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."
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