Doctors on the fly

Pat Collins, a Placerville pilot with 41 years experience and the flags from 26 countries plastered on the outside of her modest four-seater prop plane, lifted her two passengers and a bunch of medical supplies up over Sacramento. She pointed her tiny plane south, and it slid along the surface of the air as smoothly as if it were gliding along an oil slick. When the plane dipped and dropped slightly, it was only because Collins was wiggling to get comfortable in the pilot’s seat. With her logbook strapped to her thigh, she then folded and unfolded maps, sometimes taking her eye off the sky and her hands off the controls, absolutely comfortable in the air.

“It’s just like a regular plane,” she’d told her passengers, “except your seat cushion cannot be used as a flotation device.”

Filling the copilot’s seat as if he were squeezed into the front of a Mazda Miata was Eugene Olson, a mild-mannered, retired dentist from Sacramento who was new to small aircraft. On his request, Collins turned the plane nearly sideways so he could point his camera down into the valley. Connected to the dentist by headset, Collins explained the altitude gauge, the global-positioning system that ticked off the kilometers to their next landing, and the compass she’d attached high up on the windshield. She had to lift the eye shade to view it. On the dashboard was a homemade sign: “In case of engine fire, close cabin heat.”

Collins, a retired flight instructor, indulged Olson’s countless questions and then went ahead and turned the controls over to him. The plane’s nose dipped awkwardly and, after a second’s harrowing descent, was righted again. Collins turned to the passenger in the back seat. “He’s working the controls a little,” she said of the dentist. “I’m watching.”

Collins and her newly minted copilot were heading for a place where not all of the usual rules applied. Three other planes accompanied them over the barren Mexico-California border and 200 miles farther to a little clinic at Los Pinos ranch, close to the town of San Quintin on the Pacific side of the Baja peninsula. Each plane carried a pilot and a combination of doctors, nurses and other volunteers. If a plane crashed, went the unspoken wisdom of the day, you wouldn’t want to lose everybody of one discipline.

The Flying Samaritans, volunteers that provide free health care in Mexico, are nothing if not practical. The clinic on the Los Pinos ranch was donated to the Samaritans in 1977. It’s staffed by the Samaritans’ Mother Lode chapter, volunteers from in and around Sacramento, and it didn’t even have running water until volunteers installed their own water tower this year. Practicality and ingenuity go with the adopted territory.

The chapter is one of 11 that fly their invaluable staffs to monthly clinics up and down Baja. There are chapters in California, Arizona and even across the border in Mexico, and each chapter manages its own clinic.

Mauricio Leiva, a Sacramento resident and current president of the Mother Lode chapter, said that he prizes safety above all else but that in May 1999, his chapter suffered the unthinkable. One of the planes went down over the Pacific, killing three passengers. Leiva, who still mourns, especially for Christine Nichols, his good friend and longtime medical-assistant volunteer, said the Samaritans would never know why the little plane turned its nose to the water and dove. Investigators have speculated that the pilot lost consciousness or suffered a heart attack.

Making it south can be hot, scary and long for the flyers, but clinic work is the bigger challenge. Various volunteers work the clinic the second weekend of every month. Volunteers pay their own expenses, including hotel rooms and $125 a piece for airplane fuel. They work without pay, whether they are translators, nurses, doctors, dentists or pilots.

After six hours of traveling on that Friday trip, their first job would be to reopen, clean and stock the clinic in preparation for treating at least 100 patients on Saturday.

To stock the clinic, the Sams, as they are nicknamed, raise funds and accept donations. They make do with limited medications, coordinate with Mexican and American hospitals for surgeries and, as a group, know little Spanish. It’s no wonder volunteers indulge in good food and potent margaritas while they are in Mexico.

When asked what the clinic weekends were like, Leiva’s account sounded luxurious: The group would fly down on Friday and have a meal together, get up on Saturday and have a meal together, work at the clinic, share a meal and then get up on Sunday, have a meal together and fly home.

It’s hard to imagine what would happen if San Quintin had no good restaurants.

Collins glided over the Los Pinos ranch’s fields of tomatoes and zucchini and then over the squat clinic buildings, painted a watery blue by California Rotarians. She released the landing gear as if she were simply letting loose a car’s parking brake, and the plane soon bumped along a dirt runway surrounded by more dirt. Smoky fires burned in the nearby foothills.

