Report 2 from Ajijic
For lots of well organized photos, go to and click on Medical missions in the top information line and choose Chapala.  Then there are all kinds of options of what you want to read or photos to see.  Here is an explanation about the photos with the bear.  Each Rotary Club in our district was given a bear to participate in the club’s activities for the year. Rotary London Hyde Park in London sent a bear with David, our Pharmacist.  So, bear Lloyd Henry Parker has been everywhere with us and will be presented today to Rotary Ajijic as an expression of friendship.  I will exchange banners with the clubs.
Saturday was not a clinic day, so the team explored the town in the morning, finding other restaurants to eat and even finding a singer to entertain children at the school on Wednesday.  We’ll see how that works. David Knoppert (the Pharmacist who would rather golf than eat), Dr Doug and Gord and his brother in law, Peter, who lives here, all went for a game of golf on the course beside our destination this afternoon.  They were all pretty excited about their game.
Our big function was a meet and greet at 2 till 6 at Rotarian Moonyeen’s house (she is also my contact person for this project).  She and her retired architect husband Perry live in a BEAUTIFUL house high on a hill in an exclusive area looking out to Lake Chapala.  This is an interesting structure, but Perry did not design it, admitting designing the kitchen, removing walls, building balconies and making changes.  As the day wore on, everyone, I think made it to his games room down a lot of steps and located beside a pristine swimming pool among the flower beds.  Perry has his own supply of Tequila in a barrel, and it was about 1/3 full before we arrived, a little lighter now.  He keeps a towel draped over the barrel and moistens it several times a week to keep the barrel from drying out.  Yes, I tried some with a sip and the salt and lime deal.
When we arrived, the dining room table was laden with food, dips, BBQ’d ribs, rice, shrimp, salads, food for a lot of people, and lots of liquid refreshments. The house had huge windows looking out into the gardens and the view of the lake.  Lots of entertaining space and complete with 2 separate casitas or apartments for guests.
The pool at the hotel has a sign on it that is it for the use of the hotel guests.  The water is so cloudy that you cannot see 2 feet below the surface.  I have been talking to the manager about it, and it does not seem to improve.  Brave Heart Marilyn Holmes really wants to swim and she decides to try it, keeping her head well above the water line.  The temperature is freezing and she does not stay in long, but there were no holes eaten through her bathing suit by whatever causes the water to be so grungy.  
Most explored the town in small groups and while some went out for a bite to eat, about 8 of us played a rousing game of golf with cards.  Now they are eager to play again.
Sunday we are off in the two busses to Tequila, the place where the nectar of the Mexican Gods is made.  It was a 2 hour drive toward Guadalajara, and then west toward Puerto Vallarta.  Guadalajara is a city of 6 million people with another 10 million living in the surrounding villages and towns.  The speed limit is always 80 Kms, but the roads are poor even on major highways where the lanes are poorly marked.  Even on divided roads, there are hundreds, thousands of speed bumps. 
We drove past a new Catholic Church dedicated to the Martyrs and it will hold 2000 people.  
 We drove though huge valleys between high hills, where they grew corn, some millet for bird seed, acres and acres covered to grow berries, and of course the blue agave cactus plant to make tequila.  It is after the rainy season now, and the hills are dry and brown.
The corn is dry now and some has been harvested.  I am told that all of the corn is for human consumption, both white and yellow corn probably to make the masa to make tortillas.  Some fields are large but I am told that all of the work is by hand.  The rows are narrow.  They can get one or two crops per year depending on the variety.  The cobs are harvested and then the stalks are cut close to the root, probably with a sickle, laid on the ground and then picked up and stood up in huge stooks, ready to be purchased for cattle food.  The cob is never fed to animals.  I’m not sure how much nutrition is left in the dry stalk and leaves.  I saw huge grain storage bins at facilities, similar to what we store corn in on the farm.  
There are acres and acres of raspberries, blueberries, and blackberries under an overhead canopy, shielding the plants from morning cold and afternoon intense heat and sunshine.  I am not sure where the water comes from for these plants, but apparently the lake is grossly polluted from the fertilizer and the pesticides.  I am sure this industry employs large numbers of people to pick fruit for the Canada, USA and European market. 
The Blue agave cactus plant intrigues me.  There are fields and fields of them.  Just like in Guatemala, they even plant on the road allowance right up to the pavement.  Unlike Guatemala, they do not seem to plant on the steep hillsides.  I think the blue agave cactus is grown and treated like a cash crop.  But it is a pretty lengthy investment to get return on their labour.  The plant has to grow for 6 to 9 years before it is harvested, usually around 8 years when the sugar content is at it’s peak.  This plant is also called the century plant because it will grow for a hundred years until it flowers, and the bats come to suck up the nectar, pollinating the flower and creating seeds.  Then the cactus dies!  However, as the plant grows, it sends out shoots from which up to 12 small plants start to grow and they are dug and transplanted to other areas.  If not harvested, they take strength from the main plant.  The tall straight cactus leaves are removed and used as compost.  That leaves a huge ball called a ‘pina’ 
(peen ya) or pineapple, growing above ground, which is what is used to make Tequila.  
