by Margaret Regan
Photos by Jay Rochlin

Six-year-old Eneyda Guadalupe Montes of Nogales, Sonora, waits nonchalantly on a desktop while a volunteer technician checks her prosthetic legs. Born without feet, Eneyda had surgery courtesy of St. Andrew’s at the age of nine months. As she grows the clinic periodically refits her with larger artificial limbs.

On a dark winter evening in the village of Huatabampo, at the southern tip of Sonora, Mexico, a mother and daughter board a bus. They’ll ride north through the night, arriving at the border just after dawn.

The arduous 10-hour bus trip is worth it, says the mom, Rosa Amelia Martinez. It’s the only way to get to St. Andrew’s Children’s Clinic, a nonprofit medical clinic run out of an Episcopal church on the other side of the border, in Nogales, Arizona.

“This is very complete, it’s the best clinic,” Martinez declares, speaking in Spanish.

For the last 30 years, “la clinica,” as the families call it, has been offering free medical care to impoverished Mexican children with serious illnesses and disabilities. Held on the first Thursday of each month, the clinic is staffed by an all-volunteer team of some 40 doctors and other medical pros, a large majority of them UA employees, students, and alumni. Together these volunteers treat up to 300 patients a month.

“We couldn’t do it without the UA,” says Anne Bolzoni, executive director of the clinic, which over the years has treated an estimated 25,000 children.

Every month, on clinic day, hundreds of children and their parents line up outside the church as early as 6 a.m. The border checkpoint gets a monthly list of all the kids with appointments, and they’re admitted to the U.S. on waivers for medical treatment. Volunteers pick the families up at the border and drive them in vans the short distance uphill to the church.

By 9:30 a.m., swarms of people are squeezed into the intake room and every corridor and corner of the church. Dozens of kids are in wheelchairs, and others walk unsteadily with canes. Kids with Down’s syndrome, spina bifida, cerebral palsy, and neurological disorders are alongside children who can’t see, can’t talk, can’t hear, or have no legs.

“The church hosts the clinic,” explains executive director Bolzoni. “We get tremendous volunteer support from the church but we’re nonprofit and nondenominational.”

Nevertheless, one day a month, the church building literally becomes the clinic.

Orthopedists see patients in a Sunday school room, and a nutritionist presides on a couch in a lounge. Tucsonan Dennis Leal hammers a child’s prosthetic leg into shape at a workbench in the library, and up the hall physical therapists encourage kids to roll on colorful mats, their wheelchairs temporarily abandoned in a corner. Even the church sanctuary doubles as a medical office — for blind children getting training on Braille machines.

In the pediatric clinic, Maria Eugenia Piña and her colleagues stuff themselves behind card tables jammed in a row in a narrow corridor. Piña is a Nogales native who earned her bachelor’s and M.D. at the UA. She starts her day with a 15-year-old who has epilepsy and her mom. The mother, Patricia Lujan, explains that their hometown of Agua Prieta has no specialists who can treat her daughter’s condition, so they’ve come to St. Andrew’s, making a four-hour journey by bus.

“What medications is your daughter taking?” Piña asks in Spanish.

The worried mom nervously opens a bag and spills a half-dozen bottles of colored pills onto the table. Piña examines the meds, looks up at the woman calmly, and gently speaks to her in Spanish. Both mother and daughter break out into smiles.

In the orthopedic clinic, chief of staff Francisco Valencia treats kids and parents with compassion, joking with the little ones and reassuring the adults as much as he can. He rolls a tiny ball across the floor to a patient’s healthy little brother and pats the patient, a boy with splayed legs and thick glasses, asking him in Spanish, “How are you, mijo (my son)?”

Another Nogales native, Valencia went to Stanford as an undergraduate, earned his M.D. at UC San Diego, and came to the UA for his surgical training. Now once again a St. Andrew’s volunteer — he started as a 16-year-old interpreter — he helps train the UA medical students who turn up each month. The students usually are fulfilling a community service requirement, the Commitment to Underserved People, or CUP.

“They learn how to interact,” Valencia says of the fledgling docs, taking a quick morning break after he’s looked at a host of children with twisted spines, mismatched limbs, or both. “The empathy has to come through — talk to the patient, lay on hands, be gentle. The kids are scared. They’re in a foreign country in addition to dealing with their medical condition.”

Valencia turns his attention to a 14-year-old girl who’s come from a group home in Imuris, Sonora. Elsa Moreno is curled up on an examining table, glancing fearfully at the team of men who suddenly surround her. Besides Valencia, there’s Alfred Critter, a retired orthopedist from Wisconsin who volunteers at the clinic in winter; first-year UA med student Eric Robinson, who learned his flawless Spanish on a Church of Latter-Day Saints mission to Guatemala; and second-year UA med student Scott Conley.

Valencia speaks to the girl softly and in Spanish. He calls her “mija,” or my daughter. He examines her limbs carefully, reporting his findings aloud in English: Elsa is tiny for her age, and one leg is much shorter than the other, giving her a pronounced limp. Her forearms are different sizes, too, one wrist is twisted, and her spine is curved. Mindful of the sizeable audience, the doctor does what he can to keep Elsa from being embarrassed.

