Service Learning on the U.S./Mexico Border: Transforming Student Paradigms

Abstract

The purpose of our evaluation is to provide an example of how public health schools can use service-learning courses to teach students about health equity. By ensuring that the future workforce has a comprehensive understanding of regions such as the U.S./Mexico border, students will be better equipped to provide public health services. Specifically, our objectives were to (1) understand how student perceptions of the border evolve during the 1-week Border Health Service-Learning Institute (BHSLI) course and (2) understand how the service-learning experience impacted students’ proposed personal and professional goals. Using BHSLI student journals collected over 9 years, we conducted a qualitative investigation to evaluate students’ experiences of the service-learning course. Our findings suggest that BHSLI offered opportunities for advancing dialogue about health equity. Because BHSLI is immersive, it showed students a reality that they would not normally encounter. In reflecting on these new experiences, students were not only encouraged to question systems and policies but also made accountable to act upon the insights they gained. We found that BHSLI was a space for critical consciousness building, for shifting paradigms. Students learned how to intervene in real time to make change around public health issues. Service learning could be a practice-based solution to help public health students learn about health equity, especially in historically marginalized regions such as the U.S./Mexico border.

Keywords

health equity U.S./Mexico border service learning public health education qualitative research

Introduction

Because many public health interventions strive to address disparities, it is vital to equip practitioners with the necessary tools to work toward health equity while also learning to address the needs and assets of historically disenfranchised communities (Rosales et al., 2012). This idea is reflected in the accreditation requirements for the Council on Education for Public Health (CEPH, 2016), which states that schools of public health must, “explain the social, political, and economic determinants of health and how they contribute to population health and health inequities.” Lachance and Oxendine (2015) take this competency further in their call for graduate public health programs to focus equally on leadership and disciplinary skills, including “the ability to treat others with respect, trust, and dignity,” to prepare students for the workforce. Yet these skills are often not taught in academic settings (Wallerstein et al., 2005). Chandler et al. (2022) highlighted the extent of this problem in their recent systematic review examining examples of how the above CEPH criterion is met; they only found 11 manuscripts. There is a need to further document how to teach public health students about health equity (Chandler et al., 2022). This is especially pronounced in places where opinions have been formed by political debates rather than lived experience, such as the U.S./Mexico border. Service learning may be a practice-based solution to help public health students re-contextualize these spaces.

Contextualizing the False U.S./Mexico Border Narrative and Its Detrimental Effects on Public Health Practice

Beyond a geographic boundary, borders represent a transnational, transcultural discourse between two neighbors, or as Aguirre and Simmers (2008) describe it: “almost like a seam between two pieces of cloth in a quilt.” In the early 1990s, despite demand for labor, xenophobic beliefs toward the growing im/migrant population resulted in militarization of the U.S./Mexico border. The changes that followed included the criminalization of border crossers (Aguirre & Simmers, 2008) and the perception that the U.S./Mexico border is a violent place (Correa-Cabrera & Garrett, 2014). This negative framing, incomplete understanding of border dynamics, and vilification of im/migrants not only drives a generalized misinterpretation of this region and its people as dangerous (Hinojosa-Ojeda & Telles, 2021), but can also lead to anti-im/migrant sentiments that ultimately result in racist policies and practices that harm health (Morey, 2018).

Literature Review

We see service-learning as defined by Furco (1996): experiential education that benefits both parties, ensuring reciprocity and shared meaning making. This type of community-engaged coursework gives students the opportunity to cross contextual, developmental, social, and cultural boundaries, encouraging them to decenter and “remap” in constructive ways (Jones et al., 2011). Within public health, service-learning creates space for students to co-analyze social determinants of health and community-centered solutions (Sabo et al., 2015) and collaborate with local constituents (Pogreba-Brown et al., 2017). Journaling in service-learning courses can promote deep personal exploration, changing perceptions of diverse populations and politically fraught areas (Sabo et al., 2015). In an exploration of critical reflection as a way to facilitate knowledge construction in e-service-learning courses, reflection was key to learning (Guthrie & McCracken, 2014). Students need opportunities to discern what is most meaningful to them, legitimizing their lived experiences in formal education (Barbezat & Bush, 2013). Additionally, there are clear connections between writing and emotional experiences, encouraging a “pedagogy of discomfort,” or a purposeful approach to unpacking uncomfortable emotions (Barbezat & Bush, 2013). This is particularly effective in community-engaged writing courses that introduce students to potentially uncomfortable situations (Prebel, 2016).

