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NEWSLETTER FROM THE SIERRA MADRE #8
JANUARY 1973

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

The participation of Dr. Kent Benedict, pediatrician from California, at, the Clínica de Ajoya for most of the past year and a half has been a great boon. Not only have the villagers received better medical care than ever before, but all of us amateurs who have had the opportunity to work with Kent have learned a tremendous amount from him about the practice of medicine, for not only is Kent a first rank practicioner, he is an inspiring teacher.

This last November, Kent returned to California to begin a practice in Watsonville, and although his loss is deeply felt at the Ajoya clinic, the young "medics" who work there, American trainees as well as village apprentices, are able to carry on far more competently for having had the opportunity to work with Kent. Insofar as Kent, or "Andrés", as he is better known in Ajoya, has been the Big Daddy of our medical program during the past year, it is only fitting that our friends who make Project Piaxtla possible, have a chance to hear from him directly. I particularly appreciate Kent's taking over the responsibility for this newsletter since I have put off writing one myself for far too long. Lately, nearly all of my spare time has gone into preparing the manuscript for the medical handbook for campesinos (which I mentioned in my last newsletter.) This "Guía de Medicina' is now about four fifths completed, with over 160 pages and 300 illustrations. Thanks to a contact made by Dr. Norman Sissman, who arranged the open heart surgery for Manuel Alarcón three years ago, Syntex Laboratories of California has offered to publish the handbook for us as a public service.
Before I turn over this newsletter to Dr. Benedict, I will give a brief resume of some important events which have happened in our clinics in the past year.

* * *

We have been fortunate in having a large number of U. S. physicians donate their services in Ajoya this past year. I will not mention each by name, but we are grateful to all. One of the most significant visits was that of Dr. Rudolf Bock with his wife, Trude, and sons, Oliver and Peter. Five years ago we were able to get government permission for Rudy to operate in the Centro de Salud of San Ignacio. A year later, however, a team of our American surgeons was forbidden to perform surgery by the Federal Department of Health, in spite of the fact that the State Government had made the invitation. It seems probable that we shall soon re-obtain official permission to conduct surgery in Sinaloa. Nevertheless, Dr. Bock's visit this last spring had to be what we euphemistically call "unofficial". He performed surgery on the back porch of the Ajoya Clinic in a "prefab operating theater" which George Dueker helped design and we set up the day after the Bock's arrived. With his teenage sons as surgical assistants, Rudy performed cataract surgery, muscle repositioning (for
strabismus), plastic lid repair, and. many pterygium removals.


Other doctors whose visits were notably worthwhile because each stayed for several weeks, during part of which time Dr. Benedict was back in the States, were Dr. Stan Hajduk with his wife, Gloria, and more recently, Dr. David Bushman with his wife, Jean. Dr. Bushman took over in Ajoya for awhile when Kent returned to the States this November. Apart from medical professionals this last year, we have also had the assistance of several American and Canadian youths, some of whom have stayed for several months. Especially able have been those who previously attended the crash medical training program set up for our volunteers by Dr. Donald Laub and his conferers at
the Stanford Medical Center. Within a short time, these young trainees have been able to
function with surprising medical sophistication. Outstanding in this respect this past year
have been. Dave Sklar and Bill Vogel, who ran the Ajoya Clinic by themselves for a month when
Kent was in the States. My special thanks, however, go to Terry Hotti, Oliver Bock, Mark Miller and Janet Ewing, not only for their contribution medically, but also for their friendly willingness to pitch in and do the vast amount of drudge work, maintenance and unglamorous cleanup, which, although mundane, makes up four fifths of the crucial work in a village medical project such as ours.

Janet Ewing, a pre-medical graduate who took crash training with Don Laub this summer and came to Ajoya in October, will be with us at least until spring. She is doing a superlative job in every respect and has already become a first class medic.

Speaking of first class medics, Allison Akana, who spent more than two years with us and
opened our third clinic in Chilar, decided a year ago to continue her education in the field
of medicine, a long haul, since she never completed high school. But she has done very well at
San Mateo Jr. College and this year she received a modest scholarship from the Peninsula
Hospital Auxiliary.

To further finance her studies, last summer Allison served as medical director for a group of students from the Athenian School Summer Program who participated in our village project during June and July. In turn the villagers, who have become as devoted to Allison as she is to them, managed to help Allison meet her school expenses by feeding the visiting students free of charge in their homes so that the funds provided for the student's food could also go toward Allison's education, as the villagers' donation.

* * *

Visiting doctor's wives, especially, will be relieved to hear that the Clinic of Ajoya at long last has a flush toilet, a cold shower and watertank which provides us (if we conserve) with running water around the clock.

