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NEWSLETTER FROM THE SIERRA MADRE #5

OCTOBER, 1970

Concerning Project Piaxtla, a personal endeavor providing medical and
related aid to villagers in the mountainous reaches of Sinaloa, México.


ALL IT TOOK WAS HEART

After the wedding and the wedding feast, the entire village, from the tottering young to the tottering old, turned out for the wedding dance. In Ajoya, weddings don't happen very often. Of the three types of marriage -- iglesia (church), civíl judge) and matorro (underbrush) -- the matorro espouse most newlyweds, with only the stars and mosquitoes attending the ceremony. A formal wedding is a luxury few can afford. It requires a priest, who must be brought by chartered backwoods bus all the way from San Ignacio. It entails the cost of a huge wedding feast -- to which the whole village assumes Invitation -- plus the expense of contraband alcohol, not to mention the stipend for the band to play eleven hours straight at the dance. All in all, a wedding is a rare event, even more exciting than an eclipse of the sun -- or an airplane.

But the wedding dance of last July 19th was yet more special. Octavio and Tinín
-- sweethearts since age five -- had at long last wed. Octavio, a native of Ajoya, is the young headmaster of the village school and for the most part revered by children and parents alike. All those who could possibly cram into the stifling adobe room of the dance, crammed into it. Those who could not, pressed in a herd around the doorways
and out into the street. The Banda de Ajoya -- with two battered trumpets, a clarinet,
a sawed-off trombone, a bruised mini-tuba, a snare drum and a bass drum thumped by a six year old boy half its size -- blared forth with favorite rancheros. At first only
a few couples danced, modestly and rather self-consciously, within the tiny clearing
opened by the crowd, but as daylight softened with the approach of rain and evening,
and bottles of Coca Cola spiked with vino (actually tequila) circulated through the
crowd, all reserve dissolved. Temperature and tempo increased. The pulsing fever of
dance swept through the sweating spectators like an epidemic. Those with partners took them. Those with none danced alone. Those considered by the village to be too young to dance with the opposite sex, danced with the same or with broomsticks, or clasping the invisible figments of their budding dreams.

Soon the heat and confinement inside the tight room grew too much, and the dancing crowd, followed by the band, spilled out into the street. A covey of married women ranging from 14 to 40 suddenly converged in the center of the throng and began
dancing their conception of Tock and roll, laughing at their attempt as they did so. As
the band played faster, the women danced more wildly, breasts bobbing, arms and legs flailing -- steps from the Charleston, the Twist and from barn dances -- all scrambled into one. The crowd turned all eyes on the frolicking senoras and began to clap in cadence. Nobody paid attention to the first drops of rain forewarning an approaching cloudburst, and even when the shower poured down it was long before the dancing villagers, thoroughly soaked, drifted to the shelter of the verandas. There, out of the rain, the Banda de Ajoya continued to play and the villagers to dance and to dance.

Now the small children, oblivious to the warm monsoon downpour, had reign of the
street and made the most of it, like performers on stage. Through puddles and pelting drops they danced with leaps and capers in exaggerated imitation of their elders, whooping and shrieking as they did so.

Standing under the eves of the blacksmith's shop, I watched this children's comedy with full delight. But with greatest pleasure, I watched one little ten year old in particular. His energy and impishness were boundless. One moment he would lock
his arm with another little boy and whirl in circles in perfect step with the music.
Next he would dance alone, or streak like a comet among the other children, poking
them in the ribs, and gone by the time they turned around. At one point he vanished
from my sight and upon reappearing, staggered drunkenly, an upended beer bottle to his lips. When he noticed me watching, he ran toward me.

"Have a swallow, Don David:" he laughed, offering me the half full bottle. I frowned and shook my finger to say, "No thanks:", whereupon with a big grin, little Manuel poured the contents of the beer bottle on the ground. It was water. "It's sky water," he explained soberly, "and I'm =drunk:" Then, with a very serious face, he added, "But just a little drunk. I hold it well." At this point he refilled the bottle by holding it in one of the strands of water pouring from the roof tiles, took another swallow, and as if that were not enough, tossed the bottle into the street and stepped directly into the curtain of water gushing from the roof. He marched back and forth the L:~..-:;~h of the roof's edge, his arms spread in a victorious V toward the dark heaven-, and, his head tilted skyward with the warm water splashing onto his face and into his open mouth, from which he spouted it back out this way and that. Manuel was
drunk, all right; not on alcohol, but on rain water . . . and or life:

Had I never seen Manuel before, his antics would have delighted me. But the
pleasure I felt in seeing him so intoxicated with the fullness of life and health was derived from the knowledge that my efforts -- along with those of many friends
-- had in part been responsible for the first good health Manuel has known in the
ten difficult years since his birth. How often as I watched him that evening of the
wedding dance did I whisper to myself, "If only Dr. Sissman could see you now:"
. .

