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Office of Community and Educational Outreach

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The Office of Community Outreach and Education has evolved to assist the medically underserved communities along the Texas-Mexico Border and Greater Houston. The office provides daily management of the Texas-Mexico Border Health Projects, oversees the daily management of the Acres Home Project (acreindx.html) works with The Greater Houston AHEC in institutional-community collaborative educational efforts, serves as a liaison among UT-Houston Office of Academic Affairs and Medical School-Family Practice and Community Medicine, UT System Administration, and other relevant persons and agencies that have a community health and primary health care education focus. If you need any more information please email inquiries to Dr. Kathy Becan-McBride, Director of the Office of Community Outreach and Education and Professor in the Medical School Department of Family Practice and Community Medicine, Ms. Sandra Dugan-Senior Staff Assistant for the office also can be of assistance.

Through a partnership with the East Texas AHEC Program of The University of Texas Medical Branch-Galveston, the Greater Houston Area Health Education Center (AHEC) has been funded since October 1, 1994. its mission is to improve the supply and distribution of health care professionals, with an emphasis on primary care, through community/academic partnerships, and to increase access to quality health care, especially for the medically underserved. AHECs have a great sensitivity to community needs with special attention given to improving the representation of minorities and the disadvantaged in the health professions and meeting the needs of populations with inadequate access or availability of primary care services. The Greater Houston AHEC includes Fort Bend, Harris, Montgomery, and Waller Counties, and provides services most needed in these counties, including needs assessment, health careers promotion, continuing education, information dissemination services, and community based education for students in allied health sciences, dentistry, medicine, nursing, nurse practitioner and nurse midwife program, physician assistant studies, and social worker programs. The AHEC staff hopes to continue building a strong link between the community and health care academic institutions.  If you would like more information, please email Dr. Kathy Becan-McBride, Greater Houston AHEC Assistant Director for Academic Liaisons at http://www.ghahec.org/  or Kathleen.Becan-McBride@uth.tmc.edu.

The University of Texas Health Science Center at Houston (UTHSCH) Border Projects are serving a major segment of the Texas population that would otherwise not have access to such services.  The overall impact of this initiative is a health care delivery system that is exceeding the initial goals of serving the underserved population along the Texas-Mexico Border.  However, there are still many unmet needs due to a Border population that is growing faster than any other region in the nation.  The UTHSCH Texas-Mexico Border Coordinator's Office provides daily management of the projects and serves as liaison among UTHSCH, UT System Administration and other relevant persons and agencies located along the Texas-Mexico Border who are affiliated with the Projects.  The Coordinator has served as the Chair of the UT System Texas-Mexico Border Health Advisory Council for four of the seven years of The Council's existence.  http://www./utcomp.htm . Following are some of the achievements in health care education, services and research for the Border community.

Medical Mobile Clinic
Telehealth for the Colonias
Delivery of health care services, health care professional
Education, and wellness programs in
The Colonias

The UTHSCH Medical Mobile Clinic was initiated thirteen years ago to assist with desperately needed primary health care services, disease prevention, health promotion and education in the Texas-Mexico border "colonias."  This project serves the large, rural indigent population in Hidalgo and Cameron Counties, both having the Medically Underserved Area (MUA) and Health Professions Shortage Area (HPSA) designation.  Travelling to:

A major goal for the medical mobile clinic has been to provide clinical rotations for health care professional students in this federally designated HPSA area.  Fourth year medical students from UTHSCH have one month clinical rotations on the mobile clinic. In addition, third year medical students from UTHSC-San Antonio have had clinical rotations on the mobile clinic.  Over 30 UT-Pan American nursing students per year have clinical experiences on the mobile clinic. Also, a medical assistant student from South Texas Vocational Technical Institute, and nursing faculty from Lee College in Baytown, Texas have had clinical rotations on the medical mobile clinic to enhance their multicultural health professional skills and communication.

