Orthopedic surgeon Mike Berkeley, white-haired and thin as the air here at seven thousand feet in Mexico’s Sierra Madre, waves to the guard from the Sinaloa cartel as we turn off the narrow highway and head down into the canyon, a four-hour drive from Chihuahua City. The young man, positioned in a dilapidated building high above the road, raises his AK-47 in recognition.
Sunset is approaching on a spectacular fall evening. Rolling hills surround us, carpeted with fragrant pines, and the sky is more deeply blue than I’ve ever seen it. Mike says the small creek on our left holds big German brown trout. With a silent laugh, I wish I’d brought my fly rod. It’s not for nothing that a quarter century ago, this area had the beginnings of a promising ecotourism industry. That changed when the cartels came—first the Chihuahua gang, La Línea, in the early 2000s, then the Sinaloas, a few years later. The perch from which the young sentry passed us through was supposed to have been a hotel.
Mike swings off the paved road and onto the hard-packed dirt leading to the entrance of the medical complex he runs with his wife, Maci. They primarily provide care for the isolated and impoverished Tarahumara Indigenous people. Covering seven acres, the twelve-building compound includes a 10,000-square-foot hospital, a dining hall, a machine shop, classrooms, a small library with books in English and Spanish, two dormitories for the 25-member staff and families of patients, and a few small houses. A volleyball court outside one of the dorms suggests a collegiate atmosphere.
The Berkeleys are a long way from Mike’s hometown of Houston, where he trained at Baylor College of Medicine, and from Stanford University, where they met in the early seventies. Stanford is where I met them too. I attended their Christmastime wedding, in 1975, though until this trip to Chihuahua, I hadn’t seen them since.
Medicine runs in Mike’s family, which also has deep Texas roots. His father, Ralph Berkeley Jr., was an ophthalmologist who established the Berkeley Eye Center chain, and his forebears include Isaac Van Zandt, the Republic of Texas ambassador who helped bring the young nation into the United States. But after Mike finished his residency, the couple looked to make their life together outside Mike’s home state. They went to the perfect place for a young orthopedic surgeon to hit it big—the plush resort town of Aspen, Colorado, where America’s richest and most overly ambitious skiers frequently found themselves in Mike’s operating room. The Berkeleys also started investing in local real estate, and by their mid-thirties they were set, with plenty of money and two sons, living in a log mansion on a five-hundred-acre ranch outside nearby Glenwood Springs.
Maci discovered a flair for business; she turned several acres on the ranch into a turf farm and eventually outearned Mike. But their early prosperity soon caused them to ask the classic midlife question: Is that all there is? Maci, whose mother was a psychology professor and whose father was president of Oregon State University, says her family frequently emphasized noblesse oblige. Mike tired of his lucrative yet routine practice that mainly benefited the wealthy—although he did get a bit of a charge from setting Jack Nicholson’s wrist in a black cast to match the actor’s tux for the Oscars.
Both Berkeleys are deeply religious—they met in a Bible study—and ultimately felt called to serve those who have next to nothing. But where? They each spoke a little Spanish, and Mike’s grandfather had owned a ranch in northern Mexico, where Mike had spent considerable time in his youth. In 1989, after a two-year stint with Mercy Ships, which operates hospital vessels around the world, Mike started working half-time at a children’s clinic in Chihuahua.
For the next ten years, the Berkeleys shuttled between Colorado and Mexico. Then came the case that led to the founding of their Hospital Misión Tarahumara. A young burn victim with a charred and badly infected leg entered the clinic in Chihuahua a week after he was set on fire by a gasoline explosion. Mike grafted on healthy skin and treated the infection. He felt little hope when the Tarahumara boy returned home to the small town of Samachique, two hundred miles to the southwest. Hearing nothing for months, Mike wrongly presumed he had died.
Not only had the boy lived, but he was regaining the use of his leg. Mike didn’t know it, but he had become a regional celebrity for saving him. Samachique’s leaders soon offered Mike a site in a little valley in which to build a hospital, and the Berkeleys founded a Houston-based nonprofit called Mexico Medical Missions to support the endeavor. The hospital welcomed its first patients in 2001, and today it boasts twenty patient beds, with gleaming tile floors, digital X-ray equipment, a dentist’s office, two surgical suites, two maternity rooms, and six months’ worth of medical supplies at any given time.
Like the Berkeleys, many of the staff members are religiously motivated. They include both Mexican and U.S.-trained nurses, as well as interns from Mexican medical schools who are fulfilling a government-mandated year of public service. “We did not leave Aspen for a warm, fuzzy feeling,” Mike says. “There is a faith basis. It’s what Jesus would do.”
Maci adds, “People tell us, ‘You guys have sacrificed so much.’ I don’t feel like I’ve sacrificed a ton. Occasionally I look at other people’s lifestyles and think that it would be nice, going to Pilates and getting a facial once a month. But if you’re doing what you’re supposed to be doing, there’s a lot of joy and satisfaction in that.”