Manuel Alarcón was born with a congenital heart defect known as a "tetrology of
Fallot". An abnormal hole in the septum separating the ventricles of the heart, combined with a gross constriction of the pulmonary valve, prevented his blood from transporting enough oxygen from his lungs to his body tissues. As a result, Manuel existed in a state of near suffocation. His general color, especially of lips and fingernails, was blue; his fingertips were clubbed for lack of 02, his eyes bloodshot, his growth stunted. At ten years, he weighed only 45 pounds. He could not run or play or help with chores like other children, for at the slightest exertion he would be gasping for breath.. He was timid and terribly spoiled by his gentle mother, Jovita, and his blacksmith father, Salvador.

I had known about Manuel's heart condition, and suspected it was operable, ever
since Dr. Val Price and I had examined him four years before. But there it had
remained. I knew the cost of surgery would be prohibitive, and even were I able to
raise the money, it would be difficult to justify my spending on one child a quantity
equivalent to what Project Piaxtla spends on medical care for more than 4000 patients
in a whole year.

And so Manuel's chances of ever leading a normal, healthy life, or for that matter, of even surviving his teens, remained slim until one day last Spring when I was giving a
slide show on my project at the home of Stacey and Margaret French in Los Altos,
California. Among other slides, I showed one of Manuel and explained his plight. After the presentation, one of the guests introduced himself to me as Dr. Norman Sissman, Head of the Department of Pediatric Cardiology at the Stanford Medical
Center. He told me that if I could get X-rays of the boy and his condition proved
operable, he would make arrangements for surgery at Stanford. He was sure that the
surgeons would perform their services free of charge. As for the hospital bill, which
would be around $4,000 and could not be waived, Dr. Sissman offered to raise the funds himself.

The biggest problem in bringing Manuel to Stanford proved to be governmental red
tape. Manuel was willing to undertake the surgery only if his mother went with him, and she, only if her husband went too. Arranging passports for Manuel and Salvador was relatively easy, as their births had been duly recorded. But Manuel's mother, Jovita, a nearly full-blooded Indian born high in the Sierra Madre, had no way of proving her nationality: The hassle and delay was so great that Miggles and John Hicks, who drove the Alarcóns from Ajoya to the States, made it only to Santa Barbara by the day Manuel was scheduled to enter the hospital. However, my friend Norman Moore, flew with me in his small plane to Santa Barbara and brought the family back. We kept very low to the ground because of Manuel's heart. The few times we had to climb to cross hills, the darkening blue of Manuel's face registered like an altimeter. The Alarcons' first flight was, needless to say, memorable.

Once in Palo Alto, however, things went smoothly. Norman and Jean Moore welcomed the Alarcóns into their home. Their daughter, Marian, who speaks fluent Spanish, helped nobly. At the hospital everyone went out of his way to make Manuel comfortable and put his parents at ease.

Preliminary tests were performed by Dr. Sissman and Dr. Green. Open heart surgery, which I had the privilege of observing, was performed by world renowned Dr. Norman Shumway and his team. All doctors donated their services.

From the day of surgery, Manuel looked like a new boy. The blue transformed to rosy pink and his eyes cleared. Within a week he was already more active than he had ever been in his life. A minor complication delayed Manuel's return to Mexico, but in five weeks it was resolved and the Alarcóns returned to Ajoya, grateful to get home

Well after dark, the evening of the wedding dance, Jovita called Manuel in off the
wet street, but the pulsing music of the band penetrated the Casa and Manuel, still full
of life, began dancing with his five year old sister, Norma. Long after Norma and the
rest of us had given out, Manuel went on dancing . . alone and joyous . . . a child
enthralled with a marvelous new playthings himself:


MEDICAL PERSONNEL FROM THE STATES


This summer, the Ajoya clinic was able to function more effectively than ever before, thanks to a highly varied and capable staff.