    Through two grants received in 1998 from the General Services Commission State Energy Conservation office (SECO) and a TIF Grant received in 1999, the UTHSCH has developed a telemedicine infrastructure on the UTHSCH Medical Mobile Clinic.  This telehealth project  is enhancing health care to a county that is burdened by a large rural, indigent population of approximately 136,000 persons (Texas Water Development Board, 1996) who have limited or no access to the health care systems due to economic, social, geographical, and cultural factors. The SECO grants were established as a direct result of Governor Bush's Colonia Working Group Report issued on November 8, 1997. As stated in the report, Texas citizens living in the Colonias experience many impediments to their accessing health care including: shortage of health care providers, long distances to existing health care facilities, lack of means of transportation, lack of health insurance, loss of working time and salary for trips to obtain health care. These grants have provided the following telemedicine equipment:two teleconferencing units-one for the mobile clinic and the other for the Medical School specialists who provides the secondary health care consultations; and medical peripherals (i.e., otoscope, dermascope, retinal scanner, etc.) for the telemedicine unit located in the mobile clinic.

The TIF grant has provided funds for the installation of a dedicated T-1 telemedicine network from four Hidalgo County colonias' elementary schools through UTHSCH  School of Public Health at UT-Brownsville to the UTHSCH Medical School. The telemedicine encounter is equivalent to a doctor's office visit, but the doctor is 370 miles from the patient.

Thus, the overall impact is to provide not only primary health care services, but also much needed secondary health care services to the Hidalgo County residents, offering potential savings to the state by reaching those in need before the medical care evolves into more serious health problems which makes treatment more costly (i.e., emergency treatment for diabetic coma). Telemedicine consultations from UT-Houston Medical School to the border colonia residents began in September, 2000.

Overall, the implementation of this project is providing an innovative method that can provide health care technology and information to a population not known to have access to health care.  In addition, UTHSCH has established a Wellness Distance Learning Program to the elementary students via the T-1 lines installed at the colonia schools. Please contact Dr. Kathleen Becan-McBride, Director of the Office of Community Outreach and Education and Coordinator, Texas-Mexico Border Health Projects for additional information at kmcbride .

Starr County Services Project

This Project has provided, at no cost, intensive physical exams and follow ups (involving screenings for glucose, cholesterol, and triglycerides and hypertension; specialized eye exams; and ultrasound evaluations) to Mexican Americans along the border for the past 18 years.  In addition, Dr. Craig Hanis and his colleagues at the University of Chicago and elsewhere has identified at one of the genes responsible for type II diabetes mellitus referred to as CAPN10.  It is a discovery that one day could yield more effective treatments for Type II diabetes mellitus. Activities to educate those at risk and continue surveillance of the population for morbidity and mortality events are a continued focus of this major project.

An additional aspect of this project is to find genetic determinants of essential hypertension in the Mexican American population.  It is a part of a large national effort to understand the genetics of hypertension in different populations.  Among the various centers involved across the nation, this center is the only one involving Hispanics.  Because of the tremendous burden of diabetes on the Mexican American population along the border, this research effort is examining the impact of hypertension within the population of those with Type II diabetes.  The net result will be the identifications of genes and pathways leading to increased risk for hypertension and the mechanisms whereby these genes interact with environmental factors and diabetes to produce high blood pressure.  This understanding will lead to methods for identifying those at highest risk and strategies for preventing and slowing the development of high blood pressure and its attendant problems.  The Project Director is Dr. Craig Hanis.

Continuing Education for Nurses along the Texas-Mexico Border

Approved Provider Renewal Status: On January 16th, 2001, UT-Houston School of Nursing Community & Educational Outreach submitted the Continuing Education program to the Texas Nurses Association for renewal of our approved provider status. Approval as a provider of continuing nursing education for the next two years was received.

