Traveling Clinic Hits Roadblock : Funding Woes Threaten to End Migrant Health Care Program

Oscar de la Riva, a physician in the midst of a round of uncommon house calls, bounds briskly from one dwelling to another, dipping his head below makeshift roofs of rough thatch, plywood and tin to inquire about residents’ health.

“Anyone ill?” he asks, stethoscope lashed to his belt, a metal toolbox serving as his doctor’s bag. “ Hay enfermos? “

De la Riva returns to his van, followed by the usual range of walking ill: One man hobbles with back pains, his cousin holds his hand to an infected eye; another walks gingerly due to a severe and painful case of varicose veins.

The patients are among the thousands of homeless immigrant day laborers, mostly from Mexico, living in makeshift, Third World-style squatter’s camps throughout northern San Diego County.

De la Riva--doctor and educator, pharmacist and advice-giver, transporter and psychologist--is a critical link in a singular mobile effort known as the Canyon Healthcare Coalition, which provides medical assistance for the residents of San Diego’s migrant camps. (In a similar effort, a physician and students from UC San Diego School of Medicine make regular visits to a major migrant encampment in the Rancho Penasquitos area of San Diego.)

The coalition’s mobile program, while limited, is the most extensive of a number of volunteer and nonprofit health initiatives reaching out to area migrant camps, now overflowing thanks to ample summer fieldwork. The 18-month-old program is now threatened with shutdown because of a lack of funds.

Although the workers’ living conditions have engendered widespread debate and calls for improved housing, comparatively little public attention has been focused on the health predicament.

The vast majority of camp inhabitants in the San Diego area have no health insurance. (Agricultural laborers in the Central Valley and elsewhere are more likely to have coverage through their jobs, advocates say.)

North County migrant camps often lack regular water supplies, toilets or substantial protection from the elements. Water may be contaminated, food unrefrigerated and environmental hazards such as poison ivy, insects and snakes abound. Excessive exposure to sun and dust is a constant problem.

Moreover, the migrants toil in industries--typically agriculture and construction--that leave them vulnerable to a gamut of work-related injuries and accidents, such as pesticide exposure, machinery and tool accidents and hernias.

Of course, most migrants are young men of robust health, usually in their late teens and 20s. But there is a significant population of children, elderly and women, including mothers with infants.

“The real problem is a hazardous, dangerous environment, and that can’t be treated in a doctor’s office,” noted Shimon Camiel, the program’s primary consultant. “There’s a need for a lot of preventive and first-level health care to make their lives livable.”

Three times a week, De la Riva pilots a van through northern San Diego County’s streets, roadways and dirt tracks, stopping to pick up ailing migrants for transportation to clinics, where they may be examined and treated for a range of complaints. Physicians at the clinics arrange for follow-up appointments, and, if necessary, visits with specialists. (De la Riva, a licensed physician in Mexico but not the United States, also dispenses health-care advice and non-prescription medications during camp visits.)

Thanks to a variety of government grants and other funding sources, most care is provided free or for minimal cost. The entire effort is designed to detect health problems early and to avoid trips to hospital emergency rooms--the cost of which would be many times greater and would inevitably be transferred to taxpayers. The van now transports about 100-150 migrants to the clinics each month.

The effort is endangered because the Alliance Health Care Foundation, the San Diego organization that has provided about $60,000, financing the purchase of a van and other costs, is unlikely to underwrite the effort any longer.

“I felt that this was an important gesture for us to make, and I was always so hopeful that other employers and employee groups would follow through,” said Ruth Riedel, the foundation’s executive director, expressing regret that others have not come forward to fund the effort, which began in January, 1990, through the efforts of a group based at Our Lady of Mt. Carmel Roman Catholic Church in San Diego.

With a shutdown impending, De la Riva and others are examining alternatives.

“This is the first line of defense against disease,” Barbara Mannino, executive director of the Vista Community Clinic, a program participant, said of the mobile effort. “What it’s doing is keeping these people from the emergency room, where they end up when they get real sick.”

At the program’s center is De la Riva, 35, a Mexican citizen from the northern border city of Ciudad Juarez (across the Rio Grande from El Paso), a Mexican-trained physician who is now studying for the U.S. medical boards. Like other countrymen, he came to the United States seeking greater opportunity; he found work with another area health program before joining the van effort six months ago.

“In private practice in Juarez I was doing a lot of weight control work,” De la Riva recalls as he drives the van along a pothole-ravaged dirt track in Oceanside, beginning the day’s visits to the camp sites. “I decided that I hadn’t studied medicine for seven years just to be a weight-control doctor.”

The most common health complaints are predictable: allergies and visual problems such as conjunctivitis, aggravated by constant exposure to sun, dust and other materials; skin disorders, such as rashes stemming from plants, pesticides and other sources; sexual infections, often transmitted by prostitutes that regularly make the camp rounds (no AIDS cases have been detected to date, however); gastrointestinal ailments related to diet and assorted afflictions, such as diabetes, high blood pressure, tuberculosis and respiratory ailments, the latter a particular problem in winter.

“My eye is irritated,” Ramiro Ayala complains as he emerges from a bamboo thicket in Oceanside upon hearing De la Riva’s van approach.

Six weeks ago, it turns out, Ayala underwent an operation in Mexico for a visual disorder. The eye was now acting up again, apparently aggravated by dust and sun. The health worker’s advise: wear protective sun glasses and purchase some eye drops. De la Riva tells Ayala he’ll be back in a week to take him to the clinic if things don’t improve.

Each day, De la Riva follows a specific route, navigating his vehicle past major encampments and migrant gathering spots. Often he will park on a street near campsites and sound his telltale vehicle alarm, prompting patients to emerge from caves, shacks, fields and construction sites to seek out his advice.

“Take two of these three times a day,” De la Riva tells a man suffering from arthritic pain, providing him with free aspirin from a box in the rear of the van.

The vehicle heads to the rural Bonsall area, where de la Riva is seeking a 16-year-old who has been diagnosed with a brain abscess, potentially fatal. The youth was considering returning to Mexico for treatment--a path taken by many ailing camp residents, confused about U.S. health care and unable to afford it. But De la Riva explains that he may qualify for U.S. care under a federal program for migrant youths. On this day, however, the teen-ager is nowhere to be found, a not unusual scenario among the patients in such a mobile community.

In a sprawling camp along the San Luis Rey River, De la Riva stops at the hut inhabited by Nicolas and Marta Hernandez and their three lively daughters, Rosaura, 8, Virginia, 3, and Paolina, months, all from the interior Mexican state of Puebla.

“We’re all fine here, doctor,” Nicolas Hernandez tells De la Riva, cuddling his infant.

Farther along, the health professional cautions three newcomers from the southern Mexican state of Oaxaca to watch out for the poison ivy that is prevalent here.

“We’re more worried about la migra, “ one of the men, Gerardo Martinez, 22, confides later, referring to U.S. immigration officials.

Carmen Paz Martinez, who has a hernia, explains that she injured herself carrying heavy pails and other loads to her squatter’s residence beneath a row of shade-giving eucalyptus. Through the program, she has arranged for an operation at a clinic later this month.

“If the doctor didn’t come here, I don’t know what I would have done,” Paz, also from Oaxaca, says as she washes dishes at the site, adding that she had considered returning to Mexico for treatment until she inquired. “I could never afford to pay for this treatment.”