14 April 1994, 1330 Hours

The day is warm and hazy as we taxi onto the tarmac at Ontario International Airport.  At the controls of the turbocharged Cessna 182 is my brother George, ophthalmologist from Lodi, CA.  Seated in the back are Irma, George's wife, whose fluency in Spanish will be invaluable, and Harriet Mirashiro, seasoned surgical RN from Stockton.

George is kind enough to let me co-pilot, despite my inexperience in such matters.  Over two decades ago I attended flight ground school, but never took flying lessons nor obtained a flying license.  After completing the obligatory procedural check list prudent pilots invariably follow, George obtains permission to take off from the control tower.  The craft gathers speed and we vanquish gravity.

There is an exhilaration, a mixture of excitement and fear (often in varying proportions) in flying that is well-known to those who have journeyed in small private airplanes.  It is almost as difficult to describe to one who has not experienced this as it is to convey the thrill of a roller coaster ride to someone unacquainted with amusement parks.  Since the advent of powered aircraft, aviators such as Antoine de Saint-Exupéry, Beryl Markham, and Richard Bach have attempted to translate the poetry of flying from the air to the printed page.  It is not an easy task.

Since childhood I have been prone to motion sickness.  Land, sea, or air - travel on or through any of these could induce major misery.  Interestingly, I do not experience this while navigating, poring over the maps George has brought, detailing vectors, radio bands and airport codes, or while scanning the relatively complex cockpit gauges. 

There's nothing quite like viewing terrain from a small plane.  As a child I'd wonder what the earth looked like to a bird of prey, a tiny circling dot in the sky.   Now I have a better idea (although visual differences between an eagle, which can spot a rabbit from several thousand feet up, and man, who often can't see beyond his own nose, render the analogy imperfect).

The change between the spectacular California and Baja California (Mexico) coastlines is imperceptible, unlike the difference in standard of living in the two adjoining countries, which has its own multifactorial reasons.

We largely stay below cloud cover (we mainly fly VFR rather than IFR, visual rather than instrument, though George is instrument-rated), hugging the coast.  We touch down at Ensenada, where the lack of traffic and an affable customs officer make the obligatory check-in pleasant and efficient.  George and I almost forgot to bring our passports; fortunately, he reminded me during one of the many calls we exchanged before agreeing on a time and place he would pick me up in the Los Angeles Basin.

On to San Quintin, an agrarian town with some 10,000 inhabitants, about 185 miles south of Tijuana.  The dirt runway billows dust despite a smooth landing.   Several other light aircraft are already parked, indicating other anticipated team members of Samaritanos Voladores have arrived before us.  We scour fallow ground for rocks to brace the plane's wheels, slightly assisted by several shy youngsters who have congregated. 

We walk to a nearby clinic, on whose door a schedule is posted.  George picks out keys to one of the several available vehicles sitting outside.  We have a little trouble closing the lockbox.  I find it amusing that an assisting urchin, on tiptoe, seems quite familiar with its workings. 

The old Dodge van, likely donated, is definitely past its prime (not unlike some of us, I think to myself).  Despite the dust and cobwebs, the nonfunctioning speedometer and a few other minor annoyances, it is still quite serviceable.  What we don't know (but discover later, the last night in San Quintin) is that it has a transmission fluid problem.  But more on that later.

We drive a few miles, initially on a dirt road, subsequently on narrow two-lane asphalt, to the La Pinta Hotel, located virtually seaside.  Twenty years ago, the last time I stayed there, it was part of the El Presidente chain.  A slightly nostalgic wave of recognition sweeps over me as we drive up.  The clerk who registers us assures us none of our group has arrived.  Mike Reinhart, coordinator from Los Angeles, has done his job, however.  A charitable discount has already been applied to our room rates.

We unpack, and, relatively famished, take dinner.  George assures us the food and water are safe (my intestinal system is not so sure the next day; fortunately, once its apparent craving for PeptoBismol is satisfied, it settles down).  The repast is pleasant enough, though Nathan Pritikin and Dean Ornish, low-fat proponents, wouldn't have approved.  George bravely adapts.

We trudge briefly on the beach, facing the increasing wind with its accompanying chill.  The stark beauty, rapidly becoming engulfed in darkness, is at once foreboding and exhilarating.  I resolve to walk again in daylight. 

I notice a baby bat hanging (upside down, naturally) in the breezeway.  Curiously, despite beach proximity, mosquitoes abound.  I exterminate close to a dozen before retiring, sure that most if not all are females (only females are supposed to bite - is there a hidden lesson here?)

Exhausted, I sleep well.  Having a chronic sleep disorder, I am grateful for this respite from life's usual routine.  In fact, I will sleep well, better than I have for years, during the three nights we are in San Quintin.  No phones, no radio, no contact with my prior world.  I can forget everything but where I am.  The past and future dissolve.  There is only the here and now.  I immerse myself in it.