Other researchers have described service-learning courses on the U.S./Mexico border. Camacho (2004) investigated how service learning in Tijuana could be used to examine power, privilege, and subjectivity among undergraduate students. She highlighted three themes from student reflections: unintentional reifying migrants, feelings of foreign-ness, and examination of power and privilege. Similarly, in an assessment of how students critically examined their assumptions about self and society in a service-learning course in Tijuana, King (2004) found that students (three undergraduate and one graduate student) were attentive to community members’ viewpoints and contributed to raising questions about inequity. Finally, Austin (2010) described a multisectoral, binational partnership established to address environmental issues on the Nogales, Arizona/Nogales, Sonora border. This collaboration became a key mechanism for engaging people from within and across communities toward a common goal and included high school, undergraduate, and graduate students from both sides of the border. Our manuscript adds to the literature by incorporating perspectives of graduate-level students using a health equity lens, and analyzing data collected over multiple course cycles.

Border Health Service-Learning Institute (BHSLI)

In Arizona, 2008 was a significant year for public health education for three reasons. First, Community Campus Partnerships for Health (CCPH) was funding opportunities to work with community partners on strengthening health equity. Second, because of new lottery appropriations, the Arizona Area Health Education Center Program (AHEC), an agency responsible for enhancing educational opportunities for health professionals in medically underserved areas, was building programming. Third, in the wake of 9/11, the Arizona state legislature enacted numerous laws limiting migrant rights and fostering discrimination against individuals without legal documentation (Arizona Taxpayer and Citizen Protection Act (Proposition 200), 2004). Consequently, humanitarian agencies wrestled with how to handle policies that harshly criminalized immigration (Androff & Tavassoli, 2012).

With over 25 years of experience working on the U.S./Mexico Border developing reciprocal partnerships, Dr. Cecilia Rosales and Jill Guernsey de Zapien leveraged this situation and won a grant from CCPH and gained AHEC support. Their primary goal for BHSLI was to examine the synergistic dynamics between migration, public health, and economic development through an advocacy lens. They adapted the CCPH framework forming a team-based, week-long, graduate-level, service-learning course focused on the U.S./Mexico border. They emphasized co-learning between faculty, staff, students, and community partners. Joined by 13 co-instructors over 13 years, the teaching team rotated the course to different Arizona/Sonora border sites. BHSLI started in Douglas/Agua Prieta then expanded to Yuma, Somerton, San Luis/San Luis Rio Colorado, and Nogales/Nogales.

Purpose

We describe how public health institutions can use service-learning courses to teach students about health equity to ensure that the future workforce has a comprehensive understanding of regions such as the U.S./Mexico border. Using BHSLI student journals collected over 9 years, we conducted a qualitative investigation to evaluate students’ experiences of the service-learning course. Our objectives were to (1) understand how student perceptions of the border evolve during the course and (2) understand how the service-learning experience impacted students’ proposed personal and professional goals.

Methods

Conceptual Framework

We used Kiely’s (2005)Transformational Service-Learning Process Model (TSLPM) as a framework to understand and interpret our data. TSLPM posits that there are five domains when experiencing transformational learning through a service-learning experience:

Contextual border crossing: Intersecting factors that frame the way students experience service-learning.

Dissonance: Incongruence between students’ prior frame of reference and the service-learning experience.

Personalizing: How students respond to and learn from dissonance.

Processing: Searching for causes and solutions individually and as a group.

Connecting: Learning to empathize by forming relationships with community members, peers, and the instructional team.

Kiely (2005) argues that the examination of these factors together can inform the service-learning process and help instructors anticipate students’ emotional and cognitive responses.

