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Waiting in the cold for patients on the bare expanse of Pajarito Mesa, University of New Mexico medical workers (from left) Jennifer Sparks, Deidre Dietz, Dr. Roberto Gomez and Maria DeArman joke for the camera. Gomez and his medical students were bringing free medical care to the 1,500 residents of the mesa, an area southwest of Albuquerque that has no basic services such as electricity or running water.

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At 3:45 p.m. on a recent Wednesday, Hortencia Castañeda's appointment with the doctor went like this:

She drove to the top of a mesa in southwest Bernalillo County, got out in the frigid air and sat down at a card table, huddled against the numbing wind.

The cold got worse when she rolled up her sleeve for the group of medical students and a professor from the University of New Mexico.

But the free medical care in a spot that's miles from the closest doctor - not to mention years from running water and electricity - was worth it. The students told Castañeda, who has a family history of diabetes, what she wanted to hear: tests showed her blood sugar level is normal.

"I'm glad to know to my blood sugar is OK, but my blood pressure is high and I wouldn't have known," Castañeda said in Spanish before getting back into her car and heading home on the remote, 22,000-acre area known as Pajarito Mesa.

The students, led on this day by Dr. Roberto Gomez, come to Pajarito Mesa every Wednesday, bringing sorely needed help to a community that residents say has grown to about 1,500.

The students do routine blood sugar and blood pressure checks, but also offer gynecological exams, breast cancer screening and other medical tests.

"What we want is for everyone in the state to have a medical home," said Gomez, wrapped in a cozy fleece, "so people don't feel the only way to get medical attention is in the emergency room."

The outreach, paid for by UNM, usually operates out of van operated by Blue Cross and Blue Shield of New Mexico. The van on this day, however, needed repairs and the group set up a simple card table with a sign advertising the free care. They gave away hot mint tea - the only warmth for miles. They weighted their signs with rocks to withstand the wind.

The group is just one that's working to bring to the mesa some of the services that many residents cannot afford and that others, some of whom are immigrants, fear reaching out for.

The program started this year. But many of the obstacles of living on the mesa are as old as the settlement itself: there has been little progress in getting running water, sewer service and electricity, and no resolution to arguments about who had clear title to the land and whether the subdivisions that sprang up were legal.

Dotted with trailer homes, car carcasses and stripped washing machines, the area is as isolated as ever from modern life.

Along with the persistent downsides to life this far from the city - no street addresses, only sketchy cell phone service and roads that trap cars in mud when it rains - something else is new on the mesa.

Methodist Rev. Roberto Martinez and his daughter also set up shop recently at the top of the main road into the community 12 miles from Albuquerque. The sign leaning against their minivan advertised free water and free blankets.

"We care about people spiritually, but we have to look after their physical well-being, as well," Martinez said in Spanish between visits from residents.

Many mesa residents use generator-powered space heaters to keep warm, and the blankets were popular: Martinez and his daughter handed out 280 blankets the day before Thanksgiving.

The water, in used plastic Pepsi bottles and milk jugs, was popular as well. Residents typically haul their water from the South Valley or from homes near the mesa that allow them to fill up barrels.

The community was supposed to have a water source by now. After years of fighting for a community well, the state last year set aside $500,000 for the project.

As advocates for a well pushed for water that didn't have to be hauled by giant barrels in pickup trucks, they realized their challenges.

Drilling down far enough for clean water - at least 700 feet under the mesa's escarpment - might be prohibitively expensive. The process of getting permits, and finding a good site for a well, was time consuming and cumbersome.

Now, the Pajarito Mesa Mutual Domestic Water Consumers Association in mid-December will choose between a tank set up on the mesa for residents to tap for water or an off-site water filling station.

The tank would be filled by a to-be-purchased water truck.

Once a decision is made, it would be at least a year before the project is complete, according to a summary of the project done by the Albuquerque-Bernalillo County Water Utility Authority.

Back at the medical station, the students are signing up more patients as the sun starts to hide over the expanse of dirt roads, trailer homes, sagebrush and loose dogs. Plastic bags and other trash blow by as airplanes head for the Albuquerque International Sunport, carrying Thanksgiving passengers.

Dump trucks grumble their way to the private Southwest Landfill nearby. The medical students hop around to keep warm, waiting for patients.

Resident Angel Mares says he'll be back next week to get his eyes checked. He hopes others will come, too.

But trusting strangers in a place that some residents say is largely without law enforcement doesn't come easy.

"A lot of people have needs, but they are afraid to show up," Mares said.