The paperwork and red tape in arranging passports and visas is by far the biggest difficulty in bringing patients to the U.S. Documents one needs are endless. To make it harder, one must go to Culiacán for the passport, then 150 miles south to Mazatlán for the visa. At best, the procedures are involved and time consuming, but inevitably there are special difficulties. One six-year old cleft lip patient had never had his birth registered, which caused many problems, including paying a fine. Another child was in the same boat except that his mother gave us the birth certificate of an older brother who had died; this sufficed. The biggest problem of all we had with Agustina, who turned out to be “Utiquía” according to her birth certificate and “Eustaquia” according to her baptisimal records. We began to arrange her papers as Utiquía, only to find that termites had destroyed the public registry and we had to use her baptismal records, and get any new records for her as Eustaquia. At Stanford Hospital, however, she remains Agustina, for I had already sent in that name. But most important is not who she is, and – thanks to the surgery, she’s fine.

Not only have Dr. Donald Laub and his department at Stanford cooperated splendidly in performing surgery for Project Piaxtla, but along with the Clinical Laboratory and Emergency Room Staff have been of enormous help in arranging special training for project volunteers. In the early days of Project Piaxtla, Don arranged that I observe and “apprentice” at the Stanford Emergency Room. Four years ago, Chris Walker apprenticed in the Stanford Labs and then set up our basic laboratory, in Ajoya. Later, Bob Steiner spent months apprenticing at the Stanford Lab and picking the brains of the staff, so that when he came to Ajoya he was able to expand our make-shift lab considerably.

We began to arrange her papers as Utiquía, only to find that termites had destroyed the public registry

Recently, two pre-medical. students at Stanford, Bill Gonda. and Phil Mease, have committed themselves to spending the better part of a year in our clinics. In preparation, they spent the spring quarter at Stanford receiving special training. Don Laub pulled strings to get them into special courses in the Medical School, including a course in Emergency Trauma taught by himself. He also made arrangements for the boys to observe in the Emergency Room at San Francisco General, where emergencies tend to be more frequent, more messy, and hence more educational than at Stanford. Phil and Bill also apprenticed at the Stanford Clinical Lab, where they learned to perform and interpret a wide range of tests and procedures. The boys arrived in Ajoya at the beginning of summer and in my opinion have been doing a superlative job. In our primitive clinical situation, Phil and Bill, with only one quarter of specific paramedical training are in some ways more capable than some of the fourth-year medical students who have helped us. The boys' training has been specific, limited, and to the point. They are not bogged by a maze of not always appropriate theory. They rely less on complicated equipment, esoteric lab reports, scrub nurses, medical superiors, and a pre-sterilized field, but are able to improvise their own simple tests and make the most of the limited resources and knowledge available. They are, in short, more adaptable and more self-reliant. By contrast, medical students, suffering perhaps from academic overexposure, too often approach a patient as if they were taking rather than making an examination. Their nervousness is picked up by the patient, who, if a villager, looks more to his medical man’s bearing than his background, in which case the student loses half the battle before he starts. Still and all, medical students who have worked with us have contributed a great deal.

Soon medical students may be helping us on a regular basis. Dr. Larry Schneiderman of the Department of Community Medicine, U.C. at La Jolla, has visited our clinics and is eager to send us students, as a service project as well as exposure and a learning experience for the students.

Dr. Kent Benedict, a young Stanford Pediatrician, who spent the summer of ‘70 with us is planning–if he gets his draft status as a conscientious objector–to volunteer a full year at our clinics, beginning in November. This will be a tremendous boon for the project. Backed by medical students and lab techs we should be able to provide more complete consistent medical care than ever before. Kent is trying to raise funds independently for his own expenses, as well as to solicit medical supplies. He has already obtained promise of 6000 tetanus vaccines, which will allow us to vaccinate far more extensively than before.