Misión De Candelilla

Year In Review

Year in Review

December 30th thru January 3rd

This year actually began last year. Sara and I prepped the trip but we did not go by design, as we are working hard to position the mission of “life without us”, in the event that it becomes necessary. The trip went well. It was very cold that week and as result clinic visits were down.

March 10th thru 14th

Spring Break found us in San Vicente, La Union and San Miguel. We saw approximately 150 patients on this trip. We also had an optometrist go with us as well.

April 15th thru 19th

Another trip without Sara and I. Sara had a meeting to attend and I was struggling with severe shoulder pain. The group held clinics in Alamos de Marquez, Paso de San Antonio and Alamos de San Antonio.

June 8th thru 13th

Hill Country Evangelical Free Church sponsored a construction trip to Paso de San Antonio. We screened in a porch on the clinic building there while, a team conducted vacation bible school in the afternoons with the children of Paso de San Antonio and Alamos de San Antonio.

June 24th thru 28th

We held clinics in Boquillas, Las Norias and Jaboncillos. It was very hot. We had lots of musicians on this team and we were treated to a Blue Grass version of Amazing Grace during our first devotion in Boquillas. The last night in Jaboncillos they stayed up Jammin until 11PM despite the fact they needed to get up early next morning.

July 20th thru 25th

Local Missions Week. This is the 4th year in succession that we have facilitated a local project while holding a city wide vacation bible school. We had as many as 57 children attend VBS. This is the second year our project was making improvements at the local Girls and Boys Club

August 1st

Fiesta 2015 was a huge success. We raised nearly $30,000 after expenses. Shilo Harris was our guest speaker. Everyone agreed that it was an enjoyable evening.

September 23rd thru 27th

Our second San Vicente trip was a tremendous success. We saw 170 + patients. One hundred of which we saw in San Miguel. Despite all of the hard work no one on the team complained. All of our clinics ended late, so late in fact that we ate dinner each night after church.

October 14th thru 18th

Our final medical trip of the year went back to Alamos de Marquez, Paso de San Antonio and Alamos de San Antonio. We were a bit short-handed on this trip. There were only nine

of us. Again we had a great crew. We still have three trips to go this year. Two Christmas trips and one Well Child Clinic are all scheduled in December.

Ninety-Nine Plus One by Sara Allerkamp

It was way past dark.  The group was exhausted.  I was exhausted!  The day had been a long one.  Ninety-nine people had come to our clinic that day in San Miguel.  I slumped down on a folding chair.  The church service had started an hour and a half earlier and now Fidencia had her Sunday School class of children singing Open the Eyes of My Heart in Spanish.I looked to the front of me then to the right and noticed Pepe, our friend, speaking to Curtis.  Curtis made eye contact with me and signaled for me to come over.

Our day had begun in La Union that morning.  Curtis was up at 4:30 AM, I was up around 6 AM, and the rest of the group began to wake up on their own between 6 and 7 AM.  We had breakfast, then a devotional.  After the devotional, we washed dishes and packed up all of our gear to make the two hour drive to San Miguel.

We arrived in San Miguel around 10:30 AM.  It was September 26th, the day was sunny, clear, and warming up by the hour. Already a dozen people were there waiting for us and a few minutes later that number had grown to two dozen.  People continued to come throughout the day.

The group went into overdrive as Robert Maycott and Martin Martinez set up the registration table with the patient’s medical records.  We took out box after box o medications and set up the pharmacy.  Cindy Taylor set up the ultrasound machine and EKG in another room. Doctors LeBlanc and Cornett pulled out their otoscopes and tongue blades and we put three chairs in each of their “offices”.  Twelve year old Mary Cornett asked for a table so that she and her ten year old brother Otto could get out their coloring books, balls, and other games that they had brought to minister to the children.

There were all types of medical complaints: muscular aches and pains, joint pains, requests for more medication for high blood pressure, diabetes, and arthritis medications. (Our pharmacy provides enough for six months at a time).  There were gynecological complaints, requests for fetal ultrasounds, gall bladder stones and other types of stomach complaints, and depression, minor surgical procedures, etc.  The group broke for a quick lunch at 2 PM then continued seeing patients until 9 PM that night.  The total number of patient contacts had been ninety-nine. 

At eight PM a church had started at Pepe and Fidencia’s front yard.  Pastors Michael Meek and Robert Maycott had gone on ahead of us.  Michael had been asked to preach and Martin Martinez had agreed to interpret for him.

By the time the rest of the group arrived, the church service was in full swing with a local Christian from a nearby village singing for the congregation in the semi-darkness.  The women and children sat in the metal chairs, most of the boys and men stood, leaning against parked trucks.  It was almost ten PM and Michael Meek was still scheduled to preach.

