“I came to the border contracting every 2 to 3 minutes. There aren’t any clinics or ambulances or doctors offices where I live. So, we just go to the border and hope we can cross. I’ve never had a problem but some of my friends have. It’s only 1 hour to get to this hospital, but the closest one to me in Mexico is 2 hours away, but I don’t have a car.”

In Spanish, a mother from the small border town of Puerto Palomas, Mexico.

I’ve had interesting international experiences over the last decade or so since I left the town I grew up in. In college in San Diego, we were less than an hour from the border and would travel down to Tijuana from time to time for volunteering, food and, um, recreation. I grew up learning Spanish and from time to time, even though not quite fluent, have found myself as the only person in a room that can communicate with a Spanish-speaker. In Louisiana a large amount of my population as a medical student that were Spanish speakers were from Honduras or Nicaragua, and, of course, in Houston a majority of my patients at the county hospital were Spanish-only speakers. I’ll never forget the one time I was the only Spanish speaker that showed up to a true Pediatric Code and had to explain to the Parents that we were going to rush their child to get a STAT Head CT scan and likely straight back to surgery…

We’ll get to my Bulgarian, Romanian and Kenyan experiences another day.

But, it wasn’t until recently that I’ve started to really appreciate and understand, only slightly better, what it’s like to deal with Border Medicine. Even at about 40 minutes from the border, I’m fairly removed from some of the clinics and jobs I’ve been presented that are literally on the divide. Months ago I had been given an opportunity to work overnight clinics at a clinic literally adjacent or connected to the border, but was unable to take it due to my already full schedule. However, given my current GPS pin drop, I’ve started to see some of the ripples in the system and the variation in access to health care between our border between the US and Mexico as well as the desires to be in the US.

While I’ve felt a lot of judgement from providers by the border to create assumptions that just because someone came from Mexico they haven’t had ‘adequate’ medical care, this isn’t always the case; yet, it certainly does fit a large majority of patients. I find myself in a curious mix of first and third world medicine sometimes. So many patients that start on antibiotics or other medications from the pharmacy without consulting with a Physician – prescriptions aren’t really needed. Walk into a pharmacy and say you have a stomachache, and they’ll give you Bactrim or Macrofurin , which can have deadly side effects from time to time. Have a kid that has a viral infection? Here’s some Amoxicillina (which isn’t the right treatment, FYI). If there’s a fever or pain they’ll give you Neo-Melubrina, or “Mexican Aspirin,” which has been illegal in the US for years due to risk of Agranulocytosis. But, what do you do when there’s no doctors around and the nearest big city with care is 2 hours away by transportation that you don’t have?

Everyone has diarrhea. I’d never asked a patient prior to being near the border if they drank “agua de pozo” (“well water”), and now it’s part of my normal history and physical. Sanitation and public health is lacking so much immediately adjacent to the border that these problems continue to be subject of research by the department of health and researchers in Mexico. Of the children I’ve admitted to the adult medical/surgical unit at my small Critical Access hospital, almost all of the ones from Mexico come in with severe dehydration from infectious diarrhea – something seen, but often not to this magnitude in the United States.

Yet, the most fascinating and controversial part of medicine I experience so close to the border is Pregnancy, Labor and Delivery.

A majority of the mothers and new babies I see at my Critical Access hospital in New Mexico, come FROM Mexico. Often times they come to the border in active labor or with a note from their doctor saying they are at their due date and hope, just hope, that the Border Patrol will let them cross. An ambulance is called and they’re brought to Me; but, sometimes they don’t make it to us before they deliver. Why? Many times they won’t be allowed to cross if they’re in latent labor, and even if active, being non-imminent (with the baby almost falling out) won’t be good enough cause to cross. They come to us often because we are the closest hospital, but there are obvious advantages to being born in the United States. From an objective point of view, the babies are born in the United States, pass through my hands and on discharge they go back to Mexico with their mom. We try to mail discharge summaries and hospital records, but it’s unclear if the mail ever makes it to “the 2nd house after the church, the first driveway past the chicken coup.” And yes, the babies return to Mexico as United States Citizens. As they grow, they are sent across the border for primary school. Once they’re old enough, buses after buses drive from my small town to the border to pick them up and bring them to our local high school where they learn English and receive a US Education – but, their mailing address remains across la frontera. Eventually, the females will almost assuredly get pregnant and the cycle repeats. It was sweet to meet my 19 or 20 year old Spanish-only Palomas-living US citizens repeat the cycle, slightly better off than when they were born here 2 decades ago.

Often times at discharge families tell me they will follow-up with me in clinic for their newborn visits and pediatric care; but, when the time comes, this is contingent on sending the baby across the border to the hands of a relative who hopefully lives in the United States, that can bring them to see me. In other words, a majority are lost to follow-up and I never know what happened to them.

There are obvious controversies surrounding the border and my objective description of the cycle of life at my little frame of the wall likely doesn’t help the situation; but, as always, my job is to take care of and support the livelihood of Children and their families, regardless of the circumstances that surround them. So, we keep trudging on, doing the best we can to take care of my little border babies from Palomas, or as I call them, Mis palomitos.