'Dr. Moí' Will See You Now

Dr. Valeria Macías and Moíses “Moí” Mazariegos, a driver and logistics coordinator, were stuck. They idled in a pickup truck on a remote road in rural Chiapas, Mexico, with a cab full of patients and a renowned doctor from Mexico City. Facing them, a stone’s throw away, stood a large group of people who had erected a roadblock of burning tires and a chain barrier to protest its poor maintenance.

Macías and Mazariegos, who both work for Compaňeros En Salud—as Partners In Health is known locally—completely understood the residents’ frustrations, having traveled the rutted and at-times impassable roads dozens of times. But they needed to get their patients to care on the other side of the barricade.

The big city doctor decided to take matters into his own hands. He got out of the truck, introduced himself to the frustrated Chiapanecans, and asked them to move aside. No one budged. Clearly his titles held no pull here, so he slunk back to the pickup.

Mazariegos then tried to break the impasse. He told them he agreed with their protest, but that he worked for a medical nonprofit that was helping people in their communities, mentioning Salvador Urbina as one example. It just so happened that a resident was among the protestors. He vouched for Mazariegos and PIH, praising the work they’d done in his community, and urged the others to let the truck pass.

Within minutes, 26-year-old Mazariegos was back at the wheel driving through the roadblock.

Macías told the story as just one example of how Mazariegos works magic, and not just with people from the driver’s hometown in Jaltenango, Chiapas. “This magic works everywhere,” she says.

Mazariegos started working for PIH in 2012 and quickly became known for his integrity, solid advice, boundless energy, and playful personality. As a driver, he transports medications, supplies, staff, and patients to and from all 10 public clinics in which PIH operates around Chiapas. And as the logistics coordinator, he ensures the smooth operation of Right to Health Care, a referral program that helps connect patients with specialized care at faraway hospitals. He drives patients to their appointments, sits with them while they receive care, and advocates on their behalf whenever necessary.

His PIH colleagues call him a todólogo, or expert in everything. But he’s known by another name among patients in the communities where PIH operates.

“To the people, he’s a doctor, and he’s Dr. Moí,” says Dr. Azucena Espinosa, director of Right to Health Care.

From coffee roaster to caregiver

Before he was Dr. Moí or a todólogo, he was a bean roaster for a small group of coffee producers in rural Chiapas. He never earned an advanced degree, but he certainly knew everything there was to know about coffee. It was what he drank in the morning, what grew in the fields all around him, and what he worked with at least eight hours every day. But after inhaling the dust and smoke from roasting machines for four years, he’d developed a fever and a nasty cough. He needed a doctor, but was afraid of what might be found.

At a mobile health clinic, Mazariegos met a U.S. nurse who recommended he visit a nearby PIH-supported clinic staffed by Mexican and foreign doctors. “’Go see them so that they can review your case and help you get better,’” he remembers her saying.

So Mazariegos did. Dr. Jafet Arrieta, PIH’s director of operations at the time, and Dr. Daniel Palazuelos, PIH's chief strategist in Mexico, examined him and believed he suffered from “coffee lung,” a disease similar to miners’ lung that sometimes plagues workers in coffee processing plants. The only cure was to stop roasting beans, which seemed an impossible prescription to fulfill. They recommended he switch to a different job at the processing plant and that he come back in two weeks for a follow-up appointment.

But before he could ask his supervisor about changing jobs, Mazariegos cut his finger at work and was put on leave until it healed. His health improved during the 20-day break and he immediately told his doctors, who were convinced his illness was linked to coffee roasting. They chatted with him about working at PIH’s office in Jaltenango and, in early 2012, he was hired as the first non-medical employee in Mexico. He was a quick learner and soon was doing much more than driving PIH’s three routes throughout Chiapas.  

Mazariegos’s local connections and deep understanding of the culture and people come in handy in sticky situations. PIH’s executive director in Mexico seeks his advice on questions related to regional politics. First-year doctors, called pasantes, turn to him to understand patients who fail to show up for appointments or to follow tricky drug regimens. Most patients are coffee farmers, which means Mazariegos knows they are poor, are forever linked to their land, and live far from the nearest clinic. He’s often the one encouraging pasantes, who mostly come from large cities in Mexico, to consider patients’ unique situations and not think of them as simply “difficult.” But it goes both ways. He also explains to patients the seemingly mysterious actions of the young doctors.