In the orthopedic clinic, Francisco Valencia gently examines Elsa Moreno, a tiny 14-year-old with mismatched legs and a twisted arm. Alfred Critter, a retired Wisconsin orthopedist, and UA med students Eric Robinson and Scott Conley assist.

“I’m going to take her shoes off,” he says to the group in English. “It’s not fair to disrobe her completely.”

He pulls up her sweatshirt to look at her spine, but does it so discreetly that he’s the only one who sees her skin. When someone asks when the girl had her last menstrual period, information that might tell the docs whether she’ll grow anymore, Valencia leans into her ear and whispers the question. She looks at him trustingly and whispers back the answer.

“We’re trying to see what accounts for her condition,” he says to the students. The two doctors decide to send Elsa up to Tucson for a full battery of X-rays. She may need surgery aimed at aligning her legs. She’s to return to the clinic in another two months.

Janis Wolfe Gasch

“I believe strongly in follow-up care,” Gasch says. “I put them on a schedule of multiple visits,” and most families go to the clinic off and on for years.

Gasch has a private audiology practice, Arizona Hearing Specialists, with offices in Tucson and Green Valley, but she’s been donating one day a month to the clinic for the last 25 years. The need is great.

“We’ve identified a lot of profoundly hearing-impaired kids who are not getting services in Mexico,” Gasch explains.

Audiologist Janis Wolfe Gasch discovers that Claudia Martinez needs to have her hearing aids adjusted and Kristi Hesse, also an audiologist, does the fitting. Deaf since birth, Claudia has been coming to the clinic since age 5, each time riding with her mother for 10 hours overnight on a bus.

Young Claudia is a case in point. Shy and smiling at 13, she’s been severely hearing-impaired since birth. She didn’t begin speaking normally as a toddler and, in fact, never spoke until the age of 5 — a year after the audiologists at St. Andrew’s fitted the little girl with hearing aids, free of charge. Her mother heard about the clinic from another mom whose child was treated there, and she says the care Claudia received changed her life.

“Now she goes to high school,” her mom says proudly.

Gasch has high praise for dedicated moms, like Martinez, who get their kids the care they need, no matter how hard or how long the road.

Jil Feldhausen

Jil Feldhausen is a cheerful nutritionist who earned her bachelor’s and master’s degrees plus completed her dietetic internship at the UA. She now works at the UMC pediatric nutrition and growth clinic. In her volunteer work at St. Andrew’s, her task is to get enough food into kids who are sick, and poor.

This morning, a young Nogales, Sonora, mother, Dora Nelly Campos Saucedo has brought in her son Lionel. The boy is 4, but he’s barely the size of a 2-year-old. His skull is small and pointed and his face is expressionless. He can’t walk or talk and he sags listlessly in his mother’s lap. She’s been bringing him to the clinic since he was a baby.

“He’s been eating well,” she tells Feldhausen hopefully, speaking through translator Lyle Berry, an aspiring medical student from Phoenix. Lionel had been vomiting at his last clinic visit but now, she says, “We have no problems.”

Lionel, Feldhausen notes, “has barely any ability to swallow and chew.” At home, his mother feeds him only soft food, spoonful by painstaking spoonful. But when Lionel is weighed, the numbers are bad. The boy has lost weight since his last visit. Lionel’s mom’s face falls, her month of efforts seemingly a failure.

Feldhausen questions Campos matter-of-factly, searching for an explanation. She says that her blender broke two months ago, and Feldhausen seizes on this.

“We can give you another blender!” she declares. “Maybe that’s why he’s not eating enough.”

After making sure that the mom has someone to help her carry the stuff back home, Feldhausen hurries off, in search of a blender and some powdered foods. The clinic’s goal, she explains when she gets back, her arms full of supplies, is “to give the children 25 percent of their calories.”

She loads powdered milk, instant breakfast mix, and kids’ vitamins into plastic bags for the Campos family, doling out instructions about portion sizes, which tend toward ounces and tablespoons. Church groups typically donate new blenders, Feldhausen says, but today she has been able to find only a used one. She plugs it into the wall to test it, and it noisily whirs into action. Normally, she prefers to give out a new one, she says, but today she doesn’t have a choice. This old clunker just might save a kid’s life.

“There are no rules here,” Feldhausen says. She puts the blender into a bag and cheerfully hands it over.

Filling a Need

Elena and Claudia and the other patients don’t pay a cent, and the care they get doesn’t come cheap. St. Andrew’s Children’s Clinic has an annual budget of about $400,000, with two-thirds of that coming from private donations, and one-third from grants. The agency counts on another $1 million in in-kind donations, for surgery and the like, much of it performed at the UA’s University Medical Center, and in a pair of Shriner’s hospitals, in Sacramento and Spokane.

“We’re not eligible for government grants because we serve Mexican children,” director Bolzoni notes.

Most of these kids just wouldn’t get the care they need in Mexico, says Bolzoni. “They’re poor, there’s no national health, no public assistance.”

Finances and logistics limit the number of children St. Andrew’s can help, she says, but once the clinic accepts a child, they’re in it for the long haul. Patients continue to get care until they’re 21.

“We can only take a certain number of new kids. Once they’re ours, they’re ours. Our commitment is to give them what they need.”