1. Health Frontiers in Tijuana An academic community partnership Prevencasa-UCSD- UABC

2. Initiative Driven by UCSD Medical Students

3. Course Objectives Explore and address the challenges of community medicine and public health involving marginalized populations of Tijuana Participate in HFiT clinic activities, working alongside Mexican physicians, Prevencasa staff, and UABC medical students

4. The population IV drug users Female sex workers Deportees

5. Drug use in Mexico Mexico produces 30% of all heroin and 70-90% of the methamphetamine entering the U.S. Highest consumption of illicit drugs in Mexico is in Baja California Tijuana has ~21,000 drug users, and ~6000 IDUs In Mexico overall, men were 13 X more likely than women to have ever used an illicit drug; in Tijuana the ratio is 6:1 Bucardo et al, 2005

6. Female Sex Workers Prostitution is quasi legal in Mexico Up to 9000 FSWs in Tijuana alone Many women/girls from southern Mexico/ Central America Multiple venues: street, bars, massage parlors, hotels Sex ‘tourism’ is common

7. Deportees In 2009, 465,295 people were deported, 118,712 from San Diego County (Department of Homeland Security Yearbook, 2009) Deportees are often delivered by US Customs and Border Protection Patrol Agents to Mexican migration officials at deportation stations, two which are located in Tijuana Deportees are uniquely at risk because they often lack economic resources after deportation In one study, only one-sixth of deportees had received medical care in the last 6 months (Brouwer, 2009)

8. The Canal

9. Course components Classes- two hour weekly Sessions Clinic visits in Tijuana Health Education Talk Binational Social Service Referrals

10. Didactic Classes Understand differences between the US and Mexican Health Systems Learn about different programs for marginalized populations Identify health and social issues involving marginalized populations Learn about selected Global Health Issues Participate in a binational community center Electronic Medical Record Training

11. Class Schedule TimeLocationTopic 2 hrs. UCSD Prevencasa Course launch and Introduction Course requirements and outline Scheduling Universal precautions/ Safety Student safety and travel requirements for Tijuana Mexico (Check list) Question answer panel with (repeat) students 2 hrs. Medical history/ SOAP Notes/ Confidentiality/Safety Physical Exam Cultural competency 2 hrs. Substance abuse in the Zona Norte, Tijuana. Congenital syphilis in Tijuana General Hospital

12. Class Schedule, cont TimeLocationTopic 2 hrs. UCSD Prevencasa Infection Control in health care settings in the US and Mexico Case studies: TB outbreak at Tijuana General Hospital 2 hrs. Health care and health policy in Mexico Legal aspects of clinical practice in Mexico Case studies 2 hrs. Provider cultural competency Social resources in Mexico The Binational patient

13. Class Schedule, cont TimeLocationTopic 4 hrs. UCSD Prevencasa Marginalized populations Deportees Female Sex Workers IV drug users 2 hrs. Cross-border collaboration between clinician-researchers for better patient outcomes: Case studies. 2 hrs. Community as a teacher Community health 2 hrs. Wrap up/ Case studies/ Lessons learned/ Look to the future

14. Health Frontiers in Tijuana Clinic Patient care will be under the supervision of Mexican licensed physicians Teams of two students o First/second year + third/fourth year (UCSD and UABC) o Present cases to physicians o Work on social and medical referrals o Maintain and update the medical records Case discussions with fellow students will take place at the end of the clinic day

15. Electronic Medical Record

16. Health Education With a partner, the students will prepare a health education talk on a community health topic of their choice Possible topics include nutrition, HIV/AIDs risk and prevention, substance use, self defense, domestic violence, etc. These presentations will be presented to clinic patients

17. Social Resources Referral Social resource referrals are an essential part of the clinic’s activities Students will help create and maintain referrals for social services Information will be collected in Mexico and the US Telecommunication techonology is available to complete this task from San Diego

18. Basic Laboratory

19. Future Directions Expanding to other community clinic locations Rotating at Tijuana General Involvement of residents Mobile Clinic Other collaborations

20. Questions?