Beyond measure: teaching clinical skills.

I recently visited a retired physician who practiced in Roma, Texas, population 10000. His family has lived and ranched in Roma for 6 generations, well before the border was moved and Roma became part of the United States. As the town's first and only physician for most of his 4-plus decades in practice, Dr Mario Ramirez did it all: deliveries, house calls, minor surgery, and seeing 60 people a day. After wearing himself ragged by racing to attend women in labor, far away from his office, he managed to rent a house, a historical structure, right in Roma's central square and convert this into a tiny hospital—the first of its kind—where women in labor could be watched over and delivered of their infants.