Trinidad Monson Payan arose before dawn and hitched a ride to the small white adobe clinic where he knew the gringos from California would be. A wide straw hat shading his wizened face, the 77-year-old man patiently awaited his turn.
By the time the hot sun had climbed high in the sky, a couple of hundred people crowded with Monson Payan outside the clinic, located off a dirt path in this distant Mexican village. Drawn by announcements on the radio and word of mouth, the townspeople lined up under a tree, sat on benches, leaned against pickup trucks. Babies cried, gray-haired women napped, vendors with carts sold fruit and horchata , a kind of drink.
Inside the clinic, the gringos--a group of American doctors, nurses and volunteers--worked with relentless assembly-line speed: quick, efficient, hectic. Patient after patient filed in. A dentist extracted teeth in between emergency surgeries; three nurses diagnosed aches, gave shots and counseled on diabetes care; a nurse-practitioner gave dozens of women what would be their first-ever gynecological exams.
And in one of the clinic's five makeshift examination rooms, Dr. Jule Lamm, a Santa Monica optometrist, worked steadily.
As a ceiling fan whirled overhead, Lamm used a tattered eye chart, donated plastic test glasses and a hand-held retinascope to detect everything from cataracts and retina diabetes to simple farsightedness. It is a rudimentary system, Lamm admitted, but it does some good.
"We do the best we can with what we have," Lamm said, wiping sweat from his brow as he sat on a cracked metal folding chair. "I wouldn't work like this in the United States for anything, . . . (but) I feel lucky here to be able to do something that someone really needs.
"There are few things in life that if you don't do it, it doesn't get done," he said. "This is one of them."
Lamm, 65, and the others are part of a cadre of doctors and nurses from California who for years have taken time out of their often lucrative private practices to go to Mexico, where they offer free or inexpensive medical care to impoverished Mexican peasants and townsfolk.
Under the auspices of a handful of organizations, the medics fly down in small private airplanes, hauling their own equipment and boxes of medicines, vitamins, blankets and other supplies. Several of the doctors, such as Lamm, pilot their own planes.
They say the work gives them a rewarding sense of independence and gratification that they don't always get in their regular practices. Here, patients dress in their Sunday best, wait hours without complaint, and give hugs of thanks to the nurse or doctor who attends them. Here, free of bureaucracy and hospital hierarchy, nurses can diagnose; pharmacists can prescribe.
The care offered is simple, back-to-the-basics, grass-roots medicine. Immediate, quick. You see a problem, you fix it. No insurance forms, no liability, no threats of malpractice lawsuits. And it's tax-deductible.
So for one long Saturday each month, eight or nine months a year, Lamm and the others staff the Red Cross clinic in Ahome, an agricultural town of about 20,000 people roughly 850 miles south of Los Angeles.
On a recent Saturday, the day that Monson Payan visited the clinic, the American group saw about 300 people in 11 hours.
When Lamm saw Monson Payan, he shook his head. The old man was one of 23 cataract cases Lamm diagnosed that day. Most were rescheduled for operations that will be performed later this year, when the weather is cooler, by an ophthalmologist who, like Lamm, will fly down.
"I want them to operate on my eyes so I can see better," Monson Payan said in Spanish.
As the day wore on, the volunteers took blood pressure readings, inspected skin rashes, dispensed medicine for stomach ailments, and remedied vitamin deficiencies. Dozens of people with arthritis, diabetes and infections passed through.
Nurse Teresa Plomgren, a Pasadena native who works at the San Bernardino Community Hospital, compared the day's pace to that of an inner-city emergency room. Yet the solutions are sometimes as simple as over-the-counter pain relievers, eye drops or an antibiotic.
"Something that is so easy in the States is like a miracle here," she said.
"It's like the Peace Corps," said Chuck Olver, a pharmacist who doled out medicines from metal shelves set up in a side room.
