New super-card launches pilot sites for binationals
Card uses the best of the rest
Soon, physicians and other caregivers on both sides of the U.S./Mexico border will begin to take part in an experiment aimed at better case management. In four pilot sites in both countries, TB patients will get a wallet-sized card featuring a toll-free phone number and a brief summary of the patient’s history and treatment to date. The hope is that by linking clinicians on both sides of the border, patients who move back and forth across the boundary will continue treatment without interruptions or mistakes.
But wait: Isn’t there already such a card?
In fact, there are two — the San Diego-based CURE-TB card, with its toll-free number that connects the caller to bilingual telephone operators who link up providers from the two nations, and the Austin, TX, based-Migrant Clinicians Network’s TB-Net card, used more often for workers who move state-to-state within the United States, with a flip-out written record of TB treatment.
So why create a third card for binationals? According to Kayla Laserson, ScD, coordinator for the American side of the project (and epidemiologist at the Centers for Disease Control and Prevention’s Division of TB Elimination), the point is not that the other two cards aren’t working well, but rather that they are.
"There’s a desire at the highest levels of government on both sides to make something bigger of what’s already under way," she says. "Both countries want to see more case management and completion of therapy along the border." Taking the best elements from the two systems already in place seems like a good way to begin, she adds.
Bigwigs and a big crowd
The first draft of the new super-card came out of a meeting hosted by the U.S./Mexico Border Health Commission last October in El Paso, TX. The fact that 117 administrators, TB experts, and officials turned out for the two-and-a-half-day meeting shows how much the U.S./Mexican border has risen in national priorities, Laserson adds. "That many people haven’t come together to talk about TB on the border for a very long time," she says.
Nor is it an everyday event to have their bosses from Mexico City and Washington, DC, turn out to bless the proceedings. Though U.S. Secretary of Health Tommy Thompson was unavoidably delayed, causing him to miss his spot on the agenda, he did show up for other activities as did his top-level counterpart, Mexico’s health minister Julio Frenck.
Big though it may have been, the crowd was able to reach a consensus on what the new cross-border tool would look like and what form it would take. "Going in to the meeting, we weren’t even sure it would be a card," Laserson notes. The group also hashed out which variables the card would include and which ones didn’t belong. For example, instead of names or other personal identifiers (which might prove off-putting to illegal immigrants), each card bears a unique patient number. Also provided will be a brief treatment record, with drugs, dates of first and most recent treatment, and whether or not treatment was observed.
For access to a more thorough record and the chance to talk person-to-person with the counterpart provider, there is a toll-free phone number meant to link public health clinics here with health jurisdictions in Mexico, which in turn will provide links to whatever community health center provided initial care. As treatment proceeds, the idea is to make brief notes in appropriate spaces provided on the card, Laserson adds.
Ruled out, at least in this iteration of the pilot, is a central data bank where patient information is kept. Also absent will be any spaces for data on drug sensitivity, a feature some at the conference say they’d like to see included. Cases involving drug resistance will need to be referred "outside the box" to systems better equipped to handle them, Laserson explains.
Because cross-border immigrants often travel in migrant streams linking a city here with a corresponding city or region in Mexico, the card’s four pilot sites are likewise twinned: El Paso with Chihuahua and the southern Mexico region; Brownsville/McAllen, TX, with Tamalipas; San Diego with Baja California; and Chicago with Jalisco. The four U.S. sites were chosen because cross-border patients make up a significant part of the caseload in each place, Laserson says.
Besides sorting out logistical details of how the card will work, the biggest challenge looming seems to be finding some funding for the pilot projects. USAID may come through with funding for work on the Mexican side; and for the U.S. side, the hope is that the U.S. Border Health Commission might step forward.
But at the commission, there’s no consensus yet on whether the agency’s mandate, which officially is to provide a forum where binational issues can get a high-level hearing, can stretch to include acting as financier. "In a way, this [card] project will be a test case for the commission," says Miguel Escobedo, MD, MPH, regional director of the Texas Health Department. That is, will the commission really be able to pack the political punch its boosters hope, or will it turn out to be just one more group of experts talking about TB on the border?
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