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Fronteras Unidas Pro Salud

CAREM has helped restore the Campo Alaska in the Rumorosa area.
This mobile clinic travels to the far reaches of Tijuana to provide health care

Housecleaner Juanita Castro was in a market in Tijuana one day when she was approached by a promotora, or health promoter, who urged her to get a medical checkup that was being offered for free.

Castro decided to do it, and her daughter did, too. The checkup and Pap smear testing found no major problems, but the organization that offered the screening, Fronteras Unidas Pro Salud, encouraged Castro to return for other checkups in the future.

Castro did, and found out after one checkup that she had developed cervical cancer, the No. 1 cancer killer for Mexican women over age 35.

Mexican women historically have had a low rate of taking Pap tests to screen for cervical cancer, but Fronteras Unidas Pro Salud is part of an effort to change that.

"Thanks to God, and to you (Fronteras Unidas Pro Salud), I am now healthy," Castro, 66, said during a recent interview in the Fronteras Unidas Pro Salud offices.

Castro, who lives in downtown Tijuana with her husband, still had to figure out how to pay for the treatments she needed after her diagnosis. While doctors at Fronteras Unidas Pro Salud perform outpatient surgeries, patients needing major cancer treatment must go elsewhere. Castro's husband, Miguel Aguilera Guerrero, 70, is part of a musical trio, but Castro said there is little money in the street performances now that tourists have abandoned Avenida Revolución. "Avenida Revolución is dead," she said.

Castro couldn't come close to paying the 65,000 pesos (more than $5,000) she said she was told she needed for her treatment at the Hospital General de Tijuana, but she managed to wheedle her payment down to 12,000 pesos, around $1,000. Even at that, she said it took getting financial assistance from her priest, friends and friends of friends to come up with the money for her care, which included 25 radiation treatments.

Now that she has been treated, she said, "I feel perfect. Nothing hurts, and I am not sick."

Castro is one of thousands of poor Baja California residents who are helped each year by Fronteras Unidas Pro Salud, which roughly translates as United Borders for Health.

Its mission is that "Everyone, no matter where they live or how poor they are, should be able to access affordable, high-quality healthcare services. At Fronteras Unidas Pro Salud, we do not wait for clients to come to us. We seek them out."

Fronteras Unidas Pro Salud's health center provides general medical services as well as gynecology, the detection and treatment of cervical cancer, pediatrics, nutrition, and psychological assessments. It also operates eight clinics in poor neighborhoods, providing medical care, family planning services, basic reproductive healthcare and workshops. It also provides spaces for Tijuana youths to relax and interact with one another.

A van equipped as a clinic travels three times a week to poor communities and provides medical checkups to 25 to 30 women per trip, at a cost to the patients of about $4, said Lucina Gómez, coordinator of the organization's communities' program. Two doctors, a nurse and five health promoters staff the clinics; the major problems found are diabetes, high-blood pressure and breast and uterine cancer. Gómez said the mobile clinic reaches many patients that likely would not get medical care otherwise. Gómez said that oftentimes, Mixtec husbands prohibit their wives from traveling to go see a doctor. In part for this reason, the organization has the program "Dile a Una Amiga" (Tell A Friend); after a woman has had the benefit of a uterine cancer exam, it makes it easier for a friend of hers, or relative, to also decide to get tested.

Fronteras Unidas Pro Salud, which has a budget of $650,000, is the result of a partnership between the Mexican family planning organization Mexfam and Planned Parenthood of San Diego & Riverside Counties.

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Adriana Gutiérrez Vázquez, 27, is one of nine health promoters for Fronteras Unidas Pro Salud in the Valle Verde area of eastern Tijuana. Some of the promoters deal exclusively with the Mixtec community, which speak Mixtec languages.

Although promoters such as Gutiérrez Vázquez generally are not paid by Fronteras Unidas Pro Salud, they are able to make money by charging for blood-pressure and blood-glucose tests that they perform and by selling youths items such as condoms at a cheaper price than they would pay at a pharmacy (and condoms are not cheap in Mexico). Youths also feel less embarrassed about buying them from her than from a pharmacy. Fronteras Unidas Pro Salud Dictor Marcela Merino said Tijuana unfortunately has more pregnancies in girls ages 12-14 than any other city in Mexico, and occupies the second spot for pregnancies in girls aged 14-16. She said Fronteras Unidas Pro Salud's programs are designed so that "girls do not get pregnant so young." Tijuana also has a high incidence of venereal disease that the organization is trying to prevent. Gutiérrez Vázquez said high school students come to her house for condoms and said she feels this is helping prevent pregnancy and disease.

Promoters also are trained to give other health advice and to urge people who might need treatment to get checkups. They also provide education about domestic violence, how to improve family communications and how to develop beter self-esteem.

Gutiérrez Vázquez also gets paid for leading a weekly workshop to help diabetes patients. The project is Proyecto Dulce, is partially funded through the International Community Foundation (see accompanying story). The patients are educated on what to eat, what exercises to do, how to use a glucometer and other ways to control their glucose levels. "It's like alcoholics anonymous, if you don't have support of the group, it's very difficult to progress," Merino said of the diabetes patients.

Gutiérrez Vazquez also is a student herself, trying to get a certificate in health, environment and social work, with a scholarship funding from Fronteras Unidas Pro Salud.

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