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TBNetPart of the Health Network
Transborder Migration
Care of the Mobile TB PatientDeliana Garcia, Director
International, Research, and DevelopmentAdvisory Committee for the Elimination of Tuberculosis
March 20, 2007
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A national, clinical network founded in 1984 2,000 clinician membersOldest and largest clinical network dedicated to the mobile underserved
Migrant Clinicians Network
MCN’s primary constituents are clinicians working in federally funded CHCs and in state and local health departments.
Photo © Alan Pogue
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U.S. Population
By comparison to most of the world the United
States is a relatively young country that has
always relied on immigration for
population growth
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Migration in the America
Enormous expanses of open land created a
mentality of unencumbered mobility
resulting in the voluntary movement of large numbers of persons
seeking adventure and opportunity
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Changes in MigrationThe principal US
experience of internally displaced people is that of
the dust bowl era when thousands of people
migrated from states like Oklahoma, Arkansas to escape the unrelenting
wind and erosion experienced in the middle
part of the US in the 1920’s
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Changes in Migration
Because many of those displaced were share croppers or itinerant farmers the movement was generally west to areas where agriculture promised a large number of labor intensive jobs in the harvesting of fruits and vegetables.
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Changes in Migration
Agriculture was the reining industry for migrant workers for more than 50 years providing jobs for returning WWII veterans and welcoming workers from Mexico and the Caribbean.
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Changes in Migration
Until very recently, the United States has had little experience with massive internal
displacement of people and the
concomitant problems of housing and health
care that are so common in other parts of the world
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Migration Today
México is one of the principal countries that sends migrants to the United StatesIn the 90’s 300,000 migrated, in 2004 1.4 million migratedIn the 90’s 4% of those that migrated would not return to México, now it is 10% that do not return
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0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
20.00%
Jalisco
Michoacán
Zacatecas
Guanajuato
Distrito federal
Puebla
Oaxaca
Durango
Guerrero
Migration TodayJalisco 18.5%
Michoacan 15.8%
Zacatecas 8.6%
Guanajuato 7.9%
Distrito Federal 5.9%
Puebla 5.8%
Oaxaca 4.2%
Durango 3.7%
Guerrero 3.6%
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Texas ranks second among the receiving states in the U.S.
Migration Today
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46.40%
21.50%
6.70%
6.50%
5.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
1
California
Texas
Arizona
Illinois
New York
Migration TodayStates with the Greatest Immigration from
Mexico
California 46.4%Texas 21.5%Arizona 6.7%Illinois 6.5%New York 5%
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GUERRERO
GUANAJUATO
Texas is the principal destination for migrants from the states of Guanajuato and Guerrero
Migration Today
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0
2
4
6
8
10
12
Desc. DeMex.
Nat Res. Indoc
Of the 26.2 million Mexican that live in the U.S.:
11.5% Mexican descent
2.3 % Naturalized citizens
2.1% Residents
10.3% Undocumented
Migration Today
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
mestizos indígenas
Migration Today
Of the 10.3 million undocumented
97% are mestizos
3% are indigenous
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0%
5%
10%
15%
20%
25%
30%
Zapotecos: Mixtecos: Náhuatl: Mayas : Otros*:
Zapoteco 28%
Mixtecos 25%
Nahuatl 17%
Mayas 8%
Others 22%
Of the approximately 1,339,000 indigenous
Migration Today
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Menos de 10 años
10 a 19 años
20 a 44 años
45 a 59 años60 o másLess than 10 years
5.1%
10 to 19 years 12.6%
20 to 44 years 62.5%
45 to 59 years 13.6%
60 or more 6.1%
Age Groups
Migration Today
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Migration today
Leprosy affects over 12 million people worldwide, and reported cases have
increased in the US as a result of immigration. Of 1835 cases of leprosy
reported in the US from 1971-1981, only 25% of imported cases were known to have had leprosy at migration. Although most of
remaining 75% were detected within 12 months of entry, cases continued to be
reported 10 years after entry.
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International migration that involves the annual movement of tens of millions of people has become a norm, yet the public health implications are just starting to be assessed.
Internal migration that involves the annual movements of millions is still treated as an aberration rather than an on-going event of public health significance
Migration Today
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TB Among the Foreign Born
Since 2002 for the first time the majority of TB cases were in the foreign bornIn 2004, 53.7% of 14,511 active TB cases in the US were in the foreign bornOf these, 26% were from MexicoA significant number of these are undocumented residents
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TB Among the Foreign Born
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Annual Abandonment Rates Guatemala 1992-2002
0
1
2
3
4
5
6
7
8
9
1992 1993 1994 1995 1996 1997 1998 1999 2000 2002
Source: PNCTB, Guatemala 2002.
%
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Distribution of TB Cases by Ethnic Group. Izabal 2002
16 (52)
15 (48)
Indigena Ladino
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Binational TB Projects
• 1991 – Project JUNTOS- El Paso/Juarez, MEX
• 1992 – Yuma, AZ/Sonora, MEX
• 1993 – Los Dos Laredos- TX/Tamaulipas, MEX
• 1995 – Grupo Sin Fronteras- Harlingen/Mc Allen/Reynosa/Brownsville/Matamoros
• 1996 - TB Net- Austin, TX
• 1997 – Cochise, AZ/Northeastern Sonora, MEX
• 1997 – Ambos Nogales- AZ/Sonora, MEX
• 1997 – Cure TB- San Diego, CA
U.S.-Mexico Binational TB Relationship
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TBNet the Binational Bridge Case Management Program
TBNet started in 1996Has managed more than 2,700 patientsCompletion rate in 2005 of 71.4% for patients moving while under treatment for active TB diseaseManaged patients to 30 countries
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Why Bridge Case Management?
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Why Bridge Case Management?
More than medical records transferMore than communication with NTPMore than simple verification of patients’ contact informationMore than referral to a source of care
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How? Bridge Case ManagementTransferring medical records between clinics when participants move
Providing phone based care-coordination services:
Communicate with sending clinic through treatment completionCommunicate with receiving clinic for duration of treatmentEducating participants about treatment of
tuberculosis and importance of completion
Photo: Eduardo Moreno
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How Does it Work?
Discuss the need to remain in care with anyone suspected or known to have active TB diseaseGain his/her consent to have medical records transferred to ensure continued careObtain the contact information for the person or for someone who will always be in contact with Him/her
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What to ask:Where are you from?How long have you been in the area?What are your plans?How often do you move?What type(s) of work do you do?How can I contact you?Is there someone who will always know how to find you?
Photo © Alan Pogue
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How Does it Work?
TBNet staff will verify contact informationTBNet staff will identify a treatment provider in the new locationTBNet will maintain contact with the provider AND the patient for the duration of treatment
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TBNet will inform the enrolling provider of the treatment outcomeShould the patient fail to present or discontinue treatment, TBNet will communicate with all known contacts to bring the patient back into care
How Does it Work?
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Contact InformationEd Zuroweste, MD (MCN Chief Medical Officer): [email protected]
Deliana Garcia (Director, International, Research, and Development): [email protected]: 512-327-2017 or
www.migrantclinician.org