The construction of these luxuries proved a horrendous task, especially the septic system and building of the brick watertower. The job was made more difficult because we had decided to
take it on during the hot summer monsoon season (when most of the village men are occupied
planting) thinking it would be a great project for the Athenian School students to tackle. With
this in mind, the school agreed to send us a group of husky boys with experience or at least
interest in building. You can imagine our surprise when, the day after they were due, a group
of one boy and seven girls, all disgruntled and exhausted from their long bus trip descended
upon us in Ajoya!..

"Where's the bathroom?"

"Well, girls, wha'd'ya say we make one:!" . . . .

But the girls, once they got over their initial shock (which took awhile), proved to have more pluck than they themselves had ever guessed. They swung picks blistered hands, wheelbarrowed sand and even laid bricks. What is more, their mere presence recruited more muscle and manpower from the village men, in spite of its being planting season, than we could ever have got otherwise. Indeed, I suspect that if the Athenian School had sent us an all male group of strapping athletes instead of these pretty girls, the heavy work would have taken twice as long.

The success of the construction project, however, rested largely with young Bob Steiner (son of Bob and Dorothy Steiner, who come to Ajoya several weeks each year). Employed as construction foreman of the Athenian student group, Bob did a heroic job of organizing and doing the brunt of the work. Although dying to help in the dental clinic (for he plans to become a dentist), Bob worked doggedly on the construction program because this was where he was most needed. To top it off, Bob donated his entire Athenian salary to the project:

Now I turn the newsletter over to Dr. Kent Benedict! Take it, Andrés!


* * *


INTRODUCTION

By Kent Benedict

Tonight the ocean mist encloses my small house. The cliffs above Monterey Bay are shrouded in a diaphenous watery veil and all is quiet except for the faint murmur of surf. For the first time in weeks I feel I can begin to reflect and write of my experiences in México.

In the spring of 1970, while still a resident at Stanford University Hospital, I chanced upon David Werner's Report from the Sierra Madre, which he wrote in his first year in the mountains of Sinaloa. The vitality and compassion of this remarkable document impressed me considerably. I was convinced I must try to journey to this beautiful and primitive region he was writing about. Thus, armed with a few ideas and a six week crash course in tropical medicine, I approached Dr. Herbert Schwartz, my department chairman, and explained to him what I wanted to do. I wanted to take my entire two and a half month "elective" period for a trip to the Sierra Madre. After a few minutes of discussion, he wholeheartedly agreed with my plans and soon I set the date for my departure. Two weeks later, I arrived in Ajoya.

Tonight, two and a half years and a few grey hairs in my beard later, I find Ajoya and the people of the barrancas still with me. Their understanding and love, I believe, will never completely disappear from my life. I recall how presumptious I had been to think that I was going to the Sierra to teach and help a people who had the misfortune of not yet benefitting from our technological miracles of the twentieth century. But, in the weeks and subsequent years, it was they, in their own wisdom and enlightenment, who became my teachers. A vital force flows through the hearts and minds of the villagers in the Sierra Madre, for they (and I, also, for a time) lived in a corner of the world where people are still in touch with the awe and mystery of life.

As a physician, trained in the science and technology of modern medicine, specializing in diseases peculiar to children, I thought myself more than adequately prepared for what I would face in the mountains. And this was true, but only partially so. When I returned to Stanford in the Fall of 1970, I began to feel a vague internal disquiet. I wasn't sure what it was at first, but slowly it dawned on me. Ajoya had shown me something I had never had a chance, previously, to see or understand. Ajoya had shown me the incredible pleasure a man can obtain from the practice of the art of medicine. The art of medicine is that timeless, eternal experience defining the common human bond which must exist between men for the healing process to take place. To practice the art of medicine, one must act upon the premise that healing transactions, first and primarily, are founded on a relationship of genuine trust and sharing. In Ajoya, I found this relationship.

Upon completing my work at Stanford in the summer of 1971, I vowed to return to Ajoya and spend at least a year living with my new found friends. The three short stories in this newsletter only touch the surface of the many incredible events of the past year. There are dozens of others which could be, and perhaps someday will be, written.

I would like to dedicate these stories to my friends of the Sierra Madre and also to the small group of remarkable American youths who chose to share with me the profound joys and sorrows of our primitive medical clinic. But above all, I must dedicate my few thoughts and words to the family of Ramona Alarcon and her grandparents, Rosaura and Gregorio. For almost the entire year, they shared their daily life with me. Their unbelievable warmth and giving opened the door to experiences otherwise totally unavailable. The beauty, the pain and the suffering of their lives became mine. And through them, I believe I have had the chance to grow.

