TB Monitor Q&A

Border health issues finally may get hearing

Editor’s note: Laurance N. Nickey, MD, former longtime director of the department of health in El Paso, TX, recently was appointed by President Clinton to the U.S./Mexican Border Health Commission. Nickey, a pediatrician by training who says he "lives and breathes the border," agreed to talk with TB Monitor about his new role.

Q: How much do average Americans know about conditions on their nation’s southern border?

A: A lot of people still think of the border as just a string of villages, like back in 1900, when there were only about 36,000 people in the entire region. Today, 11.5 million people live along the border; by 2025, demographers predict the population will grow to 22 to 24 million. It irritates the hell out of me that we can give millions of dollars to countries on the other side of the world, but hardly anything to our immediate neighbors. This is the forgotten America.

Q: Why the big increase?

A: People come to work in the maquilas [the assembly lines and factories along the Mexican half of the border]. They come for the same reasons people have immigrated for generations: to try to make their lives better for themselves and their families. Some of the maquilas are responsible employers who pay decent wages; but others — well, some of them should simply be shut down.

Q: Can you describe the economic conditions?

A: El Paso is the 17th largest city in the United States, but with the 130th largest tax base — does that tell you something? In [its sister city] Juarez alone there are 1.2 million people, but Juarez has no sewer treatment facilities. Instead there is a ditch called the aquas negras running parallel to the Rio Grande, filled with raw waste and industrial solvents. When people in Juarez need drinking water, they drill shallow wells; this stuff is what they tap into. If this had been happening in an American city for all these years, can you imagine the banner headlines in the newspapers?

Q: What kind of public health problems does this engender?

A: TB rates are two to three times higher here than in the rest of the U.S.; we’ve measured drug-resistance rates that range all over the place. There’s hepatitis A, and I could also tell you some scary stories about cholera outbreaks.

Q: How did the Border Health Commission come to exist?

A: We’ve been trying to get this thing running for over 10 years. In 1989, we held a meeting on border health issues with the Texas Department of Health and the Texas Border Health Associa tion. That was the start. State legislators, including senators Nancy Bingamon from New Mexico and John McCain from Arizona and others helped out; the Texas Medical Association spearheaded the push; and the result was finally a law passed in October of 1994 to establish the Commission.

Q: So far, so good?

A: Well, it’s a bit like a debating society — lots of words, not a lot of action. But over the past few months, the American state department has gotten together with Mexican diplomatic corps — and it appears as though they are going to come to the table.

Q: What’s your take on relations between the two countries?

A: I hope when we finally sit down at the table together that the table is round, and that we can look at each other as equals and not castigate or criticize.

If we can work together to help these 11.5 million people who live here, it’ll be the one of the best things that ever happened to this place. After all, these folks are our colleagues and our friends. Above all, they are our neighbors.