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Volunteer Medical and Dental Missions to Mexico

Articles and Photos

Sunday, November 12, 2000
LA Times

Making a House Call South of the Border

Medicine: The volunteer members of Aeromedicos take considerable personal risks to deliver free care to the poor in Mexico.

By: ANNA GORMAN
TIMES STAFF WRITER

CADEJE, Mexico -- Though it was early on a warm Saturday morning, dozens of villagers had already gathered outside the ramshackle building to wait for the California doctors.

They heard the news on the radio and from friends, and traveled from farms and fishing villages as far as 100 miles away. Some families drove old pickup trucks. Others walked for hours along dirt roads. One man rode his horse for two days to reach the cinder-block building known as "la clinica."

"Before the American doctors came, the people suffered so much," said Bella Higuera, 54, who has lived in Cadeje nearly 30 years. "Help is very expensive. They bring us medicines and they help the whole community."

The Aeromedicos, a group of Ventura and Santa Barbara doctors, nurses and interpreters, fly in private planes to Baja California several times a year to offer free medical care to poor residents. They are among several nonprofit groups from throughout California that volunteer in the villages and pueblos of Mexico.

The trips are frustrating and risky. Often, immigration officials detain the doctors for hours, and gun-toting military officers inspect their private planes. Pilots fly over rugged hills and land on muddy runways, sometimes crowded with chickens and dogs.

Last month a Cessna 320 crashed near Ensenada, killing six members of a similar group from Northern California.

"This isn't big-city flying," said Luis Beltran, a 50-year-old pilot who flew his Cessna 210 from Oxnard to Cadeje in October. "This is Baja bush flying."

Beltran started making the treks to Mexico with Aeromedicos about 12 years ago. At home, he works as an Oxnard firefighter. At the clinic, he works as an interpreter and a dental hygienist. He also uses his carpentry skills to keep the building up and running.

"There was no way to help more than here," said Beltran, who has a jovial laugh and keeps his colleagues in good spirits amid the obstacles.

The Aeromedicos' budget is limited, making it difficult to round up enough supplies and medicines and to recruit enough doctors and dentists. And in the villages, the doctors work in makeshift clinics, treating patients who don't speak English and have never had regular checkups. The medical records are thin, and because the trips are sporadic, the doctors cannot develop treatment plans or bonds with patients.

Despite the challenges, doctors and pilots make their treks to remote, rural pueblos again and again. They go for the adventure, excitement and camaraderie. And they go because it is a way to practice back-to-basics medicine, without paperwork and politics, without managed care and malpractice suits.

"In America, we have what doctors call the liability lottery," said Chuck Montague, a pilot and retired gynecologist from Ventura. "Patients are all hoping to make it big. That doesn't exist here. They trust me and I trust them."

Most of all, the volunteers go because they say it's rewarding and inspiring to treat people who don't have access to medical care. In one day, the Aeromedicos often treat more than 100 patients. "You can't put it into words," Montague said. "You just feel good."

Montague, who joined the group more than a decade ago, said he was drawn to the work because it was a way to travel into a different world and help others. Montague said the challenges made him appreciate what he had at his Ventura practice.

The 76-year-old doctor with smoothed white hair and kind blue eyes also loves any chance to indulge in one of his favorite hobbies, flying his Cessna 182.

The town of Cadeje stretches just a few blocks, and there are fewer than 100 full-time residents. There is a boarding school for the children of nearby ranchers and farmers, one community store and a handful of well-worn homes. The landscape is sprinkled with cactus and underbrush.

Before the Aeromedicos' visits, the clinic used to be an abandoned building, without running water or electricity. Now, as one doctor put it, "it's a shell, but it has water and a roof." The roof is covered with palm fronds, and the lights and ceiling fans run off a generator. Inside, purple flowered sheets separate the examining rooms, and posters about birth control and safe dental care decorate the walls.

In the pharmacy, the plywood shelves are crammed with syringes, surgical masks and rubber gloves. The bottles of pills are organized with labels such as "allergy and asthma," "pain medication," and "cold and cough."

Wearing their Sunday best--cowboy hats for the men and colorful dresses for the women--the month's patients clutched the Manila folders that held their brief medical histories. The files listed English words most patients couldn't read: "diabetes," "hernias," "skin infections."

While they sat in a crowded waiting area, babies cried, children played and neighbors chatted. A few patients glanced at fliers on prenatal care and diabetes. Meanwhile, Beltran checked their vital signs and directed them into the doctors' "offices." In the gynecology room, Montague did pelvic exams on several women. In an adjoining examining room, Dr. Mike Lynn saw patients with everything from throat aches to allergic reactions.