Collins walked off the airstrip and into a concrete courtyard between the medical and dental clinics. Olson hurried in to check out his dental supplies, while Collins greeted the caretakers in Spanish. “¿Como estas?” she asked the children who gathered around her, wide-eyed, the fronts of their shirts colored by the same soft, brown dirt that seemed to get into everything. A small, sturdy, barefooted woman pointed out the new flowers and cactus garden that her family had planted around the property, and then she pointed to the jacaranda tree nearest to the clinic. It had bloomed, she said in Spanish, since Collins had been there last.

Inside the medical clinic, a nurse was sorting vitamins into tiny Manila envelopes that would be placed in a plastic storage cabinet, the clinic pharmacy. There was a large intake room with flowers stenciled on the walls and noise-making toys for the children; three tiny examining rooms; a room that would hold a fourth, more private ob-gyn office; and a tiny, closet-sized room that acted as a lab, an optometrist’s office, a staff kitchen and a storage room. That’s how it was down there—everything was utilized twice over, at least.

Though the whole operation seemed held together by donated tape and borrowed wire, the volunteers had it ready to open within a couple of hours—which called for a margarita.

Volunteers drifted into the hotel’s comfortable open-air bar, and the doctors flirted with the nurses as stories of past clinics began to emerge.

“Remember the nurse who forgot her medicine?”

The nurse had been allergic to whatever substitution was at hand and had ended up with a tongue so swollen she couldn’t close her mouth, which the table of medical volunteers found hysterically funny.

But mishaps like that have helped flesh out the clinic’s makeshift pharmacy. Now, the Samaritans said, the clinic keeps epinephrine on hand, which counteracts allergic reactions.

The story got them talking about why they each had chosen to travel so far to work in such compromised conditions.

“I don’t do it for the thank yous,” one doctor said. “I do it because it changes people’s lives.” He went on to give an example. He’d seen an unfortunate man once who had an enormous cyst on his butt. Enormous. “Think how long that took to grow,” he told everyone. The doctor had made one swift elliptical incision, and the guy had been able to sit down for the first time in months. That, said the doctor, was why he donated his time and money to come there.

The doctor’s name was Bob Haining, and he was considered an enormous asset. A pediatrician for the Children’s Hospital Oakland, he worked with only the most damaged children. He spoke a speedy, seemingly flawless Spanish; attacked his work with caffeinated excess; and could handle things others couldn’t, such as procuring full-body braces for polio victims and fitting prosthetic legs. He also could order vegetarian food in Spanish, so off he went with the rest of them to a restaurant surrounded by landscaped grounds and peacocks. In a picture taken that evening, Haining held a nurse on his lap as she posed, tearing apart a crab leg with her teeth.

If any one characteristic tied together the random group of volunteers, it was an enthusiasm for adventure and risk. They ran marathons, flew their own planes and traveled to Mexico in their retirement to help others. One nurse put it all in perspective when she exclaimed that she would love to go to Afghanistan as a medical volunteer.

“Personal safety,” she said, “has never been an issue for me.”

The same could be said of the group’s founder. Accounts vary, and many of the original participants have died, but the myth has only grown: As the story goes, in mid-November 1961, a well-known female pilot from Southern California, Aileen Saunders Mellott, had just won the Powder Puff Derby for the second year in a row. She was flying passengers north from the southern tip of Baja when a dust storm obliterated all radio contact with San Diego. Mellott decided to put her plane down in Ensenada, south of Tijuana, but as she approached the landing strip, the dust caught up with her and wiped out her view of the airport and the surrounding mountain peaks.

One published account based on an interview with Mellott, who died in 2001, describes how she circled above the dust and peaks with what fuel she had left and then had to land on a mesa outside El Rosario.

Villagers nursed the rattled passengers with hot chocolate and explained that two years of drought had decimated the already poor area. Mollett was touched. When she and her passengers made it safely to San Diego, she planned a charitable trip to El Rosario for Christmas and brought clothes, supplies and a doctor with his doctor bag. From that point forward, a band of scrappy medical professionals went south regularly under Mollett’s management.

The Mother Lode clinic at the Los Pinos ranch is just north of El Rosario, where Mollett first touched down.

On the morning of the July clinic, a tough, hardworking nurse from Fair Oaks asked everyone to get to the clinic by 8 a.m., so most people rolled in about 9 a.m. Until then, some perused the busy markets stocked with fresh limes and mangos and homemade tortillas and the bakeries with enormous sweet buns and cookies available for a few dimes.

