La Clinica:  A Doctor’s Journey Across Borders 

by David Sklar, University of New Mexico Press, New Mexico 2008

This is the true story of a physician who volunteered to help start a community clinic for the poor in rural Mexico at a time when his only medical experience was being accepted to medical school at Stanford.  The story uses flashbacks to juxtapose his life during that time and years later when he is running the ER at the University of New Mexico Hospital, facing a divorce, and reflecting back on his life.  The publisher claims the memoir to be a “thought-provoking meditation on the virtues of idealism in the face of the inevitable failures that haunt all human endeavors.” 

PERSONAL INSIGHT

Why I chose to read this book?  Initially, I noticed the book Right of Thirst by Frank Huyler on the desk of the healthcare director at St. Petersburg Free Clinic Health Center where I volunteer.  I read that book, but did not find it all that fascinating or an inspiring read.  However, the cover material mentioned David Sklar’s book and when I searched BN.com for the title, the reader ratings were both five star.  I could end with that, but since this review belongs to a project on reflective writing, I’ll provide (and try not to bore you) with a few more pieces of the explanation of my interest, which happens to be a little more complex.

At one point in my life I thought of joining the Peace Corps for two years until, to my surprise, I learned the education requirements consisted of a bachelor’s degree and, at the time, I only held an Associate of Arts.  I didn’t qualify to be a volunteer!

Somewhere around this same time, a time when I was young and not able to afford health insurance, I needed medical assistance.  I sometimes find it difficult to ask for help, or even admit to needing it, and was trying to ignore the back pain I was experiencing.  I was quite athletic at the time and hoped it was just a strained muscle that would repair itself with time.  Fortunately, I had a good friend who was a nursing student, who did not have the same personal issues I did; she did not find it a problem to seek help when needed.  Even more fortunately, she happened to be dating a pediatrician.  Mike suggested I show up at his office the next morning.  What a guy!

I was diagnosed with acute pyelonephritis and informed that if I had been one of his regular pediatric patients he would be admitting me to the hospital.  Obviously, that was not an option, so we went with the next best scenario.  I was to have complete bed rest for at least the next 4-5 days, consume liquids only, consume nothing containing even moderate levels of sodium, and return to his office the next week.  My fee?  Zero dollars.  Additionally, since I needed an entire bottle a day of pediatric meds in order for me to ingest the proper adult dosage, I left with a case of medication.  My fee?  Again, zero dollars!

My good friend the nursing student came by my apartment daily and provided extra care.  If I remember correctly, Mike treated me at his office once a week for one month.  Again, zero dollars.  I was quite sick.  I lost 12 pounds in 3 or 4 days.  If it weren’t for Mike, who knows what would have happened to me or my kidneys.  Death or dialysis?  I know there is a MasterCard commercial in there somewhere. Medical care not billed – $$$s.  Medication  provided for free - $$s.  Years later, after my first IVP (Intravenous Pyelogram),  when I first heard the words “no permanent kidney damage” – PRICELESS!

If I could remember Mike’s last name, he would have certainly received a few thank you cards over the years, or I’d have made a donation in his name or volunteered for some organization that he possibly assisted.  However, I forgot his last name; my wonderful friend moved away leaving no forwarding address with anyone, got married and changed her name, and I lost track of her.  Mike was a short blip on her radar at the time.  I am sure I have thought of him much more over the years than she has.  In any case, years later, when I was gainfully employed, I decided to occasionally send monetary donations to St. Petersburg Free Clinic¹.  This was my way of thanking Mike and paying it forward so that others who are not able to afford medical care (and aren’t fortunate to know someone like Mike) are able to receive the care they need.

More recently, I received a SPFC newsletter.  Presently unemployed and not knowing how long this ‘down’ market will last, my check writing abilities have been somewhat squashed.  The newsletter stated the clinic was looking for a volunteer to assist with health care statistics.  I thought ‘an expert in statistics?’ - that would not be me.  However, I guessed there was the possibility that what they actually needed was someone who could create and maintain an excel spreadsheet.  I was correct.  So I signed up to volunteer once a week to assist the healthcare director . . . thanks to Mike.

BOOK REVIEW

The story begins with Dr. David Sklar as he works in the University of New Mexico Hospital (UNMH) emergency room.  There he has a discussion with his friend and colleague, Rick, who was once his mentor.  At this point, Sklar is chair of the Department of Emergency Medicine and Rick is an ER physician on staff.  Their patient philosophy is quite different.  Rick believes that most of the patients that come through the ER are “stupid”; he equates the ER with a zoo, but adds “I love going to the zoo” (6).

Sklar leaves the ER at the end of his shift and goes home to an empty house, save for the dog and his bed.  His wife has moved out, not because she doesn’t love him, not because he’s not a good father (she believes he is both a good father and a good doctor), but because she feels she needs her own space.

He questions whether or not he has made much of a difference in the world or in the lives of those he loves.  He is full of doubt and wonders why he chose a life where he has to “face death every day” (4).  He makes the decision to return to the village in Mexico where he volunteered and first practiced medicine.  It was there that he held the conviction that he could, in fact, make a difference.  The last time he had visited the village and clinic was when he took his wife there – on their honeymoon.

The rest of the book juxtaposes his time at the clinic and with his time in the ER at UNMH and his life at home.

The first time he thought about becoming a doctor was when he was a young boy and had a discussion with his grandfather.  He told his grandfather he wanted to become a rabbi.  His grandfather tells him to become a doctor.  He considers this, but only to please his grandfather, nothing more.