The next morning we drive some miles to town for breakfast.  We pass fields in which braceros are already toiling.  Many of them are apparently Oaxacan, of Indian descent, and perhaps equivalent to the untouchables in the East Indian caste system. 

We stop at a roadside fruit stand and buy a bag of oranges.  We pay too much and later give most of them away, but I have had an opportunity to take a colorful photo to include in the collection of slides I hope to give George to supplement his visual record of this trip.

As we park at the brownish-red cafe where we will eat all of our breakfasts, a place apparently frequented by gringos, I notice what Peace Corps volunteers (I was in Afghanistan for two years in the late 1960's) used to call "international flags" - colorful clothes hanging on clotheslines.  The breakfast is tasty and nourishing.   I learn to enjoy a thin, sweet oatmeal gruel. 

Paved road becomes dirt road, which we follow some distance to the Buen Pastor hospital and clinic. A few years ago a couple local physicians,  Drs. Cano and Gonzalez, of San Quintin, asked the Flying Samaritans to provide specialists for the hospital and clinic to see patients, operate as needed, and teach local practitioners.  Represented specialties include Podiatry, Ophthalmology, Dermatology, Orthopedics, Plastic Surgery, ENT and Urology.  This particular weekend was reserved for Ophthalmology and Dermatology.

Outside are parked a number of vehicles; inside, the waiting room is packed with patients and their families and friends.  Some have come great distance; some have waited for hours.  Most are indigent Oaxacans.  They have been referred from various public and missionary clinics, or have learned of Buen Pastor by word of mouth.  Not only do most not pay anything, the Flying Samaritans reimburse the hospital $25 US for each surgery.  An anesthesiologist, if general anesthesia is needed, is supplied by the hospital.  Translators, nurses, and facilitators come from the U.S.

As we enter the facility, a vivacious woman with short hair and glasses rushes up to George and Irma, hugging them and calling them "Dad" and "Mom."  Jasmine Rosado works for Dr. Charles Tannenbaum in Arcadia, is fluent in Spanish, and has boundless energy, talking and moving with alacrity.  She and her boyfriend, Carlos, who runs an optical shop in San Quintin, visit San Quintin about twice a month.  Dr. Chuck Tannenbaum, lanky and straight-backed, sports a baseball cap.  Other Stateside personnel include Mike Reinhart, silver-haired avuncular stockbroker from Los Angeles; John Thacher, boyish open-faced dermatologist from Ojai; Cathy Ogden, pert bright-eyed officer manager and assistant to Dr. Thacher.

The women organize paperwork and schedulling.  I observe and photograph.  Patient examination begins.  I cannot comment on the type and range of diseases John Thacher encounters, since I concentrate on eye problems.   The latter include pterygia, strabismus (cross-eye), cataracts, and refractive errors. 

Pterygium ("carnosidad" in Spanish), a triangular fleshy overgrowth, grows centripetally toward the center of the eye, ultimately encroaching on the cornea; if unchecked, it may eventually obstruct vision.  Seen mainly in the elderly in the U.S., it occurs with fair frequency in the younger, even youth, in Baja CA.  Possible causes include prolonged exposure to the elements - unfiltered sunlight, wind, and dust.  It is treated by excision under local anesthesia.  I wonder aloud if the locals could learn to wear sunglasses as a hopeful preventive measure.  No one seems to know.

Strabismus, either convergent or divergent, while less common, has greater functional and cosmetic implications.  One young boy, who, along with his mother and aunt, had been driven many hours from Mulege by a retired American couple, had the tightest convergent strabismus I'd ever seen; it seemed as if his nose was all that prevented him from being a virtual Cyclops.  His rectus muscle release surgery was performed by Dr. Tannenbaum, who also operated on another case of strabismus during the two day period.

On a prior visit, George operated on a young probable Oaxacan woman, Placida, restoring sight by removing cataracts which she had had for many years.  On this trip he wants to recheck her.  Since she has no telephone, Irma and I drive out to her house to so inform her. 

Not too dissimilar from many small towns in the U.S., the San Quintin area does not abound with signs, either street or other.  One learns landmarks, and hopes one remembers them the next time around. 

We drive up and down bumpy dirt streets, Irma looking for a place she hopes she'll recognize (she's accompanied George on some prior trips to San Quintin).  Suddenly we see it, one of many anonymous abodes in this township.  Her eldest, a six year old boy, opens the yard door, crudely fastened with wire.  We enter the yard.  Plump and broad-faced, cradling her several month old baby, she greets us with a smile.  Her two other children, both girls, watch us tentatively. 

