TB Net staff offers lifeline for deportees

It’s not the cigar, it’s the microbe

As readers of TB Monitor know, deportees with TB — especially those with multidrug-resistant TB — are a continual headache for physicians working at Immigration and Naturalization Service (INS) processing centers. At present, there seems to be no economic or legal means to do what some INS docs would like to: hang onto MDR-TB patients until they’re cured instead of sending them home with no guarantees they’ll get treated. (See TB Monitor, May 2000, pp. 59-60.)

Since October, however, one small program is taking steps to make sure that’s what happens. At two INS processing centers along the Texas/ Mexico border — one in Port Isabel, the other in El Paso — two staff members from the Migrant Clinicians’ Network TB Net program are putting in long hours to ensure cross-border continuity of care.

Contacting foreign providers proves difficult

Many deportees at the two centers are bound for Central America or Mexico, but patients are also bound back to Russia, China, and South America, says Jeannie Laswell, RN, who works in the Port Isabel processing center. Laswell and her El Paso counterpart, Marta Castro, spend their days educating patients about TB, contacting foreign providers, and compiling clinical records to send home with the patients.

The two say they start a case by talking with the appropriate consulate or embassy to get an idea of what part of a country a patient is headed for and what treatment resources are available
in the area. Then comes the job of establishing phone contact with a faraway health care facility — and here, the job gets tricky, Laswell says.
"We had a patient recently from Honduras, and I’d been on the phone for several weeks trying to get through," she recalls. Despairing of busy signals and recorded messages about downed circuits, Laswell turned to Castro for help.

Castro called the Honduran consulate in Houston and discovered that the consul was headed out the door for a three-week vacation back home. Since he was already saddled with escorting one TB patient, he graciously agreed to take a second patient. In addition, he promised Castro he would take the patient directly to the hospital door and then obtain phone numbers and names of hospital physicians and staff who’d be evaluating the patient.

Compiling patient histories is also tough, says Laswell. "Many of our patients either don’t remember having taken TB meds or else didn’t understand what they were for," she says.

Helping deportees understand the importance of getting TB treatment is one of the most important parts of the job, say both women. "If you come here illegally because you have a wife and five children to support, the last thing you’re thinking about when you get home is getting to the TB clinic," says Laswell. "You’re worried about getting back up north so you can make enough money to feed your family."

Cartoons are a good place to start

Because many deportees lack education and have a hard time understanding what TB is, Castro says she often starts with a simple booklet from the American Lung Association that features cartoons and pictures. "Then I go to a higher level and use different words to explain the same thing in a different way," she says.

The stories deportees tell her are often heartbreaking, Castro says. Still, it makes her happy to think patients are finally getting the treatment they need. "Sometimes they have no idea that they’re sick. They think they’re just tired from the border crossing," she says. "At the beginning, they’re often angry. Later, they’re often very appreciative. They also begin to see how important it is not to spread their disease to others."

Castro tells of a Chinese man bound for deportation who was convinced his illness must be something he’d picked up by sharing cigars he and others smoked during the passage to the United States. Three-way conversations by telephone among Castro, the Chinese patient, and a Chinese translator didn’t seem to be advancing
the man’s understanding of the situation, Castro says. So she went to her church and found another Chinese-speaking man, took him to the detention center, and tried again. Seeing a fellow countryman face-to-face had a transforming effect, she reports: "His response was amazing."