Solving a Maze at the Border

Not until their second car wreck of the afternoon did Jimmy and Erik Wilder’s road-trip troubles in Mexico curdle into outright calamity.

The earlier police shakedowns in Tijuana, the night lost on Baja California country roads, even the flat tire that capsized the Americans’ rented Chevrolet--all seemed minor when the Mexican ambulance carrying them to safety also crashed.

Suddenly father and son found themselves facing a pile of sorry circumstances: Jimmy, 51, bleeding profusely from a head wound after the ambulance collided with a pickup; the damaged rental car abandoned who knows where; foreign surroundings; no Spanish; uncertain insurance; a new ambulance driver asking for cash they didn’t have.

“By then,” recalled Erik, 25, who was unhurt, “I’m just trying to get back to the border.”

To their surprise, a little more than two hours later Jimmy was getting top-notch care at the UC San Diego Medical Center. And a few days later, despite two broken vertebrae, the retired groundskeeper had rebounded enough to fly home to Florida with his son.

What smoothed the Wilders’ way out of Mexico was a flurry of telephone calls they knew nothing about. Making those calls was Celia Diaz, a diminutive San Diego grandmother who for more than two decades has gotten Americans out of bad jams across the border.

She set up the ambulance transfer, arranged the border crossing and briefed the U.S. emergency room doctor--a ritual Diaz has performed countless times for people who had nowhere else to turn. Even officials--in both countries--have depended on her volunteer services.

Diaz is a controversial fixer on a border traversed by millions and rife with pitfalls: language barriers, contrasting legal and health systems, and maddening bureaucracies.

Based in a drab office building in Chula Vista, her volunteer group--the Binational Emergency Medical Care Committee--says it has helped transfer 12,000 U.S. residents injured in Mexico over 24 years. It runs, mostly behind the scenes, on a paltry budget.

Diaz fields calls to the committee’s hotline, a number familiar to many veteran tourists, Mexican ambulance workers and doctors. In the Wilder case, the Ensenada ambulance company phoned.

Often, the callers are panicked relatives. They want to get their loved ones back to the United States, where trauma facilities are better.

A binder, crammed with Diaz’s scribbled notes, is a logbook of woe: car wrecks and comas, boating mishaps and broken bones, hemorrhages, four-story falls and miscarriages.

“When people don’t know what to do or who to call on the border, they call us,” she said. And they do so, by day or in the wee hours, as many as 500 times a year. A large majority of the calls come from Baja California, with nearly a fourth from tourist resorts far south of the border.

Diaz, raised in Mexico and now a U.S. citizen, is an expert at unknotting the border’s red tape. Now in her 50s, she seems to know someone--or someone who knows someone--at every police station, city hall, jailhouse, military base, airport, seaport, rescue squad, emergency room and clinic from San Diego to Cabo San Lucas.

Both Admired and Criticized

She has been the go-between during U.S. Coast Guard rescues in Baja, has extracted U.S. citizens from jail and, after the 1994 shooting of Mexican presidential candidate Luis Donaldo Colosio, was asked by Mexico to help arrange his transfer by helicopter to San Diego for medical care. (Colosio died in Tijuana before the trip took place.)

Her admirers, including many in U.S. law enforcement and at the border, say Diaz’s organization has saved dozens of lives. At the moment, said Lori Senini, border health coordinator for San Diego County, “it’s the only system that works along the border. When I crash and burn in Mexico, that’s who I’m going to call.”

But after so many years, Diaz also has generated hard feelings. Detractors mutter privately that she is self-promoting and turf conscious, perhaps even to the point of delaying an official solution to the problem of transferring American patients back to this country.

Some also question the propriety of running the tax-exempt binational group from the same office as her own business, which maintains a network of doctors in Mexico for U.S. insurers.

Ask around long enough and what emerges is a nuanced portrait: a tireless and charismatic provider of mercy whose single-mindedness has irritated many in the region’s medical community.

Diaz said she has ruffled feathers because she is relentless and beholden to no one when it comes to getting patients into the United States. Though soft-spoken and affectionate, even with new acquaintances, Diaz can badger as well as charm.

She dresses with verve--favoring eye-catching suits and spike heels that boost her above 5 feet--and is likewise no shrinking violet in her work.

“I’m a controversial person around the border because I don’t take [grief] from anybody,” she said. “Not from the politicians or the ambulance companies or the hospitals.”

Everyone agrees that she has filled a void between two systems that don’t mesh. Unlike other border health concerns, such as AIDS and tuberculosis, emergency services have received scant official notice.

Many injured U.S. residents insist on being transferred north rather than be treated in Mexican hospitals. But ambulances seldom cross the border anymore because of concerns in Mexico over illegal importation of medical equipment and in the United States over smuggling.

In July, for instance, a Mexican ambulance entering San Diego with a critically ill U.S. citizen also turned out to be carrying 1,000 pounds of marijuana.

Many patients are transferred to U.S. ambulances at the border by prior arrangement. Other times, patients are simply delivered to the border, where U.S. inspectors must dial 911 to summon help. The patient can suffer during the handoff, and doctors get few clues to the emergency they are about to receive.

U.S. immigration officials say three to 10 patients a day are brought to the San Ysidro port of entry, the nation’s busiest. In Imperial County, 199 patients last year were brought to the border at Calexico, including planned transfers and 911 cases.

