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People are poor in these parts. One in five people in the San Joaquin Valley live below the federal poverty line, according to UCLA's California Health Interview Survey.
In six of the eight counties that make up the Valley's geography, more than one in four children live in poverty, according to the Great Valley Center, a nonprofit organization partnered with UC Merced to improve the overall well-being of the region.
Educationally, San Joaquin Valley children are less likely to be enrolled in preschool, to take classes required for admission to the UC or CSU systems and to take college entrance exams.
More than one in five students in California drop out of high school. Five of eight counties in the San Joaquin Valley post an even higher rate.
Transportation is hard for poorer families, particularly in a Valley so big that trips are often measured by hours, not miles. It is one of the many issues that affect access to care, but one that can't be solved by an increase in doctors and residents.
Christine Muchow, executive director of the Merced-Mariposa County Medical Society, said transportation is the key barrier to care for many Valley residents. "If you need to be seen by a specialist, and we don't have that specialist, they may not be seen at all because they can't get transportation out of the county," she said.
Take 14-month-old Adrian Hernandez, for example.
Adrian is a quiet little boy, with short brown hair and winsome almond eyes. He is the mirror image of his twin brother, Andres -- even their teeth are growing in the same way.
But Adrian has lived a much tougher life.
He's just over a year old and has already endured four major surgeries -- three of them to repair a congenital heart problem, the fourth to treat a club foot.
Complicating his health issues is his family's lack of access to proper care.
There is only one pediatric cardiologist in all of Stanislaus and Merced counties. There is no cardiac surgeon in Merced County at all.
As a result, Adrian is routinely shipped around the San Joaquin Valley just to find care.
His mother, 29-year-old Rosario Cisneros, sighs at the medical merry-go-round of getting Adrian treated. Her son always receives care, but it doesn't come easy.
Rosario can't drive, and her husband takes their only car to work in the fields each morning. If Adrian experiences a medical problem during the day, she calls a friend to get him to the Turlock hospital 40 minutes away.
The trip doesn't end there. Doctors in Turlock call a specialist from Children's Hospital in Madera, who sends an ambulance for him so he can be transported for the care he needs there, Rosario said.
Madera is 70 miles and a 90-minute drive from the family home, but it might as well be in Canada.
Adrian's odyssey is not unique.
For regularly scheduled appointments, the family utilizes a free service dedicated to transporting area residents to medical visits called "Going Places." Since it was created in January 2001, the service has driven hundreds of patients to and from appointments as far away as Los Angeles.
Going Places partners with Healthy House, an area nonprofit organization, to provide health care interpreters for parents like Rosario who don't speak English. (A Healthy House interpreter, Teresa Reagan, translated Rosario's comments above.)
The fact that Adrian receives world-class care at Children's Hospital for his condition doesn't lessen the transportation stress. "There are days when I feel like I am not going to make it," Rosario said. "And then I tell myself 'I don't have a choice. I have to make it.'"