 “We are considered gringos there,” says Macías, who was among PIH’s first pasantes.

Coffee beans dry in the sun at a processing plant in rural Chiapas, Mexico. (Photo by Rebecca E. Rollins/Partners In Health)

A problem solver

Mazariegos began working with PIH when Macías was halfway through her service year. She had no way of knowing the driver would become like her “right arm” for two years as they built Right to Health Care from the ground up.

It all started with Macías having what she calls a “tumor week.” Patients from miles around flowed through her small clinic in Honduras, Chiapas, almost everyone with an inexplicable mass growing somewhere in their bodies. Many had been living with health problems for months, even years, but never had had access to a doctor like Macías. She could do little beyond refer them to specialized care in a hospital hours away by car, knowing that few—if any—would follow up. Most couldn’t afford the trip. And even if they could, they weren’t accustomed to navigating the Mexican health care system, and were often discriminated against when they did.

Frustrated, she talked to Flores and Arrieta to figure out a way to get patients the specialized care they needed. From those talks sparked Right to Health Care, of which Macías was the founding director. Mazariegos became her constant sidekick.

After she finished her service year, Macías worked with Mazariegos for two years to forge paths through the complex, and sometimes confusing, Mexican health care system. Each patient presented a new problem to solve. One day, they focused on getting chemotherapy for a breast cancer patient. The next day they tracked down a plastic surgeon for a woman with a debilitating physical deformity. Over time, they developed solid connections with hospital staff, nurses, social workers, and specialists in several cities in and around Chiapas who helped usher patients through the system.

Mazariegos was key in forging these relationships. “Without him, this program would not have been possible at all,” Macías says.  

A tireless advocate

Patients rely on him as well. As part of the Right to Health Care team, Mazariegos arrives at their door before dawn to drive to the closest hospital in Tuxtla Gutiérrez, the capital of Chiapas. Along the three-hour drive, they chat and tell stories to pass the time. Sometimes ghost stories slip into the mix. (His colleagues say he has an impressive collection.) Once at the hospital, he goes along to morning and afternoon appointments to ensure doctors are offering patients the best options for care.  

“Moí has an impressive warmth and treats patients like family,” Espinosa says. “It’s really clear in how he acts around them. If one of them becomes seriously ill, he worries a lot.”

Mazariegos works tirelessly and is “on call” even when he’s off duty. People regularly swing by his in-laws’ or his family’s home to ask for help, because they know he has access to good, local doctors. They say they try, but can’t, get care in the Jaltenango hospital. They tell him they need to travel to Tuxtla, Villa Flores, or Tapachula for specialized care, but have no way of getting there. And they ask if he’ll come along for appointments, because they feel lost in the system.

Sometimes, he says, they simply ask: “’What is it I have to do so that PIH doctors in nearby communities can see me?’”

That’s when he used to turn to Macías, and now Espinosa, to plead their cases. “’We need to put this patient on the list,’” Macías remembers him saying about patients with complex medical issues. “Moí has a huge heart.”

Mazariegos is too humble to acknowledge the major role he plays within the Chiapas team. He does know, however, that he loves his job, which he defined simply as “helping without expecting anything in return.”

A constant companion

Espinosa will never forget the time when, as a pasante in Laguna del Cofre, she relied on Mazariegos to get through the most difficult case she’d ever experienced. A woman who was developmentally disabled had had six children, almost all of whom had either died or been taken away from her. Only one daughter remained. The girl was clearly suffering and severely malnourished.

It was Mazariegos, Espinosa says, who tactfully removed all roadblocks once again. He spoke to local authorities about the family’s case to encourage them to act. He visited the mother to explain how giving her child up for foster care was the right thing to do. He found extended family to adopt the young girl. And he was part of the team that got the mother counseling.

 “It was a very difficult, very hard situation that I was not prepared to live through,” Espinosa says. She distinctly remembers the two-hour drive from Laguna to Jaltenango the day they brought the child to live with her extended family. She cried the entire route as Mazariegos drove, silent and calm, beside her. Every now and then, she says, “Moí would look at me and say, ‘Ya, ya, está bien.’”

“’There, there, it’s okay.’”

In the video below, Mazariegos drives the last stretch of a winding road to a public clinic in Reforma, the community closest to PIH headquarters in Jaltenango, Chiapas.