Monday, July 4, 2011
California has double the national rate of tuberculosis because of its large immigrant population and proximity to the border with Mexico. While both countries work together to stem the spread of TB, the San Diego-Tijuana region has established a unique model for that collaboration.
TIJUANA, Mexico A young woman walked into Tijuana’s tuberculosis clinic with a little plastic jar in her hand containing her saliva sample. She dropped it off at the front desk, and left. She didn’t need to see Dr. Rafael Laniado this time, because she had been taking her meds and her tuberculosis had been under control for months.
"When you visit this clinic, I can tell you if you have tuberculosis within three weeks,” said Laniado, the chief neumologist at the Tijuana TB clinic, the most efficient facility of its kind in Mexico. "I can also tell you in a short amount of time whether you are resistant to any drugs, which is the most important part of getting tested."
This is remarkable for Mexico, where tuberculosis testing generally means waiting for more than three months to get a diagnosis and having to send samples to Mexico City or to a lab in the U.S.
Tijuana’s state-of-the-art lab opened in 2006, with funding from the Mexican government as well as $400,000 from USAID for construction and testing equipment. Today, Tijuana has the most success in the treatment of drug-resistant TB in Mexico, seeing an average of 700 new cases a year.
Between appointments, Laniado took a look at a patient’s X-ray, holding it up close to the light. "He’s stable," he said to the nurse. "Tell him to come back next week."
If that patient were to stay in Tijuana, this lab would make sure he got tested regularly and took his meds. But if he happens to cross the border into the U.S., his health records and specific prescription will be available in a binational database system. This sharing of health records allows American doctors to keep treating him so that his TB doesn’t become drug-resistant.
"When I see a case here, I don’t diagnose it and treat it all by myself," said Laniado. "Instead, I present it at a virtual meeting with other tuberculosis doctors from the other side of the border, who understand the immigrant population.”
As a major crossing point for rural and poor migrants into the north, Tijuana is in a unique position to treat and prevent the spread of this infectious disease. Ninety percent of people seen at this lab go on to keep their TB under control. But those who fail to get treatment typically go on to infect 10 to 15 others.
At a recent public-health conference in San Diego, the lessons and challenges of Tijuana’s lab took center stage. Steve Waterman was there on behalf of the Centers for Disease Control.
"Tuberculosis rates in the U.S. are really at an all-time low, but parts of the country like California and San Diego -- where there’s a high number of foreign-born persons -- have higher rates than the rest of the country,” said Waterman, an expert on infectious disease across borders. “I think the Tijuana-San Diego partnership is a very focused collaboration and it’s addressing a very important need.”
One of the reasons this collaboration works is the binational sharing of resources, medical training, and common goals. At a time when budget cuts are hurting public health programs in both countries, the Tijuana-San Diego area has been able to raise money from foundations and groups, like Rotary International, to make up for the shortfall.
This summer, the San Diego-based International Community Foundation will step in as well, donating more than $30,000 to TB labs in Tijuana and Mexicali to pay for testing-equipment maintenance and personnel.
“In our border region, people work in silos, agencies work in silos," said Richard Kiy, International Community Foundation president. "Often it’s difficult to move resources across the border to promote these types of binational collaboratives that are so necessary when you’re trying to treat a disease that impacts both sides of the border.”
Other states along the border, like Arizona and Texas, have TB rates close to the national average—about 3 active TB cases per 100,000 residents. One of the reasons California’s tuberculosis rate is double that is perhaps that due to the success of this program more people are getting tested and treated.