Medical Mission

Wearing white lab coats and clutching stethoscopes, UTMB students take health care to the state’s—and nation’s—poorest immigrants

By Claudia Feldman

Juan Martinez knows his dog needs to be euthanized.

The animal’s face has swollen to twice normal size, its body has shrunk to flesh and bone, and it seems almost loopy as it trots around the hard-packed dirt outside the trailer.

“What can I do?” Martinez asks a group of medical, nursing and physician-assistant students collecting at the trailer door. “I don’t have the money to take care of myself, let alone the dog.”

Martinez, a mosaic-tile layer, turns and moves inside, with the students from the University of Texas Medical Branch at Galveston trailing behind. He comes to a stop at his sloping bed, where he spends most of his time. In 2000, he says, he had a devastating lung infection. Now he doesn’t know what’s wrong with him, but he is weak and emaciated again.

“I used to be strong,” he says, his mustache drooping.

Martinez, his wife, Clara, and their three school-age boys live in Cameron Park, an unincorporated colonia surrounded by incorporated Brownsville. The 2000 Census cites Cameron Park as the poorest area of its size in the country, and that alarming statistic has drawn an assortment of social scientists and health-care professionals to the area.

Raquel Vargas, one of seventeen UTMB students who made the trip, sits beside Martinez. She asks him to raise his shirt so she can listen to his lungs, then places her stethoscope on the bony landscape that is his back.

The usual stew of urban problems, including unemployment, substandard housing, and inadequate health care, are magnified times ten in Cameron Park. For many immigrants crossing into the United States, the colonia a few miles from the border is the first stop.

In Spanish, the dominant language in Cameron Park, Martinez says he, Clara, and their oldest boy came from Mexico to attend a birthday party eleven years ago, and they didn’t go back. No regrets, he says. “We’re alive. We may not be in the best position, but we’re better off here than there.”

That seems to be the consensus among the seven thousand residents of Cameron Park, even those who wash dishes in basins in their yards and use outhouses instead of indoor toilets. Against all odds, they pursue their version of the American dream—a plot of land, a dependable job, a happy and healthy life for their kids.

That’s where the UTMB students come in. They’re participants in Frontera de Salud (Border of Health). The program began in 1998 after a medical student named Kirk Smith did a rotation in Brownsville, then returned to Galveston and told a few of his med-student friends that there were poor patients desperate for health care virtually in their own back yard.

At the time, Smith and his cohorts were working nonstop just to get through school. Still, four or five times a year they would load Smith’s station wagon with supplies and head south. Saturday mornings they offered gynecologic exams, supervised by a nurse practitioner at the Brownsville Community Health Center. Before Frontera, Smith says, there was a two-year waiting list for lifesaving cancer screening, and women were dying needlessly.

Sunday mornings the students offered diabetes and blood-pressure checks at a nonprofit community center in the heart of Cameron Park.

As the weeks and months rolled by, more patients turned out for the screenings, more UTMB students volunteered their time, and the trips grew more frequent. But Smith wasn’t satisfied. He wanted to raise money for a nonprofit clinic inside the colonia, and he managed to scrape together $75,000 in grants. Just as the students were celebrating that good fortune, a local doctor gave them a million-dollar clinic building he had tried but failed to operate at a profit.

Smith still beams as he tells the story.

“Adults are just fine,” she says, “but kids are awesome. You can have a day where everything just sucks, then you spend some time with children, and the problems of the day go away.”

Today there are several Brownsville Community Health Centers, including the original within the city limits and the satellite in Cameron Park. Smith, now an internist and director of Frontera, says the waiting time for gynecologic exams within the system has shrunk from two years to six months.

He rejoices at the improvement but wishes care for indigent patients were better still. Juan Martinez, Smith says, is five-feet-eight and weighs only one hundred and twenty pounds. He’s been waiting months for a diagnosis. Meanwhile, he can’t work or pay his bills. His sweat pants hang on his protruding hips. His wedding band slips on and off his middle finger.

Martinez’s spirits lift slightly at the sight of Vargas. She seems so competent, so professional. She understands his wry jokes and his pain.

On the first Saturday in February, Vargas and the other students stand in the old Brownsville clinic, listening to Smith tell the Frontera story. Then they shift their attention to Barbara Hill.

The nurse practitioner tells them to use their Spanish no matter how bad it is and to remember “cultural sensitivities” and the invasiveness of the gynecologic exam.

Certain young people in the group turn pale and wish they’d worked harder in their obstetrics-gynecology rotation. “They’re so nervous,” Hill says. “Not the patients so much. The students.”

They divide into teams. Vargas and her group handle their two patients like pros, then swing into home visits. Students see how patients live, and the view is humbling.

Vargas finds herself in a sparsely decorated living room trying to win a smile from five-year-old Jorge Estrada. He has quarter-size kidney stones, and the surgery to remove them has been delayed for months by a lack of funds and by language barriers and red tape.

Vargas sits beside Jorge and tries to forget that her peers are watching and straining to hear. She introduces herself, and Jorge leans against his mama and stares. Then he inches closer. He bats his eyelashes. He cracks a smile.

