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Knight Campus talk to focus on the cornea and vision science – AroundtheO

April 11th, 2022 6:17 pm

Bala Ambati, an ophthalmologist and research professor in the Phil and Penny Knight Campus for Accelerating Scientific Impact, has seen a lot over the course of his 25-year career.

A leading eye surgeon, vision science pioneer and medical missionary, he has helped repair or restore vision to countless patients around the world, and researchers in his lab in the Knight Campus continue to develop treatments to prevent or reverse blindness, provide clearer vision and reduce the need for corneal transplants.

Ambati will focus on the cornea, the window to the eye, and provide an overview of the history of vision science, as the featured speaker at Science Knight Out, a community science talk sponsored by the Phil and Penny Knight Campus for Accelerating Scientific Impact.

RSVP online to the virtual event, slated for 4 p.m. Thursday, April 14.

Ambatis talk, Eye on the Cutting Edge: Healing the Window on the World, will highlight research from his lab, including a new gene therapy that could eventually provide an alternative treatment for Fuchs endothelial corneal dystrophy, a genetic eye disease affecting roughly one in 2,000 people globally. Currently, the only treatment is corneal transplant, a major surgery with associated risks and potential complications.

An ophthalmologist at Pacific Clear Vision Institute in Eugene, Ambati will also explore some of the breakthroughs in vision science over the past 20 years. In addition to performing thousands of cataract surgeries, LASIK and other vision correction procedures, he has alsoserved as a volunteer eye surgeon in Ghana, Zambia, India, Panama, Indonesia, the Philippines and Malaysia.

I love having the ability to take care of my patients and to help them see, Ambati said. I also love the ability to work with a fantastic group of people here at the Knight Campus and in my lab to come up with the next generation of cures and treatments to help patients around the world for years to come.

A visionary researcher and highly regarded clinician with an entrepreneurial drive, Ambati co-founded iVeena, a startup focused on developing an eyedrop for corneal strengthening and an implant for drop-free cataract surgery. Prior to joining the Knight Campus in July 2020, he completed his residency at Harvard University and a fellowship at Duke University.

Hehas been in practice 17 years as a cataract, cornea and refractive surgeon. He was director of cornea at Medical College of Georgia for five years and most recently was professor and director of cornea research at the University of Utah. Having graduated at 17 from Mount Sinai School of Medicine as the worlds youngest doctor, he was cited in 2015 as the No. 1 eye surgeon in a top 40 under 40 global competition and made the Top 100 Power List of Ophthalmology by The Ophthalmologist magazine.

Ambati has been recognized for his teaching excellence with a University of Utah Resident Research Mentor Award and the Gold Humanism Award. He servedas an instructor at the Harvard Cataract Course.

Ambatis talk will mark the sixth installment of Science Knight Out lecture series, which dates to 2017.

Past events were headlined by Leslie Leve, associate director of the UOs Prevention Science Institute; Robert E. Guldberg, vice president and Robert and Leona DeArmond Executive Director of the Knight Campus; Patrick Phillips, UO provost and senior vice president; Laura Lee McIntyre, director of the Prevention Science Institute and professor in the College of Education; and David McCormick, director of the Institute of Neuroscience.

Recordings of all past lectures are available on the Science Knight Out web page.

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Diabetic Patients with Rosacea at Increased Risk of Ocular Disease – MD Magazine

April 11th, 2022 6:17 pm

A new database study found that patients with diabetes and rosacea were at a significantly higher risk of diabetic macular edema, glaucoma with medical treatment, dry eye disease, and cataract surgery compared to patients without rosacea.

In previous research, rosacea has been associated with a variety of systemic comorbidities including gastrointestinal, cardiovascular, neurologic, psychiatric, and metabolic diseases.

Diabetes has also been associated with several ocular diseases, with previous research suggesting a systemic inflammatory component. Though the role of inflammation in diabetic eye diseases has been studied, no research has been conducted regarfing ocular complications in patient with diabetes due to rosacea.

Investigators led by Chau Yee Ng, MD, Chang Gung Memorial Hospital, Taiwan, detailed the association between rosacea and eye diseases in patients with diabetes via a retrospective cohort nationwide study.

Ng and colleagues included all patients diagnosed as having diabetes mellitus who received hypoglycemic agents between January 1, 1997, and December 31, 2013.

A total of 2,099,303 patients were identified, 5459 of whom had been diagnosed with rosacea. After applying exclusions criteria, 4096 diabetic patients with rosacea were matched 1:4 with 16,384 diabetic patients without rosacea.