After his first two years of college, he spent time as a volunteer teacher in the Philippines.  He made personal connections there and through his volunteer experience he concluded that what makes one happy is "personal and unique," but that emotions are "universal" and the simple things in life are what channel these shared emotions (11).

During his last undergrad semester at Stanford in 1972, Sklar reads an article about a medical missionary named Carl Wilson who was building a medical clinic in poor, rural Mexico.  Wilson held the attitude that any involvement with the traditional "fee for service" medical system was unacceptable.  He believed that doctors can help patients, but that many get “rich on people’s misery” and that hospitals are all about "money and power."  He wanted to create a system consisting of committed, long-term volunteers in a community where the medical workers and patients cared about each other and took care of each other (30-31).

Since he was applying to medical school, Sklar’s Stanford classmates kidded him about when he’d be buying his first Mercedes and luxury home.  The comments made him uncomfortable, so he sent a $25 donation to the clinic with an offer to volunteer.  He was surprised when he received a hand written note from Wilson in return, stating the clinic usually only took fully trained physicians, but they were short a volunteer and could use his help if he could be available for six months.

In preparation for his clinic volunteer service, Sklar obtains permission to enroll in a course for physician's assistants in order to learn to suture.  Once at the clinic, he learns how to deliver babies, treat a variety of diseases, and face the death of a patient.  He learns to practice medicine by observing, evaluating, intuiting, studying and utilizing the books Differential Diagnosis and Current Therapeutics.  When another volunteer leaves the clinic for a time, Sklar learns to pull teeth so the village is not without limited dental services.  When Wilson leaves the village to attend fundraising events, Sklar is left to run the clinic and becomes the village ''doctor."  The villagers knock on his bedroom window and wake him at night when someone in the community becomes ill.  He walks with them to town, examines the patient, walks back to the clinic to find what he can use to help, then walks again to the patient's home.  Afterwards, he walks the return home.  He does this out of his desire and dedication to help others.  The community of citizens appreciates the care and many bring fruit or eggs to the volunteers or do chores at the clinic or make repairs when needed.

There is a point where Sklar's idealism is challenged when he learns that Wilson is sleeping with a young boy from the village.  He wants to question it, but is afraid to do so.  He also learns that Wilson is not even a licensed physician, although there are licensed American doctors who also volunteer.

In his current life of pending divorce, Sklar opens up and shares his experience with his community of co-workers.  When the nurses see that he is out of sorts and ask him what's up, he actually tells them.  He discusses the failure of his marriage with his friend Rick.  He and Rick had known each other intimately (or so he thought) for twenty years, but "barely knew each other."  Now he learned that Rick's marriage had nearly failed more than once.

At one time the clinic was a model community care center that received visitors from all over the world.  When Sklar returns to the clinic for the last time, television (much to his disappointment) had come to the village, but the clinic was closed.  Carl Wilson had been the dynamic personality who organized fundraising for the clinic, and due to a public scandal over Wilson's alledged relationships with some of the village boys, major fundraisers had stopped supporting the clinic.  One of the villagers Sklar knew owned a small pharmacy in town, but the community now had to go to the government clinic and doctor for medical care.  The town was still "very loyal to Carl" who "had helped every family in the village at one time or another" and who had given them "the clinic; a grain bank; a drinking-water system; education of village children in medicine, dentistry, agriculture, and pharmacy; (a) rehabilitation program for spinal cord injuries; and travel to all parts of the world" (220).

The story concludes with Sklar working at the ER in Albuquerque.  After his last visit to the clinic, he concludes "if the clinic could deteriorate, so could anything - a marriage, a friendship, a life.  And it could also be reborn.  Change was inevitable and not anyone's fault, and it made life frightening and exciting" (227). 

Not long after, Carl Wilson speaks at a conference in Albuquerque and Sklar makes a point to meet with him.  Wilson informs him that what the village needs now is a program to combat violence more than disease.  Sklar questions him about the alleged abuse and Wilson responds that he never abused anyone.  He states that newspapers "destroy people just to sell newspapers" and the foundation is "a bunch of cowards" (229).  They have an intimate, candid conversation.

Sklar remembers how "everyone worked together -- poor villagers, volunteers, landowners -- and they made that clinic work."  They had worked as a community where neighbors took care of neighbors and they didn't "need to sell their land to doctors or hospitals to get the medical care they need."  Wilson reminds him that even if Sklar only saved twenty lives "not many people can say that" and that "we are more than all the names of the people we know" (231-232).

I enjoyed Sklar's style of writing.  I found his phrasing very comfortable to read and his insight on the minutia of life quite thought provoking.  I'd suggest the book to anyone interested in volunteering for a community or international organization.  I would also suggest it to anyone who is examining their own life and how their presence makes a difference in the world.  We all touch each other's lives in many small and large ways even when we don't realize we are doing so.  Sklar shows us that sometimes life can be both ugly and beautiful at the same time while it offers us change and surprises.  Through it all, however, we can make a difference in the world and our communities and not only help each other survive, but enjoy life and learn something along the way.

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¹ There are a lot of "Mike"s at St. Petersburg Free Clinic Health Center.  The paid medical staff consists of one full-time and one part-time ARNP (Advanced Registered Nurse Practitioner).  100% of the physicians are volunteers.  All the additional nursing staff are volunteers.  The two physical therapists are volunteers.  Additionally, there are numerous non-medical volunteers to manage responsibilities such as administration, intake and medical records.  If you think you might like to volunteer your time in this capacity, don't hesitate to pick up the phone and smile and dial (727) 821-1200 to register to attend a volunteer orientation session.

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