Maria Ynez Nieto showed her record to Lynn. Age: 50-plus. Medical history: high blood pressure and diabetes.

The doctor asked how she felt and what medication she was taking, and nurse Pat Heintz checked her blood sugar levels and blood pressure. Then Lynn went down the hall to the pharmacy and got her a new prescription to bring down her blood pressure. Take one pill every day before breakfast, he instructed her. And throw away the other pills.

"We definitely run into problems because we switch their medicines," Lynn said, noting that the doctors have to work with whatever medications have been donated. "They end up taking both."

Lynn, a 34-year-old Santa Barbara emergency room doctor, said he would love for the volunteer work to be his full-time job. "This is why I went into medicine," he said. "I wish I could do this all the time."

In a nearby room, another emergency room doctor, Eric McFarland of Santa Barbara, examined 9-year-old Fabian Garcia Madera, who complained that his ears hurt and he couldn't hear. Two years ago, Fabian underwent surgery to repair a cleft palate. But without any follow-up care, he got an infection, and now needs another surgery.

His mother, Juana Madera Javier, said she wants to take her son to get the surgery, but she has no money and no transportation to get to the nearest hospital, more than four hours away on rough roads. Javier said she was grateful for the American doctors who come to Cadeje. "But I'm sad too, because they can't do much for my son," said Javier, who lives on a ranch 10 miles away from Cadeje.

McFarland, 43, understands that feeling of helplessness. "I can diagnose, and that's something," he said. "But I'm frustrated because I don't have anywhere to send them."

In many situations, the doctors can't provide the same care they would at home. When a patient comes in with cancer, for example, the doctors are at a loss because they can't provide regular or long-term care. "We're here as facilitators," Beltran said. "We're not here to cure all the ills."

Beltran said the Aeromedicos try to teach a few locals how to do minor diagnoses and how to give out proper medications. Eventually, the group will move to another pueblo, where they will start from scratch and build a new clinic. Before they started coming to Cadeje, the doctors treated patients in a Yaqui Indian village on mainland Mexico.

In the Cadeje clinic's largest room, dentist John Grube and his assistant Melodi Willis worked with assembly-line speed, treating their patients quickly and efficiently. They extracted rotten teeth, filled cavities and made molds for dentures.

Jose Ramon Villavicencio, 34, traveled two days by horse to his sister's house, and then two hours by car from there to the clinic. The fisherman had only seen a dentist once before, and said his whole mouth ached. After a quick examination, Grube pulled out four teeth and planned to pull out more during the next visit, when he also plans to fit Villavicencio for dentures.

Francisco Lezama, 30, said he had a space between his teeth that kept getting clogged with food and was starting to smell. "But I don't want a tooth pulled," Lezama told McFarland, who was filling in as a dentist in the afternoon.

McFarland showed him how to floss, and told him that if he used the floss once a day, he would never need to have a tooth pulled.

Without all the modern amenities of an American dental room, the dentistry team improvised, using computer terminal cleaner to dry the inside of cavities and a scuba tank for air pressure to drive the drills.

During their weekend trips, the volunteers stay in Mulege, a larger town a short flight--or a long drive--from Cadeje. And while most of the volunteers were in Cadeje, an American audiologist saw about 20 patients with hearing problems at a clinic in Mulege that is open year-round and sponsored by the Rotary club. She fitted 11 people for hearing aids, and helped one little girl hear her first words.

The night before the clinic, volunteers sat around and reminisced about previous trips. One recalled pulling a fishhook out of somebody's thumb, while another remembered cleaning out a patient's ears so he could hear again. Then there were the more serious cases--a patient with leprosy, another who had a piece of metal in her eye that had worn a hole in her eyelid.

Volunteers say they know that if they didn't provide the medical care for these people, nobody would. There is no nearby grocery store for a bottle of pain medication to treat arthritis. No 24-hour urgent care center for a broken arm. No modern hospital for surgeries. "They want for nothing," Beltran said. "They just need a little bit of medical care, and here we are."

This type of work isn't for everybody, the volunteers say. Some doctors or nurses are turned off by the confusion, disorganization and uncertainty of practicing medicine in Mexico.

"It's certainly different from our day-to-day lives," dentist Grube said. "Back in the States, everything has an order. You go from Point A to Point B, and you know how you are going to get there. On any given trip here, you never know how anything is going to happen."

Though the volunteers often have to cut through bureaucratic red tape with the Mexican government to get permission to visit the villages, local residents and doctors welcome them.

"They bring things we can't afford, things the government doesn't give us, things we have to buy with our own money," said Maritza Lopez, a doctor in Mulege. "In Cadeje, they hardly ever have access to medicine. Even getting food is tough."