It was at this time that I saw Curtis signaling me to come over.  As I got there he said, “Pepe says someone has an emergency.”  Pepe looked at me and said in Spanish, “There is a lady, whose sister is sitting in the truck who got bit by an animal.”  Pepe did not know what kind of animal and my imagination saw some torn skin.  I spotted Dr. Mary Martha Leblanc sitting on a big rock at the back of the yard.  I walked up to her and repeated what Pepe had told me.

She got up and we both were led to a woman standing by a small truck.  She was in her fifties, her hair was almost bleached blond and dry.  Dr. Leblanc used her head lamp to take a better look at her.  Her lips and cheeks were swollen.  She was rubbing and scratching her left lower arm, which was red and swollen.  Her sister, who looked sunburned and tired and who had had a few alcoholic beverages did most of the talking.  Her sister had been stung by an avispa, a wasp, she told us.  It was clear to us that she was having an allergic reaction to it.  Thank God she was not having trouble breathing.

Dr. LeBlanc told them, “We have to go to our clinic.  You need some medicine.”  Curtis, Dr. Leblanc, Cindy Taylor, and I jumped into the back of the truck that her sister was driving.  This was a little scary as it was obvious that she had been drinking.  We arrived at our clinic without incident.

Dr. LeBlanc instructed me to draw up 50mg of Benadryl and administer it in the muscle.  Curtis held his flashlight so I could see what I was doing.  We also gave the lady some medication to take by mouth.  The doctor reassured her that she would be fine.  We waved as they drove away, saying, “Que Dios te bendiga,” God bless you.  My heart was touched by these two middle aged sisters living together in poverty.

Curtis looked at Dr. LeBlanc and said, “That was patient number one hundred.

I know that Christ, through us, had demonstrated compassion and care for both of the ladies.  My prayer is that the two sisters have the assurance that they are much loved by God the Father and Jesus Christ the Saviour.  We returned to the worship service, which ended at 11PM.  We all enjoyed a meal of carne con pappas (meat with potatoes), frijoles (beans) and tortillas in Pepe’s home.  We enjoyed conversation around the table with the great satisfaction of knowing that our work had touched lives.  Praise God!  Now we would get a little sleep under the big sky of the Chihuahuan desert before we travelled home.

Would you considered helping us continue this work?  Our fees from participants only cover the basic costs of each trip.  All of our other expenses are covered by private donations.  If you would like to join us on a trip, help with scholarships, or donate to our general fund, please let us know, or just click on the link on this website.San Vicente 2013 450

Testing for Typhoid in Mexico

Cody Wells drawing blood from a patent in Las Norias for typhoid testing.

Cody Wells drawing blood from a patent in Las Norias for typhoid testing.

TESTING FOR TYPHOID

On January 1, 2015 we began testing for typhoid fever in Mexico. This marks a step forward in the care we provide for our patients in the towns we serve there. There is a long story behind this, going back to the beginning of Mision de Candelilla in the 1980’s, but first a little about typhoid. This illness is classified as an indolent fever, along with several other bacterial infections that can take a slow course, persisting for months to years if untreated. Other indolent fevers include brucellosis and infections with proteus bacteria.

Typhoid results from infection with Salmonella typhi, a waterborne bacteria that only affects humans. This illness has long been eradicated from the US. A few cases of typhoid fever still seen here each year, all contracted by travellers to Asia or to Latin America, the remaining areas on the globe where typhoid remains endemic.

Typhoid starts after drinking contaminated water or eating food washed in contaminated water. After ingestion, the bacteria penetrate the intestinal lining, from there making their way through the body’s lymphatic system to the bone marrow, liver and spleen. It is in these organs that they set up the focus of infection. The symptoms are rather nonspecific, mainly fatigue and aching, but an infected person may feel intensely ill. Typhoid has a characteristic rash, but it may occur in only as few as ten per cent of the cases. There is usually fever in the initial stage of the infection, but little after that. It is said to feel like a low-grade case of influenza that goes on and on and on. The nonspecific nature of the illness can make it hard to even think of typhoid in evaluating a patient, even where it remains common.

The acute phase of typhoid may last as long as a month, and from there it goes on to become a chronic infection, mainly symptomatic with headache, joint pains, and fatigue. There is a carrier state as well, with little in the way of chronic symptoms but persistent shedding of the bacteria from the liver through bile. Sometimes the carriers are completely free of symptoms. The asymptomatic carrier state was originally identified in the case of Mary Mallon, a domestic cook in New York over a century ago. As she moved from house to house to cook for wealthy families in New York City and on Long Island, almost every family member developed typhoid. This was before the antibiotic era, so no treatment was available. She was restricted to life-long quarantine, but often escaped and spread typhoid again. She became known as Typhoid Mary.

A few cases were still occurring in Houston in my medical student days in the 1960’s. At that time we used a medical term FUO, which stood for “fever of unknown origin.” This was defined as a febrile illness lasting longer than one month, with no source detected for the fever after repeated medical evaluations over that period of time. In that day, FUO was an appropriate reason for admission to the hospital “for tests.” Diagnostic testing has evolved dramatically in the subsequent years, and I haven’t heard the term FUO in a long time. At any rate, I recall hospital admissions when I was a medical student for FUO, and we routinely tested such patients for typhoid.