Course Protocol

Before the course, instructors asked students to read books (such as The Devil’s Highway [Urrea, 2008] or Fresh Fruit Broken Bodies [Holmes, 2013]). These works of literature and ethnography highlight the push and pull factors that cause people to migrate north, the potential dangers of crossing the U.S./Mexico border, and the harsh labor conditions migrants experience. With these narratives setting the stage, during the in-person portion of BHSLI, students visited county health departments, tribal nations, clinics, as well as migrant shelters, migrant advocacy organizations, hospitals, and small businesses on both sides of the border and a U.S. Customs and Border Patrol station. BHSLI activities included: listening to presentations and panels led by community constituents, shadowing public health professionals, conducting surveys, building infrastructure projects, and sharing meals with community partners, migrants, and locals.

Data Sampling, Collection, and Processing

During the week-long BHSLI trip, students completed daily, handwritten journal entries in response to pre-assigned reflection prompts (Appendix A). These questions guided students to reflect on their experiences and the course goal: to think about advocacy in the context of public health, migration, and economic development on the U.S./Mexico border. BHSLI instructors gave students feedback on their journal entries at least one time (mid-week).

There were 71 handwritten journals collected from 2008 to 2017 available for review. Each journal was digitized into Microsoft word by a student intern. Each journal was between 4 and 14 pages single-spaced with 12-point font. We stored the journals in a locked filing cabinet, and we saved the typed transcripts in a password-protected computer. The University of Arizona Institutional Research Board reviewed and deemed this evaluation exempt from human subjects’ research.

Our data analysis team included Black, Indigenous, People of Color, and White faculty, staff, and graduate students. All team members have experience and knowledge about service-learning as well as the U.S./Mexico border region through scholarship and teaching.

Data Analysis

We created a codebook based on TSLPM to deductively code our data while also using inductive coding to allow for additional emerging themes (Table 1). Using Dedoose version 8.3.43 to organize and code, we adapted Maguire and Delahunt’s (2017) six-step guide to thematic analysis by completing the following steps. First, two researchers (AML and NMM) familiarized themselves with the data independently reading one journal. Second, AML and NMM generated initial codes through an iterative process of coding the single journal. Next, the full analysis team (AML, NMM, ESV, and MI) discussed the codes and modified the codebook to better reflect the data. The first two coders then repeated this step with a second journal to ensure the codebook changes improved the initial codes. The full analysis team (hereafter referred to as we) then divided the coding so each journal was independently coded by two researchers. When approximately half the journals were coded, we met to review the codebook and made minor edits to better clarify the definitions of some codes. Third, we defined broader themes that emerged from the data and then reviewed, modified, discussed, and further developed our themes. Finally, we formally defined the themes and wrote the results. We reviewed all the journals with available digitized transcripts during data analysis to maximize diversity of experiences represented in the data.

Table 1.

Qualitative Codes used to Analyze Student Journals in an Evaluation of the Border Health Service-Learning Institute.

Personal background	Social identities and life experiences of the student including race, class, gender, religion, nationality, personality traits, social roles, professional background, knowledge, skills, beliefs, assumptions, expectations, and ideologies
Programmatic components	Course structure, pedagogy, and components of the experience including service opportunities of meaningful impact (either positive or negative), connections to course readings, and suggested changes
Personalizing	Visceral and emotional responses or reactions that compels students to assess internal strengths and weaknesses including anger, happiness, sadness, helplessness, fear, anxiety, confusion, joy, nervousness, romanticizing, cynicism, sarcasm, selfishness, and embarrassment
Processing/tension	Struggle, resistance, surprise/awe, or challenging of student’s perspective, thought process, assumptions including grappling with what they are experiencing/witnessing, reexamining knowledge or assumptions, problematizing, questioning, analyzing, and searching
Connecting with others	Interpersonal connections with community members, peers, and faculty via conversation, sharing, serving, listening; engaging with others to understand and empathize
Application	How experiences and knowledge from service-learning can inform or be applied to something in student’s primary or home environment, U.S. or Mexican systems, or current events
Future steps	Expressed action that will be done following service-learning experience
Historical context	History, culture, socioeconomic, political, country- specific factors of others or the service-learning environment that influence current issues of the border communities

Results

Most BHSLI students were in the University of Arizona, Mel and Enid Zuckerman College of Public Health Master of Public Health (MPH) (86%) or the Doctor of Public Health (DrPH) (7%) programs. The remaining graduate students studied other disciplines including urban planning, clinical and translational science, or Mexican American studies. We present our results first by evaluation objectives: to understand (1) how BHSLI influenced perceptions of the border and (2) how the BHSLI experience impacted student intentions for future work, second by TSLPM domain (contextual border crossing, dissonance, connecting personalizing, and processing), and finally by themes and subthemes.