DAWN IN AJOYA

Imperceptably, I sense the end of night. Slumber and sleep toss fitfully on the canvas catre. Inner comfort is being shaken by an external reality. For an hour I have been aware on a deep semi-conscious level of a change. Night is becoming day and I am once again being reborn. The birth labor of the Sierra dawn transports me relentlessly onward through the dark caverns of my mind. Ahead I glimpse a faint glow. It disappears and then reappears again. It moves. I change direction to follow it . . . Shrill crowing of a lone rooster and my dream dissolves in a flash of light and color. I am awake.

The hot blinding floodlight of the morning sun slices through the iron window bars, burning off the night chill of the old attic. Bright patches of flame on wall and floor. Below, the muddy dirt street muffles shouts of the village children as they scurry along on their morning errands, clutching small packages of hot tortillas or miniature kettles of milk. I don't have to go to the window to see it, for the experience of hundreds of such mornings allows me to lie unmoving in my attic bed, visualizing it all. I hear old Goyo and his son, Francisco, starting their day's work in the blackshmith shop. Slow creaking rythm of ancient leather bellows punctuated by the bite of steel hammers crashing down on the glowing iron. It ceases momentarily. The first of this day's horseshoes is finished. I lie there, realizing my dream of dawn has replaced my night dream. I close my eyes again, trying to remember, trying to recapture the dream of night. What did it mean? Did my mind conjure it up to help explain the events of the past few days?

A soft hand touches my shoulder. Startled, I turn. There, standing over my catre is Ramona. Absorbed in my thoughts, I had failed to hear her footsteps on the stairs.

"Andrés, ¿quiere cafe?" she asks gently. "Ya es muy tarde?", I reply, still shaking the cobwebs from my eyes. "No, it's still early, but I thought you might like some coffee. I know you haven't had much sleep the past few days and you would like to sleep late this morning, but Juan Queveda has been waiting almost an hour to see you."

"Juan?"

"Yes, I think it's something to do with the coffin." She turned her head away as she handed me the hot cup. "He is a good man, you know."

I know. My hand reaches up and touches hers. "Gracias, Mona", I call after her as she leaves. Dressing quickly, I gulp down the coffee and descend the stair. I can't remember the first time I met Juan. I knew his wife, Narcisa, long before I ever saw him. When was it . . . perhaps two or three years ago when I first came to the Sierra to work with David? Those few months in the summer of 1970 remain blurred in my memory. Days of broken dictionary Spanish and medicine being practiced in a primitive village clinic. Narcisa was part of that experience, I'm sure. She and Juan lived on a small rancho about three hours walk from Ajoya. I remember her as a very poor, yet a beautiful and proud woman, always with a hopeful smile on her dark moreno face. She made a few visits that summer primarily to have her young children, Guillermo (age 2 then) and Nasario (a few months old) treated for various diarrheas and colds. But I never saw Juan.

Crossing the muddy street, I walk toward the clinic. I remember last spring. In the dry heat of that long season called "las secas", the villages of the Sierra Madre were struck by one of the worst encephalitis epidemics of years. Mules and horses died and entire village families suffered for days with severe headaches, seizures and coma. Miraculously, only one person died . . . but that one death stood out so strikingly that in retrospect, it seems hard to believe I missed the significance of it. It was early one morning in February that I first saw Juan Quevedo. A short, dark man in fading patched denim trousers and an old white shirt, he came rushing into the clinic with his four year old son, Guillermo. All morning, he had been walking from Guisache to bring his stricken son for help. He stood in the doorway, still out of breath, the small limp figure in his arms.

"Andres", mi hijo está muy malo. Por dos días ha tenido calenturas. Ahora, le pego un ataque y no anda ni habla nada." ("Andres, my son is very sick. For two days he has had fevers. Today a convulsion and now he doesn't walk or speak at all.") Rapidly, I examined the child. There was no question he was gravely ill. Completely comatose and unresponsive to any verbal or painful stimuli. His pupils reacted to light, but the examination of his fundi revealed increased intracranial pressure. A swollen brain, secondary to an infection could. explain it all. Encephalitis! I didn't dare do a spinal tap (a procedure whereby a needle is placed in the back and the cerebral spinal fluid. is examined directly, but which can be extremely dangerous or even fatal when the brain pressure is increased.) We started an I.V. Almost by reflex, the steel needle entered the vein and was secured in place with tape and. an arm board. Dextrose water slowly dripped from the inverted bottle. But suddenly, Guillermo grimaced and began grinding his teeth. His right leg began to twitch and then his right arm. Within seconds, his whole body was caught up in the terrible spasms of the siezure. Helpless, as if in the grip of an unseen monster, the small frail body convulsed and twisted, tearing loose the leather huaraches on his feet. The knuckles of his hands blanched under the pressure of his tightly
clenched fists. One c.c. of valium swiftly spurted from the needle and into his vein. Moments
stretched to eternity as his tormented body began to respond to the medication. Ever so slowly
the spasms relaxed and his breathing eased. Color flowed back into his white fists. And it was
over. Yet, for three more days and nights the convulsions returned again and again, and in the
middle of the third night, little Guillermo Quevedo died. Juan and Narcisa were both by his side
at his moment of death. Their brave stoicism broke down into tears of grief as we built the
makeshift bier on the clinic's old kitchen table. The candles were placed and lit. Fresh cut
wildflowers formed the bed upon which the small body rested through the long cold February
night. And the next day, Juan built the coffin.