The test for typhoid at that was called “febrile agglutinins.” In fact, this was a test for all the indolent fevers and it was designed to detect antibodies against the three bacteria. This test was the best we had in that time, but it was known from the beginning to be inaccurate. It was overly sensitive, often giving a positive test when in fact there were no antibodies against any of the three bacteria, and it was also known to miss a significant number of cases of indolent fevers. Evaluating febrile agglutinin results to make treatment decisions was complicated and uncertain. A positive test might signify persistently elevated antibodies from past exposure or illness that had long since resolved, or even a recent exposure without infection. The same result could also represent a current infection requiring treatment. Due to the inaccuracies of the febrile agglutinin test, doctors in the US abandoned it long ago, instead utilizing cultures for the bacteria, and more recently, tests to detect DNA fragments that are specific to typhoid. As a result, I haven’t heard of febrile agglutinins being used in the US for over thirty years. But the situation is different in Mexico.

There patients maintain their own medical records, including blood test reports and actual copies of X-Rays and scans (although they don’t maintain the doctors’ notes from their evaluations). As a result, since the early days of Mision de Candelilla, I have seen febrile agglutinin results brought by patients who had been tested by doctors in Musquiz. These patients would tell me of their fatigue and aching joints and they would show me the results of the febrile agglutinins. Over the years I have seen a number of reports positive for typhoid in patients from that area, occasionally a positive for proteus, but never a positive for brucella. When I have seen the positive reports for typhoid, I have puzzled over the cases, asking a lot of questions about other symptoms that might point to a different diagnosis. I have asked about their treatment, and I learned many couldn’t afford the prescribed antibiotics and came to us hoping we could give them the course of treatment. Some took a short course of antibiotics, maybe not being able to afford the whole prescription. I still encounter this test among our patients in Mexico to the present day, and am just as challenged now as I was then to provide appropriate care.

Knowing the limitations of febrile agglutinins, I have at times over the years looked for ways we might get more accurate evaluations on these people. One of the problems of simply treating for typhoid without knowing the correct diagnosis with any certainty is that the full course of treatment for typhoid is six weeks of two antibiotics. This is a therapy that can cause problems, including various antibiotic toxicities, an especially dangerous event for patients who must wait months between our visits. When I saw a patient who had symptoms suggestive of typhoid, I would be faced with starting the antibiotics with no diagnostic testing available to us. If the patient brought the results of his febrile agglutinin testing, I would puzzle over the vagaries of that outmoded test. I didn’t like it either way.

At various times over the years I searched for bedside tests for typhoid, something that would allow us to test for this disease on our trips where no sophisticated laboratory facilities exist. This would allow us to be more certain about the cases of suspected typhoid we saw, but nothing was ever available. We looked into drawing blood from the patients in Mexico for testing in the US, but this didn’t work out. Not only would it be difficult or impossible to communicate the test results to the patients in a timely manner, we also learned it would take a permit to bring biological specimens across the border, and we were advised this permit is difficult to get, likely only possible for medical research facilities.

About a year ago Thad Miller, a Mision de Candelilla board member and a tuberculosis researcher at the University of North Texas Health Science Center in Ft. Worth, heard of a bedside test for typhoid. In his work he has regular contact with the Centers for Disease Control in Atlanta, Georgia, and through his contacts there he learned a South African company had developed a rapid test for typhoid. Although we were unable to follow-up on that lead, my interest was piqued, once again.

Then in the summer of 2014 I saw a report of a rapid test for typhoid, something that came in the hundreds of medical news e-mails I receive. With a little research, I was able to contact the company in Sweden that makes the test, called TUBEX TF, with “TF” standing for typhoid fever. I learned that though the test is not licensed in the US or in Mexico, it can be bought for research purposes. I discussed this with Thad, and we quickly formulated a medical research study with our patients in Mexico, testing them with TUBEX TF if they seemed to have typhoid on the basis of their symptoms, and also performing the TUBEX TF test when we had patients bring us their febrile agglutinin test results, for comparison. We could test anyone who had a history of treatment for typhoid, and we could test some people at random who did not appear to have typhoid and had no history of the disease to see if we got positive results among people with no symptoms of or history of having typhoid. The main point was, since we would be doing this for research purposes, we would not use the tests for making the decision whether to treat the patients. At this time, we would be evaluating the test for its usefulness.