Collins, ever the pilot, drove a Sams van between rows of salt pines and past makeshift dwellings of pieced-together plywood. Except for two houses painted in brilliant Mediterranean blues and greens, and an enormous modern produce-packing plant of melon-colored stucco, almost everything, including junkyards of rusted pickups, seemed earth-colored.

Near the highway, a dry riverbank was strewn with plastic bags of trash. When the rains came through, said one of the nurses, the river ran all the way to the ocean. The trash along the riverbed just hadn’t made it there yet.

Collins waved as she passed an old man whose job was raising and lowering the chain at the clinic entrance, and passed women making the long walk with babies on their backs. At the clinic, a crowd dressed in bright, colorful layers already had formed.

Olson and his impromptu dental assistant—chapter treasurer Bob Watson, wearing a toothbrush behind his ear—were deep into their work by 9 a.m. Watson, a tall, exuberant certified public accountant from Vallecito, attacked every chore good-naturedly. He pulled out his toothbrush for a man immobilized in one of Olson’s dental chairs and, with no Spanish and only theatrical facial features, demonstrated brushing from top to bottom. Though the man’s gums still were bleeding, he began to brush energetically, too.

Olson, slow and gentle with his patients, sat near the second dentist chair, where an adolescent girl stared at him. In high-school Spanish, he asked whether she could feel anything along her jaw. He passed his gloved finger over the spot. The girl said nothing. It was impossible to know what she understood or whether she’d ever seen a dentist before.

Translators were scarce, as were dental hygienists and handymen, and Olson soon needed all three. He began to wrestle with his drill to install the correct bit. Watson came over to help, and the two of them forced it, babied it, debated whether it was the right one, finally got it in and soon realized it wasn’t the right one.

Then, Olson tried out the drill and realized he had no water. The drill made a sickening whirring sound as the dentist tested it against his fingers.

The girl in the chair began to fidget. Her hands hopped and grabbed at the lower edge of her leopard-print shirt. Her eyes followed the two men, who were growing frantic and speaking an unintelligible language. They’d been making a horrible whirring sound with the drill for half an hour.

A dental clinic had been unheard of until the installation of the water tower, and it promised a lot of relief to people with no other access to dental care. As Olson later explained, abscessed teeth can even be fatal, sending bacteria throughout the body and blood and sometimes leading to a heart attack. Now, dentists arrive with the doctors every other month, mostly to perform fillings and extractions. But they still have to function in a new and disorganized clinic with millions of tiny details to manage. That morning, Olson and Watson found themselves more challenged than the doctors.

The girl in the chair, through hand motions and pleading looks, made someone kick a knot of lurking boys out of the doorway. As a rule, even the youngest girls are exceedingly tough, but this one didn’t want her friends to see her scared, and scared she finally had become.

Across the courtyard, the medical clinic was better stocked. A local translator welcomed a few people at a time into the waiting room. She logged their complaints and sent them over to an American volunteer who took their weight, height and blood pressure. Though her patients didn’t know it, this “triage nurse” had no previous medical experience.

Haining was treating a demure, dark-skinned man in a beat-up straw hat who kept the little bit of leg below his knee covered with a dangling tube sock. Haining grabbed a prosthetic leg, made hundreds of miles away in the Bay Area, and then began to wrench it apart. After taking off a couple of inches in length, Haining watched the man strap on the leg and walk out of doors into the sun. After a few minutes, the two of them returned, and Haining started pulling the thing apart again. It was still too long.

Next to Haining, Mary Cunningham-Lusby, a retired emergency-room surgeon from Gold River, called for a translator. She knew no Spanish and found herself surrounded by a family of children, all of them looking baleful and coughing the same hacking, wet cough.

While Cunningham-Lusby treated coughs, an American volunteer took a bag of plastic pinwheels out into the courtyard to entertain the crowd of children still waiting. Within seconds, they gathered tightly around her, taking everything, even broken pinwheels, with pleasure. Little girls stared hard at the bright-pink plastic sticks missing their tops.

Back in Cunningham-Lusby’s examination room, a new patient explained to a translator (who was really the concierge at the Sams’ hotel) that she had pain in her legs.

Cunningham-Lusby squeezed one of the patient’s feet gently. “Here?” she asked, looking at Alfredo, who repeated the question in Spanish.

“How do I say,” he translated with difficulty, “a very arresting pain.”

“She has arthritis,” said Cunningham-Lusby, as if the examination were perfunctory. All she could do was prescribe pain pills and hot towels.

