Long-Distance Caring : Surgeons Fly Mercy Missions From the Southland to Mexico

The American surgeon was struggling.

He had left Long Beach that weekend--where his patients are whisked by his sleek black limousine to their tummy-tuck and fat-suction operations--to fly down to the state of Sonora in northern Mexico on a medical mission for the poor.

Now on the operating table in front of Dr. Michael W. Nicolle of Huntington Harbour lay Ramon Ramirez, 33, who had risen at dawn and driven the 50 miles from his hometown of Navojoa in a pickup truck to see him.

Ramirez’s arm had been crushed in a slaughterhouse accident seven months earlier. Local doctors had inserted two steel rods to stabilize the arm, but the metal was infecting it and had to come out if the arm was ever to stop draining.

Nicolle had not anticipated this operation when he packed his bags for the trip, and neither he nor Dr. James W. Thornton, who was assisting him, could get a firm grip on the end of the 10-inch rod with the instruments they had.

Finally, probing deeper into the patient’s forearm, the doctors found and removed the rod, along with a floating screw and three good-sized bone chips. They stitched the lifeless arm back together.

Then suddenly, the operating room lights went out. The hospital had lost all power. Nicolle finished dressing the wounds and splinting the arm by flashlight, but the darkness meant no more surgeries would be performed that day.

Operating conditions at the state-run Alamos General Hospital in Alamos, a town of about 10,000 nestled among earthen-colored mountain, may not be on a par with American hospitals, but they could be worse, said Nicolle, who has been coming to Sonora since 1981 under the auspices of World Health Volunteers, a Long Beach-based group.

One weekend each month, except during the rainy summer, he and a few other doctors and nurses fly from Southern California in a convoy of their own private aircraft to Alamos or Navojoa, where they operate on patients whose needs outstrip the surgical expertise of local doctors and health workers.

The most common maladies the American doctors encounter are cataracts, burns, disfiguring injuries requiring extensive reconstruction and a variety of birth defects such as cleft lips and palates.

Frustrating Times

Nicolle has made about 35 trips since he joined the group. On more than one occasion, he said, the frustrations of operating in developing countries, where hospitals are not run with the profit-making efficiency of those in the United States, and the group’s own loose organization have caused him to swear never to return.

“But then you look at the pictures of the kids with deformities and birth defects, and they will never be accepted by their peers. . . . It’s just a drive that keeps me coming,” he said.

Nicolle and the other doctors who make the trips could just as easily operate at home and earn several thousand dollars each weekend they are away, rather than spending the $400 or $500 out of their own pockets for each trip. The trips cost the doctors precious family time as well.

“My children often wonder why I have to go away, and that would probably be the only thing that would slow me down in the future,” said Nicolle, who usually puts in 60 to 70 hours a week at his Orange County and Long Beach practice.

The trips are not all work, however. Typically, the doctors fly on a Friday from Southern California to the port city of Guaymas, where they stay in a romantic, rambling, 50-year-old fishermen’s hotel on picturesque Bacochibampo Bay. Early Saturday morning, they fly about 40 minutes to Alamos or Navojoa and spend the day operating and screening patients for their next visit. At the end of the day, the doctors might return to Guaymas or fly on to Loreto in Baja California as some did this month, to soak up some sun before returning home Sunday afternoon.

Drawn In by Founder

Nicolle was drawn to World Health Volunteers by the group’s founder and president, Long Beach general practitioner Dr. Gerald W. Miller, who still heads up the monthly trips.

“It comes down to this--if you don’t do it, it doesn’t get done,” Miller said, sitting in the cabin of his Cessna 402 while his son, Curt, piloted the plane home on the group’s most recent trip. “When he (an American doctor) does a cleft palate, if he didn’t do it, that kid would go through life with a handkerchief tied around his face as a social outcast. Back home, it would be done before he even knew he had it.”

A native Nebraskan whose string ties stop a few inches short of his formidable belly and whose booming voice is capable of momentarily drowning out the drone of his plane’s twin propellers, Miller branched off from another group, Liga International, to form World Health Volunteers in 1980. A 20-year veteran of the Mexican medical missions, Miller remembers operating under primitive conditions with no electricity or running water and with one person assigned to shoo flies off the patient’s open wounds.

Conditions have improved tremendously since those days, Miller said. Still, some rural villagers walk two or three days to see the American doctors, whose visits are announced over a short-wave radio by a local Mexican doctor who serves as the group’s liaison.