Evaluation Objective: How BHSLI Influences Perceptions of the Border

TSLPM Domain: Contextual Border Crossing and Dissonance and Theme: Application of knowledge or experiences

Journal entries suggested that students used their personal background as well as programmatic factors such as course readings and group discussions as a lens for interpreting service-learning activities.

Personal background

Some students who had never visited the border or who had limited in-person exposure to the border held stereotypes, stories, and myths heard from family, friends, or the media that shaped their initial impressions. For example, one student wrote, “The media portrays the border as dirty, immoral, dangerous, and hazardous area unfriendly toward tourists, locals, and outsiders. When I say I am in Nogales, AZ/Sonora people respond with, ‘Be careful. Don’t talk to strangers. Don’t go, it’s not safe! What’s a girl going to do there? Don’t get raped/kidnapped. M’ija, they kill niñas bonitas like you. M’ija, please don’t go’” (2012 Nogales, AZ/Nogales, Sonora). Similarly, another student wrote, “The media has portrayed the Nogales area (and some other border regions) to be very unsafe places with rampant murders and drug trafficking so much so that my family all the way in [African country, name removed to maintain anonymity] was very uncomfortable with the idea of me being part of this class” (2012 Nogales, AZ/Nogales, Sonora).

In contrast, other students had either worked on the border or in other poverty-stressed settings and were aware of the need for sustainability in public health interventions, had empathy in the limited access to resources, and were inspired by the financial efficiency of Mexico’s public health system. Many students also acknowledged the influence of their birthplace on their perceptions of the border with statements like: “To me, the U.S.-Mexico border can be so fluid, but for many others it is as solid as the steel wall that divides us” (2017—Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora).

Students from rural areas found similarities with the towns on the U.S. side, yet acknowledged that the ebb and flow of migrants makes growing up in a border town unique. Others who were raised in large metropolitan or suburban areas acknowledged how far removed the border was from their life. Alternatively, im/migrant and international students reflected on their own family’s migratory experiences by comparing their lived experience to what they encountered on the U.S./Mexico border. Finally, some students used the opportunity to reflect on their own power. They identified their privilege and expressed gratitude for their life. Some struggled with reconciling their privilege and highlighted that the border is easy to cross for some but not others. This was illustrated by one student who wrote, “I’m not going to lie, but sometimes I feel a little bit guilty during the day. I was so blessed, and have been so blessed with being able to have the life I did. I didn’t have to apply for a visa and be denied for no reason; I didn’t have to cross the desert” (2015—Douglas, Bisbee, Wilcox, Arizona/Agua Prieta, Naco, Sonora).

Programmatic factors

Students used the pre-course readings as well as the presentations they received during BHSLI to contextualize activities and current events. Many students new to the border expressed evolving perceptions about the region, from a deficits-based to assets-based approach. Their interest in the border increased as demonstrated by their plans to seek additional information about border health through coursework or volunteer opportunities. One student wrote, “This course helped to completely shift my perspective on border towns and rural communities. . .this course showed me the myriad strengths that exist in these areas. . .being able to see the border and interact with the organizations and communities living there added depth and nuance to my understanding of border health issues. . .Now I am considering working in rural/border communities and am excited to learn more about migration and economic development and how they intersect to affect health” (2017—Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora).

TSLPM Domain and Theme: Connecting

Students identified connecting with others as a method to learn about the border primarily through listening (especially during meals) to personal stories or conversing with community members or staff from local agencies. Some students valued interacting with their peers and instructors while others discussed connecting with the characters in the assigned readings.

Through listening

Many students had an opportunity to talk with migrants, border patrol agents, or people who live on the Mexico or U.S. side of the border. For many, the chance to visit the Mexican migrant aid shelter, speak with someone who had recently been deported from the U.S., and learn the reasons behind their migration was powerful. These conversations helped students understand the factors pushing im/migrants from their homes and the potential dangers of crossing the border, connecting the consequences of U.S. policies with individual stories. For example, one student wrote, “as we sat eating dinner [at the migrant shelter] I asked if he knows the U.S. He replied yes –Phoenix? Tio Arpaio [referring to Sheriff Joe Arpaio]. I smirked at the joke, but immediately could feel the tension he emitted. . .The dialogue went on with this sort of tension and he made sure to mention that the reason that Sheriff Joe exists and is still in office is because people allow this to happen. I couldn’t help but feel a wave of guilt as he seemed to challenge me” (2014—Douglas, Bisbee, Wilcox, AZ/Agua Prieta, Naco, Sonora).