The pinas are trucked to the Distillery and paid by weight, going over a scale just like at the grain elevators at home.  40 kilos of agave will make 1 litre of Tequila. There are gigantic boilers to create steam, powered probably by diesel fuel.  The steam is used to cook the pinas for 40 hours, in a pressure sealed ‘room’ and then cooled for 24 hours.  Then they are chopped up or ground and pressed to extract the nectar (cannot be called honey).  The fibre of the rest of the pina is used for compost.  The nectar and a measured amount of water and yeast goes into a 42,000 litre stainless steel vat to ferment.  The yeast is actually natural agave honey or nectar.  The temperature is very closely controlled because too hot and the yeast dies, too cool and it does not ‘work’.  After 72 to 80 hours, it is ready to distill in big stainless steel stills.  The first that comes off is Methanol, not for human consumption and is used as fuel.  Tequila must be distilled at least twice, some is done once more.  It results in a clear colourless liquid with an alcohol content of 57%.  Yes, we tasted that!
Then it is diluted with water to be 40% alcohol, and this is 100% agave Tequila.  Other is sold as Tequila but is 51% sugar cane alcohol and 49% Agave.  The Tequila is now ready to be sold and is called ‘silver’ because it is clear.  Some is put into barrels to age for 2 to 6 months and is called ‘Posado’ and is a little more expensive.  Some is aged 2 years or more in a barrel and called ‘Anejo,' and some is very special aged 5 years.  
We had a lovely late lunch of platters of fajitas, in a restaurant under the trees, and started out for the 3 hour trip home, a tired group who had tasted a few Tequilas.
Monday was our second Clinic, at a residential facility for 60 men aged 16 to 60, addicted to drugs and/or alcohol.  The facility was out in the middle of the countryside with high walls like a jail and entrance by one controlled gate.  There were two pit bull dogs lying under trees outside, but they come into the compound at night.  There are dormitory rooms according to ages, with bunk beds and a small cupboard for each person.  Some are sent here by the law or families and some self admit.  The minimum stay is 6 months and if they regress, the next time is a year.  A physician visits 3 times a week which made me wonder why we were there.  Everyone who works here is an addict, even the young man in charge of the pharmacy.  Everyone has a job to do, which will only take s short period of time.  Mostly they men sit around.  They do have ‘meetings’ 3 times a day which are compulsory.  Some who are progressing in their recovery volunteer outside in return for donations.  One gentleman maybe 40, went to the storehouse and got two big hoes with short handles, a pair of clippers and a sickle with handle of a piece of wood taped on with duct tape, and he was going to the pepsi cola plant to do horticulture and a donation would be given by the plant to the addiction group.  They had a small kitchen and a dining area, a sparse workout area, and a big open square where they mostly sat.  Many carried around a plastic cup that held about 750 mls of water, coffee or tea, all that was ever allowed to be drank.  
We were definitely the biggest show in town and they really appreciated us being there.  They helped carry the hockey bags of supplies and were eager to move tables and chairs.  Our young girls received lots of appreciative eyes.  Everyone was pleasant and cooperative.  We registered everyone but many had no medical complaints, but we saw them anyway.  Dr Doug suggested we ask if there was diabetes in their family, what they were addicted to (which might bring on a larger story of their life) and if they had sex with men, a commonality in this type of environment.
Kim McKay’s job of Triage worked much better with a translator (we had three today from the addiction centre) and she worked along with Registration who prorated 63 patients seen.  Shortness of breath was a major complaint of the Chrystal Meth addicts, with asthma symptoms with any kind of exercise, and they were given inhalers to give relief.  Hernias were diagnosed, ear infections, skin fungal infections, and crotch itch (also fungal) because they share underwear and socks.  Josy brought bags of socks and underwear, a suggestion of her sister who lives here, and these items were greatly appreciated.
A gentleman was examined who had a huge cyst of the back and right side of his neck and head.  He had been to medical facilities in Guadalajara and Mexico City and been told that surgical removal would result in blindness and paralysis.  He did not come for that problem, he only wanted glasses, but his head mass somewhat restricted him wearing them.  The biggest draw of the day was the glasses, and Linda fitted 31 reading glasses, but everyone got sun glasses and a hat, and she left behind more for those that were out working.  
Ramon, our Dentist examined almost everyone and recorded their name and what dental work was needed and they will have to go to the clinic at Tepehua for treatment.  Addicts have terrible oral health and this was evident here.  His work went much faster after he was given a ‘secretary’ to record his chart so he did not have to stop to do that.  
Marilyn and Stuart were kept very busy with Stuart triaging the treatment needed and Marilyn working.  They saw 12 people, lots of injuries from past street fights, back, shoulder and neck pain, and Marilyn diagnosed a knee injury with a torn Anterior Cruciate Ligament which will need surgery.  
A buffet lunch arrived and it was very embarrassing for us to eat out in the open.  We very much enjoyed sharing food and stories with our interpreters.  They were a little rough around the edges but great translators and they thanked us for the opportunity to be useful.  (Yes, that makes me cry even now.)  I asked that the left over food which was a lot, be given to the men and they came with one gallon plastic pails to get it.  Apparently they eat rice, fruits and vegetables but only get meat once a week.  Had I known that before we ate, there would have been a lot more left over?  The caterer was reluctant to leave the food.
We returned to the hotel about 2 and about 8 people braved the pool which is still green despite being worked on.  Christy Bertrand and I continue to plan for the days ahead and we ended Monday by walking downtown to have a lovely dinner together.  We continue to be healthy, but Charlene had some nausea and Linda some sinus issues, both cleared with a good sleep.
Yours in Rotarian and Humanitarian service, Jean