The clinic is still dark in the early dawn as I enter. As those events of six months ago linger in my mind, I catch a glimpse of Juan in the courtyard. Today, Juan will build another coffin. And tomorrow, his youngest son, two and a half year old Nasario, will be buried.

"Buenos días, mi amigo", I say, taking the three steps down into the patio.

"Buenos dias", replies Juan, turning to face me, his dark eyelids swollen from the sleepless nights.

We say nothing more as I walk to the woodshop, pick out a hammer, saw and some nails. I hear Juan's tired voice behind me. "Just a few small pieces. He wasn't very big."

A thin beam of light pierces the old and cracked tile roof as I look at the pile of wood, picking out some pieces.

"Andres, I know you told me last night, but I wasn't listening very well. What did Nasario have?"

"Tuberculosis. A very severe type that infects the brain." I still am looking at the wood.

"And Guillermo?"

"Juan, your son, Guillermo, died of the same disease. I am sure of it now."

"But, how . . .?"

"Remember those skin tests we put on your family last week . . . well, Narcisa and your two other children had such a reaction they almost lost their arms. Last spring, I thought Guillermo had viral encephalitis. I had no idea it was tuberculosis. At times, when someone is very sick with tuberculosis, his skin test can turn from positive to negative. Both Guillermo and Nasario had negative skin tests. Yet, they both had overwhelming tuberculosis. And Nasario was beginning to respond to the medicines before his fatal convulsion last night . . .” I stop talking when I realize I'm talking more to myself than to Juan. I hand Juan the wood.

"And that is what Narcisa has also?", asks Juan, a trace of fear on his face.

"Yes." Then I quietly add, "That's what she has, too, and that's why she's getting her injections." We look at each other for a moment. The fear is still there. I continue looking at Juan. I am not a coffin maker. Slowly, I add, "But Juan, she is going to be fine."The look of fear lingers, then dissolves into a broad smile.

"Si Diós quiere."

And that makes all the difference.


* * *


THE EL ZOPILOTE DIARY

And the cigarettes are gone. A strange thought for so early in the morning, but not unpleasant. Now that I'm at El Zopilote, cigarettes and civilization are distant and of the past. Yesterday morning I awakened in Joquixtita. The morning before in Ajoya . . . but today the light of dawn came soft and white, reflecting off the wet pine needles of the high sierra.

The day I left Ajoya, I slowly packed the saddle bags and said farewell to my friends. My bridles and cinch checked, I mounted the mule and rode out of the village, alone at last. An hour's ride and two shallow fords later, I came upon Louis Bueno and his ten year old son, Herman. Louis's eldest daughter, Valeria, with her five year old son, Marcos, were also with them, a little farther ahead. We stopped and talked for a few moments and I offered to join them on part of their trip to El Verano, not far from El Zopilote. We quickly decided that our common destination for the night would be Joquixtita. So we set off together, the five of us, with three mules and two burros. For hours we traveled, moving slowly up the river, crossing and recrossing it over twenty times. At three in the afternoon, we reached Bordontita, a small settlement of a dozen casas, which marks the gateway to the higher mountains. After stopping briefly for a lunch of frijoles and tortillas, we remounted and pressed on. The afternoon sun disappeared behind a cloud, reappeared for a moment and finally sank below the western mountains behind us. The trail became increasingly narrow and steep. Beginning our final ascent of over four-thousand feet, I realized the most difficult part of the journey, as well as night, would soon be upon us.

For over four hours, we continued to push the mules onward through the black night, frequently stopping to check our route by the dim starlight. Fireflies flashed in the darkness, giving the scene a dreamlike quality. At last, after twelve hours on the trail, we reached Jocuixtita. I had planned on spending the night in Daniel Reyes' house, or perhaps, with my friend, Fausto. But my chance of finding their casas in the night were slim. The village was, for the most part, silent and asleep. I asked Luís where he would spend the night. "With family," he replied. I told him I would go my separate way and see what I could find. At that point, I had little idea of exactly where I was, but I did see one faint light shining through the trees and rocks and decided to head for it. Coming to the edge of the clearing, I saw a small adobe house, the kerosine lamp hanging from what appeared to be the open portal of a kitchen. Standing in the doorway was a young woman, perhaps in her late twenties or early thirties. Immediately, she struck me as being incredibly beautiful . . .but then, again, I was saddle sore and exhausted, and I suppose anyone would look good after twelve hours of riding a stubborn mule.

