For days, Dr. Rodrigo Bazúa had been tending to a steady stream of healthy teenagers at the public clinic in Plan de la Libertad, Chiapas. It was late summer 2015 and the teens, all 15 and older, were Seventh Day Adventists eager to attend a religious camp in a neighboring community. Organizers required that each one get a medical certification to prove they were healthy, so Bazúa was doing a ton of paperwork.

Rebeca Velasco was among them. The soft-spoken 20-year-old with shiny black hair had no history of illness. She was active and didn’t complain of any aches or pains. By most measures, she seemed healthy. A less attentive doctor might have happily signed her papers and sent her away.

But Bazúa, only one year out of medical school, was thorough. He looked in her eyes, ears, and mouth. He listened to her lungs. All normal. Then he listened to her heart. Here, he lingered for a beat or two longer than he had with other teens.

Bazúa heard a murmur. He placed his hand on the upper left side of Rebeca’s chest and felt a throbbing pulse. That was definitely not normal. In good conscience, he couldn’t sign her papers. He also knew she had to see a cardiologist to determine whether what he heard was innocent, or life-threatening. Within months, they would all discover Rebeca needed open-heart surgery, or she would die.

The news seemed especially cruel to the Velasco family. Exactly one year before Rebeca’s exam, another doctor had informed them that their youngest daughter, 12-year-old Leydi, needed immediate medical attention for a congenital heart defect. Now their oldest, Rebeca, was heading in the same direction. None of it made sense to their parents, Antonio Velasco and Florinda Hortencia Trujillo, who looked to their remaining three children—Carlitos, Elionay, and Daisy—and wondered, “Who’s next?”

The common factor linking the sisters’ cases was that both were detected by doctors working with Compaňeros En Salud, as Partners In Health is known in Mexico. In 2012, Plan de la Libertad was among eight communities where PIH, in partnership with Mexico’s Ministry of Health, began mentoring first-year doctors. PIH has since expanded the arrangement to 10 communities throughout Chiapas, where rural residents can now receive essential primary care and—when necessary—referrals to specialists in larger urban hospitals.

Strange symptoms

Leydi was among the first patients to benefit from the Right to Health Care program, what PIH calls its referral system. Velasco said they’d known their youngest daughter had a heart defect since birth, yet doctors at the time thought the hole in her heart would heal by itself. For most of her life, everything seemed normal.

But after she turned 10, Leydi began experiencing strange symptoms: fainting spells, shortness of breath, and pain in her left arm and lung. In July 2014, the family took her to the local clinic up the hill from their tidy, cement block home. They found the facility clean, stocked with medicine, and—surprisingly—staffed. Before PIH began working in the community, no doctor had kept a reliable schedule in this remote, mountainside community.

Dr. Eduardo Peters greeted them. The first-year doctor from Mexico City was fast-talking, friendly, and eager to help. He took down Leydi’s medical history and gave her an exam. He believed Leydi’s symptoms signaled serious heart problems and recommended she immediately see a cardiologist.

It’s a miracle that you’re alive.

Peters contacted his supervisors, who requested an appointment at the pediatric hospital in Tuxtla Gutiérrez, the capital of Chiapas. Over the course of six months, PIH staff escorted Leydi and her family to and from Tuxtla for a series of diagnostic tests. They learned she had patent ductus arteriosa, which happens when an opening between two major blood vessels leading from the heart fails to close naturally after birth. If not corrected, a patient’s heart can fail.

The good news is that patent ductus arteriosa is a relatively common birth defect. Corrective surgery is straight forward. A catheter is inserted into a vein in the patient’s upper thigh and snaked up to the septum, the thick wall that divides the heart into four chambers. The surgeon then releases from the catheter a tiny, umbrella-like device, which plugs the hole in the septal wall. Tissue grows over the device within six months, and the hole is permanently closed. 

On January 17, 2015, Leydi was admitted to the Tuxtla pediatric hospital and underwent surgery. Velasco remembered feeling completely helpless as the family sat in the waiting room, drying their tears. But the surgery went well. The only indication she’d been through the ordeal was a small incision near her groin. The following day, her father said, she practically walked out of the hospital.

Leydi’s recovery was gradual. She was still experiencing symptoms one month later, but nothing as severe as before the surgery. By her six month appointment, she and her family had noticed a remarkable change. “Thanks be to God, her heart is normal, her color normal, and her lack of air and fainting spells have disappeared,” her father said. “The surgery has been a success.”

A stunning diagnosis

But the family’s celebration was short-lived that August. Relief at Leydi’s recovery morphed into shock at the news that Rebeca might have heart problems as well. Instead of traveling to nearby Villaflores for camp, Rebeca and her father were escorted to a cardiologist’s office in Tapachula, this time with Dr. Azucena Espinosa, PIH’s director of the Right to Health Care program in Mexico. 

“We were thinking it was just a check-up to rule out certain health problems,” her father said. “In our minds, there was the idea that this isn’t serious, that she could continue living a normal life.”