The tests came from Sweden in time for our Dec. 30, ’14 to Jan. 3, ’15 mission trip. Thad and I established a simple protocol to inquire at registration if any of our patients had a history of treatment for indolent fever (in Mexico, often simply referred to as fievre, meaning “fever, sometimes as fievre de Malta, and occasionally by the correct name fievre tiphoidea). We would ask such patients for permission to draw blood for the TUBEX TF testing, and we would also draw blood from the next patient with no history of indolent fever as a presumed true negative comparison sample. We were especially interested in testing any of the patients who brought us febrile agglutinin testing results so we could compare those results directly with the TUBEX TF testing. As we began to draw blood from the patients in Las Norias, I wondered if we might eventually identify a Tifoidea Maria in the area, maybe someone unknowingly spreading the disease across the desert of northern Mexico the same way the original Typhoid Mary did in New York.

We went to three towns on this trip, but only one clinic yielded patients meeting our testing criteria. This was Las Norias, where four of twenty-four patients seen reported past indolent fever treatment, and we drew a blood sample for each of these, as well as from four “true negative” patients. One typhoid patient had been treated twenty years ago, two about ten years earlier, and another we had treated about one year ago when he brought us his febrile agglutinin results. I saw him then and recorded his test results in our medical record. He told me he had never gotten over his symptoms of fatigue and aching joints, then he had worsened recently and had been tested in Musquiz again a month prior to our trip. He did not have his test results this time, but he reported the febrile agglutinin test had shown fievre tiphoidea. I decided to treat him again, this time with different antibiotics, with the presumptive diagnosis of chronic typhoid with a prior treatment failure.

TUBEX TF is a serum test, and it can be run soon after the blood has been drawn if the tube is spun in a centrifuge to separate the red cells from the serum. Blood left to stand a few hours in the collection tubes will separate as well, so serum can be easily obtained for testing later, even without a centrifuge. Since we would not be using the tests for our treatment decisions, I decided not to add a centrifuge to all the things we take on our trips already, but to just let the samples separate and do them all at the same time after clinic.

When I finally sat down to run the tests, I found the serum from a control patient was not usable because the red blood cells were broken up at the time of drawing the sample, and the serum was blood-stained (the test relies on detecting certain colors, and the redness of the serum for that patient’s test obscured the result). Of the others, all seven of our tests were negative for typhoid, including the man who got a six week course of antibiotics from us.

The decision to run the tests later led to an unexpected problem: despite our careful explanations prior to drawing blood, our patients all asked for the test results prior to leaving the clinic. We didn’t seem to be able to communicate to them the concept we were doing the testing to evaluate the test itself, that it wouldn’t make any difference in treatment if we had the results for them. They still wanted to know, and I disappointed them in this. Next time I’ll need to tell them something different, maybe that the results won’t be available until much later, or maybe we could tell them we’ll give them the results the next time we are there in Mexico. Or, maybe I might tell them the results would be available if they come by early the next morning before we leave their town to go to the next clinic.

It’s much too early to know how our study will go, but it appears possible, judging from the negative results we got on our seven patients, that we may not actually have typhoid in the towns we serve, and Tifoidea Maria may not exist. We may have been making inappropriate treatment decisions on the basis of false positive febrile agglutinin tests or on our clinical impressions of these patients. If this were true, the health risks these patients face does not come from typhoid, but rather from the unnecessary course of antibiotics indicated by a flawed and obsolete laboratory test that has given us the idea typhoid is endemic to this area.

We have seventy-two TUBEX TF tests, and if we use perhaps eight or ten per trip we’ll about use them up in the six medical trips we’ll do this year. As we gain more experience with the tests, the trends should become clearer. Thad and I plan to write a medical journal article about our study. It should be publishable, whatever the results. The company in Sweden that makes TUBEX TF is also interested in the results of this study, because they need clinical experience in order to proceed with marketing their product. We will see where it takes us. For now it is enough to know that this project has potential to yield real improvements to health and healthcare among the people we serve in Mexico.

End of Year Letter

This time of year we like to stop and thank our wonderful friends that support this work of Misión De Candelilla. We hope and pray that the upcoming Christmas season brings you great joy. We have had an outstanding year! We have held 20 medical clinics, facilitated two Well Child Clinics, completed three construction projects in Mexico and one here in Fredericksburg. We brought Christmas to San Vicente and we leave next week (December 20th) to bring Christmas to La Union. After years of struggling to have enough volunteers to serve on the various trips our group are well staffed with equipped volunteers. We are grateful to the Lord for all of the folks he has sent to us.

In the process we have had close to 1,000 patient visits in an extremely rural region where the closest significant care is as much as five hours away. In spite of very high transportation costs we deliver an excess of $1,000,000 dollars of care in doctor visits, EKGs, ultra sound services and medications. All for less than $180,000.

This year we also screened all of the windows and doors in San Miguel. This was the last of the seven villages that received these services in conjunction with Rotary International. We added on to the building we use for Paso de San Antonio. Each one of these construction projects is accompanied with a team that brings vacation bible school to the children.

Whether we are doing construction projects or medical clinics we also have worship services with the people while we are there. This year we held 27 services. In many instances we bring the only church services that these folks receive. The goal of all the groups is to touch the people they are serving with the love of Christ. Our goal is to not only minister to the people we serve but to meet the needs of the volunteers as well. To that end we have devotional services everyday for our volunteers. As a result we have seen the lives of our volunteers changed as well.