Slowly, I rode out of the darkness, hesitant to say anything. The woman turned her head ever so slightly. Unmoving, she stood there, staring, looking me over very carefully. I greeted her with a simple "Buenas noches . . , por favor, donde estoy?" (Good evening, where am I?)

No reply. Her gaze remained fixed on me. As I continued to wait for her answer, I noticed four silent men standing in the shadows near her. I began to feel uneasy. Still saying nothing, she picked up the lamp and walked toward me. She halted, four feet away. My skin began to crawl with fear as she lifted up her lamp to my face. Then she spoke, "Andrés? . . .?"

To say the least, I was shocked, for obviously this woman knew me: But where . . .? I struggled with my sluggish memory. And then . . . of course: In a flash of recognition, I smiled confidently, "María, Maria Delgado."

She laughed and thrust her hand forward to take mine. "A sus ordenes." For it was María Delgado, a woman I had met the year before at E1 Zopilote. The woman who was considered by many villagers to be a witch. Well, if so, she looked like the good witch to me. After our brief, but enthusiastic exchange of greeting, she turned to the men in the shadows and told them to unsaddle my mule and get my bags into the house. Soon, we were all sitting about the kitchen's cooking fire, laughing and joking.

Rising early the next morning, I rapidly devoured the tortilla and chicken soup breakfast, thanked Maria for her hospitality, and headed for Fausto's house. Sure enough, there was my mule, eating some old corn stalks in front of the house. Fausto was sitting on the veranda, watching. We greeted each other, chatted for a few minutes, smoked a cigarette and then said our good-byes. I was eager to be on my way,

The ride from Joquixtita to El Zopilote is truly the most beautiful part of the trip from Ajoya. Although only an hour and a half long, it includes spectacular views of flower carpeted hillsides and jagged gray granite escarpments of the High Sierra. The trail climbed slowly out of the Arroyo de Jocuixtita and gained a high ridge. Soon, I was riding easily along a level path, deep in the pine-oak forest. An hour later, I reached El Zopilote.

E1 Zopilote . . , to feel the breath of life whispering softly in my ear: To smell the soil drinking in the afternoon thundershower. Lightning leaps from a cloud to peak across the great deep valley. And then . . . it's finished, and all is once again a whisper.

Each day now, Carmela, with her infant son and her eleven year old daughter, Luisa, climb the trail from El Llano in the valley and come to visit. But not completely for pleasure. The infant, barely four months old, has severe pneumonia. Three days ago he was wracked with coughs and fever. Day before yesterday, he stopped eating. But today, after two days of penicillin, he is afebrile and is once again eagerly at her breast. I think he'll be O.K.

Carmela has insisted on helping around the house. Yesterday, she and Luisa carried over eight bucket loads of water from the spring, a few hundred feet down the trail. She takes great pride in the garden and it is thirsty, requiring much water. She is also bringing food . . . chicken and some tortillas. Very welcome since the provisions in this isolated log cabin are meager. I have to rely completely on the people for food. They give generously; not a person comes who does not bring at least a morsel. I now have an ample supply of pork meat, eggs, oranges, apples, empanadas (squash turnover?), wild bee's honey, cheese and, of course, tortillas. All my meals, I prepare myself over the open wood fire. Firewood is plentiful right now, but I can see that soon the axe will be required.

Fausto dropped by the other night, an hour after dark, just as I was preparing to go to bed. He spent the night and we talked, smoked Fausto's last two cigarettes and shared some cups of hot chocolate. (I really wish I had brought some coffee).

It's nice here alone. I am enjoying the solitude immensely. Seeing an occasional patient. Reading the poems of Robert Frost. Writing off and on when I want to. And for the first time in months, I have been able to spend time studying Spanish.

The other evening, I went up the hill above E1 Zopilote to watch the sunset. Looking across the deep blue green valley below, my gaze was lifted to the majestic mountain peaks of the High Sierra, rising sharply out of the pale valley mist.

I felt like the last man on earth . . . or perhaps the first?

It is evening, cool and quiet. Two days have passed since I last wrote. Much has happened. As I sit here in the lofty crow's nest of the mountain dispensary, writing by kerosene lamp, I reflect on the events of night before last.