From there, investigators compared the risk of time-to-event outcome between rosaces and non-rosacea groups in the propensity score matching cohort using the Fine and Gray sub-distribution hazard model.

Following a mean follow-up period of 5 years, investigators observed that patients with diabetes and rosacea had significantly higher risks of diabetic macular edema (sub-distribution hazard ratio [SHR]: 1.31, 95% CI: 1.05-1.63), glaucoma with medical treatment (SHR: 1.11, 1.01-1.21), dry eye disease (SHR: 1.55, 1.38-1.75), and cataract surgery (SHR: 1.13, 1.02- 1.25) compared with patients without rosacea.

Additionally, the team observed a significant association between psoriasis, irritable bowel syndrome, anxiety, and depression in patients with diabetes and rosacea compared to patients without rosacea.

In this retrospective cohort nationwide database study, diabetic patients with rosacea had significantly higher risks of diabetic macular edema, glaucoma with medical treatment, dry eye disease, and cataract surgery compared with patients without rosacea, the team wrote. This is the first study demonstrating the association.

The findings were presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston.

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Regular eye examinations, are key to early stage disease detection: Dr Girish Rao – Times of India

April 11th, 2022 6:17 pm

The retinal disease burden in India is on the rise. While 35% of the Indian population needs some form of vision correction only 25% of those have had their vision corrected. This is mainly since retinal diseases can go unnoticed for a long time, as some have no symptoms at first. A comprehensive eye exam by a retina specialist or ophthalmologist is necessary to find these diseases in the early stages, when treatment to prevent vision loss is most effective.

Eye examinations includes test visual acuity, depth perception, eye alignment, eye movements and eye pressure measurement. Eye drops are used to make your pupils larger so your eye doctor can examine the retina and also check for signs of health problems. An ophthalmologist may be the first to detect conditions such as high blood pressure or diabetes, sometimes before your primary care doctor does.

Eye Exams: How Often?

Eye checkups are advocated, as a routine, for all children before the age of 5 years and there after once a decade till the age of 40 years. During the presbyopic years it is advisable to have checkup every 2-3 years. Children with glasses need checkup after 6 months till end of schooling. People with specific eye ailments like squint, Glaucoma, Uveitis, retinopathies require closer follow-ups as advised by the ophthalmologist. People with diabetes should have a dilated eye exam every year.

Better managing eye health

The most important step in an eye disease treatment is its early diagnosis. The patient must adhere to the four-point vision loss prevention program that includes regular eye examination, good control on your diet, a healthy lifestyle, and keeping an eye on vision problems.

In a similar manner, diabetic patients are required to monitor their blood sugar levels. Keeping a regular check on their diet, post-lunch sugar levels, and following doctors advice can help maintain the ideal HbA1c levels. Antidiabetic medicines coupled with lifestyle modifications such as, a healthy diet plan, exercising, and smoking cessation is the path towards efficiently managing diabetes. It is key to manage diabetes to halt the eye diseases that come with the territory.

A diabetic patient is simultaneously required to be a key observer of their vision aberrations. If vision suddenly changes or becomes blurry, spotty, or hazy, contacting an ophthalmologist immediately will prove beneficial. Ensuring an early detection of Diabetic Retinopathy & Diabetic Macular Edema, and an early diagnosis allows effective treatment and prevents complications like irreversible vision damage. A regular eye check-up is crucial for a diabetic to avoid any delay of treatment and hence vision loss.

Vision care beyond treatment

The technological and medical advancements today have brought in a number of treatment options that can be availed, such as focal laser treatment, anti-VEGF injections, surgery etc. Whats important is to understand and adhere to regular check-ups. Visiting the doctor every 6 months allows the patient and doctor to catch the condition in its early stages and find an accurate treatment for it. Ensuring a regular contact with the eye doctor to find correct medication, treatment options, treatment process, and care should be a priority for the patient. Treatment helps immensely, but following up on scheduled appointments, ensuring that your eye health doesnt derail again is equally important.

The COVID pandemic had a devastating effect of the health of the people worldwide. The repeated long periods of lockdowns, reduced access to healthcare facility and restricted transport resulted in majority of patients with co-morbidities not seeking medical aid at an appropriate time. While some were lucky to avoid lasting side-effects to delayed treatment, many had to pay a heavy price for the delay.

Views expressed above are the author's own.

END OF ARTICLE

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Medical Musings: The growing prevalence of Lyme Disease – Daily Press

April 11th, 2022 6:17 pm

While walking in a grassy or wooded area, there is an increasingly prevalent infectious disease that can be contracted from the bite of an unseen tick.

