exists for these new TB treatment centers, Project Juntos has provided X-ray equipment and film. Furthermore, all of the Project's lab cultures are done in El Paso: approximately 3,000 between 1994 and 2000.

Project Juntos--a true success

Besides looking at its 80% cure rate, another way of gauging the organization's success is seeing how well it treats Multidrug Resistant TB (MDR TB). MDR TB is a form of TB that is hard to treat and has become immune to the effects of traditional, first-line TB drugs. Because MDR TB may be acquired when a patient stops treatment without having gotten rid of the disease, MDR TB patients may also be some of the patients that have the most trouble finishing their prescribed treatment. Successfully reaching out to these people and curing them is a sign of a good program.

Between 1994 and 1997 Project Juntos found 27 people with MDR TB. Of this group, 15 people were cured for a 52% cure rate. Five of the people died, five of are still in treatment and three have refused treatment. While the 52% figure may seem low to people that are not doctors, TB experts or epidemiologists, González says that Project Juntos has the same MDR TB success rate as the best lung-treatment hospitals in the US.

40% of Mexican TB cases cross legally to the US on a regular basis

To people that might wonder why the US should support TB treatment in Mexico, González points out that 40% of Mexican TB cases cross legally to the US on a regular basis. Most of the other Mexican TB patients receive visits from people that come from the US. TB is an infectious disease so it is important to the health of people on both sides of the US-Mexico border that all people with TB get treatment. However, so as not to create hysteria around the thought of TB-infected people moving from one nation to the other, it should be noted that only 3-5% of household members contract TB in homes where someone has been diagnosed with the disease, according to González.

If Ciudad Juárez and El Paso are viewed as one population that share health, immigration, and environmental problems it is beginning to make sense that problems should be resolved for the good of people in both cities. In the future, perhaps other programs will follow the example of Project Juntos and pressing border social needs will be addressed by putting results before cost and nationality.