• Little research had previously been performed to examine pain experiences in Hispanic patients although reports indicate they are at a higher risk for poor pain management and receive less medication for reported pain. Through Texas-Mexico Border funds, the School of Nursing collected data on pain management from 125 Hispanic participants in health care facilities along the border. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire-Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. The conclusions from the study increase the base of knowledge about ethnic minority patients' needs for intervention and serve to begin the process as the basis for further intervention outcomes' studies.
• Drs. Sherwood, Starck, and Adams have received over $100,000 in grant funds for continued research in this area. The UTHSCH Texas-Mexico Border Health Project funds have served as seed funding and provided pilot research information.

Dental Branch Clinical Rotations at Brownsville Community Health Center (BCHC) and the City of Laredo Health Department Dental Clinic

The Laredo Dental Clinic serves indigent residents in the Laredo area and migrant workers. For 21 years, the Laredo clinic has been the site of a three-week externship for fourth year dental students from UTHSCH. Working under the supervision of the clinic director, students provide a wide range of dental services specifically for disadvantaged children. In addition to dental services, the students provide instruction in preventive dental care and oral hygiene techniques.

The UTHSCH Dental Branch provides services in the Brownsville Community Health Center (CHC) in conjunction with the other health care services provided at this CHC. Fourth year dental students receive extramural credit for extra three week rotations at the Community Health Center. Two students are assigned per three-week period. The students are supervised by a full-time faculty member of the Dental Branch. The students provide wide range of dental services to mainly pediatric patients of indigent residents along the border. In the past, the students have provided on the average, over 4000 treatments in over 100 patient visits per year. In addition, the students provide dental preventive services and dental health education programs in the Cameron County elementary and high schools for one-half days a week during their rotations. The Project Director for this project is Dr. Martin Hobdell .

The Dental Branch public health residents and director have collaborated with a team of medical students from The University of Texas Medical Branch (UTMB) to screen residents in Cameron Park (a colonia),at the Brownsville Community Health Center and at a church in Cameron County. This is an ongoing interdisciplinary health care activity. In addition, the residents work with the "promotoras" to promote oral health along the border. This project has been developed with Ms. Paula Gomez, the Brownsville Community Health Center Executive Director.

As part of the residency program, the residents have been involved in the following research activities:

• Evaluation of dental services at Brownsville CHC
• Evaluation of dental services at the Dental Clinic, Laredo City Health Department
• Oral cancer knowledge and practice attributes among dentists practicing along the Texas-Mexico Border
• Dental caries status among Willacy County children: Baseline data in the post-fluoridation era
• Evaluation of immigration on oral health as a strategy to develop oral health services along the border.

School of Public Health Funded Projects

Activities initiated by the School of Public Health include coordinating efforts of UTHSCH and of community and political border organizations to define health problems, health service use, and barriers to health care services. In addition, the Texas-Mexico Border Project funds provide internships for School of Public Health students to work on Border community projects.

As an example, one student project was a feasibility study to look at the future needs to implement Medicaid Managed Health Care along the border. A rapid community assessment was conducted in the four counties of the Lower Rio Grande Valley to determine the characteristics of Medicaid-eligibile non-users for services, and to identify barriers which may prevent them from accessing available services. One of the major recommendations from the study is to increase culturally sensitive health education on disease prevention and health promotion to this border population.

Another example was the development of the data resource "Texas-Mexico Border Health Statistics: Projections 2010." A public health student intern provided data gathering and entry, together with the revision of the statistics from the 1994 publication, and designed the new statistical book with inclusion of charts and graphs on the health status of the border counties. Dr. Frank Moore .

A joint project between UTHSCH and UT Pan American led to the development of low-literacy, culturally sensitive health promotion brochures in Spanish and English on the topics of anemia and menopause. These brochures are distributed to the clinics and hospitals throughout the Texas-Mexico Border region to provide patient education in areas that previously had a serious lack in health promotional materials in Spanish.