Dr. Kent Benedict, resident in pediatrics at Stanford, who in early July brought little Manuel back to Ajoya after his surgery, stayed with us until September. Kent -- or "Andres" as we dubbed him -- has a straight forward and easy going manner essential to survival here. Above all, he is able to shift gears from a modern American hospital to a back woods Mexican clinic with a facility many American doctors find difficult.

Jim DiSalvo, a third year medical student, and his wife Lana, also helped in the clinic in June and July.

Angela Fogg, who has been working on her doctorate in microbiology at Stanford, took charge of our simple lab; and through analysis of urine, stool, blood, sputum and
skin samples, helped greatly in diagnoses. Her most valuable assistance, perhaps, was
in pinning down malaria. There has been a severe outbreak this rainy season, with cases in at least eight of the lower villages. Our first definite case this summer, we
misdiagnosed until Angie found the parasites on a blood smear. It is, of course,
important that malaria be treated early, as it can be devastating or even fatal. A
number of children have been brought to our clinic with permanent brain damage said to have resulted during bouts of very high fever, conceivably malaria. Malarial fever can be extreme. One delirious eight year old boy brought in on mule back by his brother from eight miles away, had a temperature of 107.6oF: Angie found his blood loaded with Plasmodium vivax.

Carol Plant, a medical secretary from New York City, also joined the summer staff. She assisted energetically in many of the clinical chores and helped establish a
record file on patients. For the first time we were able to keep accurate tabs on the
total number of patient visits. The figures proved more impressive than I had estimated. Within the first fifty days we saw over 1000 patients, with nearly 2000
consultations, counting return visits-. . . an average of forty patients a day in the
lower clinic alone. Hopefully, Carol will return this autumn. In any case, she and
Angie plan to be here over Christmas.

During most of the summer the upper dispensary at E1 Zopilote was staffed by
Allison Akana, a former student of mine from Pacific High School, who has come twice previously. A native Hawaaian, Allison won the reputation among the summer staff at the Ajoya clinic as the "Wonder Girl" for her fearless efficiency in a variety of clinical procedures. At 19, with most of high school and a few junior college courses in biology and physiology behind her, she is surprisingly able. Not only can she now conduct the clinic, but with a sure hand has learned to suture wounds, place IVs, give nerve blocks and extract teeth. Most important, she has won the love and admiration of the villagers from Ajoya to E1 Zopilote. We are considering opening a "mid-way" first aid station in the village of Chilar, where Allison would be in charge and, hopefully, train one of the village girls to take over. The village is unanimously for it and offers to fix up a special casa.

This September, a week after most of the summer staff had left and only Allison and I remained, Joe Humphry, a fourth year medical student at the University of California who spent the summer of '69 with us, returned for three weeks during semester break, thus helping us to keep both dispensaries staffed.

Bob and Dorothy Steiner, who worked tirelessly in the Ajoya Clinic from last Autumn until Spring, hope to return this January.


DUMB DUMB


In a discussion of clinical personnel, one could scarcely forget to mention Dumb
Dumb. Dumb Dumb would not permit it. He is sitting on my desk beside my typewriter, carefully watching my moving fingers, which are the closest thing he knows to a parental beak. Every time a fly or a leaf-hopper comes in through the window, I stop long enough to catch it and drop it into Dumb Dumb's gaping mouth;
whereupon he thanks me by peeping monotonously at two second intervals, rather than one second intervals, which is his pattern when asking for food and attention.

Dumb Dumb is an immature Blue Mockingbird who holds good prospects for one day
becoming a beautiful blue and grey songster. But for the present, he is just a ragged
black peepster. He was sent to me by a little girl in Jocuixtita as a downy, hungry
fledgling, and has since grown to nearly full size. He has already learned to fly, if
clumsily, a fact in which he takes great pride. Dumb Dumb follows me everywhere at E1 Zopilote, upstairs and down. When I consult with a patient, he often perches on my shoe, waiting for me to lift up my foot so that he can hop on to my hand. When I feed the poultry at dawn, Dumb Dumb pecks on the ground along with the chickens, snapping up weevils between the grains of corn.

Dumb Dumb is a delight to all who come to the clinic, and when men patients help
out by chopping firewood and women patients by sweeping and carrying water, I give the children a butterfly net and send them to the fields to catch grasshoppers for Dumb Dumb. "One grasshopper for every pill", I tell them jokingly.


THE DENTAL PROGRAM


The Indians of México, in time past, reputedly had very good teeth. Skull fragments and jaws found among the remains of old burial urns in caves around E1 Zopilote bear this out. Teeth in skulls of the aged are usually worn almost to the roots from chewing on fibrous material and eating stone ground corn. But rarely is there much sign of decay.