Cunningham-Lusby, who retired in 1996, was used to emergencies. At the clinic, people came for vitamins or to show off their new babies, she said, but rarely did the doctors see anything very serious. She did remember, however, one man who arrived at the clinic and said he’d been coughing for three weeks. At the end of the day, he finally had been admitted, carrying a foam soda cup full of something frothy and pink. Cunningham-Lusby had watched as the man hacked and coughed and spit more pink foam into the cup. Just like that, she’d known it was congestive heart failure. In the United States, the man would have been airlifted with doctors and medical kits to a good hospital immediately. In Mexico, he’d been put on someone’s private plane. The pilot had been asked to fly low to preserve oxygen, and the man had made it alive to the hospital in Ensenada. Cunningham-Lusby didn’t know if he survived.

“We don’t do a whole lot of good,” said Cunningham-Lusby, “but we do some.”

Like Olson, Watson and others, Cunningham-Lusby volunteers (though she is personally terrified of small planes) because she feels Americans have access to so much; it is only fair to share some of those resources beyond the borders. Like her peers, Cunningham-Lusby also has a ball being part of the lively Sams social scene.

In another clinic room, in a dark, sweltering corner where modesty kept all the windows and curtains tightly shut, an American translator-in-training, relying heavily on a two-way medical dictionary, explained that the nurse’s next patient was 14 and pregnant. “She said she couldn’t go to one of the hospitals,” said the translator, “because she doesn’t have a marriage license.”

In Haining’s room, the man with the prosthetic leg had been replaced by a young woman with an intelligent face and bookish glasses who stood crooked and bent at the hip. “Polio,” said Haining as he buckled her into an ill-fitting brace. With a tape measure, he measured the gap between the woman’s hipbone and the brace. Then, he photographed her with the tape measure in place, preparing a visual record for his colleagues at home. The brace had taken four years to deliver, said Haining, and now he would have to take it back for refitting.

Outside Haining’s examination room, a doctor conferred with the medical coordinator, Bill McDavid, who watched everything with energetic interest.

“Anything I can tell this guy with the enlarged prostate?” the doc asked the coordinator.

“He’s got no social security.”

Without participating in one of Mexico’s social-security agencies, patients can’t get treatment outside of clinics like the Sams clinic. And one has to have a job to get social security. Even those who are covered sometimes come to the Sams clinic.

“They want American doctors,” explained one volunteer.

Some patients travel for hours to get to the clinic, but others work nearby for Martha Rodriguez, a formidable matriarch and the owner of the Los Pinos ranch. Though surrounded by the same dirt and poverty with which all of San Quintin’s residents live, Rodriguez’s estate looks light and fresh and includes a luxurious pool and roomy buildings for her extended family.

Her workers, she said, all have social security, and they all have shelter for the harvest season.

On a tour of the compounds where the workers live, Rodriguez said that people prefer the old, more traditional dwellings to the newer ones. “We’re trying to change their way of living,” said Rodriguez. “They don’t like to be cleaned up.”

The old camp consisted of dirt-floor cubbyholes, side by side under the same roof. The doors were curtains or the limbs of salt pines. The people shared communal washtubs and communal showers, and at the edge of the camp, they hacked apart tree trunks delivered by the Rodriguezes for firewood. There was no grass, just dirt.

“Now, I’ll take you to what we want the people to have,” said Rodriguez.

In the new camp, the cubbies were still tiny, but they were of peach-colored stucco, just like the ranch’s large packing plant, and were private, with their own neat, white doors. Outside, a big, grassy lawn surrounded a gazebo large enough for a dance floor. Baseball diamonds, schoolrooms, a small store and a room for the resident first-aid clinician completed the community.

“They don’t like this,” said Rodriguez. “They have to keep it clean.” Rodriguez’s family had fitted each dwelling with its own gas tank for cooking.

With gas tanks and firewood and the long rows of cubbies, it was amazing to think of the damage one fire could do.

The Sams had heard that those who worked Rodriguez’s fields worked six days a week, 10 hours a day, for a couple of dollars, but if the Sams didn’t appreciate Mexico’s employment practices, they still treated Rodriguez with the utmost respect. Her family had loaned the Sams the clinic buildings and the land.

Leiva had explained that the Sams’ job was to provide medical care, not to push for social change. Though many of the problems the doctors see are rashes caused by the pesticides in the fields, the Sams respond by teaching people how to cover up and absorb fewer toxins into their bodies. They don’t fight for pesticide regulation.

Back at the clinic, Watson wandered over to the makeshift pharmacy and asked the medical coordinator if he had any Q-tips.

“What do you think this is,” replied the jovial coordinator, “a hospital?”