Dr. Margarita Olvera delivered different news. Rebeca, the cardiologist told them, had an ostium secundum atrial septal defect. Most people have four separate chambers in their heart, two atria and two ventricles. Rebeca's heart was structural sound, except for a hole in the wall separating her atria. As a result, the right side of her heart had enlarged significantly over time. If she didn’t have surgery, the doctor explained, Rebeca's life would not be the same.  

I just want my sister to stay, to have our whole family together.

“’It’s a miracle that you’re alive,’” Trujillo remembered Olvera saying. She struggled to understand how her oldest daughter, who used to walk 10 km every day to school, had a life-threatening heart condition. “I didn’t accept it at all.”

Her father felt equally stunned. “From one person who I have seen all my life, 20 years seeing her as a normal girl, and then suddenly they tell me that she has a serious problem,” he said. “It seemed like it was a dream and that, waking up, everything would be different.”

They worried about the economic blow their family would take. Like most of their neighbors in the Sierra Madre, they were coffee farmers and struggled to make ends meet. The past three years had been especially trying, due to a fungus called la roya that had plagued most coffee plantations. Harvests had shrunk by as much as 80 percent. There simply was no money to spare. Would they have to sell their land, their home? Would public health insurance cover the entire procedure?

“The whole family was wondering what was going to happen,” Trujillo said.

What was most troubling, though, was imagining life without Rebeca. “It doesn’t matter if we end up in the street,” Trujillo remembered her 14-year-old daughter, Daisy, saying. “I just want my sister to stay, to have our whole family together.”

 

Coffee beans dry in the midday sun outside the Velasco home in Plan de la Libertad.

 

“Another opportunity to live”

Through it all, the Velasco family leaned heavily on their faith. And on PIH.

Espinosa was there to comfort the family immediately after the diagnosis, and in the weeks and months ahead. She ensured they would receive the organization’s full support—including transportation to and from Tapachula, scheduling appointments with specialists and surgeons, and navigating the labyrinthine public health system. And she collaborated with hospital director José Manuel Pérez Tirado, who guaranteed necessary staff and supplies would be available for the open-heart surgery. 

When the family learned that Rebeca’s procedure would require a stockpile of blood, their community rallied around them. PIH staff drove 20 people—friends, neighbors, and fellow parishioners from the family’s church—to the blood bank in Tuxtla so surgeons would have what they needed.

Six months later, everything was in place for the surgery. Rebeca and her mother were alone in her hospital room early the morning of February 3, 2016. At 8 a.m., hospital staff arrived and told Rebeca she had to bathe before entering the operating room. The young woman calmly did as she was told. Trujillo and the nurses waited outside the bathroom and heard the shower turn on. Then they heard singing. Rebeca had chosen a hymn her parents knew well, one that had given them comfort in the past.  

Afterward, hospital staff wheeled Rebeca down to the operating room. Before passing through the double doors, they paused and Trujillo remembered them saying “’Seňora, say good-bye to your daughter.’” But Trujillo’s own heart had started to race, she felt light-headed, and was only able to say, “Adios!” before Rebecca was pushed out of sight.

Velasco found his wife in the waiting room shortly afterward. He had been up for hours and looked tense. Trujillo sensed her husband’s unease. “’Don’t worry,’” Velasco remembered her saying. “’I was with her. She was well.’” Then she shared the story of Rebeca breaking into song in the shower, and they both settled in for an unbearable wait.

Doctors had said they could expect news by noon, but noon came and went without word. Another hour passed. Then another. Just when Velasco and Trujillo were beginning to feel desperate, the surgeon arrived to say all had gone well. Rebeca was still under anesthesia, so her mother stayed at the hospital waiting for her to awake.

The rest of the family stayed the night with relatives and returned by 10 a.m. to see Rebeca resting in bed, half-conscious but happy. Trujillo fed her apple juice, maneuvering around the multiple machines hooked up to her oldest daughter. She would later tell them she remembered opening her eyes after the surgery to see her doctors’ faces.

“I understood that I had survived everything, that everything was over,” Rebeca said. “I felt like crying from happiness because I had another opportunity to live.”

The family was prepared to stay up to three months in Tapachula as Rebeca recovered. But a mere eight days after her surgery, she was discharged. After a quick check-up on February 19, she and her family returned to Plan. 

A family reunited

 

(From left) Antonio Velasco and Florinda Hortencia Trujillo are happy to have their daughters, Leydi and Rebeca, home and recovering well.

Within weeks of her surgery, Rebeca sat rosy-cheeked and relaxed in her family’s living room, where the walls were covered with pictures of the five Velasco children and certificates from their many accomplishments. A rooster crowed outside, and the zinc roof crinkled with the passage of the midday sun. Freshly harvested coffee beans dried on the cement patio abutting their home.

Beyond a minor infection along her incision, Rebeca had no complications. Even when her heart was in bad shape, she said she never felt a thing. “Now I feel the same, as if nothing happened.” She hopes to return to university soon to study psychology. Meanwhile, Leydi looks forward to finishing high school and the day she can run, carefree, after her schoolmates.

Their parents were simply relieved this nightmare was over and thanked PIH staff for their support.

“Alone, we wouldn’t have been able to do it,” Velasco said. “Really, for us, it was a blessing.”