One day, students meet the director of the Laredo Health Department. Another day, they hear about curanderismo, medical sociology and border health at Texas A&M International University. A third day, they tour a maquiladora in Nuevo Laredo and visit families in the colonias. That's just in the first three days.
For four weeks, their immersion into border life continues as the students, many seeking to become physicians, nurses, public health specialists and allied health professionals, learn the key environmental and occupational issues that impact the health of the border region. The South Texas Environmental Education and Research Program (STEER), part of The University of Texas Health Science Center at San Antonio, coordinates the eye-opening experience.
Many dedicated partners in Laredo, Webb County and Nuevo Laredo share the credit for STEER's success, which has translated into two recent national and state awards. The first was a U.S. Olympic "Spirit of the Land" Award that brought recognition to STEER for environmental education as part of the celebration of the 2002 Salt Lake Winter Games. The second, announced by Gov. Rick Perry, is a Texas Environmental Excellence Award from the Texas Natural Resource Conservation Commission. STEER personnel will be on hand as the Health Science Center award for two projects, including STEER, is bestowed May 7 in Austin.
"I am delighted that this important border health education program has been singled out for state recognition," said State Senator Judith Zaffirini, D-Laredo, who authored legislation creating the South Texas/Border Region Health Education Initiative (STBI) under which STEER was established in 1996.
"STEER is the first program of its kind in the country," Senator Zaffirini added. "It has introduced hundreds of health professionals in training to border health and environmental health concerns. In addition, STEER graduates have elected to enter practice at the border as a result of this experience."
STEER's topics include sociocultural issues, water quality, infectious diseases, zoonoses (diseases carried by insects and animals), outdoor and indoor air quality, hazardous materials, food sanitation and pesticides. "STEER is a magnet for health professionals who are concerned about their patients' environments and have the goal of preventing illness," said Claudia S. Miller, M.D., M.S., STEER director and associate professor of environmental and occupational medicine in the Health Science Center's department of community and family medicine.
One such health professional is Dr. Gustavo García Ramos, a physician in private practice in Laredo. He completed the STEER rotation in 1997. "I was very curious about environmental issues and didn't know where to find answers or do research on it," Dr. Ramos said. "Thanks to STEER, I was able to see the breadth and complexity of environmental issues. I am working on my master of public health degree (M.P.H.) and plan to enter an occupational and environmental training program next year."
"Although patients increasingly turn to their physicians to address questions concerning the role of environmental exposures in their illnesses, already overcrowded U.S. medical school curricula have not added training in this vital area," Dr. Miller said. "The average time devoted to this area in U.S. medical schools is around eight hours. STEER is a one-month rotation."
The rotation, offered eight times a year, has hosted 170 health professions students and many more part timers. STEER's outreach extends to schoolchildren and teachers on both sides of the border and to entire families. During one grant project, known as La Cuenca del Rio, 300 Mexican middle school children received training about how water quality affects health.
Another grant project, Agua Para Beber, instructed 500 colonia residents about hygiene and water purification. A third funded project, Environmental House Calls, benefited families of asthmatic children through home environmental assessments and recommendations on limiting exposures to allergens and irritants that can aggravate asthma.
"STEER's vision is to reunite medicine and public health," said Joan A. Engelhardt, a registered nurse and one of STEER's environmental medical training coordinators (Roger Perales, a registered sanitarian, is the other). "Doctors used to make house calls and thus were aware of their patients' circumstances and environment. Now, patients are seen in offices and physicians are often unaware of the environmental factors that underlie their patients' illnesses. If doctors receive training in environmental medicine, becoming more aware of possible environmental sources of patients' symptoms, treatment can be improved by modifying these factors."
Perales added: "Patients and communities ultimately benefit. Physicians are most often the experts who are consulted when environmental health threats are suspected."
STEER has partnered with a wide variety of agencies and organizations on both sides of the border. These include the Laredo Health Department, Texas Department of Health's Office of Border Health, Mercy Regional Medical Center, Texas A&M International University, Texas A&M School of Rural Public Health, Environmental and Occupational Health Sciences Institute (Robert Wood Johnson Medical School consortium in New Jersey), United and Laredo Independent School Districts, Global Business Academy at United South High School, Laredo Community College and its Lamar Bruni Vergara Environmental Science Center, CIER (an environmental science center in Nuevo Laredo), Nuevo Laredo School District and Nuevo Laredo Health Department. Other partners include the Webb County community centers,
Laredo Development Foundation, International Bank of Commerce, Central Power and Light,
Mid Rio Grande Border Region Area Health Education Center, UT Health Science Center at Houston School of Public Health, U.S. Department of Agriculture, U.S. Customs Service, U.S. Immigration and Naturalization Service, and U.S. Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry.
"Our wonderful partners, coupled with the support of Senator Zaffirini and Dr. Francisco G. Cigarroa, president of the UT Health Science Center at San Antonio, are responsible for STEER's success," said Dr. Miller, one of the nation's most cited experts on the health effects of low-level environmental exposures. "Some of our students have settled on community, occupational or environmental health practice and are working toward M.P.H. degrees. One of the students will be interning with the CDC and worked on border health issues during the most recent state legislative session. Awareness of the environmental and occupational factors that affect the health of patients is a very important mindset to cultivate in our nation's physicians."
More information about the Texas Environmental Excellence Awards is available at www.teea.org. The UT Health Science Center at San Antonio's Dental School also will be recognized for its program to recycle mercury-bearing waste from amalgam dental fillings.