Lunch on Gurney
The Americans, who work with interpreters since few speak Spanish, paused only for a lunch of refried beans, tortillas and spaghetti, served up on a gurney that also doubled as the operating table.
Behind one door with a hand-lettered sign saying Quirofano (surgery), Dr. Eric Munson, a dentist, spent most of his day pulling teeth. No suction is available, and fillings are not performed because they are too complicated. Munson said he can relieve a lot of pain by the relatively simple procedure of extracting rotten teeth.
But there are emergencies. A 15-year-old boy working in the nearby fields receives a deep cut on the arm from a machete. Munson is called upon to sew it up, an operation that requires 16 stitches.
Later, 6-year-old Abel Camacho, cut in the head from a falling piece of door frame, is brought in, sobbing. His wound requires six stitches. The local public hospital has refused Abel because it doesn't have anesthesia, the boy's father says.
Munson, 41, who has private practices in Redlands and Palm Springs, admitted he was a bit surprised to find himself sewing up machete cuts, and drew on training he had received during a two-year stint at a cancer hospital in Houston. But he basked in the appreciation his Mexican patients showed, a contrast to what he described as an annoying need to "cater to" wealthy patients back home.
"It's good for your soul on occasion to do this kind of thing," he said. "I guess I saw more (patients) in one day than in maybe a month of practice. . . . You just do what comes in. Fortunately, it was the sort of thing I could handle."
Lamm, like the other physicians, had set out for Ahome the day before. He loaded his single-engine Cessna-182 with boxes of Medipren samples and cans of a nutritional supplement, and took off Friday morning from Santa Monica Airport.
The six-hour journey would be made in two shifts. On Friday he flew to Guaymas, a Gulf of California resort, where he spent the night. The next day he flew into a private airstrip at Los Mochis, before driving on to Ahome, in Sinaloa state.
Lamm, an Air Force pilot in the Pacific during World War II, said he usually works in affiliation with LIGA, an organization several decades old composed of about 400 members--health care workers, pilots and others that also builds clinics and airlifts supplies into earthquake-damaged areas.
Others at the Ahome clinic are members of Christian Wings, a newer, nondenominational organization of about 100 members. Christian Wings also recruits Southland hospitals to offer free treatment to a small number of Mexican patients with problems that require sophisticated hospital treatment. The patients are flown in.
The volunteer missions to Ahome and other Mexican towns are not for everyone, Lamm said. He recalls doctors who have been stymied by the confusion and apparent lack of organization, or who have balked at riding in the back of trucks, or who are turned off by the Spartan facilities.
'It Was a Shock'
"The first time for me, it was a shock," said Lamm, who has been making the trips for 12 years. "We have a lot of (medical) people come down, they're so upset they never come back."
Dr. Brian Kinney, a plastic surgeon who lives in Westwood and practices in Century City, is one who plans to return, despite the difficulties. In seven trips to the Ahome clinic over the last year and a half, he figures he has seen about 200 patients and performed, free, surgery that would be worth $100,000 in his own office. Among his cases have been patients with cleft palates, deformed fingers, skin cancers and ptosis, or drooping eyelid syndrome.
Kinney, 35, is part of a team of doctors from the UCLA Medical Center who recently joined the monthly pilgrimage to Mexico. He remembers performing surgery last summer on a 7-month-old boy with a harelip. In the operating room, as the temperature reached 110 degrees, Kinney noticed a hole in the wall where the air conditioner should have been.
"I was dripping sweat, and flies were coming in through the window, and one of the nurses was waving a paper fan over the wound so flies wouldn't land," Kinney said.
"It's incredibly difficult to concentrate in 100-degree heat and totally gowned and gloved for surgery. . . . I thought to myself, why am I doing do this? But I looked at the kid and thought, well, it's worth it."
It was a far cry from the state-of-the-art nose jobs that are often the staple of Westside plastic surgeons.
Kinney said he never detected resentment from the Mexican officials or doctors. "We even made the front page of the (local) Sunday paper," he said.