There are so many example I would like to share with you of how your contributions have impacted the lives of the people we serve. The medical clinics provide so much needed care, especially when it comes to medications of rate chronically ill. The simple act of screening windows and doors allows the people to sleep with their windows open without being bitten by mosquitoes.

There are, however, to things that stand out the most for me. They are the change in San Miguel and the “Local Missions Week.” This year we did two construction projects in San Miguel. During those projects our teams also facilitated Vacation Bible School. This encouraged a local lady to hold Sunday School and no fifty children are attending. She also has 11 teenagers assisting with children. This means that almost all of the children in this village are being reached with the love of the Lord. In addition she is also meeting with some of the ladies in the village for prayer every week. Sara and I are so very exited about this development.

We are also excited about what happened during Local Missions Week. This year the students from Heritage School worked on several construction projects at our local Boys and Girls Club. In the evenings they assisted with vacation bible school at Primera Bautista Iglesia. After VBS they would return to camp at our river bottom. They would eat dinner, then they would hold their own worship services. On a couple of occasions they shared their struggles with sins, “confessing them one to another”. Local missions week was effective in touching the lives of children in our community but the impact it had on the students was dramatic. We continue to hear testimonies of how their lives were touches and changed! We are so grateful that God allowed us to have a role in the lives of these young people. We hope to expand in this area of ministry in the years to come.

Next week we leave with a group from Holy Ghost Lutheran Church. We will be leaving with their youth group (15) to bring Christmas to La Union. We are so excited to see these folks join us again. Please keep this team in your prayers.

We need your continued prayers to conniption touching the lives of people with His love. Chris and Ruth Avery have chosen, once again, to give us a matching grant. If we completely match it, we will have raised a total of $30,000 for this effort. Please meditate and pray on how God would have you support this work.

 

Sincerely, Curtis B. Allerkamp

Executive Director

Soldiers In The Night

It was the first day of our summer medical trip to Boquillas (6-25-14). Crossing the border had gone smoothly enough, but we hit a delay at la garrita, the check point where we get vehicle permits, tourists cards, and pass through customs for a second time before we are finally free to pass on into Mexico. La garrita is twenty-six kilometers from the Texas line, and it marks the end of the border zone in Mexico, the area that can be travelled without a vehicle permit or a tourist card.

Over the years, La Garrita was a frequent point for delays for us, for any number of reasons, including dealing with missing documents for our group members or our vehicles, officials who wanted to make us jump through more hoops than we went through at the border, an occasional international glitch with a credit card, and sometimes being told we needed to pay duty on materials or equipment we brought into Mexico.

These were mainly problems in the few years after we started crossing the border at Eagle Pass in 2001 and before we began to get the help of the Rotarians from Piedras Negras for our crossings. They gave us the kind of documentation we needed to pass both the border and the checkpoint more easily, something we gringos had never been able to get done to Mexican standards. Also, Rotary is highly respected throughout Mexico, and this connection was helpful to us for this reason as well. It had been a few years since we had any significant delays at the check point.

La garrita jutted into view as we turned a curve in the highway about a quarter mile before arriving at the structure. The first thing visible was a high metal structure that spans the entire highway, held up by heavy metal trusses. Tall pecan trees in orchards on both sides of the highway had obscured the view of la garrita until we were suddenly upon it.

There are unused booths in the center of the road, supporting the long span of the upper building, a remnant from simpler times when it was not necessary to go through as much as we do now in order to pass into Mexico.

On getting closer to la garrita, it can be seen that the road is divided into lanes labeled overhead, “DECLARE” and “NOTHING TO DECLARE,” in both Spanish and English. Later we would pull through the lanes and turn right into the customs area, going through inspection again, having done so only forty-five minutes ago at the border. Vehicles with nothing to declare simply stop at a red traffic light in the “nothing to declare” lane, and ninety per cent of the cars are given a green light to go on, the other ten percent are sent to customs for inspection. Because of our medical equipment, we would have to go through the declare lane.

But first we pulled into an expansive parking lot to the right side of the road. A large masonry building houses the vehicle permit office and the immigration station. This building is off-white in color, a contrast to the metal building that spans the road, which is a dark and dirty gray.

On the opposite side of the road is a vacant military checkpoint, previously used to inspect people coming from deeper in Mexico. It was abandoned in 2013. Now it remains a remnant of past attempts to intercept drugs on their way to the U.S.

Twelve of our group entered the vehicle permit and immigration building for our tourist cards. Only Curtis and Sara had valid cards already. The immigration official wanted to see our passports before handing us the tourist card form to complete. In the past he gave us the form first, and then wanted to see the passport only after the form was completed. Then I saw the reason he wanted the passports first. I saw him scan the first few passports before handing out the forms. This was the first time I had encountered this in all the years of going to Mexico, but I gave it little thought initially.