By contrast, the teeth of the mestizos in the Sierra Madre today are often deplorable. The Spanish element seems to have introduced a sweet tooth. Certainly the introduction of sugar cane, which is grown in small patches along arroyos and used to
make panocha (crude sugar blocks) has been a factor in tooth decay, for in ranchos where ca a is grown, even young children have serious dental decay. Ten year olds sometimes have three or four molars already beyond repair. In a region where there have been no more dentists than doctors, the extent of suffering from decayed and abscessed teeth has been fearful. One sees abscesses which drain on the outside of the face, infections so severe they cause fusion of the jaw or permanently blind an eye.

There is little concept of oral hygiene in the barrancas. Until recently, in the upper barrancas, the toothbrush was unknown except in schoolbooks, where its use was directed toward good grades rather than good teeth.

For the past five years, on my return visits to the United States, I have petitioned for toothbrushes -- even used ones -- in order that children of the Sierra Madre might brush their teeth. Last February I hit the jackpot when Dr. Marvin Stark of the University of California's Mobile Dental Clinic donated hundreds of toothbrushes,
cases of toothpaste and a generous supply of stannous fluoride paste, a single
application of which helps protect teeth for six months.

Last March I brought to the Sierra Madre a group of five high school students from the Athenian School in Danville, California. Traveling on foot and mule back from
village to village, the students conducted a program of treating the children's teeth
with the fluoride compound, taught them how to brush their teeth and presented each
child with a toothbrush and toothpaste of his own. The Athenian students conducted the program eagerly, and the children responded in like spirit.

Over the past four years I have extracted thousands of decayed teeth, having been
taught the basics by a dentist in Santa Barbara. But what has grieved me most has been the necessity to extract or leave to decay further, teeth which could be filled were there a dentist to fill them. This summer, at long last, we conducted a full scale
"Operation Drill and Fill". Dr. Pieter Dahler, a Dutch-born senior dental student at
the University of California, spent most of August as dentist in Ajoya, with his new
bride Barbara, as dental assistant. Amongst Pieter, Dr. Stark, Dr. Charles Renn and
other dentists from California to Ohio, we managed to equip an impressive dental
clinic, complete with high and low speed dental drills, electric amalgam mixers, and
suction machines; all powered by a new gasoline-run generator.

The same day Pieter and Barbara reached Ajoya, Mrs. Shirley Luedders and her
daughter, Melany, arrived from Cincinnati. A trained dental hygienist, Shirley not
only vigorously cleaned badly encrusted teeth, but became proficient at extraction.

Operation Drill and Fill got off to a slower start than expected. The first few mornings I even had to go out and drum up business. Most of the villagers had never seen a dentist before, and the concept of repairing a tooth before it became unbearably
painful was new to them. Many of our first teeth were, therefore, cases for extraction.
But after Pieter filled a few black-pitted front teeth for teenage girls, leaving their
mouths as bright as new, the idea took hold and the last week of Pieter's stay, the
waiting porch was packed with patients needing fillings. Pieter filled over 200 teeth,
but the need remains enormous.

While in Ajoya, Pieter also taught me the basics of filling teeth, and Miguel Angel did some observing and assisting, so that in cases of emergency we are able to do stop-gap repair. The need remains great for real dentists, however, whether for long or
short term visits. The clinic is fully equipped. Any dentist or senior dental student who might be interested and can put up with a few backwoods inconveniences, like gnats flying into the mouths of his patients, is encouraged to contact us.


ECOLOGICAL PROBLEMS IN THE BARRANCAS


In spite of the closeness of the people of the barrancas to the land, some of the natural resources are being depleted through careless abuse. It is the old timers who tend to be frugal with the resources, the young more extravagant.

In the realm of my upper dispensary at E1 Zopilote, the pine forests are steadily
diminishing. Prime pine stands are timbered, or ringed, to plant beans or corn on the
steep slopes and the timber is mostly wasted. Trees for beams and hand-sawn planks are cut from more accessible areas. More destructive still is the extensive gathering of ocote, or pitch torches. Many families use ocote rather than kerosene for light at night. Healthy trees are slashed at their base so that the exposed scar "pitches in". Later the pitchy scar-wood is chopped out for torches, leaving a deeper scar which in turn pitches in and is chopped out. Eventually the trees are so weakened that they blow over in the monsoons. A third of the pines above E1 Zopilote have already been scarred for ocote, and the process continues. I have managed to prevent it only within sight of the clinic.