Some students emphasized how excited they were to listen to public health practitioners such as doctors, nurses, county health department staff, and community health workers (CHWs). CHWs shared insightful, first-hand experiences by describing the opportunities and barriers border residents face daily. Additionally, students who shared common experiences with speakers, such as substance use disorders, found the personal stories they heard from border residents or migrants powerful. One student captured this idea when they wrote: “Ernesto’s presentation today at CREDA [drug rehabilitation center] hit very close to home. I am very close to someone who has been affected by alcohol and was recently at a rehab center in Tijuana, Mexico. Ernesto’s story made me understand how this person might be feeling and how hard it might be for him to stop drinking or just be understood by others. In relation to the course/service-learning, Ernesto’s narrative made me realize how the wall and militarization of the U.S./Mexico border cause the increase of drug use substance abuse in Mexico and all along the border” (2017—Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora).

These conversations helped students build empathy for the speaker, brought them new perspectives or realizations about border policy, privilege, and culture, and inspired some students to continue further studies or work in public health. For example, one student wrote, “Bringing us together with fantastic people who take such pride in their people and community is deeply inspiring. I am overwhelmed with the info I am absorbing from these professionals” (2012—Nogales, Arizona/Nogales, Sonora).

Through sharing

Some students also acknowledged that they learned by connecting with peers and instructors. Time spent conversing between activities was valuable for reflection and digesting experiences. The unique experiences afforded by BHSLI helped them build new friendships or mentorships made evident by statements like: “I’ve made more (+ better) friends this week than in two semesters of law school so far. So very glad to have been here” (2012—Nogales, Arizona/Nogales, Sonora).

Through reading

Finally, other students described feeling connected to the characters in the assigned readings. They wrote about how these characters gave them a better sense of border life or border crossing and helped them begin to understand the migrant or farmworker experience. One student wrote, “The second half of the day was not as fun, but I appreciated having the opportunity to visit the border patrol. . . Through much of this experience felt staged, my conversation w/the female agent humanized their work. I thought a lot about the agent Archie, in “Into the North” [book], who helps Nayeli and Tacsio [fictional characters], and our relations as humans divided over issues which too often supersede basic kindness” (2012—Nogales, Arizona/Nogales, Sonora).

Evaluation Objective: How the BHSLI Experience Impacted and Intentions for Future Work

TSLPM Domain and Theme: Personalizing and Processing

Education

BHSLI students reported an increased interest in their public health areas of interest and motivation to learn more about the border. For example, one student wrote, “This presentation gave me hope in pursuing my dream to go to medical school and return to my community (San Luis, AZ) to serve them as a public health physician” (2017—Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora). Many non-Spanish speakers expressed a desire to learn Spanish. Some students planned to pursue educational opportunities like completing theses or dissertations with the community organizations they met during BHSLI. Students also reported making pacts with course peers to teach others their lessons learned at the border.

Action

After completing BHSLI, students felt empowered to participate in community-based work. The experience illuminated how social justice can be integrated into existing or future career plans, including outside of public health. Students indicated intentions to or became immediately involved in advocacy organizations when they returned to Tucson (as stated in the final journal entries 1-week after BHSLI). After learning more about farmworkers and fair trade, some students felt an enhanced sense of conscious consumerism regarding purchasing power. They intended to buy co-op owned coffee and patronize socially responsible companies. Finally, students wrote about personal introspection that motivated them to transform their prejudices, worldview, and role in society. Many students described a new-found sense of self and positionality regarding their own privilege. They expressed a desire to use their privilege(s) to make a difference in their communities (Table 2). For example, one student wrote, “Now that I am more aware of the border health issues I am read[y] and wanting to be more involved, more of an advocate, and a conscientious consumer and voter” (2008 Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora).

Table 2.

