House Calls with John
and can mimic the symptoms of pregnancy over many months. What I had supposed to be ruptured membranes was instead an accidental emptying of an overfull bladder—it having been an evening too cold for our patient to comfortably use the outhouse at the camp. For about a week, the other doctor and I were the laughingstock of the hospital. Another visit proved more productive. I examined a man who had broken his arm two weeks before but had received no treatment. Lacking transportation, the workers were at the mercy of the growers. I was able to arrange for his admission to the University Hospital.
Soon I was named director of the university's Migrant Health Program. I grew more and more incensed at the conditions in the camps and the exploitation of the workers. On one house call, a farmworker showed me the 10-cent check he had received for two weeks of work; the crew bosses would peddle liquor to the workers at inflated prices and deduct fines for minor infractions.
In 1968, I testified before a committee of the U.S. Senate and led Senators Robert Kennedy and Jacob Javits on an inspection tour of the camps. Local growers were, not surprisingly, unhappy with this activism. But so, too, were doctors in private practice in the Rochester area. They complained that the Migrant Health Program was "socialized medicine." The dean and my department chair asked me to meet with these critics but ultimately stood behind the outreach effort.
I was impelled to look beyond injustices in the Rochester area by the 1969 Biafran refugee crisis. The Biafrans of eastern Nigeria had suffered the largest genocide since the Nazi Holocaust. I volunteered my services as a pediatrician in the Biafran refugee camps, hoping I could help save the lives of a few of these victims of a tragic civil war. I was granted a leave of absence from my faculty position and traveled to Africa under the auspices of Operation Medicorps.
The conditions in the camps were haunting. The children all had the potbellies, skeletal arms and legs, skin
"I soon had my eyes opened to a totally neglected population. Unbeknownst to me, Rochester was surrounded by many migrant farmworker camps. At one, I saw workers housed in a chicken coop with its walls covered with chicken excreta."
sores, and swollen feet characteristic of kwashiorkor, or protein deficiency disease. Malnutrition complicates infectious diseases, and many children also suffered from tuberculosis or intestinal parasites. Some had enlarged livers due to malaria; others had congestive heart failure, also from inadequate dietary protein; and most had scabies, a skin parasite that caused them to scratch incessantly. Sanitation was a major problem due to rampant diarrhea. Flies were so prevalent that the children could not keep them off their food and had a hard time sleeping.
Yet the children also had a strong will to survive. With proper food and good care, their health slowly improved. They began to respond to adults by hugging our legs or crawling onto our laps. Once, when I sat to watch a movie with the children, I found myself cradling half a dozen in my arms and several others on my lap, with a few more draped over my legs. Clearly, caring was as important as medicine. As I saw older children carrying younger ones
to the dining hall, or feeding them in their rooms, I felt a strong sense of community and purpose.
When I returned after seven weeks to my safe and loving home, I couldn't forget the Biafran children—and the uncertainties and losses they would return to. In that frame of mind, I received a telegram a few months later. It read: "it's official. we are funded for july first. a day to celebrate. we are all waiting for you. viva la causa. la clinica gilbert lopez."
I had been offering advice from afar to a group that was trying to organize a farmworker clinic in Brawley, Calif. They had received funding for the venture and wanted me to join them. I decided that full-time service to a migrant population was where my heart lay. It would be a big change from my part-time academic practice, parttime migrant activism. And it would be an even bigger change for the whole family, from the cool Rochester climate to the dry heat of the Imperial Valley and from Rochester's mixed culture to a predominantly Mexican-American, Spanish-speaking environment.
After a one-month immersion course in Spanish, we moved to Brawley in the summer of 1970. The Clinica de Salubridad de Campesinos approached many of my ideals of community-based medicine. Its board, consisting mostly of farmworkers, quickly won the loyalty of patients and staff alike. House calls were not the habit of most local physicians but soon were very popular with our patients. Many of the calls, usually made in the