Annually, half a million people in the United States develop Lyme disease. Over the last two decades, there has been a sharp rise in both the number of cases and the geographic distribution of the malady.

The disorders clinical course is variable; the majority of the afflicted have mild symptoms and usually recover after taking antibiotics. In those that are untreated or have a therapeutic failure, complications involving multiple organs systems may ensue; it can last from months to years. The condition is rarely fatal.

Lyme disease is caused by the spirochete bacterium borrelia burgdorferi that is transmitted to humans through the bite of an infected black-legged tick, commonly known as a deer tick.

While the ailment is primarily observed on the East Coast, it has been reported in all states except Hawaii. The disorder can occur in any season but is most common from May to August.

Only a minority of tick bites lead to an infection. The longer the insect remains attached to the skin, the higher the threat of getting the disorder. If affixed less than 36-48 hours, the risk of contracting the illness is greatly reduced.

Once the bacteria enter the blood stream, the pathogens spread throughout the body. Feeling ill stems from the immune systems response to the microorganisms in various tissues and organs.

Untreated individuals go through several stages with different clinical characteristics in each phase that frequently overlap.

During the initial manifestations, flue-like symptoms of fever, chills, body pain, headaches, neck stiffness and swollen lymph nodes occur. These indices are associated with a distinctive rash (erythema migrans) that develops 3-30 days after an infected tick bite.

This skin eruption which appears as a bulls eye is annular, reddish, with or without a central clearing and neither itchy nor painful. It expands slowly and can spread up to 12 inches. Up to 30% of those infected may not form a rash, or its presence was overlooked.

If you notice a tick on you but dont develop the telltale bulls-eye-shaped rash, dont assume that youre in the clear; its still possible to develop Lyme disease. Be on the lookout for symptoms including fever, chills and aches and pains, and if you notice any, go to the doctor immediately.

In those with untreated disease and a small subset of victims with treatment failure, serious more broadly distributed findings can appear. These include facial palsy, meningitis, cardiac abnormalities, severe joint pain, arthritis and eye inflammation.

An early diagnosis can be a difficult task.

An article in Frontiers of Medicine notes that outside of the diseases nascent ruddy rash, proof of the disorder relies on non-specific clinical signs that in the initial stages may not be supported by laboratory data.

A delay in confirmation of the condition occurs in upwards of 40% of those ultimately diagnosed. Frequently these individuals will have advanced clinical findings as a consequence of the stalled recognition of the malady.

One explanation for the lag in diagnosis is that many who have been exposed to ticks often ignore non-specific symptoms particularly when there is an absence of a rash. They do not seek timely medical advice.

For those with classic clinical findings, doctors can make the diagnosis with near certainty when an expanding bulls eye red rash is present. For the less-apparent cases, a combination of a history of tick exposure, physical exam and blood tests to detect antibodies can usually confirm the diagnosis.

Humans have been inflicted with the tick-borne bacteria since ancient times.

The oldest known case was documented in a 5,300-year-old iceman found in a glacier in the Italian alps. Closer to the present, in Colonial America there were many early settlers who suffered from Lyme-like symptoms. An abundance of ticks dwelled in the forests in the northeastern colonies. The diseases modern moniker emanated from the town of Lyme, Connecticut, where the disorder was documented in the 1970s.

Unlike in the 17th and 18th centuries, preventive measures are known today. These include using insect repellants, wearing light-colored clothing and checking for and safely removing ticks after a walk. When these precautionary measures fail, and one is faced with the diagnosis of LD, effective treatment is available for most cases.

The earlier the therapy begins, the better the prognosis.

Antibiotics are the definitive medications for Lyme disease. When more advanced symptoms are present, the drug is continued for a longer period. For those with post-treatment reoccurrence, there is less of a consensus as to the treatment regimen for this poorly understood subsegment of the disorder.

While there are ongoing investigations for new therapeutic modalities, a safe and efficacious vaccine has become a priority.

Historically, a Lyme disease vaccine for adults was approved by the FDA in the late 1990s, but it was withdrawn in 2002 by the manufacture because of the limited response in the marketplace. Currently, a vaccine has renewed research attention; there are some promising products in the preclinical phase.

Lyme disease is not only a human disorder its common in mans best friend.

Veterinarians in endemic areas are familiar with the afflictions symptoms, diagnosis and treatment for their tic-prone furry patients. The clinical signs are largely non-specific in dogs; the humans signature bulls eye lesion does not develop. The treatment process generally mimics the same approach as with humans, except for canines there are commercially available vaccines. Lucky dogs!

While the infection cannot be directly transmitted from a pet to a human, an outside dog or cat may act as a carrier and bring a tick hidden in its fur into a home; once inside, it could bite a human.