On busy weekends, more than 100 patients may be lined up waiting to be screened by one of the American doctors, although on their most recent trip, only about two dozen showed up. Most had eye problems, and, because no ophthalmologist had volunteered to join the group this particular weekend, they were sent home and told to return next month.

At home, said Nicolle, a Boston native who learned medicine at UC Irvine, “I like to keep my patients relaxed and comfortable”--hence, the limousine. “Every patient I operate on, I call them at home that night. Down here you have to change your ideas and your philosophy.

‘Do What You Can’

Following up on surgery patients is difficult because there are no nurses or office assistants to maintain contact with them, as there are in the United States, Nicolle said. Physical therapy, crucial to patients’ recovery in many reconstructive surgeries, is something they must do at home--if the doctors are able to make clear what should be done and why. Most of them speak little or no Spanish, and an interpreter is not always available.

“A lot of doctors come down here once and get frustrated and never come back,” Nicolle said. “But you just come down here and do what you can. . . . You’re doing it to help that one individual patient because nobody else cares.”

The patients he treats in Mexico, Nicolle said, are more appreciative of his services than his patients in the U.S., 95% of whom undergo some kind of cosmetic surgery.

“You can see it in the face of a mother of a child,” Nicolle said. “They’re so grateful. In the States, the first question they ask you is ‘Did you do it right?’ ”

During the February trip, besides attending to Ramirez’s arm, Nicolle and Thornton operated on Casme Jasfiel Avendano Soto, a 1-year-old boy who had stuck his hand in boiling hot soup several months earlier. The hand would not develop properly unless the tendons were stretched and skin was grafted on to the fingers--procedures that should have been done shortly after the injury, explained Thornton, a University of Michigan professor who is interested in sending some of the medical school’s residents on the World Health Volunteers trips.

Quick and Flawless

The boy’s mother, Maria de Jesus Soto, looked worried as her child shook off the effects of the anesthesia and began to cry in the hospital’s small recovery room. “Did everything go OK?” a tired Soto asked in Spanish.

Yes, she was reassured, the operation was quick and flawless. They could board the bus soon and return to their home in Navojoa, which they had left early that morning.

The doctors had also planned to operate on a child whose malformed tongue needed “snipping” so that it would reach the top of his mouth, enabling him to learn to speak normally. But the afternoon power outage delayed his operation by at least a month.

When he first began coming to Mexico, Nicolle expected the “red-carpet treatment,” he said. “You know, I was a cocky guy right out of plastic surgery . . . coming down here with all my tools and instruments, I was going to change the system. Wrong.”

The Mexican doctors and nurses seemed indifferent to their American colleagues’ visits, he said, adding that language barriers and cultural differences could account for some of the problems. A delicate reconstruction only they could do would be bumped from the operating room schedule--on the one day of the month the Americans were in town--for an “emergency” tubal ligation the local doctors wanted to perform. There were inexplicable delays in sterilizing instruments and prepping patients, Nicolle added, and on the most recent visit, the hospital staff inadvertently fed lunch to an old man who was to be operated on that day, forcing the doctors to wait another month to clean up his amputated leg.

No Patients Lost

With all the problems and uncertainties of operating under less-than-perfect conditions in a strange environment, the group’s doctors have never lost a patient during surgery, Miller said. Once, though, an American doctor died of a heart attack in the village of Tesopaco, about 100 miles east of Guaymas. Mexican law required his burial within 24 hours, and Miller knew he would have trouble getting the corpse back into the United States. “A local Mexican official told us to just put him on the plane and don’t tell anyone,” Miller said. “When we got back home, we told them (the American authorities) he died on the way.”

One medical volunteer group that preceded his was kicked out of the country when a newspaper published photos of the group’s doctors amputating a leg on a tree stump, Miller said. He therefore tries to avoid openly criticizing the Mexican health authorities--even when $100,000 worth of medical equipment that World Health Volunteers was shipping to its hospital in Alamos was suddenly declared government property, as occurred a few years ago, he said. Some of the equipment, donated by several hospitals and doctors, is in a warehouse in Hermosillo, the state capital, and Miller is still trying to get it back. He is not optimistic.

Still, Miller, now 60 and with four grown children, has no plans to stop his monthly flights; he is trying to expand the program by getting more doctors involved and hopes that support from local authorities will be more forthcoming after meetings with health officials in Hermosillo next month.

He sees his work as the ultimate gift: “You’re giving to somebody who can never pay you back.”