Darkness had surrounded the mountain and I was reading by the subdued lamp light. While preparing for bed, my ears caught the faint sound of barking dogs across the distant arroyo. This almost always signals the arrival of someone. I waited. Fifteen minutes passed, and then I heard the heavy hoofbeats of horses coming hard up the trail. Quickly putting on my huaraches, I opened the trap door and climbed down out of the crow's nest and ran to the front patio. Horses and men were waiting. They were from Jocuixtita. Breathlessly, they told their tale. A young girl, the wife of one of the men, had been walking back to Jocuixtita after an afternoon of gathering wildflowers. In her arms, she had been carrying her three month old son. As she passed along the cliffs above the village, she lost her footing, slipped and fell over forty feet to the rocks below. Miraculously, the infant was unhurt, but she apparently had suffered multiple facial and head cuts and a broken arm. This had all happened less than two hours before and the men were dispatched an hour later.

Grabbing a saddle bag, filling it with bandages, plaster, demerol, syringes and other medicines, we left for Joquixtita. The trail was obscured by the darkness, but the animals knew their way instinctively. An hour later we were in the casa of Andrés Pereda and I had a chance to see the extent of Raquel's wounds. The cuts and scratches about her face were not bad and no sutures were required. But her arm was another story. She had a nasty fracture of her right wrist. It wasn't easy to reduce, but finally after 100 mgs of demerol, it was set. Secured in plaster, bandaged and sedated, she soon fell asleep. By then it was past midnight and a stiff chill wind was blowing. I gratefully accepted her family's invitation to spend the night.

The next morning, I checked Raquel. She was feeling a bit better, and so I decided, to find Fausto. After breakfast at his house, we left for the mountains. This was the day he had chosen to pick the beans in the field high above the dispensary. He worked the slope most of the day while I saw a few patients. Luis Bueno had comelup the mountain from El Verano to tell me his grandson, Marcos, who had ridden with us from Ajoya, was sick with a fever and a large swelling under his arm. I sent antibiotics and promised to go to E1 Verano in a day or two if there was no improvement. He assured me he would return the next day to inform me of Marcos' progress.

Later in the afternoon, Carmela came up the trail with my clean clothes. What a pleasure to change into some fresh pants and a clean shirt: A feeling of celebration came over me as I searched for David's old battered phonograph machine and put on a record. It happened to be Tchaikowsky's Fifth Symphony. I was just getting down into the first movement, when I noticed that Carmela, and the half a dozen children with her, were staring at me, blankly. A little embarrassed, I asked, "No le gusta?"

"Si . . .", she smiled broadly. "But is that music?" Always a lady. Quickly I searched out another record. An old scratched and warped disc of Mexican Rancheros caught my eye. I put it on. Within a few minutes everyone was singing along with the record. When Fausto returned from the bean field, he joined in on the fun and showed the kids a couple of magic tricks. It was a good day.
I felt like the last man on earth . . . or perhaps the first?

It is evening, cool and quiet. Two days have passed since I last wrote. Much has happened. As I sit here in the lofty crow's nest of the mountain dispensary, writing by kerosine lamp, I reflect on the events of night before last.

Darkness had surrounded the mountain and I was reading by the subdued lamp light. While preparing for bed, my ears caught the faint sound of barking dogs across the distant arroyo. This almost always signals the arrival of someone. I waited. Fifteen minutes passed, and then I heard the heavy hoofbeats of horses coming hard up the trail. Quickly putting on my huaraches, I opened the trap door and climbed down out of the crow's nest and ran to the front patio. Horses and men were waiting. They were from Joquixtita. Breathlessly, they told their tale. A young girl, the wife of one of the men, had been walking back to Jocuixtita after an afternoon of gathering wildflowers. In her arms, she had been carrying her three month old son. As she passed along the cliffs above the village, she lost her footing, slipped and fell over forty feet to the rocks below. Miraculously, the infant was unhurt, but she apparently had suffered multiple facial and head cuts and a broken arm. This had all happened less than two hours before and the men were dispatched an hour later.

Grabbing a saddle bag, filling it with bandages, plaster, demerol, syringes and other medicines, we left for Joquixtita. The trail was obscured by the darkness, but the animals knew their way instinctively. An hour later we were in the casa of Andrés Pereda and I had a chance to see the extent of Raquel's wounds. The cuts and scratches about her face were not bad and no sutures were required. But her arm was another story. She had a nasty fracture of her right wrist. It wasn't easy to reduce, but finally after 100 mgs of demerol, it was set. Secured in plaster, bandaged and sedated, she soon fell asleep. By then it was past midnight and a stiff chill wind was blowing. I gratefully accepted her family's invitation to spend the night.

