Healthcare at the Border

“It was something different,” is how Billie Black ’94, ’01 MSN, ’14 DNP described why she spent six months at the southern border as a nurse practitioner. Located at the U.S. Border Patrol Alpine (Texas) Station, she served as the first line of medical care for undocumented immigrants detained by U.S. Border Patrol officers.

Located some 60 miles from the Texas–Mexico border, Alpine Station is a multi-agency facility responsible for 158 miles of international border with Mexico. Officials from the Drug Enforcement Administration, Federal Bureau of Investigation, as well as the Border Patrol’s parent agency, the U.S. Department of Homeland Security, operate in partnership at the station.

The medical services personnel were employees of Loyal Source, a government contract staffing agency. “They sought me out,” Billie says. “It took three months of extensive background checks, including the FBI, before I was hired.” She began her term at Alpine in November 2022 and served through April 2023.

Each day was different, in terms of patient load and their medical issues. Some days, Billie would see only two or three individuals, while other times a bus full of immigrants was brought from the El Paso point of entry and processed at the station. No matter the number, each individual was processed and evaluated with the same level of professional care and military-like security and precision. “Everything ran very smoothly,” Billie says. “I never saw anyone mistreated or felt concerned for my own safety.”

Once detained by the Border Patrol officers, the undocumented immigrants are brought by vehicle to the Alpine facility. As with most law enforcement facilities, they entered via a “sally port,” which is a secured, controlled entry way to the facility. Surrounded by guards, cameras, and fencing, the initial screening takes place in the sally port. The men and women are then separated, with family members who are brought in together allowed to remain together.

But not all children travel with family members; some arrive alone, and others with adults who portray themselves to be family. It was the encounters with children that were the most emotional for Billie.

She recalled cousins, two girls who were 11 and 13 years old, traveling by themselves. “Seeing little kids come through was heartbreaking,” Billie says. “They have to deal with the cartel, which controls everything, as well as harsh terrain, coyotes, and rattlesnakes. It was the worst, because the 11-year-old had already tried to take her own life three times. Who knows what that little girl had experienced?”

Then there was the 10-year-old boy who left his parents in Mexico and was detained trying to cross the border with his aunt and uncle. He did not want to return to Mexico because he promised his parents that he would “work on a strawberry farm” in the U.S. so he could send money back to them.

After completing the initial screening and searches, the undocumented immigrants are moved out of the sally port and into an area where Billie and other nurse practitioners conducted interviews and evaluations to determine each immigrant’s health and safety. Guided by a questionnaire, the nurses worked to identify health issues like communicable diseases, drug use, and chronic medical conditions. After traveling so long in hot weather, across barren landscapes, extreme dehydration was a common problem.

If no health issues were identified, the individuals were processed by the U.S. Border Patrol and returned to their country of origin. Individuals with medical conditions were treated, as needed, before they were returned.

Given the location on the United States–Mexico border, one might expect all of the undocumented immigrants to be Mexican — not so. Billie said it was a multi-national group that came through Alpine, including citizens of Haiti, China, Russia, Turkey, Canada, Guatemala, Bangladesh, and El Salvador. Even a few American citizens, who were involved in human trafficking, were arrested.

Billie attributes Professor Julie Koch ’98 MSN, ’11 DNP, who also served as the assistant dean of graduate nursing programs, and Professor Emerita of Nursing Elise Alverson ’96, ’11 DNP for guiding her through her Valpo education and always being there for her. “I am very proud to hear Billie is meeting the health care needs of this vulnerable population,” says Professor Alverson. “She was always up for a challenge and is continuing to embrace the health care philosophy of our College of Nursing and Health Professions.”

Throughout Billie’s nearly 30 years in health care, she has worked in a variety of settings and positions, including outpatient, family practice, office, and urgent care clinics. It was her background and experience that best prepared her to handle the caseload at Alpine. All of her experience is rooted in her three Valpo nursing degrees and the education that prepared her to lead and serve.