1-800 service aids cross-border referrals

Bilingual operators make cross-border referrals

Along the U.S./Mexican border, it happens all the time: A TB patient in the midst of treatment leaves the country. Whether he leaves for good or only for a short while, unless his health care provider can find a way to intervene, his TB treatment will be interrupted.

Typically, cross-border referrals are fraught with obstacles, including language and monetary barriers, legal problems, and a lack of understanding about how a foreign health care system operates.

San Diego TB controllers recently have created a new program they hope will serve as a solution to at least some of those problems. Called CURE-TB, the program offers bilingual patient referrals between physicians and public health agencies on the American and Mexican sides of the border. Equipped with knowledge of how each country’s public health infrastructure operates, its two full-time staff members are able to call ahead across the border. That way, they can help ensure TB patients don’t get lost to follow-up when they leave one country for the other.

The service is free. In the United States, patients and providers who want a referral to Mexico can call 1-800-789-1751. In Mexico, the only difference is that patients must dial 001 instead of 1. Basically, CURE-TB aims to make it as simple for a health care provider in the United States to talk to a counterpart in Mexico as it is for TB controllers here to talk to one another, says Kathleen Moser, MD, TB control officer for San Diego.

How do you call TB control in Oaxaca?

"Here in the U.S., if I have a patient turn up who’s been [undergoing TB treatment] in Nebraska or Ohio, I can just call Nebraska or Ohio," Moser says. "It’s a lot harder if you have a patient who’s headed somewhere in Mexico. People don’t usually know how to go about calling the public health department in, say, Oaxaca. It’s partly the language barrier, and partly it’s not knowing how the [health care] system in Mexico works."

The telephone number is staffed continuously by two bilingual employees, she says. (Even the name "CURE-TB" was selected specifically because it means the same in Spanish and English, she adds.)

The state of California pays the salary for one of the staff members; money for the second comes from a temporary grant from the Centers for Disease Control and Prevention in Atlanta.

San Diego TB controllers have begun to publicize the program and its telephone number, and they are working hard to spread the word of the program’s existence to physicians and public health agencies both here and in Mexico. Since the hope is that patients as well as physicians will use the phone number, pocket-size business cards also have been printed and distributed. That way, patients can call the 1-800 number on the card from their destination, says Moser.

She hopes the new service also will be used by TB controllers and private physicians in the United States who encounter a patient headed to Mexico but aren’t sure about how to give him the referral he needs.

"We just sent [a notice] to all the U.S. states that have a lot of Mexican patients, saying they can use us to refer their patients back to Mexico," she says. "That means that if some private physician [with a binational patient] calls us from somewhere in the middle of Wyoming, for example, we will contact the health department in Wyoming to make sure they know about the patient and that they have the information on him; and we’ll also help them refer the patient to Mexico." (For phone calls between U.S. locales and San Diego, Moser asks that users take advantage of their own telephone systems, reserving the 1-800 number for cross-border purposes.)

Hearing a friendly voice reassures patients

The program is designed especially to be non-threatening to individual patients. "Suppose a patient is headed south and gets stuck in Tijuana, and he can’t get home to Guadalajara," says Moser. "If he calls, we can tell him exactly where to go for care in Tijuana."

She also likes the idea that the new system may help TB controllers in the states establish ties to the physicians who are treating their patients in Mexico. "We’ve already begun to get calls, mostly from physicians in Tijuana [across the border from San Diego]. In Mexico, cost can be a big barrier; people there often don’t have the money to make a long-distance phone call."

The system uses patients’ real names, not unique identifiers, but staff make a point of reassuring callers their data will be kept in confidence, she says. "We try as much as we can to get to the patients themselves. Certainly, we’re not asking them to come north; we’re just telling them that if they do, to call us, because it’s important to us that they don’t spread disease."

Controllers coordinate with INS

San Diego TB controllers also are working hard to establish better links with the Immigration and Naturalization Service (INS).

"We ask them to tell us where [deported patients] are going and to let us talk to them; that when they get there, they’ll at least know how to continue their TB treatment," she says. "We’ve already been called by some [deportees] on the 1-800 number, asking what they should do now and where they should go to keep up with their treatment."

The fact that the system works by telephone (instead of through paper correspondence or records) offers advantages, she says. "For one thing, we don’t think people usually carry paper records — they just lose them."

A phone call also is much more personal, she says. "It’s one-on-one. Our people talk directly to the patients." At first, offers to help may be met with suspicion, she adds. "There’s usually a little initial distrust. It’s like, You’re who? In San Diego? You’re with the health department?’ But our people always say, Don’t worry — all we care about is your health.’"

Moser says the new program will succeed because it provides a personal connection. "When you talk about case management and getting patients to do the right thing, it’s because you talk to them," she says. "If you don’t do that, they don’t think it matters. We tell people to call whenever they need us, whichever side of the border they’re on.

"We reassure them that we want to talk to them not because of anything to do with their legal status, but purely because it’s important to their health and to the health of their kids and their families. And that’s something they can relate to and appreciate."