While scientists continue working to unravel the mysteries of Lyme disease, remember, when out for a walk in a grassy field, infected ticks are eagerly waiting on the tips of vegetation ready to crawl onto a person or dog and then find a place to bite. Take precautions.

Dr. Jonathan L. Stolz is a retired physician and author of the book Medicine from Cave Dwellers to Millennials.

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UCF Part of Historic Civilian Space Flight to the International Space Station – UCF

April 11th, 2022 6:17 pm

When the first four civilians travel to the International Space Station April 8 they will be working with a team of University of Central Florida doctors to study how space travel affects the human body, particularly the eyes and brain.

Three faculty physicians at UCF Health, the College of Medicines clinical practice, are collaborating with Axiom Space and two Israeli medical centers Sheba Medical Center and Rabin Medical Center to conduct clinical studies with passengers aboard Axioms private flight that will take four passengers to the International Space Station aboard the SpaceX Crew Dragon. The flight is scheduled to launch from the Kennedy Space Center and should return 10-14 days later. The space explorers received pre-flight testing at UCF Health facilities and will be back for post-flight testing.

The eye study will include the use of high-definition technology unlike any used before to examine the participants eye structure. The brain study is the first of its kind in space. These studies represent UCFs first human subject space studies.

Its a historic moment for space exploration with civilians going to the ISS and for UCF, says Deborah German, vice president for Health Affairs and founding dean of the College of Medicine. These two studies are just the beginning. We have several more to come. Its not just about exploring. What we find will contribute to keeping space explorers safe and finding new treatments here at home.

Its All About the Eyes

The first study, a collaboration between Gal Antman, ophthalmologist from Rabin Medical Center in Israel and UCF Health ophthalmologist Mehul Patel, will examine how the microgravity environment of space affects the structure and function of the eye in a condition called spaceflight-associated neuro-ocular syndrome or SANS that typically occurs in astronauts. The most commonly reported symptom of SANS experienced by astronauts is decreased near vision.

In a microgravity setting, one of the theories is that there is fluid buildup and congestion inside of the orbit, which is the bony space in which our eyeballs rest, Patel says. And so, if there is a buildup of fluid even in short duration flights, that exerts pressure on the eyeball which changes how blood enters the eye and leaves the eye and the actual shape of the eye.

The study includes a range of pre-and post-flight eye exams using a noninvasive approach called optical coherence tomography angiography with the comprehensive imaging device called the Spectralis HRA+OCT2 on loan to UCF from Heidelberg Engineering in Germany. This is the first space eye study that will benefit from this kind of detailed imaging.

All prior studies have used MRIs and other ways to image the back of the eye with photos, Patel says. But this newer OCTA technology can be compared to a 4K or 8K TV and those high definition cameras that are allowing you to see greater depth and clarity. So, we can now do something similar in the back of the eye, to really look at detail and definition of blood flow and vascular changes in the back of the eye.

The Brain and Alzheimers

The second study is a collaboration between Professor Yael Mardor and physicians Itzik Cooper and Harel Baris from the Sheba Medical Center, Israel and UCF physicians Joyce Paulson and Ali Rizvi. The study will examine how space travel affects the structure of the blood-brain barrier (BBB). The barrier is a semipermeable coating around the brain that acts as a filter to prevent harmful toxins or pathogens carried in our blood from getting into the brain.

While the barrier has a protective function, it can also filter out or restrict beneficial substances like therapeutic drugs. Researchers are hoping the barrier can be altered through microgravity to allow better absorption of medications that treat neurodegenerative diseases, like Alzheimers.

The civilian astronauts will undergo pre- and post-flight evaluations (including MRIs) to see if there are changes in the BBB.

If there are any changes, Rizvi says, the end goal is to see whether the blood-brain barrier can be temporarily altered by exposing patients to microgravity either in space or simulated on Earth to facilitate the treatment of diseases like Alzheimers.

This is the first blood-brain barrier study to be conducted on human subjects during space travel at the cellular level.

UCF is grateful for this opportunity to collaborate on this project to help enhance the treatment of neurodegenerative diseases, Paulson says. Right now, there are limitations in terms of what we can do to help these patients. Neurodegenerative diseases are not only difficult to treat, but they are also very progressive and impacts not only the patients but their caregivers as well, so studies like these are very important.

The researchers see these studies as an important step in providing new treatments on earth.

