UW Medicine Fellow Rebecca Touger, MD, has spent the past year in different parts of the world: Alaska and Tijuana.
This was intentional. As a fellow in the UW Global and Rural Health Fellowship, she wanted to learn what each setting could teach her about how to bring healthcare equity into her practice as a physician.
The fellowship is a two-year program. Fellows spend their first year working with Native communities in Alaska, as Touger did, or in South Dakota. The second year is typically spent in an African country. During these years, fellows spend their time doing clinical training, education, teaching, career development and mentorship, and scholarly and research projects. The goal of the program is for fellows to become the next generation of medical leaders engaged in sustainable and justice-focused practice.
In Anchorage, Touger saw patients from remote Native communities, most of which could only be accessed by plane. Now in Tijuana, she has spent the first half of 2021 not just helping people medically, but also helping them achieve their goal of crossing into the United States.
Instead of spending her second year of the fellowship in Africa, Touger saw a different opportunity.
“I’m fluent in Spanish and given everything that’s been happening at the southern border, I thought I could do impactful work closer to home, in a border city,” she says.
Her proposal was approved, but she had to do her own research to find organizations to work with. One that she chose is Refugee Health Alliance, which operates two clinics in Tijuana, one focused on prenatal care and the other on general adult and pediatric care.
“The clinic I’m at focuses on LGBTQ care and gender-affirming care, and I’ve learned a lot because I didn’t get to prescribe hormones for transitioning patients while in residency,” she says.
At the beginning of February 2021, Touger and her partner, their newborn and their cat packed up and left Alaska for Tijuana. They will be there through the end of June 2021.
Setting the scene
The clinic Touger works at is located in Zona Norte, the northernmost part of Tijuana that was traditionally its red-light district. Over the past few months, it has morphed into a huge camp where migrants have set up tents and other semi-permanent dwellings as they wait to cross the border.
There is a bottleneck of around 30,000 people who have been waiting a long time — sometimes years — to cross, plus many more now flocking to the border, Touger says.
Because the people at this camp have few resources and little access to necessities, Refugee Health Alliance set up not only medical clinics but also a free public water fountain and a soup kitchen.
The care Touger provides migrants is similarly comprehensive. She regularly works at the adult and pediatric care clinic, which has walk-in hours.
She also writes letters of medical advocacy for patients with pending asylum cases, attesting that they need access to medical care in the U.S. that they can’t get in Tijuana. (The one hospital in the city that used to take migrants has since been converted to a hospital solely for COVID-19 patients.)
Her third job is doing medical screenings at a shelter for people who have been granted access to cross. She checks to make sure they don’t have any contagious illnesses and also asks if they have any chronic conditions.
Each week, she brings a large bag of medications with her to give to migrants who need them, because immediately awaiting them on the other side of the border is a two-week quarantine hotel stay where they won’t have easy access to a pharmacy.
“I see around 50 people each Friday, then they cross the next day. It’s probably the most upbeat part of my week. Some people have been waiting for two or more years and they’re excited. I get to hear about their journey, what challenges they’ve had along the way, where they’re going and which family member lives there,” she says.
The challenges of COVID-19
Like in most places, the pandemic has created additional problems at the border for people who are already dealing with many.
Most shelters and encampments don’t have the space to allow for physical distancing, and migrants don’t have the option of getting vaccinated. The process of getting people across the border is slow, too, considering the current bottleneck.
Because of all these factors, Touger believes rates of COVID-19 are higher among migrants than people realize.
Trauma and resilience
Another and often more lasting problem migrants face is trauma. Touger is also trained to do forensic asylum exams, where her job is to document the physical injuries and mental traumas people have been subjected to during their journey.
“One thing I didn’t realize before working here was how common it is for people from South and Central America to be kidnapped in Mexico and held for ransom while they are waiting to cross. If they have family in the U.S. those people are extorted for money,” Touger says.
One thing she wants people to understand about the people she cares for is how much resilience they have.
“I wish it was more common knowledge just how traumatic and difficult it is for people to migrate north, how much desperation that reflects for people to flee the place they were born,” she says.
Though her time in Tijuana is almost over and she’s looking forward to returning to Washington, she knows the people she has worked with will stay with her and the experiences she’s had will inform the rest of her career.
“I’m grateful to be here, in the middle of history, to have the flexibility and opportunity to be here now where there’s a huge crisis and need,” she says.