Health educational videotapes that are culturally sensitive have also been developed through the Texas-Mexico Border funds. Patient education videotapes in English and Spanish for diabetics were developed through the School of Nursing. Through research studies on patient compliance, these health education videotapes have shown to be effective for health care changes in diet and exercise. These videotapes are made available at no cost to community/migrant health clinics and hospitals. In addition, a patient education videotape entitled "Lowering Your Cholesterol" in English and Spanish has been especially developed for culturally sensitivity of border residents. It ia also available at no cost for community/migrant clinics and hospitals. Contact Dr. Kathleen.Becan-McBride for additional information.

Tuberculosis, an infectious disease caused by Mycobacterium tuberculosis (TB), has plagued humanity since before recorded history and globally, is still the leading infectious cause of death.  Since 1985, there has been a noteworthy increase in incidence of new cases of Mycobacterium tuberculosis (TB) in the United States and other countries, along with the emergence of multiple-drug resistant (MDR) forms of TB.  The resurgence of TB has hit hard in many areas of our country, particularly in Houston and other major cities with many international visitors.  Houston (Harris County), for example, reported  456 or 27.7% of the 1,649 new cases reported in the State for 1999, compared to 462 or 25.4% of the 1,820 new cases reported in 1998. State data for 2000 is not currently available.  Houston ranked 12th in the Nation by case rate in 1999 compared to 11th in 1998.  Houston’s case rate for 1999 is 12.0 per 100,000 population compared to the U.S. case rate of 7.7 per 100,000.  According to the recently released Institutes of Medicine report  entitled Ending Neglect: The Elimination of Tuberculosis in The United States, the key to achieving TB elimination in the U.S. will be through social mobilization and maintaining the public interest and commitment necessary to provide sufficient resources for the effort. The global pandemic of TB must be addressed immediately to avoid a drastic increase in TB cases in international cities such as Houston.

These numbers are magnified in the at-risk groups like the homeless by a factor of 25.  There is an increased risk for those working with the homeless, including shelter staff, physicians, nurses, social workers, and their families.  As shown through research in the American Journal of Public Health (AJPH-3/2000), hospitalization cost $2000 or more per homeless patient than the general patient with multiple-drug resistant TB (MDR TB). Despite long and arduous treatment, individuals in this high-risk group die within just a few years.  Persons with impaired immunity, such as those infected with the human immunodeficiency virus (HIV), are especially at risk.  The use of ultraviolet germicidal irradiation (UVGI) to kill bacteria in the air before they can be breathed in is a potential solution to this problem.

The Centers for Disease Control and Prevention (CDC) has listed TB as one of the most serious public health problems of our time. Dr. Charles Wallace, TDH Director of TB Elimination, has stated that one infected TB case can affect 15 persons per year!

This homeless shelter project will serve literally thousands of men each year.  Persons enrolled in the study will be benefiting from the application of UVGI and increased TB skin testing, which means that these persons will have a better chance of NOT contracting TB in the first place.  Based upon the annual rate of TB cases in Texas and also the TB hospitalization cost estimates of $9,834 for a homeless person vs. non homeless of $7,967 (American Journal of Public Health, 3/2000), there is a possible savings to the State of roughly between 16.2 million dollars per year through this project application. Therefore, prevention, both in the form of regular skin testing, especially of high-risk populations, and UVGI is the most effective method of controlling the spread of TB. This project includes both of these methodologies, while attempting to provide conclusively and irrefutably that UVGI, which is low cost and virtually maintenance free, is one of, if not the most effective preventive measure, for controlling the spread of TB.

Open Door Mission is the first of two Houston homeless shelters that have been identified as demonstration sites for the project. Houston Endowment and Reliant Energy have graciously provided funds for the initiation of this project. H.E.B. has provided food certificates for the homeless shelter residents that participate in the project. St. Vincents' Hospital is providing funds for the research activities.

The Houston Project Director for this project is Dr. Kathleen Becan-McBride. She is the UTHSCH Director for the Office of Community Outreach and Education, Professor in the UT Medical School Department of Family Practice and Coordinator of the Texas/Mexico Border Health Services Projects.

shd   01/14/02