Thought some of the visitors here might be interested in the story



Patients wait in La Paz, but surgical supplies are blocked

By Sandra Dibble
UNION-TRIBUNE STAFF WRITER

December 1, 2002

TIJUANA – Hoping to walk again, the 35 patients prepared for hip and knee replacement surgery at a public hospital in Baja California Sur. Flown in from Florida, Idaho and California, the team of 40 U.S. medical volunteers was ready to get to work.

But more than 900 miles north, a truckload of medical supplies sat at the border, without permission to pass. Frantic efforts to obtain an import permit could not overcome the demands of Mexico's bureaucracy, and the mission was scrapped.

"We've been in countries all over the world, and most of the time they get down on their knees and thank us for coming," said Dr. Lawrence Dorr, the team leader and founder of Operation Walk.

The Inglewood-based group enlists specialists from across the United States to perform the procedures on patients who can't afford the operations.

"This is the first time we've had a government that tried to hold us up," Dorr said in a telephone interview from Centinela Hospital in Inglewood, where he runs an arthritis institute. "I am not completely sure why."

Jorge Vargas Coello, head of the federal customs office in Tijuana, said the Baja California Sur agency in charge of importing the medical team's shipment, worth more than $500,000, should have acted sooner in seeking a permit.

Founded by Dorr in 1994, Operation Walk uses donations and volunteers to offer free hip and knee replacements to patients as nearby as Los Angeles and to those as far away as Russia, Cuba, Nicaragua, the Philippines and Nepal.

The Baja California Sur effort marked the team's first venture into Mexico. It took months of preparation in the United States and Mexico. The Baja California Sur government took charge of getting Operation Walk's medical equipment through Mexican customs, providing the hospital and selecting the patients.

"All these people were very much in need and would be waiting a long time, and possibly die before receiving the implants," said Dr. Miguel Mondragon, an orthopedic surgeon at a state hospital in La Paz. He had persuaded Operation Walk to come to the city, the seaside capital of this sparsely settled state.

Mondragon said poor, uninsured patients in Mexico do receive hip and knee replacements at the government's expense. But "the demand is greater than the supply."

One of those selected was Lucero Arcadia, 54, a bilingual secretary who was once her family's main breadwinner. Deterioration of her hip joints forced her to stop working two years ago, and she lost her medical benefits. For close to a year, she has been bedridden, in need of two hip replacements and without the means to pay for them.

Baja California Sur state officials said a single hip implant runs close to $10,000 in Mexico, and a knee implant about $3,500.

"I truly believe these people are angels," Arcadia said. "This is the only real hope that I have."

The procedures were scheduled for Nov. 4, 5 and 6. But Arcadia and her fellow patients, waiting at the state hospital in La Paz, were told that the equipment was stuck at the border.

State officials in Baja California Sur said they first approached Mexico's customs office in La Paz and were sent to the regional office in Culiacan and central offices in Mexico City before ending up in Tijuana. They couldn't begin the paperwork until Oct. 23, the day the shipment left Los Angeles and when they received the final list of what the medical team wanted to bring into Mexico.

Importing donated goods is a time-consuming process that requires many steps and signatures. The procedure was unfamiliar to Baja California Sur's social welfare office, the agency responsible for importing the items.

"For one import request you've got to fill out 10 documents, each of which leads to another," said Bertha García Melgar, the office's director. "But they only told us on the run – we want this document, we want that document, we want the other document," García said.

Customs officials in Tijuana said they first became aware of the shipment Nov. 1, three days before the operations were scheduled. The group had yet to apply for a tax exemption from another government agency. It also needed a temporary import permit for items the doctors intended to take back out of the country, and it needed approval of the federal health department in La Paz.

"We tried to help them speed up the process, because it seemed like an important case," said Vargas Coello, the customs administrator in Tijuana.

On Nov. 3, the day before the operations were scheduled, the state's health secretary flew up to the border to meet with customs officials, "but nothing could be done," García said.

Not even calls to Mexico's ambassador to the United States, nor to top-ranking officials in Mexico City could cut through the red tape.

"If I let them just pass, they could have had their shipment impounded at any checkpoint between here and La Paz," Vargas Coello said.

After standing by for two days, the volunteers had to cancel the procedures.

"If some of this is my fault, I accept the blame," said García of the Baja California Sur welfare office. "They all tried to help us, but there was not enough time."

Despite the problems, Operation Walk's volunteers are eager to return and have rescheduled the operations for January. "Once you get into a relationship with a patient, you can't abandon them," Dorr said.

In La Paz, Lucero Arcadia lies in bed, counting the days.

"I am waiting for them," she said. "With all my heart."