STEERing doctors to environmental health awareness. (NIEHS News).

Everybody knows American doctors don't make house calls anymore. But in Laredo, Texas, health care students in an innovative program are putting a new twist on the house calls doctors used to make. They are making "environmental house calls," actually looking, for example, inside homes to see what attack-triggering exposures the resident child with asthma may have encountered, or checking kitchen pottery for lead, or testing a family's drinking water for fecal contamination.

It's all part of the Environmental Medicine/Border Health course at the University of Texas Health Science Center at San Antonio. Eight times each year, the course sends medical and other health profession students for a month-long stay at the Texas-Mexico border. There, they slog through polluted water, test indoor and outdoor air quality, and track exotic pathogens to learn firsthand about environmentally related health problems that plague people throughout the world. The course was the first--and is still the only--environmental medicine training elective of its kind in the United States. It is run by the university's South Texas Environmental Education and Research (STEER) Center.

The course is designed to "unite medicine with public health," says Claudia Miller, an associate professor in the Department of Family and Community Medicine who started the STEER Center in 1995. Many doctors receive only minimal environmental health training during their time in medical school--maybe a chapter in a textbook or a few lectures in a classroom. "In many ways, doctors are not as aware of environmental health as the public has become," Miller says. "If doctors receive training in environmental medicine, they become more aware of possible environmental explanations."

The course covers more than 30 topics, including indoor and outdoor air quality, wastewater treatment, food sanitation, heavy metals, pesticides, risk management, epidemiology, and zoonosis control. The students also learn about traditional folk healers called curanderos who use alternative healing methods in conjunction with herbal medicines to treat patients.

To date, 175 full-time health profession students and more than 500 part-time students have completed the course. Each session is limited to six students--or as many as can be hauled around in the center's Chevy Suburban.

In essence, the course is a face-to-face encounter with public health and environmental problems in the fast-growing sister cities of Laredo, Texas, and Nuevo Laredo, Mexico. With a combined population of more than 700,000 residents, these cities have doubled in size in 10 years, due in part to the power of the North American Free Trade Agreement (NAFTA). Laredo, on the banks of the Rio Grande, is the busiest inland port in the United States, handling more than half of the NAFTA trade between the two nations. Concerns over materials storage and handling (especially hazardous materials and hazardous waste) and the potential for spills, as well as concern over diesel emissions, are growing along with the numbers of tractor trailers that fill Laredo's streets and back up on its bridges waiting to cross the border.

This rapid urbanization has also exacerbated existing problems; the term "border health" refers to a complex and multifaceted set of health stressors rising up out of disproportionate poverty and disease rates for environmentally related illnesses such as hepatitis, salmonella, dengue fever, asthma, and tuberculosis. The area also suffers high rates of diarrheal diseases, especially in children. These play out in communities that are as much as 95% Hispanic, a minority group that often lives in communities eligible for environmental justice remediation.

But the course does more than just teach students about these types of problems. Equally stressed is "service learning," becoming part of and giving back to the community. Students have participated in health fairs, animal vaccination events, and "environmental house call" outreach in the community to help, for example, school-children with asthma reduce the triggers in their home environments.

Experiencing international health without really leaving home "opens the eyes, minds, and hearts of students," says registered nurse Joan Engelhardt, who coordinates STEER student training and developed the Environmental Medicine/ Border Health course along with Roger Perales, a registered sanitarian. Perales says the lessons learned in Laredo are applicable everywhere, urban or rural. "A lot of people think public health is for the poor," he says. "They don't understand that water pollution, waste management, and control of pathogens affects everyone."

The STEER Center has won some significant public awards, including one of the 2001 Olympic Games Spirit of the Land Awards, given for excellence in environmental education, and the Texas Environmental Excellence Award, given by Texas governor Rick Perry in April 2002. Because of its success, plans are under way to expand the STEER program into the lower Rio Grande Valley as part of the new regional academic health center for the medical school.

"This is an absolutely unique training program in environmental health," says Lucy Peipins, a senior epidemiologist in the Division of Health Studies at the Agency for Toxic Substances and Disease Registry. "This allows students, who receive little such information in medical school, to step back and look at the environmental factors that play into people's health."

Peipins teaches epidemiology at the STEER Center several times a year because she feels the program is so important. "I don't know of any other effort like this, and there should be many more," she says.