She calls to a middle-aged man in the yard and introduces him as her father.  Irma tells her, in Spanish, why we've come (Irma informs me later that Spanish is not Placida's native tongue - Indian apparently is - and that even in that language, there is a minor barrier). 

We are shown around.  Placida's father's one-room cardboard house is rude, Spartan, and windowless.  Hers is luxurious and commodious compared with his, though by our standards hers would qualify as little more than a cinderblock shack.  Her floor is cement rather than dirt.  Cleanliness and order do not seem high priorities.  Her baby has difficulty nursing due to severe coryza.  One wishes for a bulb syringe with which to suction its nostrils.  We walk gingerly through the yard, trying to avoid chicken and dog droppings.  Two pigs are staked on short tethers.  A small garden of greens sits in the middle of the yard.  We pass out oranges before leaving, and make a mental note of the particular power pole marking their street on our way out.

The next day George, under local anesthesia, removes scar tissue from one eye which has caused Placida some visual disturbance.  She thanks him as "Hermano" (brother), addresses Irma as "Hermana" (sister) upon her departure from the clinic.  She, and other patients express deep gratitude for what is done for them by the medical team. 

While not optimally equipped, the hospital could be worse.  The ophthalmologists have an operating microscope; an on-site autoclave permits cases to be schedulled back to back; George is able to gauge the size of lens implants with a pen-sized ultrasonic unit; he has brought a small, portable phakoemulsifier with him for trial use in removing cataracts. 

Harriet works tirelessly without complaint.  She has also donated her time and energy, as well as expense, to this project, in between her regular job as scrub nurse for a multispecialty facility in Stockton.  There is no shortage of hands.  Mike and I, who are no good at translating, but can put together a passable lunch of tomato and avocado sandwiches in the 20-bed hospital's spare kitchen, help out in the OR, procuring supplies, adjusting lights and stools, etc.  I think Mike, in particular, gets a kick out of this sort of thing, being a far departure from his usual occupation of brokering.  As for me, I am afforded the opportunity to observe for the first time, at close range, intricate and delicate eye surgery not extant during my medical training.

We visit an orphanage, not far from Placida's home.  Christian in approach, it appears well-run and -staffed, with over 30 children ranging in age from infancy to around 15.  They seem well-fed, -clothed, clean, and happy.  They learn about the Bible and Jesus, say grace at mealtime, and are a full-time responsibility.  We meet a newly-married young American couple, she a recently-graduated RN from PUC.  She holds a baby, one of the youngest orphans.  Five kids have the measles and are quarantined with Steve and Linda in their tiny apartment.  Upon learning we're Adventist, they hug us and suddenly warm to us as family.  Their loneliness is palpable.  The only Adventist church is Spanish-speaking, and not close.  They tend to spend their Sabbaths on the beach, playing guitar and worshipping by themselves.   After returning Placida to her home, we drop off a large stuffed animal at the orphanage. 

I drive back to the hotel.  Irma tells me Placida's husband is away, apparently working or trying to find work.  She has no phone and is illiterate, so she doesn't know his whereabouts.  It is fortunate she has been fixed so she can't have any more children. 

Sometime later, the transmission slips, in and out of neutral.  I wonder if the bands need tightening.  We stop at a roadside vendor, and, after viewing his wares, which he largely displays atop his old car, buy a few items.  George refuses to try to bargain with him; instead, pays him a bit more than he asks.  He thanks us profusely, mentioning this has been his only sale all day.  George believes him.  While not so sure, I smile, knowing George has the right attitude.  A relatively easy way to make someone's day.

We have a little time before dinner.  I determine to visit the beach one more time.  I trudge out to the strand, pick up a few sand dollars and mussel and clam shells as souvenirs.  A field mouse runs toward me and I watch it scurry to the water's edge, wondering if lemmings ever rush to the sea individually, or only en masse.  Someone shouts from the hotel that whales are passing.  I peer intently but fail to see them; I fear my gradually deteriorating vision may be responsible.  An inexplicable calm, the kind I always feel at the seashore, comes over me.  I have always loved walking on the beach.

With considerable effort, George and I check the transmission fluid level in the van, discovering it to be below the dipstick.  We realize why this has happened: there is no dashboard gauge or light to indicate inadequate transmission fluid, and checking the dipstick requires removal of the bulky engine cowling between the two front seats, a considerable task in itself.  By now it is dark.  We have missed our dinner appointment with the others in town.  I opine we should wait till the morning; George is intent on getting some fluid now. He hitches a ride to town with a hotel employee and returns with four quarts, three of which the thirsty van accommodates the next morning.  He gives a Spanish copy of The Great Controversy to the employee before bidding adieu.

On the way to the airstrip, we talk of various things.  As his guiding credo, George shares these words of John Wesley (who was apparently once quite affluent, but a pauper when he died): "Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can."
 

I am grateful beyond expression for having such a brother.