The next morning, I checked Raquel. She was feeling a bit better, and so I decided, to find Fausto. After breakfast at his house, we left for the mountains. This was the day he had chosen to pick the beans in the field high above the dispensary. He worked the slope most of the day while I saw a few patients. Luis Bueno had comejup the mountain from El Verano to tell me his grandson, Marcos, who had ridden with us from Ajoya, was sick with a fever and a large swelling under his arm. I sent antibiotics and promised to go to El Verano in a day or two if there was no improvement. He assured me he would return the next day to inform me of Marcos' progress.

Later in the afternoon, Carmela came up the trail with my clean clothes. What a pleasure to change into some fresh pants and a clean shirt: A feeling of celebration came over me as I searched for David's old battered phonograph machine and put on a record. It happened to be Tchaikowsky's Fifth Symphony. I was just getting down into the first movement, when I noticed that Carmela, and the half a dozen children with her, were staring at me, blankly. A little embarrassed, I asked, "No le gusta?"

"Si . . .", she smiled broadly. "But is that music?" Always a lady. Quickly I searched out another record. An old scratched and warped disc of Mexican Rancheros caught my eye. I put it on. Within a few minutes everyone was singing along with the record. When Fausto returned from the bean field, he joined in on the fun and showed the kids a couple of magic tricks. It was a good day.


* * *


THE CLINIC OF EL POTRERO


"One more manojo and it's finished," called Esteban, his voice cutting like a knife through the cold winter air. I turned towards the tasalera. At the very peak of a twenty foot tower of corn stalks stood old Esteban Sanchez, looking like a great eagle perched on his mountain nest.

"Come on Andrés, the last one!" he cried again.

This time I reached down for the remaining bundle, then quickly looked up and sent it flying to the top of the stack. Skillfully he packed it in place and scampered down. Together we stood in the chilled sunlight, silently admiring the results of a morning's work. Enough feed to keep the mules healthy for the entire winter. As we stood there, gazing up at the golden stack, I found my attention drawn to even taller peaks rising majestically in the distance. The High Sierra Madre loomed above us, beautiful and beckoning. A mammoth wall of rock and trees. Lifting its craggy granite face higher than all the others was one particular mountain . . . so tall its peak was perpetually hidden in clouds . . . so massive that all nearby giants paled in comparison . . . so magnificently beautiful: Without a word from me, Esteban sensed my thoughts.

"San Rafael," he said quietly.

I repeated the words softly to myself. "San Rafael, San Rafael. Que linda esta su cara!" Lost in the splendor of the moment, I imagined myself an eagle, lifting my feathered body off the tasalera, soaring higher and higher, gaining great altitude, looking down upon the green pine forested wilderness, flying onward. toward the High Sierra. Suddenly a blast of chilled wind caught ray wings, bringing me back to reality. Once again I was standing next to Esteban in the garden of E1 Zopilote. Yet as my fantasy faded, I realized how much I desired to see the Sierra. Little did I realize how soon my chance would come.

The next day I had a visitor. It was Gilberto Medina, a campesino from the state of Durango, and he had brought a large package from Ajoya, containing urgently needed medicines and supplies. While we unpacked the box and placed the medicines on the clinic shelves, I asked Gilberto about his journey. He was on his way back to his village of El Potrero, an isolated area high in the mountains. Our discussion turned to the topic of medicine and Gilberto related to me the many problems of his people, including the sad tale of an old man suffering from a disease which sounded suspiciously like leprosy. My curiosity was aroused. I looked at Gilberto and asked him exactly where his village was. With a smile on his face he made a sweeping gesture with his arm and pointed his brown gnarled hand. toward the distant peaks and said, "Up there, beyond those mountains." His smile broadened as he continued, "It is a beautiful country, Andrés, cold and fresh." His gaze steadied on me. "Do you want to see it?" Unable to hide my enthusiasm, I quickly agreed and soon we were busily making plans for the journey.

The next morning broke cold and clear. After a quick breakfast of warm oatmeal and hot chocolate, I set off to find Big Red. Big Red is my eight year old mule. Although she looks strong and capable, I have come to know her as the slowest, laziest mule in the mountains. When riding Big Red, time loses all meaning. A short two hour ride on any other mule becomes an all day journey of frustration on Big Red. She has never, never galloped in her life. Her strong flanks and withers shudder at such ideas. Just to trot seems an unnatural act for my great steed. Trot indeed: She doesn't even walk: She plods: And how well I know her plodding pace, drooping head, her baleful brown eyes, half closed by her eternally heavy eyelids.

