If you ask some of the staff at St. Andrew’s Children's Clinic, they will say that the clinic has gone through 5 or 6 executive directors in the past 5 years. Others will tell you 2. Some will say that the last executive director was just what the clinic needed to grow into a finely orchestrated operation. Some will say he was not the right fit.

The St. Andrew’s Clinic has experienced its ups and downs in recent years concerning the management of the organization. With the board of directors voting to oust several prospective directors for various reasons, and with the clashing of opinions between staff and volunteers, the situation has proven difficult and confusing.

St. Andrew's Children's Clinic, located in Nogales, Arizona, has spent the last 35 years providing medical attention to around 250 underprivileged Mexican children every month. Without the help of a generous staff, board and volunteers who dedicate their time and effort to the mission of the Clinic, many of these children would not have the chance to experience a normal life.

But beneath the surface of the clinic lies a certain level of disorder, stemming from the lack of a unified vision between past executive directors and the board of directors. Differing goals and opinions have caused a rift between members of the clinic’s administration, resulting in a string of directors and feelings of resentment between members.

Barbara Blake, a member of the Board and President of the organization for the past five years, does not believe that the clinic has seen a flux in directors in recent times.

“I guess the reputation that we’ve gone through a lot of directors isn’t really correct” she said.

Blake insists that there have only been 2 directors since Ed Gustafson left due to health related issues. The most recent, Bob Phillips, resigned in January 2008. Blake says that those who have filled in have been interim directors, and only went through trial periods before it was decided that they were not the right person to lead the clinic.
Barbara Gray, a volunteer at St. Andrew's, said that those outside of the board of directors were generally kept in the dark about these assessments.

“What’s sticky about this is that we only get the story from those who have left,” said Gray. “You get different versions from different people, so there’s always been a lot of tension about it.”

The clinic’s board, made up of nine self-appointed members, makes the final decision as to who will be executive director, without consent from the medical staff or the volunteers.

This has left some members of the clinic feeling excluded, especially in the case of Bob Phillips.

"We certainly weren’t asked whether he should go or not,” said Gray. “And that was the tragedy."

Mary Moucha , a volunteer at the clinic for the past five years, agrees. “We’ve not really heard anything from the Board of Directors,” she said. “And basically I think that is an ongoing problem.”

Phillips, who is known for his extensive background in non-profit work as well as grant-writing, led the clinic as executive director for 15 months before he left to pursue his current position as executive director of the Santa Cruz Foundation.

Much controversy surrounds his departure from St. Andrew's, and some believe that his resignation was prompted by disagreements about his vision for the future of the clinic and it's expansion into a more professional medical health center.

“Things needed work,” said Phillips. “The Board has not put together a strategic plan, there is no basic documentation, no policies, and no guidance on how to deal with changes. There is no checking of credentials. And I could see that that this was no longer a small mom and pop operation.”

Philips cited this opposition to change the way things have always been as the largest fault of the clinic.

“There was a resistance to the changes that needed to be made to maintain the clinic,” said Phillips. “There was a lack of understanding and unwillingness, for fear, and this is just my assumption, that if the informality were lost it would become corporate. And I respectfully disagreed.”

Phillips also believes that the mechanics of the board need to change, and that the medical staff, who he refers to as the core of the clinic, needs to be more involved in the decision-making.

“Without the medical staff, there would be no clinic,” said Phillips. “They deserve a voice in its policies.”

However, Phillips has come to terms with his resignation.

“No matter what the vote was, there was no willingness to support the things that I believed, and I think the medical staff believed, needed to be done for the clinic,” said Phillips. “And ultimately that is the board’s right. Legally they have that power. The issue is, does this serve the Clinic well?”

Blake said that there was simply a clash between the board and Phillips.

“Bob had some good ideas,” she says. “Some that might have worked or might not have worked. I could see both sides of it. I had to play the middle road there. I saw all of Bob’s abilities and I liked some of his ideas but I could see that some of them weren’t going to fly.”

St. Andrew's Children's Clinic cares for about 250 children each month. With cohesion in the administration, could they be doing more?

Coca Romero, a long-time staff member and the person in charge of deciding which children will be seen each month, doesn’t believe that the managerial aspect has had any affect on the overall quality of work that the clinic strives for.

“Having gone through so many directors, well people exaggerate,” she said. “They say we’ve gone through six or seven. But there have really only been three official directors at most. And the whole time everything has run perfectly. Everything has gone smoothly. The executive director’s job is to bring in money. It’s very separate. The clinic has not been affected.”

Although there have been differences of opinion, the clinic has not failed to accomplish what it has set out to do, and that is to help those children in need.

“Every blessing has its opposite looming in the wings,” said Gray. “That’s true of everything. And the blessing of the clinic is that you have two cultures working across the border. And that is what makes people weep when they come here.”

Blake believes that the new director the clinic has recently hired could finally be the person the clinic has been searching for these past years.

The new executive director, Ted Estreda, previously the senior vice president of Hospital Operations at CIMA Hospital in Hermosillo, Son., Mexico, could not be reached for comment, but Blake feels confident in the decision.

“He has a fabulous background and he’s bilingual,” she said. “He’s well liked and has a wonderful reputation.”

Blake accepts that the clinic has a journey ahead of it, but with the new director and unified plans, development is possible.

“We have to do a lot of things. We’re struggling to get them done,” said Blake. “We’re far from perfect and we’re trying to improve. But it has to be done with everyone on the same page and everyone feeling good.”

Buck Clark, a volunteer at the clinic, knows that the mission of the clinic will overcome any obstacles facing the management.

“The clinic will survive whatever goes on,” says Clark. “And we will put the kids first no matter what.”




Barbara Blake, President of the St. Andrew's Children's Clinic board of directors, discusses funding for the clinic as well as the search for a qualified executive director.






Mary Moucha, a long-time volunteer of St. Andrew's Children's Clinic, talks about the tension between the St. Andrew's Children's Clinic board of directors and Bob Phillips, the former executive director, in regards to the future of the clinic.



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