The framed, hand-written letter from a patient that hangs on Dr. Francisco Chacon's wall isn't your usual glowing testimonial. In fact, it's full of complaints.

"I give up trying to doctor with you," the writer finally concludes. "It just don't work." Chacon, when asked why he displays the letter, says simply: "Motivation. I'm sure he's partially right."

Perhaps. But motivation doesn't seem to be a problem for Chacon. A native of the northern Mexico state of Chihuahua, Chacon, now 34, came to Liberal with his family just before the start of his second year of grade school. He learned English, did "okay" in school (he chose not to participate in National Honor Society), and won a state wrestling championship as a 140-pound senior.

After finishing his medical education at the University of Kansas School of Medicine–Wichita, Chacon returned to his adopted hometown, which sits on the Oklahoma border and has a population of just over 20,000. Its large immigrant population, harsh environment, poverty, and other factors make practicing medicine even more challenging than normal.

That's clear as Chacon sees patients in the Liberal Family Medicine clinic, which is attached to Southwest Medical Center. His examination rooms stay full of patients ranging from 4-month-old Elijah Brewer, in for a routine checkup, to a 96-year-old resident of an assisted living facility who's suffering from restless leg syndrome.

Elijah is the son of Chacon's nurse practitioner, Holly Brewer. Chacon banters with Holly as she lays her son on the examining table. "You don't have any depression?" he asks. "Work is going okay?" "Uh, yeah," Holly says with a smile.

In the next room is a manual laborer, experiencing chronic pain over most of her body. She's tearful as she describes her condition and reliance on the pain medication she's taking. "I take two (of the prescribed doses), I'm not going to lie to you," she tells Chacon.

Next up is a woman who is suffering from pain in her left knee. She hands Chacon a box of pills from Mexico - apparently a mix of vitamins, aspirin and a pain killer - that she's been taking. "We see a lot of medication from foreign countries," Chacon says. He orders an MRI for her knee.

According to the U.S. Census Bureau, Liberal had the highest percentage of foreign-born residents of any place in the nation last year. Jobs in the meatpacking plant drew Chacon's own family to Liberal when he was a boy. Working conditions have improved, Chacon says, but the area's concentration of agroindustry is still problematic.

The 96-year-old woman is waiting for Chacon in a wheelchair. She's neatly dressed and mentally sharp, although hard of hearing.

"Oh, what a great heart!" Chacon exclaims after placing his stethoscope on her chest. He prescribes medication for the woman's leg. After Chacon examines another potential problem - what appears to be a benign growth behind the woman's ear - he and the patient mutually decide not to do anything about it for the time being.

A young woman suffering acute depression - "I'm crying a lot and feeling out of control," she tells Chacon - and an old family friend battling problems exacerbated by smoking and drinking are among other patients Chacon sees this morning. Periodically, he receives and sends text messages about others who've been admitted to the hospital next door.

Just before noon, Chacon's wife Lindsay, who works as a pharmacist nearby, drops off their five-year-old daughter Keira, who plays on an office computer while she eats lunch. The couple also has two sons - Francisco, 11, and Caleb, 7.

Lindsay, who's from the Kansas City area, admits that moving to Liberal took time for her to adjust to. She says her husband could have practiced elsewhere, but ultimately decided Liberal was where he was needed. "He cares about this town a lot," she says.

"It helps that I have an understanding of the culture," Chacon says.

Chacon said his growing patient load tells him the area is underserved by doctors. Many come to him after being unable to see their regular physician. Liberal has trouble attracting doctors and retaining those who do come, he said.

Chacon has no plans to leave. All the motivation he needs comes in the form of his patients. "I learn every day," he says. "You really just learn medicine at the bedside."