The U.S. Consulate in Tijuana keeps a staff member on duty around the clock to help sick and injured Americans, but the office often is not called. When it has been, consular officers frequently have sought Diaz’s help in arranging ambulance transfers. Local agencies, lacking international authority, have stayed clear of border medical emergencies.

Diaz’s committee was launched in 1976 by Bay General Community Hospital in Chula Vista. Then an administrative aide, she was asked to help out because she is bilingual. The program grew.

Diaz, whose husband died of a heart attack in 1982, took the program on its own six years later, after the hospital was sold.

Armed with a double-wide Rolodex and a phone directory worn nearly to tissue, she simultaneously plays emergency dispatcher and impromptu diplomat. She relays word to San Diego trauma centers and U.S. ambulances, warns border inspectors to be ready for patient handoffs and stays in touch with Mexican rescuers. It’s a flimsy but vital link.

“We don’t have any other means of communication” with the U.S. side, said Jose Luis Rodriguez, who heads a Tijuana rescue team.

Formal Procedures May Be Instituted

That could change, though, with new efforts by Baja California and San Diego County officials to draw up formal procedures for handling injured U.S. residents, which eventually could make much of what Diaz does unnecessary. County officials contend that ambulance oversight is the responsibility of government.

“Necessity breeds innovation--and she’s been innovative,” said George R. Flores, San Diego County’s public health director. “But it’s time for us to move on.”

Planners are considering creation of “turnover sheets,” in English and Spanish, so ambulance drivers can check off injuries and other data to avoid language mix-ups. Another proposal would require that U.S. patients be stabilized at Mexican hospitals before being moved.

Cross-border transfers would be arranged directly between hospitals. The county is seeking $300,000 in federal funds to write the procedures and track border emergencies--a problem never measured.

Diaz and supporters see politics behind the governments’ recent interest in border emergencies. Last year, the family of a San Diego motorist who was hurt in a Baja crash protested that his transfer to a U.S. hospital had been needlessly delayed by Mexican authorities.

Donald Kraft, 44, was moved after his family posted a $2,500 bond. But by then he had spent 18 hours in an Ensenada clinic. He died two weeks later in San Diego.

Kraft’s truck had happened to collide with a car driven by a top Baja state official. Many in San Diego viewed the delay as inhumane. Mexican officials said they followed their country’s laws in requiring a bond because Kraft was deemed to have been at fault. Public awareness campaigns were launched.

Diaz, who had worked to get Kraft transferred, found herself in the middle of the storm, alienating Mexican officials. Baja state officials have told their U.S. counterparts that they do not want Diaz involved in the effort to write new transfer rules because it is a matter for governments to work out.

The Kraft case and a subsequent crash in Baja involving three Orange County men added to concerns in the Southwest that border emergencies have been ignored for too long.

“This is an issue that we think is critical,” said Dan Reyna, who directs New Mexico’s border health office. “It’s an issue for the entire border.”

Diaz said she fears that the new push will spawn funding for government agencies while leaving her group to do the scut work with few resources. And supporters question whether the county is serious about taking on a burden that Diaz continues to carry.

Diaz, who raised less than $34,000 last year, mostly from small donations by individuals, has a hefty wish list: a new binational radio dispatch system, more aid for Mexican rescuers who drive hand-me-down ambulances, and separate quarters for her business and the committee.

Payment on Old Debt to Americans

She said she is uneasy with the shared office arrangement but defended it as the only way to keep the committee afloat. Diaz said the business, United International Health Net, covers about half of the binational group’s budget. On a recent day, nearly all of the two dozen or so incoming calls were for the emergency committee.

Diaz doesn’t bother finding out how cases turn out; it’s too wrenching, she says. Seldom do those whom she has helped ever meet her.

So why does Diaz bother?

She says helping Americans is, in part, payment on an old debt: It was Americans who came to her family’s rescue after her father died in a huge theater fire in Tijuana in the 1950s.

But her efforts also extend to Mexicans: getting visas to visit loved ones in U.S. hospitals, collecting truckloads of clothes and blankets for Tijuana’s poor, donating ambulances to Mexican emergency crews and giving them training.

A longtime border survivor, Diaz doesn’t expect to go away. Her future role? That’s unclear.

The crossroads facing her was apparent at a meeting of Rosarito’s Red Cross team. She cheered the volunteers’ work and shared news.

But when she turned to the role of her binational group in easing ambulance transfers, someone interrupted to point out that San Diego and Baja officials were working out their own procedures. Diaz nodded and said good for them; she’s heard it before.

“I have minutes from [meetings held] twentysomething years ago, and they’re talking about the same thing,” Diaz said later. “In the meantime, there’s nobody doing it. And we are.”

Contact Information

The Binational Emergency Medical Care Committee hotline is (619) 425-5080. Other numbers for Americans to know while traveling in the state of Baja California:

* U.S. Consulate in Tijuana: 011 52 (66) 81-74-00 (from United States); 681-74-00 (from Tijuana); (619) 692-2154 (for emergencies after hours).

* Baja California tourist assistance: 078, during business hours every day throughout the state.

* Red Cross in Baja: 066, except in San Felipe (77-15-44).