Once a week, Adrian Billings drives his white Chevy pickup from his home in Alpine, Texas, to Presidio, a city along the Mexican border. This summer he’s been taking his son Blake, who’s home from college, with him. The drive, through mountains and desert on a two-lane highway across which actual tumbleweeds roll, takes an hour and a half.
Billings is a family doctor, one of only a handful in this part of West Texas. He offers a one-stop shop for his patients’ ailments: heart murmurs, kidney stones, etc. Most of the time he works in Alpine or the nearby city of Marfa. But he makes the weekly drive to Presidio because, without doctors like him, it wouldn’t have medical care. There’s no hospital and no full-time doctor. His clinic, which opened in 2007 with the help of government grants, is the only access residents have to even a local pharmacy.
Presidio is poor. The median household income is $20,700, one of the lowest in the US, though still well above Texas’ miserly Medicaid income eligibility limits. “We have a lot of uninsured patients here,” Billings says. Because of this, he sees many cases of unmanaged diabetes and high blood pressure. He also sees a lot of pregnancies. On a sunny Thursday in early June, Billings wheeled out a sonogram machine donated by a charity a few years ago and confirmed that a young woman was pregnant. She was happy—she wants to have a baby. But in West Texas, that’s easier said than done.