But that is not always the case, and learning to sidestep local, complicated politics has been one of the more delicate parts of the project.
A customs agent once accused the doctors of using their Mexican patients as guinea pigs, Lamm said. Several doctors complained of problems in bringing their supplies into the country, of having supplies confiscated by the authorities, or of having to pay the legendary mordida (bribe) to police.
And over the years there have been charges that the doctors perform what is known as itinerant surgery--on-the-spot operations with little or no follow-up. Some of the American doctors have even been prohibited from performing surgery.
A Way to Cope
Sylvia Wood, one of the coordinators of a group called Aeromedicos that frequently visits a Yaqui Indian village in Sonora state, said her group has started working with a local Mexican civic association called Club Jueves (The Thursday Club) to avoid contact with the Mexican government.
Wood said the local director of the Mexican public welfare institute admonished her group that American doctors coming to Mexico was like Japanese doctors going to the United States. "He asked us, how would we like that, Japanese telling us we were not caring for our people?" Wood said.
"He pointed out that they have a social service system, and that we could not insult them by saying that it is not doing its job."
But amid such problems, there are success stories.
Members of the medical team at the Ahome clinic recalled that in their visit a month earlier, a pregnant woman, Nidia Zavala de Montes, waddled into the clinic for a checkup. Suddenly, she went into labor, and the first baby to be born at the clinic soon came into the world. The case especially touched the group because another daughter born to Zavala de Montes last year had died of a heart defect.
There also are patients for whom the team can do little, however, such as Rita Castro de Verdugo, a 60-year-old widow suffering from diabetes. The doctors can't afford to offer insulin, so they can only counsel Castro de Verdugo on her diet and give her a pill to lower her blood glucose level.
"I have no insurance, no money. I have nothing," Castro de Verdugo said in explaining why she and her daughter left their home at 4:30 that morning and made a four-hour journey to the clinic. "If I didn't come here, I wouldn't have treatment."
Lucila Trueva Flores brought her five children and her husband, a carpenter, to the clinic. She said her husband needed to see the visiting chiropractor to help his back, which he injured in a fall. To see a private local doctor, Trueva Flores said, would cost 10 times the small fee that the American group charges, plus medicine. At the Ahome clinic, patients are asked to pay 3,000 pesos, about $1.30, and medicine is free.
'A Last Recourse'
Jesus Espinoza Zavala, 62, who works in a travel agency, proudly told of his son who lives in Hollywood. Espinoza Zavala came to the clinic for knee pain that he believed had been repeatedly misdiagnosed. "I came here as a last recourse," he said. "It is in one's interest to wait here the whole day. You come with the hope, a little chance, of getting cured."
After their long day, most of the Californians who worked at the Ahome clinic celebrated over pitchers of margaritas and plates of seafood. And they planned their next trip.
Despite the crude conditions, they said, their program has come a long way. Not too long ago, before the clinic was built, they worked on the dirt floors of a century-old hacienda, with chickens scratching about as the staff saw patients.
In the midst of those surroundings, participants recalled, doctors were performing an operation in which they removed a man's cancerous ear. The ear fell to the ground, and a dog ran off with it.
"Yeah," nurse and pilot John Krueger said. "I had to catch the dog."
The medics know their limitations. There are many cases they do not attempt to treat, diseases they cannot diagnose. A cancer they cannot extricate, a case of Parkinson's disease that must be left to run its degenerative course.
During previous trips to the Ahome clinic, Charlene Canter, a registered nurse who is studying to specialize in obstetrics, had noticed the need for gynecological services. So, she brought a microscope this time and analyzed results from more than 40 pelvic exams that she conducted.
Canter said she believed long-term training of local volunteers would in the end serve the Ahome townspeople better than the one-shot medicine that the California groups offer. But for now, short-term care is better than nothing at all.
"If by coming and treating one person, you can change their life," Canter said, "then the whole trip is worthwhile."