She’s almost got him. She shows him her stethoscope and lets him listen to her heart. He nods when it’s her turn to listen to his.

She extends long, slim fingers toward his midsection, then tickles him, which makes them both laugh. “That’s good,” she says later. “If a kid laughs, he doesn’t hurt. If he stiffens, he does.’’

After Vargas graduated in May, she started a pediatric residency at the prestigious Cleveland Clinic.

“Adults are just fine,” she says, “but kids are awesome. You can have a day where everything just sucks, then you spend some time with children, and the problems of the day go away.”

Vargas, thirty-six, was born in Peru and grew up in Venezuela. Her mom, an American Indian, and her father, an indigenous Peruvian, sent her to live with her grandmother in Bridgeport, northwest of Fort Worth, for her last year of high school. New schoolmates thought she was stuck up. Wrong, Vargas says, just shy and self-contained.

She enrolled at the University of North Texas, then called North Texas State. She’d always talked about becoming a doctor. When the time came to pick a major, however, she checked the biology and psychology boxes, not pre-med.

“I thought it was too much work, and I didn’t want to take biochemistry.”

Instead she studied psychology, earned a master’s degree and landed a job working with children with cognitive and physical disabilities.

Her first day of work, toting a briefcase and decked out in business attire, it hit her: she wanted to be the last word, the final authority. She needed an M.D.

For the next seven years, Vargas worked during the day and tackled pre-med requirements at night. In the fall of 2001, she rented out her house, put away her work clothes, and started medical school in Galveston. She was thirty-three, her work experience no longer counted, and she was broke.

Vargas had been salting away money for medical school in the stock market. After 9/11, she lost almost everything.

An Indian Health Service scholarship saved her from a mountain of debt. When she graduated, however, she still faced a three-year residency, a three-year commitment to the health service and a $30,000 loan.

Vargas was so close to graduation that she could feel the cap on her head and see the diploma in her hand. It’s a question, then, why she complicated her last semester with Frontera. When the other students went home Sunday, she stayed as a cultural immersion student for the next month.

There are many ways to explain it, Vargas says. She is a habitual volunteer, and she enjoys having fifteen projects going at once. Growing up, she was taught to give back.

It’s the old thing about wanting to help and make a difference. That, she says, is what drives her, dozens of students she knows and programs similar to Frontera around the country. She winces. “It doesn’t sound very sexy, does it?”

When a middle-aged woman drops by a health fair Sunday morning, the students break into cheers.

She is Enedina Zamarippa, star patient. Last September, she came to the health screening to check her blood pressure. Students did that, then asked her about the twelve-pound goiter ballooning from her neck. It was impossible to miss—people had been staring and pointing for years.

The goiter grew over a fifteen-year period, she told the students. “It’s getting worse. When I lie down, I can’t breathe.”

The students leaped up to find their supervisor. A goiter that size could kill her.

With much planning, the students and Smith arranged for her surgery. They escorted her to Galveston, visited her in the hospital and arranged for her trip home.

Now Jorge Saenz, one of the students who saw her initially and sat in on her surgery, can’t stop smiling. “When I first met her, she was depressed; she kept her head down. Today there’s a glow around her. She’s a different woman.”

The experience changed Saenz, too. That’s the real beauty of  Frontera, Smith says.

The giving goes both ways.

About forty men, women and children come and go at the fair. Students who need a break step next door to San Felipe de Jesus Catholic Church. Father Mike Seifert conducts three Masses on Sunday morning; by noon he’s preached to fifteen hundred people.

Common themes: everybody is somebody, take pride in yourself as the son or daughter of God, love your enemy, lend without charging interest.

“It’s not all sweetness and light,” Seifert says. “It’s a call to live better than we do. I’m not saying, ‘Oh, you poor people, Jesus loves you.’ That’s a stupid message.”

Sunday morning has become Sunday evening—that time when folks of all ages and occupations start to worry about the coming week. The UTMB students are long gone except for Vargas, who is camping out in a Frontera apartment until she moves in with her host family on Tuesday.

There have been improvements in the neighborhood, just not enough, says Galvan, who wears a lifetime of experiences engraved on his face. “Things change,” he says, “and stay the same.

Restless, she turns on the Super Bowl.

“It’s not much fun to watch it by yourself,” she observes, and heads to the movies to see Million Dollar Baby.

She’s expecting a comedy, not a tragedy, and she cries through the second half of the film. It’s something about the dark theater, the unconventional heroine, the limits of modern medicine.

On Monday, Vargas settles on a work schedule, and then she, Smith and Sister Phylis Peters, the efficient and kindly parish nurse, visit Guadalupe Galvan.

The yard is immaculate. Galvan, seventy-nine, has made sure of that. Inside, things are clean. His wife, Maria, seventy-eight, has made sure of that. There’s little they can do, however, about the clothesline inside the house, the odds and ends stacked in piles, the absence of sinks and indoor plumbing.

The old man wants a toilet before he dies. And he worries about Maria. The brick-and-plywood floors are uneven, her legs are unsteady, and she’s already taken a fall.