The Mexican government has been slow to implement computer systems to monitor people entering Mexico. Computerizing the vehicle permit system had come a number of years ago. The computer kept a record of all vehicles permitted to foreigners entering Mexico, and this meant we always had to be sure to turn in the vehicle permits when they were expired, because we couldn’t get another permit if we still had one showing in the system.

After the official scanned our passports, he checked on the completeness of the tourist card form. Then he sent each of us to the bank, conveniently located right there in the office building. We each paid twenty-two dollars for the permit, then we went back to the official with the receipt before he finally handed us the cards.

This all progressed slowly but smoothly until Michael Dennis presented his passport. This time the new scanner brought our trip to a halt for two and one-half hours. Michael was with us for the first time, a doctor who came to give me some much-needed help in the clinics that awaited us. He had lost his passport seven years earlier. He had gotten a proper replacement at the time, but somehow the Mexican computer system flagged his passport with some sort of an indication that his lost passport may have been used by someone else to cross the border at some point in the past. We never got the details, but we were told this issue had to be cleared by a higher immigration official at some remote location. For some reason, he was out of touch.

This reminded me of a time before the Rotarians began to help us at the border, a time when Curtis and I customarily visited the director of customs prior to a trip, hoping to prearrange permission to cross with our group. The director had met us and graciously agreed to allow us to come through with our medical trip, but when we got to the border with our group two weeks later, he was no where to be found. He had left no word with anyone that he had approved our coming through. After about two hours of waiting, we overheard one of the customs officers who was helping us say the director was off with his girlfriend and he might not be back in touch until the next afternoon. On overhearing that, we began to ask who else could authorize us, and we eventually got through. We didn’t overhear any such conversations this time at la garrita, but it revived my old memory.

We were simply told to wait. In the office building only the offices themselves are air-conditioned. Inside the gaping expanse of the building we were uncomfortably hot, despite high ceilings and masonry construction.

Outside was only a little better, but at least we could feel a little bit of a breeze as we took shade at the side of the building or under the metal awning that covers of a few parking spaces near the front of the building. June is the beginning of the hot season in the Chihuahuan desert, and I felt the heat as we waited and waited. The two and one-half hours of trying to stay cool finally ended and Michael got permission for a tourist card. No one in our group grew impatient and no one complained. That was my first indication that we had a very special group of people on this trip.

Then we were off to Muzquiz to gather our medications for the clinic. We also had a lovely dinner served to us by Cinthia Prado. We had helped her get life-saving brain surgery five years earlier, and she and her family have been faithful to feed us each time we pass through Musquiz. Dinner was served at the Pemex station where we fill up one last time before striking out across the desert toward Boquillas. With no delays, it would take four hours to get to Boquillas. Even with a nine pm sunset in June, we would arrive at Boquillas after dark, thanks to the delay at La Garrita.

The highway from Muzquiz has been paved now all the way past San Miguel, but the road that cuts off to go down to Boquillas is still a dirt-and-gravel affair, prone to a washboard surface that rattles our vehicles into a loud roar as we zoom down the straight stretches of this road. Some have said that Curtis, in the lead vehicle that day as usual, might drive too fast on these back-country Mexican roads. But that day the road had had a recent grading and there had not been enough time for much washboarding to develop. Curtis was flying, and the only downside in the vans was the roar inside the vehicles.

We made good time on the roads, but we couldn’t make up the lost time from la garrita. We approached Boquillas in full darkness. The road to Boquillas, like most of those in the area, was constructed in the 1960’s, in the time when most of the towns there were established. Prior to that most of the territory was comprised of huge ranches, and these had fallen prey to one of the Mexican government’s land reforms, which established the towns of the area as co-operative communities for ranching and harvesting candelilla.

At that time, none of the roads were paved, but the government of the state of Coahuila brought in big equipment and made good roads. There were cuts and fills, culverts and low-water slabs, and even an actual bridge just before getting to Boquillas. The traces of all that work seem to indicate it was well-done, but no one came back to maintain the road to Boquillas until the late 1980’s, about twenty-five years after the original construction.

That was after the time we began raveling the roads in the area in 1986. I recall that almost all of the culverts were filled in with rock and gravel by that time. Many of the fills had eroded down to barely the width of a pickup, sometimes with perilously steep washouts on the sides plunging down as much as fifty yards. There were many times in the early years when we had to stop and haul rocks by hand to fill in a washout in the road so we could go on to hold our clinics.

The bridge right before Boquillas was one of the first parts of the construction to go, washing out completely in a flash flood within a few years of its completion. The locals had taken to leaving the road at the washed-out bridge to drive down a dry river bed for a mile or more to reach the town. This route varied from time-to-time because high water would wash out the tracks and leave the river bed impassible in places. We usually just had to follow the tracks on leaving the main road to find the way into town.