Even so, it’s not been easy. The hospital’s 24-hour, seven-day-a-week emergency room is always busy. And at age 72, Mike often gets tired from performing long surgeries. The surrounding poverty and disease can also be overwhelming. Donors are welcome and necessary, but courting them can prove a grind. The hospital’s $1 million annual budget comes mostly from contributions from churchgoers in the U.S. Mike says the philanthropy generally falls short; he and Maci balance the books with their own money when necessary.
Maci says their faith is often what propels them when they feel tempted to pack it in. A year younger than Mike, she too gets exhausted. Despite her sense of fulfillment, she admits, “It really is hard.”
Dr. Diana Román is in a world of hurt. Even more so is her patient, a young woman on the cusp of giving birth. She needs a cesarean delivery, and Hospital Misión Tarahumara has neither an obstetrician nor a general surgeon.
Román and a midwife, a redheaded American named Katie Morales, have been working the phones for more than an hour, trying to get their patient admitted to one of two regional government hospitals. Mexico’s national health insurance program promises care for the country’s poorest populations, but Román says that promise frequently eludes the subsistence-farming Tarahumara, who often live far from even the roughest roads within the Sierra Madre’s forbidding Copper Canyon region, often called the Sierra Tarahumara.
That isolation contributed to the Tarahumara’s brief international fame as “the world’s greatest distance runners,” chronicled in the best-selling book Born to Run, in 2009, and a subsequent ESPN documentary. Throughout their history, they have run while hunting and traveling from village to village, either barefoot or wearing the huarache sandals that various Indigenous peoples in Mexico are credited with inventing before the Spanish arrived. (The shoes were originally made with fibers from agave plants.)
Tarahumara footraces attracted U.S. attention as early as 1893, when a posthumous book by the explorer and author Frederick Schwatka reported that the Tarahumara were employed as long-distance couriers and that a Tarahumara man had covered ninety miles in eleven hours and twenty minutes. More than a century later, the cartels also took note; as described in a 2017 Texas Monthly article, Tarahumara were forced into a cross-border drug-delivery service between remote regions of Mexico and the U.S.
At the hospital, Morales at last finds an open spot at Hospital General de Chihuahua, an hour’s flight away. Mike alerts the pilot of the hospital’s brand-new, bright red Carbon Cub single-engine plane. That night, word comes that the young mother and her newborn are doing well.
They’re among the lucky ones. A 2011 article in the Journal of Obstetric, Gynecologic, & Neonatal Nursing reported that the Tarahumara, who represented just 3 percent of the population of the state of Chihuahua, accounted for 38 percent of maternal deaths related to childbirth.
Consequently, the Berkeleys emphasize health care for young children and expectant mothers. They try to persuade pregnant women to give birth at the hospital instead of in the thick pine forest, where they traditionally go alone, grip an overhead tree limb, and drop their infants onto the ground. Not infrequently, the Berkeleys say, both mother and child die, an observation supported by a 2013 public health study by a doctoral student from the University of California, Berkeley. So many children die within just a few months of birth that the Tarahumara are said to name them only after their first year.
If children survive longer than that, the principal dangers become malnutrition and dehydration from chronic diarrhea caused by dirty water used in cooking and mixed into powdered milk and baby formula. To help avoid the latter, Maci encourages Tarahumara women to breastfeed. The problem, she says, is that many soon become pregnant again, which reduces their milk production.
For many, the area’s poverty and attendant medical problems have created an atmosphere of hopelessness. And then, as if that weren’t enough, there is the constant danger of the menacing and omnipresent Sinaloa drug cartel.
Those neighbors from the south exploit the strategic advantage of the same high, boulder-laden forestland that helped the Tarahumara resist the Spanish conquistadores in the 1500s. It offers the Sinaolas a natural fortification against the police, the army, and other cartels.
Mike matter-of-factly calls the Sinaloas “cold-blooded killers” and notes that he sometimes has to repair horrific wounds presumed to have come from their AK-47s (fearful patients never tell). Even so, he, Maci, and the staff prefer them to the previous gang in town. La Línea, they say, couldn’t keep order among its own people and others around Samachique.
Maci says the Sinaloas’ number two man once put his hand over his heart and swore to prevent any harm to the hospital. Even so, one night in 2011, a battle broke out between the Sinaloas and La Línea on the road to the hospital. Vehicles blazed, and machine-gun fire split the darkness. Except for a handful of patients who couldn’t be moved—and a stubbornly devoted nurse who refused to leave—the hospital complex had to be evacuated. Everyone who was left took refuge in the X-ray room, which has the hospital’s thickest walls and doors.
In the end, the conflict bypassed the hospital. I ask Mike what he and Maci would have done if it hadn’t, especially because no one at the hospital carries weapons. In his characteristically soft voice and precise way of speaking, he replies, “We would have told them that if they attacked us, we would close the hospital and leave.”
I turn to Maci. At five foot eleven, with a warm but tough-minded personality, she’s not the sort to back down. I ask her, “Aren’t you afraid?”
“Of course I’m afraid,” she says. “But what we’re doing here is too important.”
