Background: Our Academic Medical Center, (AMC), located near the US-Mexico border, began receiving and treating patients with COVID-19 beginning in February of 2020. After activating incident command to increase surge capacity and developing protocols for treatment of patients with COVID-19, we developed adequate capacity for the most likely scenarios of pandemic progression. By April of 2020, we began hearing reports of a worsening pandemic situation in a major Mexican city of over 2,000,000 people across the border. One particular hospital, due to illness among employees and other challenges involving equipment and personnel, was in danger of being overwhelmed. While there was a substantial desire to send aid, a lack of organization or leadership coupled with hesitancy by some officials had stalled tangible aid efforts.
Purpose: As a grassroots effort between practicing physicians and nurses from the AMC, a U.S. hospital near the border, and the county medical society, we devised a plan to provide support to the Mexican hospital. Eventually, this plan grew to include another hospital from an adjacent Mexican city as well as a remote regional medical center located in a rural part of the U.S. County in question.
Description: Beginning in May 2020, volunteer teams (physician, nurse, interpreter, respiratory therapist), traveled across the border 7 days/week for 4 weeks to aid in providing intensive care unit (ICU) training to their Mexican counterparts. At the request of the Mexican Hospital Director, these teams also identified equipment deficiencies and offered detailed suggestions for improvements in care. Initial efforts were followed by multiple weekly Tele-ICU sessions along with intermittent in-person visits to 2 Mexican hospitals and one rural US hospital. Prior to the Tele-ICU service, 62% of U.S. onsite staff felt patients were receiving evidence-based care compared with 81% after. Such improvements were also qualitatively observed at the Mexican hospitals. Additionally, a WhatsApp group of involved physicians was created, and transfers were made to the AMC from the Mexican hospitals when needed. Our grassroots, cross-border efforts resulted in the generation of trust between providers across different cultural contexts who were united in the goal of optimal patient care.
Conclusions: It is becoming increasingly clear that hospitals and health systems do not exist in a vacuum but rather are affected by the broader context of their surroundings. This is readily apparent in contexts such as a pandemic where a lack of capacity in one hospital creates an increased demand in the adjacent hospitals. However, other phenomena such as ransomware attacks can result in similar surges and have been shown to have a measurable, negative effect on hospitals not directly impacted by ransomware but that are adjacent to affected hospitals. Any hospital closing its doors due to a pandemic, a cyber-attack, financial concerns, or other factors is an immediate concern to the surrounding healthcare community. Silos and fragmented systems are unprepared for this reality in an increasingly interconnected world. More work needs to be done to develop cross-hospital and cross-border collaboration between neighboring systems. Innovative methods such as Tele-ICU and other digital strategies should be explored. Regulatory, financial, and cultural barriers need to be overcome. Such collaboration does not have to come from hospital leadership but rather can be catalyzed from the bottom-up by practicing physicians.