On a dark December evening in the village of Huatabampo, at the southern tip of Sonora, Mexico, a mother and daughter board a bus. They'll ride north through the night, arriving in Nogales, Sonora, just after dawn.
The arduous 10-hour trip is worth it, says the mom, Rosa Melia Martinez Valdez. It's the only way to get to St. Andrew's Children's Clinic, a nonprofit medical clinic run out of an Episcopal church al otro lado in Nogales, Ariz. For the last 30 years, St. Andrew's has been offering free care to impoverished Mexican children with serious illnesses and disabilities. Held on the first Thursday of each month by an all-volunteer team of some 40 doctors and other medical pros, the clinics attract upwards of 300 patients.
"This is very complete; it's the best clinic," Martinez Valdez declares, speaking in Spanish.
On this recent Thursday, Martinez Valdez watches as her daughter, Claudia Cazares Martinez, gets examined in a church office temporarily converted into an audiology clinic. A shy but smiling 13-year-old, Claudia has been deaf since birth. The girl didn't begin speaking normally as a toddler, and in fact, never spoke until the age of 5--a year after the audiologists at St. Andrew's fitted the little girl with hearing aids. Her mother heard about the clinic from another mother whose child was treated there, and she says the care Claudia received changed her life.
"Now she goes to high school," Martinez Valdez says proudly.
Audiologist Janis Wolfe Gasch, a volunteer from Tucson, explains to Claudia in Spanish that both of her hearing aids need adjusting. Gasch will send one of the devices off for repair, and Claudia will have to return in January to pick it up. Then she'll have to surrender the second one for fixing and make a third journey in February to get that one back.
Obviously, Claudia's mom is not the only parent determined to get her kid the care she needs, no matter how hard the road. Each month, hundreds of children and their parents start lining up outside the church at 6 a.m., says St. Andrew's board member Buck Clark. The border checkpoint gets a monthly list of all the kids with appointments, and they're admitted to the United States on waivers for medical treatment. Volunteers pick the families up at the border and drive them in vans the short distance uphill to the church.
By 9:30 a.m., swarms of people are squeezed into the intake room; they fill every corridor and corner. Dozens of kids are in wheelchairs, and others walk unsteadily with canes. Kids with Down syndrome, spina bifida, cerebral palsy and neurological disorders are alongside children who can't see, can't talk, can't hear or have no legs. The crowd is so thick that even a cheerful red-clad Santa is barely noticeable.
Orthopedists are looking at kids' limbs in a Sunday school room, while pediatricians and their interpreters have set up shop at card tables tucked into a long corridor. One doctor peers at an X-ray he's holding up to a church window, while up the hall, physical therapists are encouraging kids to roll on colorful mats, their wheelchairs temporarily abandoned in a corner. Kids unable to speak are encouraged with a game of colored cards in a classroom.
"The church hosts the clinic," says executive director Anne Bolzoni. "We get tremendous volunteer support from the church, but we're nonprofit and non-denominational."
Even the church sanctuary doubles as a clinic, for blind children. Four-year-old Ronaldo Felix, of Nogales, Sonora, sits happily at a Braille machine set up among the pews in front of the altar. The boy was born blind after his mother, Ana Maria Contreras, became ill during her pregnancy. She says the Braille machine "enchants him." She wishes he had one at home, but she can't afford it. In Mexico, she adds, no social services provide things like a Braille machine to the children of the poor.
Most of these kids can't get the care they need in Mexico, agrees director Bolzoni.
"They're poor," says Bolzoni, who until recently was a children's-services fund-raiser in San Diego. "There's no national health, no public assistance."
Finances and logistics limit the number of children St. Andrew's can help, she says, but patients continue to get care until the age of 21.
"We can only take a certain number of new kids. Once they're ours, they're ours. Our commitment is to give them what they need."