Vargas listens carefully. Falls lead to broken bones, which can be life-threatening for older women.

There have been improvements in the neighborhood, just not enough, says Galvan, who wears a lifetime of experiences engraved on his face. “Things change,” he says, “and stay the same.”

That night Vargas goes across the border to Matamoros, Mexico, with Smith and his wife, Lida. They’re flying home to Galveston the next day.

Everyone unwinds, finally. Vargas talks about the crowd coming to see her graduate—her mother from North Texas, her dad from Venezuela, brother Kenneth from Spain, and brother Nicholas from Las Vegas.

Kenneth spent six months in Iraq, and she says she did her part by worrying nonstop. “It was the scariest, most nerve-racking experience of my whole life.”

Vargas has silky black hair and liquid brown eyes. She looks at Smith and Lida and says the beautiful night, the open-air cafe, remind her of Venezuela and home. These days, she’s a rolling stone.

In the mid- sixties, the first residents of Cameron Park were Mexican immigrants who settled outside the Brownsville city limits. Over the next thirty years, Brownsville grew to surround Cameron Park, but there was little talk of annexation, and colonia residents received few government services.

Longtime residents say they went for years without running water, electricity, and paved roads, and firefighters, postal workers, and school buses came only as close as the perimeter. The first inkling of change came in 1989, when Texas legislators voted for water and sewer improvements in colonias statewide.

About the same time, a small Catholic mission was built in Cameron Park, and in 1996, Seifert and Brother Albert Phillipp arrived. Their charge: to convert the mission into a parish. The small building was expanded and transformed into a church, and the two men established a nonprofit community center and limited health services. With open arms, they welcomed the UTMB students.

What really turned things around, however, was a community-wide effort to get out the vote. In 1998, when Cameron Park residents showed up at the polls in force, local politicians such as County Judge Gilberto Hinojosa listened.

Today, Hinojosa says, there are eighteen hundred registered voters in the fourth-largest community in Cameron County. He campaigns in Cameron Park often, sometimes door to door. While he continues to see dogs running wild, dilapidated trailers occupied by three and four families, and the occasional outhouse, he also sees progress.

There is a sprinkling of construction sites and new houses. There are some neat brick homes ringed by shrubs and flowers.

Hinojosa says some of his Cameron Park supporters have good jobs and kids going to four-year colleges. “They are moving up the economic ladder.”

In the next few years, Hinojosa says, Cameron Park is going to look even more like the city that surrounds it. The Texas Department of Transportation and Brownsville’s Public Utilities Board are working together on roughly fifteen million dollars in improvements that include street curbs, gutters and water and wastewater lines.

Annexation, Hinojosa says, is within grasp.

Seifert says it’s not time to celebrate yet. He reminds that Cameron Park’s per capita income was $4,103 in 2000. (Houston’s per capita income was about five times higher, $20,101.)

Unemployment in Cameron Park, according to the census, is 10.2 percent. Seifert believes that number is low, and he says many residents who are employed are underpaid.

Slave wages, he means.

He’s still upset with the Anglo woman who told him she paid her live-in Hispanic maid one hundred dollars a week.

He asks indignantly, “Do you know anyone living in the U.S.A. who works and is on call for twenty-four hours a day, six days a week, with a job description that includes child care, housecleaning, cooking, and dealing with anything that comes up—including sudden weekend excursions by the father and mother that rob you of your day off at no extra pay—for a hundred dollars?”

Seifert is the rare person who speaks his mind, and he and Vargas make friends instantly. She asks him in a low voice, “Are there any good Asian restaurants around here?”

They laugh at the desperation in her voice and the futility of the question.

Is she going to be able to sleep? he asks her. She’s about to move in with Juan and Epifania Banda, whose children and grandchildren are visiting.

She’s in the parking lot of the church when Seifert stops her. He presses earplugs into her hands and mouths two words: “Chop Sticks.”

That’s the name of the Asian restaurant in Brownsville he likes best.

During the week Vargas divides her time among home visits, clinic work, and teaching sessions with local volunteers.

In the evenings she jogs and enjoys dinner with the Bandas. She told Epifania she loves cactus, and Epifania has dug up and cooked every cactus in sight.

One of the Banda sons is deaf, and Vargas has spent some time trying to master sign language.

“It’s very difficult,” she says ruefully. “I haven’t made much progress.”

She’s also tried to keep tabs on the patients she met the first weekend.

Little Jorge, still waiting for his operation, runs a temperature off and on and has blood in his urine.

Galvan still is hoping for indoor plumbing.

Zamarippa is enjoying her grandchildren, unfettered by the monster goiter.

Martinez has learned that the lung infection, which he still has, is in the same class as TB, but the Cameron County Department of Health and Human Services has closed his case. The students and staff of Frontera will try to provide him with a treatment plan.

Not unexpectedly, his dog died.

Claudia Feldman writes for the Houston Chronicle, where this story originally appeared April 3, 2005. Copyright 2005 Houston Chronicle Publishing Company. Reprinted with permission. All rights reserved.