It was different on this trip. Curtis had gotten word that the river bed was more treacherous than usual (we have gotten stuck there a number of times, especially when it was wet). The townspeople had been using a different route, one that went around the washed-out bridge, through the gully and up onto the road beyond the bridge. This road takes a higher route along a ridge, avoiding the treacherous river bed.

The problem is, nothing is marked, and in the dark Curtis could not find the way around the washed-out bridge. We back-tracked to go down the river bed and that’s where I had problems. Recent rains had washed in fine sand that lay in a stretch of about fifty yards in our path.  It was not possible to know the depth of the sand from inspecting it.

Curtis made it through in his pickup. I was next, with a van pulling a trailer. I didn’t hit it with enough speed, plus I felt the van begin to shudder. I took this to mean I was spinning the wheels too fast and I thought I was at risk of digging in too deeply in the sand. In retrospect, I think I was beginning to drag the heavily-laden trailer on its frame across the sand.

At any rate, I came to a stop about halfway through the sandy stretch. No amount of pushing the van or digging out the wheels was helpful. The soft, fine sand was a foot deep.

At that point we were considering options. Some thought it would be necessary to unhitch the trailer in order to be able to pull the van out, maybe with Curtis’s truck. There was also talk of unloading the trailer so it wouldn’t drag across the sand.

As this talk was just getting going, headlights suddenly appeared out of the darkness ahead. A wide, low vehicle pulled up to the front of the van, and against the headlights we could see men dropping of the side of the vehicle on either side and striding toward us. In the harsh light we could see each man had a high-powered rifle slung across a shoulder and most were helmeted.

The new people on the trip feared we had fallen into the hands of the Zetas, a paramilitary organization that has thrown in with the drug cartels, but I knew it was the Mexican soldiers who were based at Boquillas. Their barracks sits on an overlook about a half mile across the river bed on a bluff with a commanding view of the area. Their vehicle was a HumVee, donated by the U.S. government during the Clinton administration to help equip the soldiers that were then deployed to sites all along the border in an attempt to stem the flow of drugs into the U.S. Most of the soldiers were now gone from the border, but the outpost at Boquillas had been maintained. The soldiers had discerned our plight from the vantage point of the lookout, and they had come to help.

Their plan was to unhitch the trailer and use the hummer to pull the van out with a chain. The initial attempt was made with the hummer linked front-to-front with the van, backing up to try to pull us out. That didn’t work.

Then they turned the hummer around, we dug out the van wheels more effectively, and we had as many hands as possible to push the van from behind. With this effort, the van slowly began to move and the hummer pulled it onto a firm surface. I had the fun of steering the van out of the sand behind the hummer.

Next we jacked up the tongue of the trailer, hitched it to the hummer, and out it went as well. Getting stuck slowed us another hour or more, and we pulled into Boquillas at 11pm, still needing an hour to unload the vehicles and set up camp. It was much too late to make my usual visit to the hot springs for a starlight bath. At midnight, the temperature probably was still in excess of 90 degrees. I was hot, sweaty, and stinky for the entire next day until I finally got to the spring for a bath at 10:30pm after our clinic and church service.

We went on to see about 150 patients in the three days of clinics. There were no more delays or glitches. We had good cases, we had an excellent group of volunteers, we had wonderful camaraderie, and we had some excellent Mexican food. When asked about the trip later, I usually said, “It was hot, it was hard, and it was wonderful.”

Ultrasounding the Intestine

Misón de Candelilla is well-known throughout the northern regions of the Mexican states of Coahuila and Chihuahua for the excellence of our medical care. Our reputation was established early on, back in the 1980’s, by a few special cases that became famous throughout the region.

As a result of being known in the area, we have had many, many requests over the years from people from other towns in the region to please come to their villages for clinics. Along the way we have also had requests from officials of the State of Coahuila to expand our ministry, including one from a comandante of the state police. This came back at the time when we were still crossing into Mexico through Big Bend National Park. The Rangers had begun to resist our crossing the river these and the comandante came to try and help us, hoping we would not only keep coming but expand our ministry there.

Over the years we have not been able to grant most of these requests for expansion, but we do now go to a town that was suggested by the comandante.

Sara recently talked to some women in the town of Paso de San Antonio about why they like our coming there. Paso de San Antonio is one of the newer villages we go to, this one on our far western route that crosses the border at Presidio. Sara learned (once again) that they are aware of the excellence of our medical care, but they also told her they find the medications we bring are more effective than the ancient generics that are provided by the Mexican social medicine system. Sometimes I get to see the medications used by the social service doctors, and many are drugs we haven’t utilized in the U.S. for twenty-five years or more.

These ladies also mentioned specifically they like that we have ultrasound available for their medical evaluations. I fact, we commonly have patients come to the clinics to request a specific ultrasound study. Their requests are not always the right study to do from a medical standpoint, but they know we have ultrasound and it makes sense to them.