SUCH CARE DOESN'T come cheap. St. Andrew's has an annual budget of about $400,000, two-thirds of that from private donations and one-third from grants. The agency counts another $1 million in in-kind donations, for surgery and the like, much of it performed at University Medical Center and other hospitals in Tucson, and at a pair of Shriner's hospitals, in Sacramento and Spokane.
"We're not eligible for government grants because we serve Mexican children," Bolzoni notes.
Monthly spending, on everything from wheelchairs to artificial legs, is about $33,000 a month, with some $8,000 to $12,000 going for medicines alone. Donations plummeted during the summer, and in October, St. Andrew's basically ran out of money.
"It got to the point where the money in the bank was less than the bills," Bolzoni says. "It got very scary. I was retained Sept. 6, and the first thing I was told was, 'Cover payroll on Sept. 15.' É We had to hold off on X-rays, on any new prostheses."
Emergency appeals for donations have paid off, although St. Andrew's always needs money. "We're all paid up. We have a budget. We can proceed."
The clinic has just three paid employees, and it relies on the volunteer labor of such medical professionals as Dr. Francisco Valencia, a Tucson orthopedist and Nogales native who speaks gently in Spanish to his tiny patients; and Jil Felhausen, a Tucson nutritionist whose difficult task is to advise impoverished parents on how to feed their sick kids. (The clinic provides free meals to all the patients and families while they're at the church, along with formula, diapers and clothing they can bring home.)
UMC medical residents volunteer readily to work in the clinic, in part because "they see such a wide range of disabilities and health conditions you don't see in the United States," Bolzoni says.
Among the 150 or so non-medical volunteers are a team of retirees in Green Valley who handcraft wooden toys for the kids. One 4-year-old boy who can barely walk wobbles up to their table and selects a yellow-painted school bus. He puts it on the ground and gleefully cries "buh," his word for bus.
In a cinder block Sunday school room--today a makeshift orthopedic fitting station and repair shop, volunteer Dennis Leal of Tucson hammers straps into an artificial leg. Leal takes the clinic's controlled chaos in stride.
"Yes, it's great here," he says, looking up for a moment from his work. "It's like this all the time. Things get done. Kids get seen."
One of his young customers, 6-year-old Eneyda Guadalupe Montes of Nogales, Sonora, sits nearby. She's waiting her turn nonchalantly on a desktop while her mother, Eneyda Gutierrez Hernandez, removes the prostheses from her truncated legs. A clown wanders by, wins a smile from Eneyda, and drops off a gift of socks and a doll.
"She had no feet at birth," the mother says. Eneyda started at St. Andrew's at the age of one month, and at 9 months, she and her mother were packed off to Spokane for surgery. Now she's healthy and growing, which means she has to come back to the clinic regularly to get fitted for bigger new prostheses to match her growing limbs. Each new leg costs $3,500.
One patient has come all the way to the clinic just to say thanks. Rosana Amiel Lizarraga Enriquez, 16, has journeyed by bus from a town two hours away, in Huatabampo, Sonora, with her mother, Rosario Margarita Enriquez. Rosana is a pretty, smiling teen, but until last summer she had an eye monstrously--and dangerously--swollen by glaucoma. St. Andrew's arranged to have the bad eye removed, and have it replaced by a glass eye.
"There are clinics in Mexico, but not free," her mother explains. "Next year. Rosana will return to school."
Director Bolzoni has an endless supply of ailing kids to help. On any given day, she'll get a phone calls, for example, about a kid with a brain tumor--she's on the lookout for free brain surgery right now--or a message about a boy with no legs in a Sonora orphanage. But she remembers Rosana. Bolzoni persuaded a Tucson doctor to knock down the price of the glass eye, and she enlisted teams of schoolchildren to raise money for it. Bolzoni says, with satisfaction, that the eye will last into adulthood.
But she adds, "She's just one story. They just keep coming in. You know you can't do it all. You feel wonderful about doing what you can."
Rosana is feeling pretty wonderful herself. She bends over a school notebook paper, and writes out, in Spanish, her note for the clinic and its workers.
"May God bless you," she writes. "I'll never forget you."