Results of the Border Health Service-Learning Institute (BHSLI) Evaluation Presented by Evaluation Objective, Transformational Service-Learning Process Model (Kiely, 2005) Domain Addressed, and Theme With Additional Representative Quotes.

Evaluation objective #1: Understand how BHSLI influenced perceptions of the border
Contextual border crossing and dissonance: application of knowledge or experiences	Personal Background. If you have reviewed my notes and heard me speak during team reflection you will know, perception, both from point of view and my families point of view, is what has shocked me. My mother immediately began to worry of being surrounded by the drug cartel and what kind of violence they could inflict on me. While my father worried about being kidnapped and held at ransom. Albeit, this has made me cautious and vigilant. It wasn’t a world-view I shared, obviously because I am here. Nonetheless, I have stayed with my group at all times and per my mother’s request kept $20 in my shoe at all times. However, 36 hours later in Nogales, Arizona it has been a true paradigm shift.
	Some of the reasons for this transformation has been the people of Nogales, AZ both working in the community and residents. In speaking with the mayor of Nogales, AZ and a representative of the mayor’s office from Nogales, Sonora, I was amazed at how it seemed our conversation compared to that of an old friend or close family friend. We were speaking of memories from their childhood, giving me lessons on the importance of one’s heritage, and even jokes! It was all just overwhelming, and it was my first step to comfortability and the start to dissolving the veil for ignorance my parents had on the border. (2012—Nogales, Arizona/Nogales, Sonora)
	Programmatic factors. The part of today that impacted me the most was the Cochise County Health Department. I am so impressed that a rural, small border area has such an intact, engaged, and passionate health facility. This was surprising and inspiring to me because I grew up in rural AZ ([town name removed to maintain anonymity], pop. 500) where none of this exists. Seeing what can be done with driven and passionate people in a small community is inspirational. My hometown faces many of the same challenges that [name of clinic chief executive officer removed to maintain anonymity] discussed, such as poverty, shortage of providers, and distance to hospitals. That presentation encouraged me to think about what could be. (2017—Douglas, Bisbee, Arizona/Agua Prieta, Cananea, Sonora)
Connecting	Through listening One important thing I learned is that each story has multiple sides. As a person who advocates for public health and the improvement of health as a population, I have to always keep in mind that learning to listen and understand the opinions of others different from mine is part of moving forward. Learning to compromise and not impose my own ideas but instead understanding the context of other people’s beliefs and ways of life are key to creating policies and cooperation among communities. This is why immersion, albeit a short one, was a major factor in the depth of my understanding of what comprises the border issues present today. If the learning was limited to reading secondhand information through books, I would have had a bias depending on the source of the information. Speaking to various stakeholders in the communities, a more cohesive picture evolved and a better comprehension of the kind of actions the border health region needs to improve in economic opportunities, the lifestyle changes local residents must be encouraged to do, the gaps in the health infrastructure that need to be filled and the importance of the participation of members of the community. (2016—Douglas, Bisbee, Wilcox, Arizona/Agua Prieta, Naco, Sonora)
	Through sharing My roommate had such an impressive transformation and this desire to learn more and more each day. It was so great to be surrounded by people with so much knowledge and desire to help and become a public health practitioner. I know for a fact that I have started a good friendship/relationship with some classmates. This course has confirmed what my heart desires and it is to work as a public health practitioner and work binationally. (2015—Douglas, Bisbee, Wilcox, Arizona/Agua Prieta, Naco, Sonora)
	Through reading Today, I also reflected on Nayeli from the book [Into the Beautiful North] aspirations and vision for the future. [Local youth coalition members] spoke of career aspirations and successful futures as doctors and other respectable jobs. I noticed that these girls had aspirations beyond being a mother, as they seemed to have high self-worth and opportunities that their friends across the line might lack like Nayeli and Veronica [fictional characters] who have lost one or both parents. . . Nayeli’s [fictional character] father disappeared when he left their family for work up north. This tragedy of an absent parent is a reoccurring theme. The dark forces that contribute to Mexico’s corrupt economic policies, the push vs. pull factors. From other readings are to blame for the youth crisis in these border towns. (2016 - Douglas, Bisbee, Wilcox, AZ/Agua Prieta, Naco, Sonora)
Evaluation objective #2: understand how the BHSLI experience impacted student intentions for future work
Personalizing and processing: education	This experience is highly motivating for me. I must learn to speak Spanish fluently! I had the pleasure of interacting with a N’ejita today I feel in love with her. I wish I could have communicated more effectively with her. She reminds me of how much I love elders. (2012—Nogales, Arizona/Nogales, Sonora)
Personalizing and processing: action	The experience has served as a strong reminder to never lose sight of the underlying motivations of social justice that brought me into the field of public health and that have driven my studies and career choices since high school. It is too easy to get caught up in the day to day obligations and busy work, and in doing so forget why you do what you do. Daily challenges seem large and successes small unless you keep in mind your ultimate purpose, I realized that I don’t need to change careers or my academic path to work for social justice. I only need to keep my passion at the forefront and let it guide all my endeavors. (2013—Yuma, Somerton, San Luis, Arizona/San Luis Rio Colorado, Sonora)

