A trip to Mexico can be a vacation for most people; for The Flying Doctors (Los Medicos Volodores), it is a mission of mercy. We go as a team in a small aircraft loaded with physicians, translators, volunteers, medicine, and supplies on weekend trips to provide medical and psychiatric services. Trips typically depart from Northern California on a Thursday morning and return on Sunday evening. We clear Mexican customs in Ensenada or Mexicali, and our return trip stops on the U.S. side of the border for customs and fuel for our airplanes.
The orphanage I visit on a regular basis is located approximately 12 miles south of Chapultepec, the airport serving Ensenada, and can be reached by the local microbus. We wait at the side of the road until the small vehicle comes along, flag it down, and tell the driver where we need to go. This time he was very cooperative, for one of his daughters received dental care during our last visit.
After a bumpy ride with mariachi music blaring from the speakers, we arrive at the orphanage to the shouts of greeting by the children who live there. There were 19 children when I first visited them in 1993. The number has now grown to 35, ranging in age from a few weeks to 14 years.
The children at the orphanage are cared for by a young married couple who themselves were orphans. They are devoting their lives to the care of these unfortunate unwanted children. Some of the children are orphaned because their parents are dead. Others were abandoned when their parents had no money to feed another hungry child or to buy medicine for a sick baby. Some parents think their children are better fed and cared for in the orphanage. They are concerned about their children's survival only in the physical rather than the psychological sense, the result of abject poverty.
There's a makeshift clinic nearby, about 100 meters from the orphanage, that the Flying Doctors established in a small church. Our organization has no religious affiliation but sometimes uses the facilities of churches, unions, farmers' associations, or community organizations to see patients.
Mali A. Mann, M.D., is training and supervising analyst at the San Francisco Center for Psychoanalysis. She is also an associate child and adolescent supervisor and adjunct associate professor of psychiatry and behavioral science at Stanford University Medical Center.
The clinic is primitive by any standards: a few folding chairs and tables, basic supplies, and medicine we bring on our airplane and leave behind with instructions when we depart. Our visit is announced sometimes on a local radio program, more often by teenagers going through the streets shouting, “The Flying Doctors are here!” The news of doctors being there generates a sense of hope and excitement for villagers.
Soon whole families are lined up outside the clinic, waiting to be seen for various medical conditions. As the word spreads that free medical care is available, some families in the surrounding villages walk as much as 10 miles, bringing their sick children for treatment in our tiny clinic. A common scene is a mother holding a baby tight in a shawl wrapped around her bosom, waiting with many others long hours for the doctors or a nurse to put a caring touch on them. These children have various medical problems, usually malnutrition, fever due to upper respiratory infection, and gastrointestinal illness.
During my visits, I see mainly children and function as a general pediatrician and child psychiatrist at the orphanage clinic. I also work with the staff to help them with their more difficult cases, ranging from behavioral problems, sleep disorders, eating disorders to attachment issues.
I remember several particularly moving cases. One involved a two-year-old boy whose mother abandoned him to the orphanage two months prior to my visit. He looked despondent, unresponsive, and angry. No verbal engagement or prompting worked with him. He sat on the stairway and pouted for a long time. Trying to play with him, talk, or give him food did not move him at all. His big brown eyes were defiant, mistrusting; yet at the same time he waited, wondering what I was doing there. His voice was weak, distant, and lifeless. He tried to mumble a few words in Spanish. I thought the little boy was in despair and most likely traumatized over his abandonment.
Was there any answer to this human tragedy?
Did he sense my doubt and despair in the face of such massive injustice?
Do these children want an answer to an old question when there seems to be none?
These children must rely on who is available and trust them. Could they afford to be distrustful?
Was I embracing irrationality by volunteering to do work that does not appear to make that much of a difference?
It seemed the boy wanted the head woman in the orphanage to let go of other children, return to him, and spend time exclusively with him. He needed a loving touch and did not know if he could get it or how to ask for it. Making the nature of his problem understandable to the staff helped his situation to some degree. Once again I was facing the old question of whether my providing healing and caring to children in a devastated orphanage could possibly make much difference in their overall living conditions, when their poverty was unimaginable? Did being there give me a sense of false satisfaction?
There were those moments when I found myself struggling with just what to give to these kids. Despite my self doubt, I felt I was giving what appeared to be a helping hand and attention, however brief, through translated words and the music of my voice.
Working with staff was a crucial step, similar to my working with parents as a child psychiatrist in my practice. Explaining what was happening to these children at an emotional level helped the staff feel supported and understood. They put a great deal of trust in doctors. The staff was no longer looking at a young patient as an oppositional toddler. They were more empathic and changed their approach by giving him the extra affection and love he needed.
There were infants who had been separated from their mothers very early during the first three months of their lives. In some of these cases, a substitute was not available. These children were apathetic, with tears on their faces as they sat in a corner, dazed and unable to communicate. Their behavior reminded me of Rene Spitz's infant observation—what he called “anaclitic depression.”
One 18-month-old boy with marasmus, a form of malnutrition, who looked markedly apathetic, would not respond to any external stimulation. He seemed to have regressed to a neonatal state with defense against stimulus barrier. The look in his hollow brown eyes was hopeless and searching. Perhaps he was searching for his lost mother. Again. I found myself questioning how much help I could be to a problem so vast.
Once an attractive young girl arrived with a worried look on her face. She claimed to be 16 but was most likely not a day over 14. “Rosa Maria” thought she might be pregnant but could not believe that was possible. She confessed to having sex “only once” with her boyfriend, but explained that the act could not have made her pregnant. Her boyfriend had assured her that drinking Corona beer before and after lovemaking made her invulnerable. Luckily she had dodged the bullet this time, and a clarifying explanation gave her knowledge and contraceptives if not willpower.
Our work with the staff at the orphanage presents a challenge for us as well. There are too many children and too few staff. The main female caregiver, Soledad, is overworked and suffers from chronic kidney problems. Much of our time is centered on helping the caregiver provide love and attention to these 35 unfortunate, poor children.
Moments later, I have had to detail the list of problems these children were dealing with in their records, charting them so that the next group of doctors would have some idea about what I had done.
This is the condition of poverty I encounter in parts of Mexico, and it is substantial. People live in shacks, struggling for survival, yet their resilience is amazing. For us, members of The Flying Doctors, the pleasure of doing good—with real, immediate results—certainly outweighs the hardships we face in travel and staying over a weekend. Just being there, touching and examining, talking and educating, guiding people with a sense of respect, and sharing their pain seems to make them feel better.
I have been impressed with each subsequent visit. The structure and cleanliness of the orphanage has improved since my first trip in the early 1990s. The children appear better nourished, and the look of despair on Soledad's face has disappeared. In fact, there are rays of hopefulness and enthusiasm among the staff. One new staff member in her mid-forties appears to be very nurturing and caring for these children. They call her “Mom.”
Although we cannot solve all the problems brought about by poverty, giving these people medical treatment and education lessens their pain. My hope is that small steps taken towards international understanding and care will someday help bring about a healthier world.
From my experience, I have learned that the power of healing has no boundaries and caring hands can touch a human heart.
Editor's Note: A similar, previous version of this article appeared in the newsletter published by the Association of Child Psychoanalysis. Permission was given to reprint.