The biggest tragedy for the pine forests is that no new growth is replacing the old. The pines are potentially prolific, with thousands of seedling springing up each year, but the campesinos plant by slash and burn, and although they clear modest fire breaks, fire invariably escapes from some fields and sweeps uphill into the pine forests. Large trees are usually unharmed, but all seedlings perish. Except for a few which we protected near the clinic, there are no small pines within miles.

As an ecologist and lover of pines, I am doing all I can to preserve the forests.
Fortunately, many campesinos are in accord. Most who live close to the forests now cut their ocote only from fallen trees. All agree it is wrong to let fire escape. The problem is one of enforcement. The local comisario (mayor, more or less) and campesinos I have talked to agree that a penalty should be set up. Rather than exact a monitary fine, which would be difficult for the poor farmer to pay, my suggestion was that an offender replant burned over sections with seedlings. The idea was accepted and, hopefully, next season there will be some improvement. In the meantime, I have undertaken transplanting of pine seedlings, and before the dry season I will clear a fire lane around the pine grove behind E1 Zopilote.

Another thoughtless abuse of resources is indiscriminate hunting of game. Almost
the only meat which the campesino tastes comes from wild animals. His pigs and goats he mostly sells below. Big game is scarce, however, due to lack of seasons and
limits. Does, which are shot at anytime, are particularly easy targets when they have
fawns. Villagers say they feel guilty shooting a doe, but when their children are
hungry . . . . Needless to say, I try to convince them that in the long run they could eat much more venison if they would use a little more constraint and foresight. A similar problem exists for peccary and other game animals.

Fish in the Rio Verde could also be a good source of protein for those who live near its banks. But again, wasteful fishing techniques reduce the potential. The Indians
traditionally fish by making a tachecual or simple dam of stone, boughs and earth where the river divides into two channels. The dam shunts the water into one channel, leaving the other dry. The people then rush in to gather the fish and crayfish trapped among the rocks. Although there is no size limit, at least all fish taken are eaten. Afar more destructive method of fishing, however, has become popular since the white man introduced dynamite. Villagers "poison" the river with the juice of certain plants,
causing all fish to swim down stream ahead of the poison until they can take refuge in a deep pool bypassed by the main flow. When the fish have thus congregated, a small bomb is dropped into the pool, killing and maiming the fish; whereupon the children dive in to recover as many fish as possible before the current carries the rest away. In this manner an entire sector of river is denuded of fish. Fishing with dynamite is illegal in Mexico, but unless enforced, laws do little good. The people need to realize that in the long run they could eat more fish by using other methods.

Another error on the part of campesinos is wanton slaughter of beneficial animals
which are believed destructive. Many species of insect eating birds are shot in cornfields because "they eat the corn". Even roadrunners, which in the Sierra Madre are found all the way up into the pine zone, and which eat mice, lizards and insects, are shot because they "dig up and eat the freshly planted corn". Small lizards and even
toads are also thought guilty of this, but toads are spared for the belief that the rains will fail if a toad is killed. As in farmland elsewhere, beneficial hawks and owls
are lumped with the "chicken hawks", and shot. Boas and all rat eating snakes, on the
other hand, are killed not because they are thought destructive, but because they are
feared. I have tried to counter this fear by catching and handling non-poisonous snakes and getting children to handle them.

The biggest ecological blunder in the upper barrancas, however, has been sponsored
by UNESCO by its malaria control program. This is the only government health program which has reached the remote high country of Sinaloa, and ironically, in the high country malaria has never been a problem. The UNESCO malaria control program consists basically of heavily spraying every but with DDT every six months for several years, the theory being that the major vector is the anopheles house mosquito. True, for the first few years the program was tremendously effective in heavy malaria areas of the lowlands. But in the highlands of E1 Zopilote, where there has never been any malaria, the result of spraying DDT has been disastrous. The campesinos rely on cats for rat control, and it turns out that cats are tremendously susceptible to DDT. The malaria control program exterminated hundreds of cats, with a resultant rat epidemic. In some huts, rats are so thick they devour a large part of the stored corn, a loss which hits hard where the supply is short to begin with. With so many rats, the huts, in turn, become infested by fleas, with the danger of Typhus and other disease. Although the first sprayings of DDT dramatically reduced cockroaches and bedbugs, the survivors bred resistant strains and subsequent sprayings were less effective. Now, after each new spraying, it seems that cockroaches and bedbugs reach new population heights, perhaps because their natural predators, such as spiders and geckos, remain susceptible.