I encountered one such request in Las Norias. It came from a twenty-three year-old woman named Adelina. She came to the clinic with her two sons, ages eighteen months and two and one-half years, with her mother there to look after the boys while she had her consultation. It was good she brought grandmother, because both boys were high-spirited and active, crawling under the pews in the sanctuary where we held clinic and picking items off the table where I kept my otoscope and other diagnostic items for examining my patients. They were hard for us to keep up with, even with their grandmother there to help manage them. They were handsome and delightful boys, just curious and highly active.

Adelina was tall for a Mexican woman, about five feet seven, and she had a slim elegance to her presence. She wore a simple white blouse over a denim skirt with a leather belt. Her hair had a soft wave, and later, when I pushed it back to examine her ears I noted the fresh fragrance of shampoo and I felt her hair was still damp. She had simple silver hearts for her earrings and she wore no makeup, which is usual for the women of the area.

She opened her conversation by telling me she was there for me to do an ultrasound of her intestines. I asked her for some details of her request and she told me she had been having some lower abdominal discomfort off-and-on for a few weeks. There were no other symptoms, but she explained she’d like for me to take a look inside with the ultrasound to see what the problem might be.

The difficulty with her request was that ultrasound doesn’t show anything about the intestines. We can get a good look at the liver, gall bladder, pancreas, kidneys, aorta, uterus, and ovaries on a full abdominal and pelvic evaluation, but sonograms don’t give any useful information about the intestines. In fact the intestines sometimes get in the way and block the view of organs we want to see, especially the ovaries.

We have had ultrasound for about ten years now, and in the early part of that period of time I was usually the only one on my trips who could do the sonograms. It can take a cause a significant delay in the clinics if I get bogged down in a lengthy ultrasound exam, especially if I’m the only doctor on that trip. For this reason, my usual practice for dealing with request for needless ultrasound exams has been to explain why ultrasound won’t be helpful in the specific case and then go on with the usual medical evaluation for that patient.

But this situation is different now, because in 2013 we had an ultrasound course for the group of doctors and nurses who regularly come on our trips. Judy Hutcherson was with us on this trip, and she is one of the nurses who took the course. Doing an ultrasound on Adelina’s intestines would not slow the clinic because Judy could do the sonogram.

I thought briefly about the medical situation back in the U.S. At home if I ordered an unneeded study, insurance would deny payment and I would have to write letters or make long phone calls to try to justify why I ordered the exam. Sometimes the letters and calls have to be done even if the study is justified, and a number of insurance companies now require preauthorization for some of the more expensive examinations, such as MRI. I probably smiled briefly as I thought about the fact I didn’t have to deal with insurance companies here south of the border. So, why not?

Judy took Adelina into the back room for some privacy to ultrasound her intestines and I went on with another patient. It wasn’t long before Judy pushed through the curtain in the doorway and called out, “Dr. Layne, I have something for you to see.”

Judy smiled broadly as she put the ultrasound probe on Adelina’s lower abdomen, then turned the machine so I could see. There, in black and white on the screen was an eighteen-week fetus, waving both hands.

Adelina asked if she would have another son, but it was too early to tell the sex of the fetus on ultrasound. That would have to wait. She’s probably worried she’ll have another over-active boy.

Adelina was in a state of shock, her mother couldn’t stop smiling, and I was happy I had requested an unneeded medical study. Adelina got prenatal vitamins, treatment for a minor urinary tract infection (something that can easily get out of hand in pregnancy), and she got acetaminophen for the abdominal pain. I suspected the pain was probably just from stretching the suspensory ligaments of the uterus as it enlarged with Adelina’s pregnancy.

            I have told this story to a number of people, and a consistent question from the ladies who have heard it has been, “Didn’t she know she was pregnant?”

            The answer to this question appears to lie in the different way people view the passage of time in Mexico. There it seems one day is the same as the next, and people live in the present more than we do north of the Rio Grande. I have also noted that the people who come to our clinics don’t complain about waiting and they don’t mind if we somehow take someone out of turn.

At the time, I asked Adelina for the date of her last menstrual period, a question that is less significant these days, now that we have a way of determining the age of the fetus with ultrasound that is far more accurate than dating the pregnancy by the timing of the last period. She simply didn’t keep track. Time is perceived differently there, and this is one of the many reasons I love to go to Mexico.

I suppose I might have found out Adelina was pregnant if I had gone about her evaluation like I would have in the U.S., taking it step-by-step, waiting for the results of a pregnancy test before ordering the ultrasound. But it was much more fun to discover her pregnancy through an unnecessary ultrasound

Matching Grant

We are once again grateful for the Avery’s matching grant of $15,000! They have been extremely faithful and generous through the years in supporting the Mission. This match will run till February 15, 2015. If you would like to contribute to our goal you can donate online or by mail in the contact section. We appreciate all the support so that we can continue to change lives of those in Mexico and those that serve in the United States.