ALAMOS, Mexico — The American surgeon was struggling.
He had left Long Beach that weekend--where his patients are whisked by his sleek black limousine to their tummy-tuck and fat-suction operations--to fly down to the state of Sonora in northern Mexico on a medical mission for the poor.
Now on the operating table in front of Dr. Michael W. Nicolle of Huntington Harbour lay Ramon Ramirez, 33, who had risen at dawn and driven the 50 miles from his hometown of Navojoa in a pickup truck to see him.
Ramirez's arm had been crushed in a slaughterhouse accident seven months earlier. Local doctors had inserted two steel rods to stabilize the arm, but the metal was infecting it and had to come out if the arm was ever to stop draining.
Nicolle had not anticipated this operation when he packed his bags for the trip, and neither he nor Dr. James W. Thornton, who was assisting him, could get a firm grip on the end of the 10-inch rod with the instruments they had.
Finally, probing deeper into the patient's forearm, the doctors found and removed the rod, along with a floating screw and three good-sized bone chips. They stitched the lifeless arm back together.
Then suddenly, the operating room lights went out. The hospital had lost all power. Nicolle finished dressing the wounds and splinting the arm by flashlight, but the darkness meant no more surgeries would be performed that day.
Operating conditions at the state-run Alamos General Hospital in Alamos, a town of about 10,000 nestled among earthen-colored mountain, may not be on a par with American hospitals, but they could be worse, said Nicolle, who has been coming to Sonora since 1981 under the auspices of World Health Volunteers, a Long Beach-based group.
One weekend each month, except during the rainy summer, he and a few other doctors and nurses fly from Southern California in a convoy of their own private aircraft to Alamos or Navojoa, where they operate on patients whose needs outstrip the surgical expertise of local doctors and health workers.
The most common maladies the American doctors encounter are cataracts, burns, disfiguring injuries requiring extensive reconstruction and a variety of birth defects such as cleft lips and palates.
Nicolle has made about 35 trips since he joined the group. On more than one occasion, he said, the frustrations of operating in developing countries, where hospitals are not run with the profit-making efficiency of those in the United States, and the group's own loose organization have caused him to swear never to return.
"But then you look at the pictures of the kids with deformities and birth defects, and they will never be accepted by their peers. . . . It's just a drive that keeps me coming," he said.
Nicolle and the other doctors who make the trips could just as easily operate at home and earn several thousand dollars each weekend they are away, rather than spending the $400 or $500 out of their own pockets for each trip. The trips cost the doctors precious family time as well.
"My children often wonder why I have to go away, and that would probably be the only thing that would slow me down in the future," said Nicolle, who usually puts in 60 to 70 hours a week at his Orange County and Long Beach practice.
The trips are not all work, however. Typically, the doctors fly on a Friday from Southern California to the port city of Guaymas, where they stay in a romantic, rambling, 50-year-old fishermen's hotel on picturesque Bacochibampo Bay. Early Saturday morning, they fly about 40 minutes to Alamos or Navojoa and spend the day operating and screening patients for their next visit. At the end of the day, the doctors might return to Guaymas or fly on to Loreto in Baja California as some did this month, to soak up some sun before returning home Sunday afternoon.
Drawn In by Founder
Nicolle was drawn to World Health Volunteers by the group's founder and president, Long Beach general practitioner Dr. Gerald W. Miller, who still heads up the monthly trips.
"It comes down to this--if you don't do it, it doesn't get done," Miller said, sitting in the cabin of his Cessna 402 while his son, Curt, piloted the plane home on the group's most recent trip. "When he (an American doctor) does a cleft palate, if he didn't do it, that kid would go through life with a handkerchief tied around his face as a social outcast. Back home, it would be done before he even knew he had it."
A native Nebraskan whose string ties stop a few inches short of his formidable belly and whose booming voice is capable of momentarily drowning out the drone of his plane's twin propellers, Miller branched off from another group, Liga International, to form World Health Volunteers in 1980. A 20-year veteran of the Mexican medical missions, Miller remembers operating under primitive conditions with no electricity or running water and with one person assigned to shoo flies off the patient's open wounds.