If all this is not misfortune enough, now in what were supposed to be the final
stages of the control program, there seems to be a dramatic increase of malaria in the
low country, where initially the program seemed so effective. In my first years at the
Ajoya clinic -- which were also the early years of the control program -- we didn't
treat a single case of malaria. Last year we treated four cases, and this summer only,
we treated at least fifteen. A possible explanation may be that the house mosquito, like the cockroach and the bedbug, is developing a resistance to DDT.


HIGH PROTEIN CORN


The typical diet in the Sierra Madre consists of about 90% corn, in the form of
tortillas, for corn is one of the few basic crops that grows well. The growing season is
limited to the summer monsoons, which are torrential. Crops grown at other times must be irrigated, and in the steep barrancas, streamside plots which can be irrigated by gravity flow are very limited. Unfortunately, also, the alluvial flats by the river near Ajoya where irrigation by pumps would be economically feasible, are held by the wealthy land barons who prosper through share cropping and have little incentive for higher yield. Most planting is done by the slash and burn method on steep slopes, where profuse leaching during torrential summer rains makes for nitrogen-poor soil. Within one season after land is cleared, erosion makes the soil virtually useless until wild vegetation has slowly reestablished new topsoil. I have grown a variety of vegetables, experimentally, mostly with discouraging results. Many did poorly because of soil, others, such as giant pumpkins, grew robustly, only to rot before producing because of excessive rain. Other crops, such as sesame, mangoes and oranges near water courses grow well, but are in constant danger of invasion by leaf-cutting ants. Leaf-cutting ants make it impossible to grow wheat below 6000 feet, yet the leafcutters do not touch corn.

Corn, after all, is a native American plant as suited to living with leaf-cutting ants as the Indians are suited to corn. In many ways corn is the ideal crop. Even if another more nutritious crop were found to grow as well, the villagers would be slow to change their taste and planting habits. Unfortunately corn lacks certain factors needed for adequate human nutrition. It is deficient in niacin, hence the high incidence of pellagra in the world's corn belt. While corn has most of the essential amino acids, it is low in lysine and tryptophane, so that protein deficiency is common with a high corn diet. We have treated hundreds of children for severe protein deficiency. It is of interest to note, however, that we have seen fewer cases of marked malnutrition in the darker skinned, more pure blooded Indians than in fairer individuals of more obviously Spanish extraction. The predominantly Indian families, even when dirt poor and surviving on tortillas with chilies and salt, are often surprisingly hardy, the mothers producing ample milk and their children roly-poly. By contrast, impoverished Spanish mothers tend to go dry early. Their children, weaned on corn meal and water are often sadly malnourished. It is conceivable that the Indians, through a longer history on a high corn diet, have better adapted to it.

A significant breakthrough on the problem of protein deficiency with high corn diet
has recently been made by agronomists at Cornell University, who developed a hybrid corn called Opaque-2. This new corn, high in both lysine and tryptophane, supplies all the essential amino acids for human nutrition. Keith McFarland of Los Altos, California, secured four varieties of Opaque-2 for experimental planting in the barrancas. Dr. Donald Aitkin of La Honda, California, obtained for Project Piaxtla, a grant of $100 from the John Muir Institute for Environmental Studies, to conduct the planting experiment. At present, we have thirty experimental plots, some planted by plow and some with planting stick, in varying terrain from 1000 to 5500 feet in elevation. It is still too early to know the final results, but most of the corn is growing well and already producing ears. If Opaque-2 succeeds in the barrancas, it will make a tremendous difference in the nutritional level of the people.

EDUCATION

Each year for the past four years Project Piaxtla has sponsored the education away from home of a youngster from the villages, as well as continued to sponsor those
from the previous years. This year I had no particular student in mind, when one day
this summer a shy 14 year did boy, slight for his age, arrived at the clinic. I asked
him if he had come for medicine. He said not, and after a long pause, asked me if it
were true that I helped young people continue their education. The boy turned out to be Angel Alvarez Amarillas, of whom his teacher, Octavio, speaks with high praise. Last June, Angel finished sixth grade at the top of his class. He was eager to continue his studies, but the school in Ajoya goes only through primary school. Angel's family lives in a small rancho a mile or so from Ajoya, and is too poor to send the boy away to school. I asked Angel if he had relatives in San Ignacio. He said, "Yes, an Aunt." I
told him that if his aunt would provide food and shelter, I would cover his tuition for
secondary school, plus books, school supplies and uniform. Next day -- during which
temperatures rose to over 100º F. -- Angel hiked 17 miles to San Ignacio, consulted with his aunt and hiked back to Ajoya, arriving at dusk "a little tired" but happy to tell
me that his aunt had agreed.

