Mexico City:
Dr Tien Vo’s last stop of the night is the home of a 35-year-old woman who has diabetes, asthma, rheumatoid arthritis, and, now, the coronavirus. The virus killed her father six days earlier. The oldest of her four children, a 15-year-old boy, learned he had it that morning. Tilted back in a reclining chair at her bedside using an oxygen device, Cynthia Reyes tells the doctor she can no longer stand up herself.
“I can’t catch my breath. It takes a long time to get to the restroom. I feel like I’m going to faint,” she says anxiously. Vo, who exchanges text messages with Reyes every few hours and speaks with her almost daily, listens and nods.
“I’ve tried my best already, but sometimes, you know, we can’t do enough,” Vo says after leaving. Reyes lives in California’s often-forgotten Imperial County, a farming region along the Mexican border. Until recently, it had the state’s highest coronavirus infection rate and its two hospitals were overwhelmed. The county is largely Latino and low income, groups that have suffered disproportionately from the virus.
Vo is “a rock star” for bringing medical services, says Alex Cardenas, a former mayor of El Centro, the county seat. The doctor’s two clinics have done more than 27,000 coronavirus tests since March 23, with a positive rate between 25 per cent and 30 per cent. Vo and his wife, a nurse, emigrated from Vietnam as teenagers. They drifted west from New York to settle 10 years ago in Imperial County, which produces a major share of vegetables in US supermarkets during the winter.
Vo, 43, says he stayed because people are friendly and appreciative. He sees happiness in their eyes when they greet him. “They really need a doctor here,” he says from the front seat of a company van between house calls. “They’re not very hard to please. They chat with me. They text me every day.” To date, Imperial County has had more than 5,200 cases for every 100,000 people, nearly triple that of hard-hit Los Angeles County, the nation’s largest county. Nearly 20 per cent of Imperial patients have tested positive, compared with 6.3 per cent statewide.
Deaths have reached 220 in a county with about 180,000 residents. San Francisco has five times the population but two-thirds fewer deaths. El Centro Regional Medical Center, which briefly stopped taking patients in May, is “bursting at the seams,” says Dr. Adolphe Edward, chief executive officer. Tents set up in a parking lot serve COVID-19 patients, one an emergency room and one an intensive care unit.
A lack of beds has forced the transfer of more than 600 coronavirus patients to hospitals elsewhere in California and brought an influx of state and federal aid, including a spillover 80-bed hospital in a community college gymnasium and additional intensive-care beds. There is no single reason for Imperial County’s plight, but inequalities loom large. It often has the highest unemployment rate among the nation’s 389 metropolitan areas. The jobless rate was 27.3 per cent in June.
Imperial is 85 per cent Latino, with elevated rates of diabetes and obesity. Wind-blown dust contributes to asthma. Its 21 per cent poverty rate is among California’s highest. Crowded, multigeneration households spread the virus quickly. Mexicali, Mexico, an industrial city of 1 million people, brings additional strain when people cross the border for medical care. Many are U.S. citizens and legal residents.
Imperial County is surrounded on three sides in the U.S. by vast, uninhabited desert and Mexicali’s urban sprawl to the south. Settlers diverted Colorado River water with a dike that breached in 1905, causing a two-year flood. Large farms have been passed through generations of families of white European descent. Colorado River water gravitates through hundreds of canals along highways and dirt roads to the farms, getting saltier before it empties into the Salton Sea, California’s largest lake. It was once a desert playground for speedboat racers and Hollywood entertainers but now is evaporating as less water seeps down from the river.
The lake’s shores occasionally are blanketed with the carcasses of oxygen-starved tilapia, while dust from newly exposed lakebed is kicked up by desert winds, helping explain why air quality in the area violates federal standards. Dulce Garcia, who was born in Mexico and settled with her family in California’s Central Valley when she was 12, moved to Mexicali 10 years ago after her husband was deported. She walks across the U.S. border to her job in Calexico to work as a medical assistant at a El Centro Regional Medical Center clinic. She is one of the hospital’s 60 employees who live in Mexicali.
Garcia, 38, rents a room in a Calexico house with other women, letting her register her US-born sons, ages 17 and 15, in the city’s public schools. She sleeps some nights on the US side but usually returns to her apartment in Mexicali. Her husband picks her up in their 2001 Chevrolet Monte Carlo for a 10-minute drive to their leafy neighborhood with a large park for evening strolls. Garcia, a naturalized US citizen, is uncomfortable crossing the border daily to be around COVID-19 patients but, like many others, sees no alternative. A U.S. salary goes much further with Mexico’s cost of living and makes up for the scant wages her husband’s construction job pays in Mexicali.
