On the border of health

Tags: frontera de salud, big bend, rural health care, billings, border of health, strecker

On the Border of Health

Perdita Henry

The family medicine revolution manifests in many ways. Whether it is residents teaming up with local docs to hold a Hard Hats for Little Heads event or medical students coming together to hold a vaccination drive in their local communities, everyone is doing their part to ensure that communities have the chance to feel how much their family docs care. Just this past December, Frontera de Salud, a student-run volunteer organization at the University of Texas Medical School at Galveston, completed their first mission trip to the Big Bend area. On December 19, 2016, 14 students and accompanying faculty set out on a three-day mission to bring a helping hand to the rural communities of Alpine, Marfa, Presidio, and Candelaria. The goal was to assist physicians who make special visits to provide services for these communities.

TAFP member Adrian Billings, MD, welcomed the group to his hometown practice in Alpine and accompanied them as they provided care to people who rarely have the opportunity to see a doctor. “You can do domestic missionary work, and get paid for it, and do something that’s sustainable and prolonged. There are still isolated communities like Presidio and Candelaria that do need health care.”

For three days, Frontera volunteers spread out assisting multiple area clinics from morning until evening so students could assist with primary care clinic operations. Students gained practical experience, interacted with the residents seeking care, and provided educational support for patients diagnosed with chronic conditions.

From underserved to Frontera de Salud
Areas like the Big Bend are precisely why Frontera de Salud – which translates to border of health – was created. Kirk Smith and other medical students at the University of Texas Medical Branch at Galveston founded Frontera in 1998, seeking to help underserved areas of the lower Rio Grande Valley. In the early days, Frontera volunteers provided 600 patients with medical care and over the years grew to include additional chapters at other medical schools across the state, expanding its reach to over 10,000 patients per year.

Today this student-led organization, with elected student directors, is overseen by Executive Director and Faculty Advisor Norma Perez, MD, DrPH. As access to care became more readily available to people in the Valley, she set her sights on another area that would benefit from their work. After speaking to Billings about the Big Bend area, Perez recognized it as the perfect location for Frontera’s next project and set about cultivating relationships with doctors and community leaders who were familiar with the communities.

A new frontier
Like so many rural parts of Texas, the town of Candelaria has no hospital, no ER, and no physician in residence. Twice a month a physician comes to see patients in the West Texas town, perched on the north bank of the Rio Grande among the yucca and lechuguilla of the Chihuahuan Desert.

While Frontera volunteers were briefed and aware of the challenges facing Candelaria and the other towns on their itinerary, they were not quite prepared for what they encountered. Medical student Edward Strecker had previously rotated with Billings in his Alpine practice, so he knew what a shock the experience might be for less-seasoned volunteers. “We are trained in a medical center so everyone assumes there will be specialists, there’s care whenever you need,” Strecker says. “It is a great eye-opening experience for people to realize that a section of the population does not have these opportunities.”

These communities are not just medically underserved; they exist in a medical frontier that lacks many features of modern life we take for granted. The students found that Presidio is a food desert. “They have a bus that takes them every week to El Paso or Odessa,” says Jennifer Espinales, a student director of Frontera. “They leave at 2 a.m. and then they return at 5 p.m. – just to get food. Of course, since there is no grocery store nearby, they can’t buy fruits and vegetables because they are going to spoil, so you have to buy the necessities like beans, bread things that can last longer.”

Chronic health problems abound in these communities, hypertension, diabetes, and acute conditions are rampant and often go untreated for long periods of time. It’s bad enough dealing with these conditions but when you add in the distance one must travel to seek medical attention, things go from bad to worse. Without consistent medical care and education, by the time patients can see visiting physicians, their symptoms have risen to a level not often seen in cities.

Frontera de Salud, the Big Bend, and the future
While Frontera’s initial mission in the Big Bend was a success, there is still a lot of work to be done. The goal is to stage two annual events that will continue assisting clinics and visiting physicians and eventually expand to include other specific community events, such as breast feeding, obesity, healthy living, and diabetes education classes to improve public health.

Perez and Billings are also looking to expand Frontera, hoping to create a chapter at Texas Tech University Health and Science Center School of Medicine at the Permian Basin. Perez hopes more university faculty across the state will dedicate themselves to “building courses and letting their students know about these areas so they can go and help make a change.”

Billings hopes Frontera volunteers will be inspired to come back. “One thing I think is really sexy in medical school education is global medicine. It seems like every medical student and every resident wants to go abroad to do an international rotation. I have always felt that I am doing domestic missionary work in my own town, my own region, and my own country.”

Imagine what could be if the domestic missionary spirit caught fire in medical students and residents across the nation. Imagine what would happen if they took to their cars and instead of driving to the airport, they stopped just a few hours away.


For more information on Frontera de Salud, how to get involved,
and to find out if there is a Frontera chapter near you, visit