The innovative breakthrough in this study lies not only in the specific research questions and methods but in the creativity of referring to the physiological impacts of exposure to microgravity as holding a therapeutic potential- which holds a promise for harnessing space endeavors to other medical applications and healthcare innovation, says Baris, director of the ARC Space Lab at Sheba Medical Center. We are confident that the collaborations on these studies will pave the way for further shared efforts and enable our clinicians to provide better healthcare, for all human, either in space or on Earth.

Sheba Medical Center is the largest hospital system in Israel and Newsweek has ranked it in the top 10 internationally.

Israeli astronaut Eytan Stibbe has completed all pre-flight testing and will return for post-flight testing at UCF Healths Medical City location and UCF Lake Nona Hospital, the medical schools partnership hospital with HCA Healthcare.

I am excited to be able to participate in these research studies and contribute to medical knowledge for future generations, Stibbe said as he began testing at UCF days before being quarantined before the flight.

The UCF-affiliated studies are just two in of many experiments being conducted during the mission.

The UCF College of Medicines Department of Clinical Trials, under the direction of Amoy Fraser, is leading the trials. Fraser says more space flights studies are under negotiation.

The medical schools research expertise and its Medical City location , close to an international airport and the space center make us an optimal partner for medical space research, Fraser says.

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Fenofibrate Use May Reduce Progression to Vision-Threatening Diabetic Retinopathy – MD Magazine

April 11th, 2022 6:17 pm

New findings suggest fenofibrate use was associated with a decreased risk of progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and vision-threatening diabetic retinopathy (VTDR), but not diabetic macular edema (DME) alone.

Additional clinical trials may be necessary to determine if these associations are representative of a causal relationship between fenofibrate use and reduced risk.

Our positive association for progression to PDR coincides with results of previous clinical trials and adds new information with regards to the impact on DME, wrote study author Brian L. VanderBeek, MD, MPH, MSCE, Scheie Eye Institute.

Previous research including the ACCORD-EYE study showed reduced progression of diabetic retinopathy severity, but did not address the thresholds of DME or PDR. In contrast, the FIELD study showed reduced laser treatment of DME and PDR with fenofibrate use, but mixed results in the overall progression of diabetic retinopathy.

Accordingly, there is interest in the potential role of fenofibrate in diabetic retinopathy care, with ongoing randomized clinical trials taking place through the DRCR Retina Network.

The current study aimed to further assess the association between fenofibrate use with diabetic retinopathy progression using medical claims of all beneficiaries in a commercial and Medicare administrative database.

Study cohorts were created from all patients with NPDR 18 years or older from who had laboratory values from January 2002 - June 2019. Criteria for exclusion consisted of any previous diagnosis of PDR, DME, proliferative vitreoretinopathy, or treatment used in the care of VTDR.

The main outcomes were identified as a new diagnosis of VTDR or DME and PDR individually, defined by International Classification of Diseases or Current Procedure Terminology codes. Additionally, a time-updating model for all covariates was used in multivariate Cox proportional hazard regression to determine the hazards of progressing to VTDR.

Investigators included a total of 5835 fenofibrate users at baseline with a mean age of 65.3 years (3564 [61.1%] male patients; 3024 [51.8%] White patients) in the analysis. Moreover, they included 144,417 fenofibrate nonusers, with a mean age of 65.7 years (73,587 [51.0%] male; 67,023 [48.4%] White) in the analysis.

In the observation period, data show 27,325 (18.2%) patients progressed to VTDR, 4086 (2.71%) progressed to PDR, and 22,750 (15.1%) progressed to DME.

After controlling for covariates, Cox model results showed the association between fenofibrate and a decreased risk of VTDR (hazard ratio, 0.92 [95% CI, 0.87 - 0.98]; P = .01) and PDR (hazard ratio, 0.76 [95% CI, 0.64 - 0.90]; P = .001).

However, no association was observed on development of DME (hazard ratio, 0.96 [95% CI, 0.90 - 1.03]; P = .27).

Our findings offer further hope that the DRCR Retina Network clinical trial will prove beneficial for progression to PDR but some concern for those who are hoping for reduction in DME incidence, VanderBeek concluded.

The study, Association of Fenofibrate Use and the Risk of Progression to Vision-Threatening Diabetic Retinopathy, was published in JAMA Ophthalmology.

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Beyond the Wall: Eye-opening visit to U.S.-Mexico border | Faith Matters – NJ.com

April 11th, 2022 6:17 pm

PART 1: Life and struggles of migrants, aid workers

Driving an hour from the Tucson, Arizona, airport to the Mexican border, you go through miles of mountains and desert that in the dead of winter appear dark and ominous. Occasionally you see signs for a town -- Rio Rico, Patagonia, Tubac carved out of the terrain.

