BY SHILPA RAJAGOPAL

Around three-quarters of the way from Galveston to Alpine , Texas , the landscape begins to change dramatically . Flat plains give way to contoured hills and mountains , larger highways narrow to single-lane roads , and large trees condense into prickly desert flora . Yet these transformations presage something less beautiful for the residents who live there , one that mirrors the emptiness and scarcity of the region : access to healthcare services . We were a group of 20 medical , nursing and occupational therapy students from the University of Texas Medical Branch at Galveston representing Frontera de Salud ( FdS ), an interprofessional organization dedicated to rural and border health equity .

Every year , FdS organizes a medical service trip to Brewster and Presidio counties , medically underserved frontier counties in West Texas . Over the course of five days in December 2023 , we worked with Preventative Care Health Services , a federally qualified health center ( FQHC ), to conduct medical screenings and to distribute resources for community members in the communities of Alpine , Marfa , Presidio and Marathon .

Presidio in particular introduced me to many of the challenges and joys that accompany rural medicine . The town is home to only a few thousand people , most of whom are Hispanic and Spanishspeaking , and many of whom live in poverty . Though Presidio has an FQHC clinic , it has not had a physician living in the town for more than 20 years . The nearest after-hours care facility and hospital is two miles away in Ojinaga , Presidio ’ s sister city across the Rio Grande . The nearest American hospital is in Alpine , some 90 miles away . The hospital in Alpine is a critical access facility with limited resources ; individuals with acute and serious conditions that need critical care services are flown to larger hospitals places in El Paso and Odessa via a medevac aircraft , a journey that can be dangerous and financially prohibitive .

As many Trans-Pecos residents can attest , resource and geographic constraints , insufficient transportation , limited local healthcare providers , and long wait times create significant disparities when accessing care . While volunteering at our popup health screening in Marathon , I met a patient who said distance and money were among her biggest barriers to seeking