It is anyone's guess what Angel will do with his education once he gets it, or whether as I hope, he will return to the villages to benefit his people in some way. But I do know that a boy as eager as Angel is worth a bit of investment.

Of the other young people whom Project Piaxtla has helped sponsor, Juan Sánchez is continuing school in Culiacán, and Martín Reyes and Miguel Mánjarrez are continuing school in San Ignacio. Miguel and Martín, who studied in the States for one and two years, respectively, returned to visit the U. S. A. this summer. In July, Miguel and I visited my father and brother in Cincinnati and New Hampshire. Martín, together with his 14 year old sister, Ynez, went to California. Ynez lived with the family of Thomas Prosser of Cupertino while Martín stayed at the home of Dr. Carlo Besio of Portola Valley.

Last June Dr. Besio, a veterinarian, together with his wife and children, brought a load of supplies from Palo Alto to Ajoya. The Besios helped Martín and Ynez get visas and drove them back to California. Martín, who has helped a good deal in the Ajoya clinic, apprenticed with Dr. Besio this summer in the Portola Valley Animal Hospital. What he learned will be of use in the treatment of animals in Ajoya, but will also help him toward becoming a medic for the people.

Dr. Besio and I have considered that a good way for young villagers to get training as backwoods doctors is for them to apprentice with U. S. veterinarians.
Physiologically, after all, man is an animal, and much of diagnosis and treatment in
veterinary medicine parallels that in human medicine, particularly in pediatrics. Even
if it were practical for a gifted young villager to apprentice with an M.D. (which for
obvious reasons it is not) in some ways the veterinary apprenticeship would be more
appropriate for a backwoods practice, in so far as veterinarians often do more of their
own lab and X-ray work. The other alternative of sponsoring a village youth through the entire educational hierarchy ending in medical school is impractical not only because of the many years and huge expense involved, but because it is so unlikely that a young man with a medical degree under his belt would return to the villages to practice. Forty per cent of Mexico's M.D.'s are in Mexico City. More than fifty per cent of the municipios (counties) are lacking in any qualified medical personnel whatever. Apprenticeship with a veterinarian is a far surer short cut, and Dr. Besio is eager to cooperate. Martín has a start. The potential, I believe, is enormous.

The cooperative corn bank, now under the management of Daniel Reyes of Jocuixtita, very nearly broke even this past year in spite of heavy crop damage by last
year's hurricane. This planting season the bank loaned 100 and 200 liter lots of corn
to more than 40 families.

The rain has to date been heavy and fairly regular, with the promise of bumper crops if it keeps up, and if there are no big wind storms. I would like to thank all those who bought the sets of prints of my black and white paintings of the Birds of the Sinaloan Barrancas. I thank, also, Robert Knudsen and all the others who, through donation of their time and skills, helped produce the prints at a minor cost. The sale of prints went well and provided enough margin in funds for Project Piaxtla to support a number of ventures which otherwise would have been unfeasible.

One such venture was to arrange and finance eye surgery for 60 year old Rosalío,
blind with cataracts. From the slums bordering the city of Mazatlán, Rosalío first came to the Ajoya clinic nearly a year ago. Word had reached that far of an American in Ajoya who gave sight to the blind, free of charge. (The reference was surely to Dr. Rudolph Bock, Palo Alto eye surgeon, who came in 1967, performed 55 eye operations in eight days, and in fact, restored the sight of three blind cataract patients.) We explained to Rosalío that although we wanted to bring the eye surgeon back, the Mexican government had blocked any further surgery by U. S. doctors, and our hopes for gaining permission were dim. Nevertheless, Rosalío stayed on the off chance. Martín's family, who live in the house of our clinic, took Rosalío in and he stayed for eight months, still hoping. At last, this summer, with the extra funds brought in by the sale of bird prints, I took Rosalío to the one good eye surgeon in Mazatlán to have his cataracts removed. Now he can see again.