But for the hundreds of thousands of migrants from Central America and Mexico stuck in the state of Sonora, Mexico, the desert is often the only way out and into the U.S. And it can be treacherous.

In mid-February, I spent a week in Nogales, Arizona, with Jesuits who run the Kino Border Initiative in the other Nogales, across the border in Sonora.

Jesuit seminarian Kieran Halloran, 29, who just left St. Peters Prep in Jersey City after two years of teaching, is spending his third year of regency, or apostolic work, at Kino working with migrants. Reading and hearing so much about issues at the border, I decided to visit him and see for myself.

The suffering and desperation along with the daily heroism of those devoted to help -- are real and ever-present.

As an example, at dinner with the Jesuit community in Arizona one evening, seminarian Victor Yanez received a phone call from a border rescue group that they were on their way to retrieve a man from Mexico who was trying to get into the U.S. and became disoriented.

Nighttime temperatures in the desert are cold and although the stars are so bright you think you can reach up and grab one, the sky is very dark. The migrant was lucky his cell phone worked and he could reach his family, who called the rescue operation, and that they could locate him.

He was also lucky he survived; many do not. Bodies and bones, KBI staff told me, are routinely discovered in the desert. Against the wishes of the U.S. Border Patrol, activists regularly traipse through the desert in daylight and leave jugs and bottles of water along with blankets in what appear to be some well-traveled paths so migrants would have some relief.

But providing relief has become a monumental task.

In the last 40 years, the U.S. government has been tightening immigration policies and millions of migrants, even those seeking asylum for life-threatening situations, have found themselves in limbo at the border. Then-President Trump, through White House immigration adviser Stephen Miller, enacted harsh measures, including Title 42, which requires that migrants seeking asylum remain in Mexico until their cases are heard, which could take months or years. Perhaps as many as 200,000 people hoping to immigrate to the United States remain in the Nogales, Mexico, vicinity.

On April 1, the Biden administration announced plans to finally end Title 42 restrictions starting May 23.

More welcome news had come last month when the Biden administration announced a new policy through which some migrants seeking asylum will have their claims heard and evaluated by asylum officers instead of immigration judges, cutting down the massive backlog of applications.

More than two-thirds of the 11,015 migrants who arrived at KBI last year reported violence or persecution as the main reason for migrating, the organization reports.

And the harshness of life on the Mexican side of Nogales was chronicled in a remarkable 2021 book, Voices of the Border (Georgetown University Press), edited by Tobin Hansen and Sister Maria Engracia Robles, KBI Mexicos director of education.

Robles is the superior of the Missionary Sisters of the Eucharist in Sonora and spent years listening to and transcribing migrants stories of wanting a better life but being stymied by U.S. policies going back to the 1980s. While Trump was a megaphone for hate, even President Obama was deporting people at record numbers.

Maras, or gangs, rule much of Mexico and they demand payment to escape via train. But once on the train, migrants are targeted again for hundreds of U.S. dollars, which most do not have, to continue the journey. Those who refuse or cannot pay would be thrown off into the train tracks, decapitated or attacked with a machete, the VOB book detailed.

From 1998 to 2020, the authors write, more than 7,500 people lost their lives while attempting to cross the treacherous U.S.-Mexico border due to heat stroke, dehydration, hyperthermia and drowning.

Some have been killed in incidents with Border Patrol. On the Mexican side of the border, Halloran and I stopped by a huge painting of 16-year-old Jose Antonio Elena Rodriguez, who was shot and killed 10 years ago by a USBP agent who fired into Mexico from the American side. The agent claimed the boy threw rocks at him, putting the agents life in danger. Mysteriously the camera video disappeared and the agent was acquitted of murder at trial in Tucson.

FLEEING VIOLENCE

Among the 50 migrants in the shelter when I was there were people from Central American countries fleeing gang violence and threats on their lives. KBI protects them while providing legal aid to expedite their asylum claims.

The seriousness of their situations is evident in the fact that the new KBI building, open since 2020, has no outdoors space where the shelter residents can go out in the sun even though there is endless land around it. On the land adjacent, men who appear to be squatters wander. Yanez calls them the Mafia, who spy on people coming to and from the border crossing and are part of an underworld of people who take advantage of desperate migrants.

As a priest, I had free reign at the shelter but as a journalist could not interview the migrants there. KBIs policy is not to revictimize the migrant, said Yanez.

We work with each migrant how to tell his or her story in a fashion that looks toward the future, he told me.

That is the role of Gia Del Pino, 31, KBI director of communications for the last eight months.

Migrant justice is my calling, said the Ph.D. candidate at the University of Arizona in Tucson, a beautiful campus I visited. She is a child of Cuban and Venezuelan immigrants.