Lessons Learned

Our findings suggest that BHSLI offered opportunities for advancing dialogue about health equity. Because BHSLI is immersive, it showed students a reality that they would not normally encounter. In reflecting on these new experiences, students were not only encouraged to question systems and policies but also made accountable to act upon the insights they gained. Thus, using Kiely’s TSLPM framework, we found that BHSLI was a space for critical consciousness building, for shifting paradigms. Students learned how to intervene and advocate for change around public health issues.

Humility and respect are necessary to achieve critical consciousness and paramount to constructively engage with border communities toward the elimination of health inequities. Service learning is one mechanism through which public health students come to embody these principles. Yet, much of what we learn about the border stems from media depictions driven by agendas originating outside the community. Consequently, when BHSLI students witnessed the symbiosis between U.S./Mexico border communities, their understanding of this space shifted from one of deficits to assets. Students discovered community members’ strengths and passions and acknowledged the innovative strategies of those working in the public health sector. Students experienced an internal process of challenging their own assumptions about the border, themselves, where they come from, and what they hope to contribute to the field of public health. Because course activities centered on the work of long-standing community organizations, this occurred even for students who had lived or worked in border or other marginalized communities.

We recommend the following future directions for improving the potential for service learning to impact health equity scholarship. First, we used student journals to assess course impact. How could we employ other evaluation methods to capture multiple ways of knowing beyond reflective writing to ensure that students and community constituents are benefiting from the course? Second, the quality of journal writing varied. How could we adjust the journal assignment as a writing skill development activity? Third, although some students acknowledged their power and privilege, how can we more directly address and model these areas within the course structure? Fourth, in their journals, students write about communities. How could we co-create knowledge together with communities?

In this article, we analyzed graduate student journals to evaluate a service-learning course on the U.S./Mexico border. BHSLI students learned to take an assets-based approach, build their critical consciousness, and planned to participate in public health advocacy work to promote im/migrant rights, health equity, and positively reframe borders moving forward.

Supplemental Material

sj-doc-1-php-10.1177_23733799221085250 – Supplemental material for Service Learning on the U.S./Mexico Border: Transforming Student Paradigms

Supplemental material, sj-doc-1-php-10.1177_23733799221085250 for Service Learning on the U.S./Mexico Border: Transforming Student Paradigms by Abby M. Lohr, Namoonga M. Mantina, Elizabeth S. Valdez, Charisse S. Iglesias, Maia Ingram, Luis A. Valdez, Jill Guernsey de Zapien and Cecilia Rosales in Pedagogy in Health Promotion

Footnotes

Acknowledgements

We are so grateful for all our community partners who made the Border Health Service-Learning Institute (BHSLI) a transformational experience for everyone—you inspire us to continue this work. Thank you to all the past and present BHSLI co-instructors and students for your enthusiasm and interest, flexibility, and drive. Additionally, we would also like to thank Assumpta Nsengiyunva for transcribing all the journals. We respectfully acknowledge the University of Arizona is on the land and territories of Indigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson being home to the O’odham and the Yaqui. Committed to diversity and inclusion, the University strives to build sustainable relationships with sovereign Native Nations and Indigenous communities through education offerings, partnerships, and community service.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Abby M. Lohr

Maia Ingram

Supplemental Material

Supplemental material for this article is available online at .

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