Two months pregnant, Jessica Mejia of Honduras received flu and tetanus vaccinations and prenatal vitamins in the health clinic at Tijuana’s El Barretal shelter Friday.
She was one of many in the 6,000-strong migrant caravan to receive checkups, medications and even minor surgery from a growing set of medical services that added a mobile hospital last week.
It’s a far cry, said Jose Mateo, 30, of Guatemala, from the single medicine dispensary initially available to migrants who began arriving at Benito Juarez Sports Complex in mid-November.
“Everything here is more organized,” Mateo said. "It changes everything in the sense that we have better treatment.”
As the caravan of asylum seekers approached the border, many in Mexico and the United States worried that such a large group would increase the odds of a public health crisis.
But Dr. Wilma Wooten, San Diego County’s public health officer, said that the health services now being provided in migrant shelters on both sides of the border provide an important point of contact to spot early symptoms of disease and separate those who are infected from those who aren’t.
Accessible healthcare inside shelters, then, is an important part of keeping disease outbreaks from moving into the general population that crosses the border by the thousands every day.
According to Baja California’s health ministry, workers have provided more than 5,000 medical consultations to migrants in Tijuana and Mexicali, ranging from dental work to vaccinations, as of Monday.
A registry is tracking the health status of 45 pregnant women living in the shelters. Though the Mexican government has said that rumors of a tuberculosis outbreak in the shelters are not accurate, nearly 3,200 are dealing with respiratory ailments, mostly colds and coughs. Four have tested positive for HIV, two for syphilis.
The largest health threat so far has been a chickenpox outbreak which had, as of the government’s Monday update, infected seven people. At the request of volunteers, Dr. Adam Breslow, president of the Children’s Physicians Medical Group in San Diego, sent 70 doses of chickenpox vaccine south to inoculate children at risk of becoming infected.
And 600 doses of hepatitis A vaccine also moved south last week, sent by San Diego County’s public health department.
Wooten said a request for the doses came from the Baja California health department. Filling that order, she said, made sense from both a humanitarian and an epidemiological standpoint. Infectious disease, she noted, does not respect borders.
“It’s important to get the vaccines on the Mexican side so that we can protect people in terms of diseases that are preventable,” Wooten said.
Sending chickenpox vaccines south, Breslow added, is not just charity. His medical group, the largest pediatric practice in the region, has plenty of young patients down near the border, and many of them are too young to be vaccinated themselves.
“We have plenty of kids under 1 year of age who are not yet available to get the chickenpox vaccine. We have three offices in Chula Vista, and it doesn’t take much for someone to cross the border and suddenly we have sick infants. By immunizing kids in Mexico, we’re also helping our kids as well,” Breslow said.
The public health departments of San Diego and Tijuana, Wooten added, have a history of cross-border collaboration that gives her confidence that she would be quick to learn of any outbreak originating among the caravan population.
“Because we have a good working relationship with Tijuana in general, if there was some outbreak or issue that we should be aware of, they would notify us,” Wooten said.
In the case of the chickenpox shelter cases, Wooten said, her department spotted two cases in San Diego County but neither was linked to Mexico. Were a larger outbreak to occur down south, Wooten added, her department would reach out to local doctors through the California Health Alert Network to request heightened vigilance and remind physicians that they need to ask every patient if they have recently traveled.
Wooten said she meets face-to-face with public health officials in Tijuana as often as once per quarter and has for many years. She said her office would be notified quickly as required by a formal protocol that governs U.S.-Mexico outbreak communications and coordination.
The protocol specifies 24-hour notice for all binational outbreaks, meaning those that involve patients with recent travel histories, and a list of “binationally notifiable conditions” including smallpox, polio, new types of influenza, SARS, Ebola, cholera and plague. Other conditions that may also require notification are meningococcal disease, rabies, tuberculosis, Zika virus, West Nile virus and chikungunya.
Though the Mexican government has not said much about the vaccination status of the migrants who have arrived at the border, many present at the shelter Friday said routine childhood vaccination is common in the Central American countries they came from. And many received flu shots in Mexico City during their long walk north.
Mejia, the young mother who got her tetanus and flu shots Friday, said she stopped at health clinics throughout Mexico during the journey and, so far, the best care has been at the end of the road.
“It feels very nice to get this kind of attention,” Mejia said.
Luis Enrique Rodriguez, 36, from Guatemala agreed after exiting the shelter’s dental clinic with freshly cleaned teeth, a service he couldn’t afford back home.
“My mouth feels brand new,” he said. “It’s been 10 years since I’ve seen the dentist.”
Still, noted Dr. Robert “Chip” Schooley, chief of the division of infectious diseases at UC San Diego in an email, the likelihood of infectious disease increases the longer people live packed tightly together in shelters.