My closest contact to these protected migrants was sitting in on the ESL classes given by Sister Marlita Henseller in a back section of the shelter. Shes on a one-year sabbatical volunteering at KBI. A Wisconsin Franciscan Sister of Christian Charity for 58 years, she represents for me the best of the hundreds of women religious I have met in my years as a priest. They started out as school teachers or working in Catholic institutions but then embraced the Vatican II spirit to get out into the world and minister to the poor.

Henseller learned Spanish in Bolivia over five months and then served as a missionary in Peru for 12 years.

Wanting to go to Sonora, she said, I told my provincial I wanted to hug Spanish babies. And surely her warm, friendly style embraces migrant women and children as she guides them to learn English.

The mothers are young, but their children seem to pick up the English quicker. Sometimes, the younger children are restless and distract the group, but Sister takes it in stride and shows humor.

The international charity Save the Children staffs a large, colorful education center at KBI and works with the children to keep up with studies and also provide them with some activities.

COMEDOR

While KBI now has many components, it is commonly referred to as the comedor, or dining room, after its initial mission to feed migrants.

As soon as you enter the large central space, your eyes are drawn to a huge mural of the Last Supper on the far wall, a painting of actual KBI migrants, staff and volunteers done by Wenceslao Hernandez, a migrant who has established himself as a Sonora, Mexico, artist. Its so realistic you think it is a photo, but it also captures what continues to be KBIs main mission: feeding the hungry.

On any given day pre-pandemic, KBI would serve anywhere from 100 to 900, estimated Joanna Williams, 30, executive director for the last year, though employed there for seven.

The current building opened Feb. 12, 2020, right before COVID closed it down, and it has slowly been building up its clientele and services. Food service is now to-go.

My first day there I was part of the morning food serving team dishing out string beans mixed in with scrambled eggs and then rice, once the eggs were finished.

Henseller checked in the migrants, mostly women with children and some men.

First, soup, then I would be next. They would say in Spanish how many people they would feed that day and I would scoop that number. Then they could have mole, chicken pieces in chocolate sauce. They help themselves to some drink and bread and then go on their way.

Its very eye-opening to see these young mothers with young children following behind them often clinging to their blouse. I asked each child his or her name and made faces at them to make them smile. The special treatment they receive blunts the harshness of daily life they face.

In the month of February, KBI served 8,374 meals. While the number of people they feed now is lower than pre-pandemic, the numbers grow daily.

These migrants are staying in Sonora shelters while their asylum cases are processed, Halloran said.

Without KBI, where would they be able to get as much delicious and nutritious food?

The prep kitchen is always a beehive of activity. After serving, the food for the next days meal is prepped and I was assigned chopping a huge bin of onions along with Kevin Miller, a 28-year-old Californian discerning whether he wants to enter the West Coast province of Jesuits this summer, and Chris Nguyen, 45, a Jesuit seminarian and a regent in campus ministry at the University of California, San Diego.

Four Mexican Missionary Sisters of the Eucharist oversee the kitchen and food prep. They get lots of help from recent college graduates and some gap-year students who spend anywhere from two months to a year living in community in a house nearby in Mexico.

Courtney Smith was next to me on the food serving line. A graduate of Georgetown, the Connecticut native is spending one year at KBI to see the migrant experience first-hand so she can go into work, perhaps in D.C., writing policy for a member of Congress or an immigrant advocacy group.

ADVOCACY

Indeed, advocacy is a big part of KBI mission to promote U.S./Mexico border and immigration policies that affirm the dignity of the human person and a spirit of bi-national solidarity.

To achieve this goal, they provide direct humanitarian assistance, accompaniment with migrants, social and pastoral education, networking to research and transform local, regional, and national immigration policies, according to their website.

In fact, Executive Director Williams credits the decision to end Title 42 in part to the persistence and courage of asylum seekers here in Nogales who have shared their stories and illustrated the suffering that the policy has created.

Yanez, 31, has the job of directing KBIs operations.

A Jesuit regent, who just spent two years at Fordham studying philosophy and also receiving a M.B.A., would typically just volunteer. But his abilities made him suitable to fill a valuable role.

What leaves him completely joyful, he said, is that KBI can provide food and services and allow migrants to acknowledge their own dignity.

He made a coup this year by attracting KBIs first full-time medical doctor. Mexican native Dr. Obed Ruiz, 34, has been a doctor for four years. He sees perhaps a dozen or so migrants each day and said, They have lots of needs.