I had warned Gilberto of Big Red's slow pace, but he shrugged off my warning, assuring me that even a slow mule could make it to his village in less than ten hours. Gilberto's confidence did little to calm my apprehension as we prepared to depart. After an hour of packing and saddling, we set out for the trail to Durango. All morning long we traveled. At noon we met Gilberto's fifteen year old son, Pablo, and his seventeen year old nephew, Ernesto Medina, who were waiting for us at a trail junction, We continued on. The dirt trail was steadily getting steeper, requiring us to dismount every few minutes to lead the mules around huge fallen timber and boulders. And, as I had predicted, good old Big fled was the slowest of the bunch. Refusing to move faster than her painful plod, she trudged along the trail, halting to examine every tree and rock we passed. The hours slipped by. Fifteen miles of rugged riding and walking finally brought us to the very crest of the Sierra. We were now four
thousand feet above E1 Zopilote, standing on the great divide of the Sierra Madre. Below us to the west lay the blue haze of Sinaloa. To the east, the rugged mountain peaks of Durango. It was three in the afternoon, but we still had over seven hours of hard riding ahead of us. Great gray thunderheads were beginning to form on the horizon as the cold wind moved through the lofty pines. By dusk, the sun and sky were totally obscured by black clouds and we were now in the heart of the mountains with four hours yet to go before we would arrive at any human settlement.

Gilberto led us down a dark, dank canyon and soon we were settled in around a large campfire. Above us, in the topmost branches of the huge trees, the wind continued its mournful cry. While the mules foraged in the woods, we heated up the last of the tortillas Pablo and Ernestro had brought with them from Joquixtita. A few small scrub bushes of limoncilla were found near camp and we brewed up a delicious pot of herb tea. Yet our forest camp was a far cry from cozy. The wind kept up its howl and, frequently, short silent bursts of snow fell on us. At last, the long awaited morning finally came. Chilled and bone tired, we repacked and set out for El Potrero. At noon we arrived.

El Potrero is a small settlement of a half dozen wooden casas, spread out over a hundred acres of forest at the mouth of a canyon, and is home for the large Medina family. Gilberto's grandfather came to E1 Potrero seventy years ago and built his first casa out of hand hewn pine and oak. The other casas have all been built the same way. In the immediate area, there are a few other small settlements of people, but no real village. Perhaps five hundred people live in the twenty square mile region.

Soon after our arrival, the weather turned completely sour. Ice cold sleet came screaming out of the mountains. For more than twenty hours the weather kept us inside Gilberto's kitchen, forcing us to stay close to the fire. Adults, teenagers, children of all sizes, and an occasional pig or dog, all crowded into the single smoke filled room. In the midst of the crush of human bodies worked Socorro, Gilberto's young wife. Frijoles, tortillas, soups and chicken poured forth from her open cooking fire. Occasionally the rain slowed enough for a few of us to make a run to the grain storage shed, which we were fixing up into a small clinic. The task of converting a shed into a clinic really wasn't all that much . . . we dug a fire pit in the floor, brought in an old burlap catre for an examining
guerney, built a small wooden table for medicines and equipment, swept the dirt floor and finally shooed out the chickens and pigs. That was it.

By morning, the storm had gone. The clear crisp dawn brought patients from miles away. Fifteen patients were seen before breakfast. But what a difference in diseases compared to what I had been used to in Ajoya and E1 Zopilote. In the valleys and canyons of the Rio Verde, there is still much malnutrition, epidemics and untended infections. But here, in this remote valley of the High Sierra of Durango, live people who have never had even the most rudimentary health care. One after the other, patients came to the grain storage shed in search of remedies for every kind of disease imaginable. We saw massive goiters as large as pumpkins; sores and wounds which, for lack of treatment, had been festering for weeks or even months in some cases; pellagra and malnutrition in even small children; two cases of Kwashiakor (a form of severe protein-calorie malnutrition); and leprosy.

The good weather held for almost two days and the stream of human illnesses continued to pour into E1 Potrero. Each person, no matter how poor or destitute, brought some gift of appreciation. Chickens, eggs, honey, wild fruits and vegetables were carried to the clinic for Socorro and the other women to fix into splendid meals for the rapidly growing crowd. By the second day I had seen over a hundred patients and pulled almost forty teeth. And at last, my medicines were gone and everybody had been seen. The crowds departed and once again we were alone at E1 Potrero. That evening, Gilberto and I went for a walk down to the creek to talk and watch the sunset. The next morning, I was going to have to return to E1 Zopilote. As we talked, I could hear the soft rasping sound of the corn husks in the light evening breeze. The sun dropped slowly behind the western hills, flashing colors upon the crags and peaks above us. Gilberto talked of his family and his love of these mountains. Yet his words seemed no match for the natural splendor about us. For over an hour the colors reflected off the high mountains, bright yellows dissolving into oranges and blood reds. All was darkening into a deep purple as we walked back to El Potrero and I knew that some day I would return to this place of beauty in the High Sierra.



"The Children of Ramiro Arriola"
by Dale Crosby from a photograph by Kent Benedict