Medical schools in the United States routinely send students to areas where they can gain diverse experiences and do the most good or have the most impact on the population. Communities with limited access to healthcare resources are frequently chosen, and this category includes areas along the US/Mexico border known as colonias. Residents in colonias typically lack access to basic needs that are usually provided by the infrastructure of incorporated communities and so, in many ways, colonias exist “off the grid.” The vast majority of colonias are found in the Texas/Mexico border regions. These communities frequently arose by providing affordable housing for migrant farmworkers, who are indispensable to the region’s agricultural sectors. Aspiring physicians often use their pre-professional skills to provide medical screenings for health issues commonly found in colonias, such as diabetes, hypertension, and childhood obesity. Interactions with residents of these communities can have positive impacts on the medical students as well as on the colonias residents. Medical students may be introduced to health problems and access issues that they likely did not face in their own educational journeys, but which may be more common within the population they end up serving as physicians. They also gain important skills in interacting with people from diverse backgrounds and performing the repetitive tasks of checking blood pressure, drawing blood, and checking vitals.
If knowledge is power, then informing colonias residents of current and potential threats to their health through screenings should empower them to gain greater health literacy and to change their behaviors. All in all, having medical students travel to colonias to perform screenings for common health threats would seem to be a win-win situation. Such programs can be great publicity for the medical school.
Unfortunately, residents of colonias not only lack access to necessities like potable water, reliable sewage, and safe paved roads, they also lack access to affordable medical care. Telling people who cannot access health care that they have Type 2 diabetes or extremely high blood pressure might only marginalize them further without any follow-up plan or any real way to prevent the heart attacks, amputations, and early deaths that result from untreated hypertension and diabetes. Although working with diverse patients in general is likely a positive learning situation for medical students, it may reinforce stereotypes of noncompliance that some US physicians associate with poverty and race. What does it actually teach medical students when they screen for diseases with no hope of prevention?
*From the 2023 National Ethics Bowl
Cases prepared by:
Robert Boyd Skipper: Chair, Case Preparation Committee
Robert A. Currie
Abigail Feldman
Cynthia Jones
Sophia McWilliams
Heather Pease
Mallory Wietrzykowski