Far from being old-time Bible thumpers, the Berkeleys are intellectual Episcopalians who belong to the church Mike grew up in—St. John the Divine in Houston. They’re outspoken in their resentment of medical evangelists who open third-world clinics to convert the natives. The Berkeleys’ approach to spreading the word mainly involves their medical work and what Maci calls “a gentle mention of Christianity.” Asked what percentage of his time at the hospital involves doctoring versus proselytizing, Mike offers an oxymoron worthy of Yogi Berra, the great New York Yankee: “It’s one hundred percent of both.”
If that sounds imponderable, spend a day shadowing Mike and other medical staff members as they hurry from room to room treating patients, who fill the large waiting area each morning. Mike x-rays the left ring finger of a farmer named Guadalupe, whose horse unexpectedly jerked the rein. He examines the torn rotator cuff of a wrinkled Tarahumara woman named Maria, whose daughter translates the questions Mike asks in Spanish. He replaces a temporary cast on a nine-year-old boy who tripped and broke his leg while playing at school. Finally, he takes more X-rays of a twenty-year-old man whose leg he reset with screws and a stainless steel plate after an operation at another hospital failed.
“I’d love to stop and pray with a patient or tell them about Jesus,” Mike says. “But I often lack the time.” There are visual reminders of Christianity—a mural of a shepherd and his sheep above the entrance, a few crosses, a long quotation from Jesus on a wall in the waiting room—but the only semblance of witnessing I observe is when midwife Morales comforts a scrawny, malnourished ten-month-old baby while humming “Amazing Grace.”
Elsewhere in the hospital, I watch Abraham Galeana, one of the two chaplains, try to get a straight story from a man with a badly beaten face and a bandaged forehead and scalp who was delivered nearly dead from the back of a pickup truck the night before. The bandage covers a machete wound. The 38-year-old man tells Galeana it’s his first time in a medical facility.
Other patients have received care only in the far-reaching area’s government hospitals; the closest is ninety minutes away. Through an interpreter, a few Tarahumara tell me that Hospital Misión Tarahumara’s staff members are much friendlier and more personally concerned about their well-being than the doctors and nurses elsewhere. Another substantial difference: The Berkeleys provide free meals and dormitory lodging for families during every patient’s entire stay.
There’s also a difference, the Tarahumara say, in the quality of care. Not even attempting to conceal his disdain, Mike taps on his laptop and calls up the intake X-ray of the young man whose broken leg was mishandled by a government hospital. There’s a pronounced gap visible in his bone, months after the initial surgery. The government doctors also tried to jam an oversized catheter into the patient, injuring his urethra, and sliced a long, unnecessary incision into the side of his leg. Mike then shows me the X-ray he took minutes before, which shows the bone reconnected and healing normally after what he calls a routine procedure.
“In the States, this would scream malpractice,” says Mike, who holds dual citizenship and is licensed and board-certified in both the U.S. and Mexico. “There would be lawyers, the hospital would investigate, the state medical board might get involved, and the doctor might lose his hospital privileges. But here, there are no legal or professional consequences for crappy care.”
Mexico can indeed require compensation through its national arbitration system for doctors and dissatisfied patients. But Mike says that in his region, the payments are rarely awarded, especially to Indigenous people. Asked why, he gives a meaningful, exaggerated shrug that captures the dismissive attitude he sees toward the people he treats. “ ‘Who cares?’ ” he says. “ ‘It’s just another Tarahumara.’ ” It’s this sense of injustice, combined with their faith, that the Berkeleys say keeps them going.
On another day, Mike joins associates of the hospital who are helping Tarahumara drill wells and construct clean-water systems. Another volunteer, a long-bearded farmer from Indiana named Andrew Bornman, works to improve crop yields through soil management and more effective corn-planting techniques. (The Tarahumara subsist mainly on corn, beans, and occasional goat meat.)
Back in the office, Maci deals with suppliers, solicits donors, and scours accounts for money to use to pay incessant bills. In the evenings, she assembles anything from chiles rellenos to meat loaf for Mike, staff members, and an average of about a dozen guests each night. “I don’t like cooking so much as I like to feed people,” she laughs.
Are they making a difference? The hospital treats about 10,000 patients each year—so many that Mike and Maci continue to write donor appeals and grant applications to increase the staff.
Still, there are crushing losses, like an infant who died in the arms of one of the nurses, Adriana Madalinski, on the way to the nearest government hospital. “It was dark, and no one could see me crying over the baby,” Madalinski recalls. “I was the only one in the ambulance except the driver, and I just felt so alone.”
But such tragic outcomes are offset by those of patients like the boy whose right arm and hand were mangled, apparently when he and his friends were playing with an AK-47 they had found. Mike pieced him back together after other doctors considered amputation the only option.
Among do-gooders of all stripes, there’s an oft-repeated story of a little girl walking along the beach at low tide and throwing stranded starfish back into the ocean. A grown-up comes along and tells her, “You’ll never save them all. What you’re doing doesn’t matter.”
The girl picks up another starfish and flings it into the water. “It matters to this one,” she says.
I mention the story to Maci, who thinks about it for a long moment. “Well,” she says quietly. “You win a few.”
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