He treats for dehydration, wounds, blisters and also sees victims of violence. Many, he said, have psychological problems from abuse in so many forms.

The shelter, which accommodates up to 150 individuals, is on the far side of the KBI building. They sleep in bunk beds in several large areas where there are also showers and restrooms. There is also an isolation section for individuals with COVID.

One of the most colorful people I met during my trip was Jesuit Peter Neeley, the superior of the Jesuit community and one of KBIs founders. A Jesuit for 50 years, he reminded me of the many Jersey City Jesuits Ive known, except he wears a cowboy hat and sports a handlebar mustache. Like the Jesuits in Hudson, Neeley came to the order while its 28th Superior General, Pedro Arrupe, moved the Society of Jesus in the late 1960s to live religious life through the prism of social justice.

We moved away from Christ the King to Christ the liberator, Neeley said.

WHO WAS EUSEBIO KINO?

In a way he is a lot like the namesake of the Border Initiative: Eusebio Francisco Kino, from Segno, Tirol, now Italy. The Spanish king in the late 17th century sent this Jesuit priest to evangelize through missions in the Pimera Alta region, now divided between the Mexican state of Sonora and Arizona. Kino was quite successful and even the Spanish military reported to him. Named after Kino is a parkway road, a sports complex and even Kino Springs.

Neeley lives with four seminarians half his age -- Halloran, Yanez, Jarrett Ornelas, who was away while I was there, and Max Landman, 35, a Texas diocesan priest transitioning into the Jesuits. All of them speak Spanish and relate well to each other, sharing in cooking dinner and taking on community tasks. They celebrate daily Mass in a small chapel in their house usually right before dinner.

We are doing what Christ wants, Neeley told me, not to be a prophet, but to live by example.

U.S. Customs and Border Protection vehicles are positioned in Nogales, Arizona, under a pedestrian bridge used by documented commuters. (Rev. Alexander M. Santora photo)

PART 2: All they want is a better life

President Trump used to claim that U.S. border agents supported his draconian immigration policies, and migrants routinely report abuse by USBP. But there are agents, I found, who do their job without malice.

One day, I took a bike ride through downtown Nogales, Arizona, and could not go any further since I reached the elaborate crossing where people, mostly Americans, legally walk to and from Mexico for work. Obviously, they have papers.

During a shift change, I encountered an agent when he disembarked from a USBP van to stretch. He told me he was watching the people exiting on the Arizona side, saying migrants trying to illegally enter the U.S. sometimes dress like commuters and flee into the country.

Hes worked for Border Patrol through three U.S. presidents. He himself is a migrant and now lives a few towns north of Nogales in an upper-middle-class suburb.

He seemed very caring and sensitive. Just that day, he said, he stumbled across a bin of old boots he intended to bring to the job and give to migrants who need them. He knows the agents have a job to do but seemed aware how Trump demonized their work and their image.

Morale is low, he admitted.

I told him I was a Catholic priest and he said he was Catholic and that might have colored what he told me: We feel sorry for the migrants because we know all they want is a better life for their families.

Shops and supermarkets in Nogales, Arizona, have a large selection of Catholic statuary. (Rev. Alexander M. Santora photo)

PART 3: Mexican, Catholic influences strong in Nogales

When I visit a new area, I like to explore the neighborhoods, so I spent several periods during the week walking and biking around Nogales, Arizona. I stumbled on the local library where I could read the Arizona Daily Star and some weeklies.

Nogales has been hit hard by the pandemic with many storefronts shuttered and others trying to hang on. I kept passing a closed store that sold Mexican artifacts. Finally, I found it open, met the owner and learned it is actually a business that sells Mexican items to other businesses for design and decoration.

The owner told me hes been there 23 years and might open a small retail space to attract more customers. Business is bad, he lamented.

Nearby Food City, the equivalent of our Shop-Rite or Acme, has a very popular bakery. Almost all the staff and patrons are Spanish-speaking. As I walked throughout, I noticed that their healthy alternatives, though, were minimal with little choices for no-sugar or low-fat options. But they have two aisles of religious statuary and candles.

Across the street and up the hill is Sacred Heart Church, which I attended on Sunday morning along with about 200 people, again mostly Hispanic.

I later crossed the tracks, which seem to bring freight trains to and from the Mexican border and their box cars seemed endless. It reminded me of what Jersey City had been in its industrial heyday when boats would dock on the Hudson waterfront and trains would transport goods to the heartland.

The Rev. Alexander Santora is the pastor of Our Lady of Grace and St. Joseph, 400 Willow Ave., Hoboken, NJ 07030. Email: padrealex@yahoo.com; Twitter: @padrehoboken.

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