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Frontera LEADERSHIP
KIRK L. SMITH M.D., Ph.D.
Executive Director
Kirk L. Smith, MD, PhD, the director of Frontera de
Salud, is one of the founders of Frontera and has supervised its
direction and expansion. Dr. Smith
completed doctoral studies at the UTMB Institute for the Medical
Humanities in 1998 and graduated AOA with honors from the UTMB
medical school in 2000. He completed his residency in the
Internal Medicine department at Georgetown University Hospital in
Washington, D.C. where, concurrent with his clinical duties, he
held a position as a faculty associate at the Georgetown Center
for Clinical Bioethics and was active in teaching and
research. He has published both in the U.S. and abroad,
including a series on the Medical Humanities published in JAMA
and articles (in translation) introducing the Medical Humanities
to Chinese audiences. In addition to his duties with Frontera
Dr. Smith is Community Outreach Director for the Stark Diabetes Center
at The University of Texas Medical Branch. He can be reached via e-mail
at klsmith@utmb.edu. HISTORICAL BACKGROUND
FRONTERA’S WORK WAS INITIATED IN 1998 by students returning from the Rio Grande Valley of South Texas. During clerkships at the Brownsville Community Health Center in Brownsville, Texas, he observed first-hand the misfortune of the “working poor” (i.e., those who cannot afford insurance, yet earn too much for Medicaid and are too young for Medicare) who rely on publicly funded clinics for their health care. With the loss of government aid, these clinics are cutting back on services and have begun to compete both among themselves and with private providers for insured patients, leaving the uninsured to fend for themselves. To aid these patients, and as evidence of their commitment to the humane tradition of medicine, this handful of students founded Frontera de Salud, an all-volunteer organization which has grown to include healthcare professionals-in-training at the University of Texas Medical Branch at Galveston and the University of Texas Health Science Center at San Antonio.
Blessed with continued growth and success Frontera is working toward its second phase of development.
Phase two involves: 1) strengthing and growing student health professional chapters throughout Texas 2) developing a sound organizational structure and 3) implementing our new Integrated Community Health Elective for physicians in family or internal medicine residency training programs.
ORGANIZATIONThe greatest strength of this organization is the health professional students. There are currently two official Frontera de Salud chapters in Texas. These chapters are located on the campuses of the University of Texas Medical Branch at Galveston and the University of Texas Health Science Center at San Antonio. Each chapter is led by a health professional student with mentoring support provided by health professions faculty. 
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* * * * * *OBJECTIVES* * * * * *
Caring for Communities
FRONTERA DE SALUD HAS established a partnership with the Brownsville Community Health Center, a federally qualified health center in Brownsville, Texas, where Frontera volunteers operate weekend clinics to provide examinations and physician referrals; cancer, diabetes and hypertension screenings; and focused healthcare counseling. In addition, in cooperation with community outreach programs in Cameron Park, an impoverished community on the outskirts of Brownsville, Frontera volunteers offer services beyond the usual scope of clinical practice, e.g. health maintenance classes, domestic violence screening and counseling, men’s health discussion groups, pre-natal workshops, etc. These efforts reflect Frontera’s determination to encourage the students’ appreciation of all aspects of the human experience, emphasizing the rich interplay of mind, body and spirit as these affect health. Through such experience, Frontera nurtures insight and understanding and assists students in building the kind of sincere and sympathetic relationships patients expect of ‘good’ care-givers.
Patient Care
FRONTERA’S PRIMARY PARTNER is the Brownsville Community Health Center (BCHC) in Brownsville, TX, which supplies clinic facilities and support staff to conduct
Saturday special clinics once per month. During clinics, Frontera teams perform gynecological exams including breast and pelvic exams, pap smear, a well-woman
check-up and counseling. The activities of the students are supervised by a BCHC care-provider who consults with students concerning suspicious findings
and arranges for physician follow-ups. On a typical Saturday, thirty (30) gynecology patients are seen. Concurrent with this work,
Frontera students also
conduct diabetes education classes. Twenty-five (25) patients typically attend the classes where they are familiarized with the nature, symptoms and
complications of diabetes, and given specific recommendations to alleviate diabetic complications.
On Sunday, Frontera travels to the community center of Iglesia San Felipe in Cameron Park, an impoverished neighborhood just outside the Brownsville city limits. Services there include blood pressure and blood glucose monitoring stations, depression and domestic violence screenings, a diabetic foot assessment station, and counseling stations to serve individuals whose exams raise suspicion of cardiovascular and/or diabetic disease. On a typical Sunday, Frontera screens and counsels from twenty-five (25) to forty (40) patients, of whom three (3) to five (5) require referral to the BCHC.
Frontera is currently expanding its patient care activities with the new Integrated Community Health Care Elective for physicians in residency training programs.
Education and Quality
TO QUALIFY STUDENTS FOR THEIR WORK, Frontera has developed a preparatory course that includes extra-curricular instruction by volunteer
faculty, as well as a lecture series emphasizing the pathophysiology of commonly encountered diseases. In addition, the program sponsors campus-wide
discussions focused on topics of specific humanistic importance, e.g. ‘the provider/patient relationship in the era of managed care’, ‘the role of the
healthcare professional as citizen’ and ‘the ethical tradition of American healthcare.’ Through these educational efforts,
Frontera promotes not only the technical competence of
students, but also their understanding of the moral tradition of medicine.
TOPTeam Building and Cultural Competency
SINCE MUCH OF FRONTERA’S TARGET population is Hispanic, cultural sensitivity is critical to the program’s success.
Frontera has devised a range of
strategies to inculcate cultural competence, beginning with the resources available in virtue of the volunteers’ own diversity. Frontera de Salud comprises
a culturally rich mix of Asian, African-American, Anglo and Hispanic students and the program avails itself of the opportunity afforded by this mix
to encourage frank discussions of race and culture. Such discussion is critical not only in forging intra-team understanding and solidarity, but also
enlarging sensitivity to the cultural differences between the students and the patients they serve. In addition,
Frontera is committed to professional as well
as cultural diversity: Frontera teams incorporate students from nursing, medical, allied health and graduate school.
The program recognizes that healthcare is a multidisciplinary effort and believes students benefit from early exposure to a team approach, especially when the disciplines are inspired by a shared sense of purpose and moral commitment. In building teams that reflect the cultural and professional diversity of American healthcare, bringing those teams’ efforts to bear in a community that is culturally challenging, and encouraging health care providers to reflect on the barriers to healthcare posed by economic, social and linguistic differences, Frontera works to promote an honest, self-reflective and practice-based approach to cultural diversity.
Email to Kirk Smith, MD, PhD with questions or comments about this web site. · Site design by Fausto Meza M.D. and e-Medico, LLC