The volunteers let Collins go for fish tacos and then gathered around the fly-infested table to wolf two each before heading back to work.

Alfredo doted on the children and babies, coaxing them to swallow cough medicine. Like Olson flying Collins’ plane, the young man looked awed and delighted by the responsibility.

“You do so many not-important things in a day,” said Alfredo, “and then this.” He gestured around the clinic. “It gives balance,” he added.

In the next room over, Haining was photographing the chest of a small, sour-looking little girl while other doctors watched. On her perfect skin were slightly dark patches that looked like birthmarks. “Cafe au lait spots,” said the medical coordinator. “Remember the elephant man?”

The little girl probably had a condition called neurofibromatosis and would develop tumors. She likely would die at a young age.

Quickly, the medical coordinator moved over to Cunningham-Lusby’s room and kicked the physician out, forcing her to take a break. Cunningham-Lusby agreed to rest but then stood around fidgeting while the coordinator took her next patient.

The medical examiner looked at the feet of the stone-faced woman sitting on the table.

“Am I hurting her?” he asked Alfredo. The woman shook her head. Her babies and her husband sat in low chairs and watched. Alfredo cooed at the baby.

The doctor took a pair of medical scissors and clipped away at the ingrown nail of the woman’s big toe. He asked again, “Am I hurting her?” and again the woman shook her head, though the procedure was done without anesthetic. Someone read her paperwork; the lady with the high threshold for pain was only 15 years old.

In the dental clinic, Olson was speeding through extractions and fillings. He’d taught Watson how to spray water from a different instrument onto the drill to cool it.

And one of the volunteers had joined them as an official hand-holder. She prayed with her eyes closed as Olson twisted with a pair of pliers and yanked out the last of a woman’s bad teeth.

“What did we pull here?” asked Watson.

“Number 14,” said Olson, “and 12, 25 and 26. Twenty-seven is the strong cuspid. We want to leave that here.” He spoke with grandfatherly sweetness.

Olson dropped the bloody tooth into a cup, and the woman, her mouth packed full of cotton, gestured that she would like to take it with her. Watson handed it over, looking slightly bewildered.

At 4:30 p.m., the dental clinic closed down officially, and Watson, still wearing his toothbrush behind his ear, picked up a mop and pail and went over the clinic floors.

In the dark ob-gyn examination room, the nurse still had patients, as if the last people to make it to the clinic that day were the pregnant women.

“Do you smoke?” the nurse asked a young expectant mother.

The woman smiled and shook her head demurely. One of the doctors noted with amazement that even the 14-year-old mothers knew which medications would leach into their breast milk and which ones wouldn’t.

Behind the curtain, the nurse covered the woman’s bare belly in gel and ran a wand over it, producing an ultrasound image of the fetus. She coaxed the father over, and the parents stared at a screen showing the obscure image of a tiny beating heart.

Outside in the courtyard, a registered nurse declared the clinic a success. The physicians had seen at least 100 patients, she estimated. “Maybe 120.”

Pilots hauled bags of trash from the bathroom—no paper of any kind went into the sewage system—and took it out back for burning. One of the nurses covered the examination tables and the other sensitive machinery. She said she stole the covers from her own hospital when they got ratty.

Slowly, the courtyard was transformed. Except for the large, dead flies that lay everywhere and the bits of food left by the patients, everything was the same as it had been 24 hours before, when the planes had first arrived. The same dog snooped in corners, and the same curious children watched the clinic volunteers with shy smiles.

The volunteers headed back to their hotel on the beach, with its clean, red tile floors and its hard but clean beds.

Perhaps it was the ubiquity of good works—even if they relied on faulty drills, broken pinwheels and high-school Spanish—that gave the Sams their unflagging energy and sense of camaraderie.

On Sunday morning, when breakfast was still a while away, Haining was busy collecting live purple sand dollars for his daughter, the artist. A nurse and another doctor paired up to do some bird watching, and Watson sat in the sun reading the paper, quiet and unhurried now that he was relieved of his duties. The tone of everything had slowed down, but the Sams still seemed lit up with energy. Before the team members got back into their tiny planes and flew back over the border, they loudly took over a few tables in a local restaurant and ordered tortilla mash. They passed around names and e-mail addresses, as chipper as if they’d done nothing but lay around at the beach all weekend. And perhaps that’s what some of them should have been doing. Many of the volunteers were past retirement age and could have been off with their friends enjoying themselves on the weekends.

Of course, they might say that’s exactly what they had done.