MATAMOROS, MEXICO - Aurora Leticia Cruz has tried to keep up with her blood pressure medication since fleeing Guatemala more than a year ago, but the limbo she finds herself in — stuck in a sprawling camp at the Texas border after traversing Mexico — has made that hard.
When Cruz felt woozy on a recent day as her blood pressure skyrocketed, it could have ended in tragedy, leaving her 17-year-old granddaughter and two toddler great-grandchildren alone in the camp in Matamoros. But instead, a nurse practitioner from Oregon and a Cuban doctor, who like Cruz is awaiting U.S. asylum proceedings, were able to pull up her medical record and prescribe the correct dosage.
The health care workers who helped Cruz are with Global Response Management, a nonprofit that is attempting to go beyond crisis response and build a system to make it easier to track the health of migrants along their journey from Central America to the U.S. border. Cruz's medical record was created in June by the group, which has been collecting patient information.
"I envision this as a relay race in which we are passing the medical baton to other providers as people work their way north," said Blake Davis, a paramedic from Maine who volunteers for the organization.
The efforts are part of a growing trend in humanitarian aid that has accelerated amid the coronavirus pandemic, which has highlighted the difficulties in getting basic health care to migrants. With public hospitals overwhelmed by virus cases, migrants with heart conditions or problematic pregnancies have nowhere to go. Others have been prescribed ineffective medications because a changing array of doctors are forced to treat them without any medical history.
Led by U.S. military veterans, Global Response Management is staffed by volunteers primarily from the U.S. and paid asylum-seekers who were medical professionals in their homelands. The group has treated thousands of migrants over the past year at two clinics in Matamoros, including one inside the camp.
Medics with the group have innovated to bring care to the austere environment, building on what they learned from the organization's work with displaced people in countries such as Bangladesh and Iraq.
They have used telemedicine to consult specialists in the United States and connected a portable device to an iPhone to perform a sonogram. They have also worked with local leaders in the camp to control the spread of the coronavirus by encouraging mask wearing, increasing the number of hand-washing stations and setting up an isolation area. Only one person from the camp has been hospitalized with the virus, even as medical facilities in the area struggled to keep up with infected patients this summer.
Treatment in transit
But the group's goal is not just to care for migrants once they reach the border. It wants to offer health care along the routes migrants take.
"Humanitarian aid has to be thought of in a different light," said executive director Helen Perry, an Army Reserve nurse.
It's uncertain how long the camp will exist since U.S. President-elect Joe Biden pledged to undo the Trump administration policy known as Remain in Mexico, which has forced tens of thousands of asylum-seekers to wait across the border while their cases are considered by U.S. courts.
Regardless, there will continue to be people fleeing violence and poverty in Central America, and aid agencies are trying to figure out how to protect them.
Davis, the paramedic from Maine, plans to set up a clinic next year in Tapachula, on Mexico's southern border. He recently flew over the isolated terrain migrants traverse in Guatemala to view the challenge medical teams would face in treating people in transit.
"There is nothing out there for them to get help," Davis said. "We want to be able to fill that void."
The group is working to connect migrants to health care and other resources by asking them what they need via WhatsApp. The idea is to make contact as early as possible with migrants, treat their health problems before they worsen, and create a system where their records can be accessed by doctors along the way.
It is a daunting task that will require finding the migrants, many of whom are trying to avoid detection, and winning their trust. The group's members also must get government officials on board.
And they must tread carefully, so the health data cannot be used against the migrants. As they do in Matamoros, the group will label each record with a number, rather than a name.
Other aid groups are also tackling the challenge.
The International Rescue Committee next month is launching InfoDigna, an interactive map in Mexico that connects migrants to shelters, health care providers and other services wherever they are. It will offer live chats to answer migrants' questions about everything from the latest COVID-19 restrictions to the status of immigration court operations.
InfoDigna is part of the group's global digital information service, which informs asylum-seekers from Italy to Colombia via smart phones.
"It meets people where they're at," said Edith Tapia, who coordinates the effort in Mexico.
The organizations are stepping into a gap that the World Health Organization has urged governments of host countries to fill, but few have. The issue of how to care for vulnerable people on the move is only likely to grow: A record 80 million people are fleeing poverty, conflict and environmental disasters, according to the WHO.
Maria de Jesus Ruiz Carrasco says she would have lost her foot if Global Response Management hadn't stepped in.
The 31-year-old Cuban woman was rescued by Border Patrol agents who found her along the Rio Grande with a broken leg in October after she crossed from Matamoros.
She underwent two surgeries at a hospital in Brownsville, Texas. But two weeks later, Carrasco was sent back to Matamoros with an oozing wound and 14 pins in her leg. U.S. Customs and Border Protection guidelines recommend asylum-seekers with medical problems not be returned to Mexico.
The agency said that because of privacy laws it could not discuss Carrasco's case, but generally if a patient is "cleared for travel" upon release from a medical facility, then the asylum-seeker may be returned to Mexico. Decisions are made case by case.
A Mexican official at the border directed Carrasco, who was on crutches and in need of help, to the Global Response Management clinic, where she met Mileydis Tamayo, a nurse from Cuba who is also seeking asylum. Tamayo has been treating Carrasco's wound for 10 weeks.
"If this group wasn't here," Tamayo said later, "many people would be in very bad shape."