Life as the Only Doctor Atop Mexico's Sierra Madre
Posted on Aug 19, 2016
Marina López held her 3-year-old son, Wilmer Godínez, snug in her lap. The boy’s spiky black hair and worried eyes peered out from the gray woven cloth in which he was wrapped. It was difficult to tell who was more nervous as the mother and son sat in Dr. Martha Arrieta’s tiny, sun-splashed exam room in Monterrey, Chiapas.
Arrieta, a 25-year-old doctor dressed in jeans and a red hooded sweatshirt, sat an arm’s reach away and gently peppered the young mother with questions. Responses came back in halting Spanish, clearly not her first language. The family was among a group of Guatemalan migrant workers who traveled to Chiapas to help with the coffee harvest. They had walked at least two hours to get to this remote clinic atop the Sierra Madres.
Wilmer had been suffering from diarrhea since yesterday morning, López said. He’d gone to the bathroom six times in two days. Although he didn’t have a fever, he refused to eat or drink—a problem for any child, but especially one who was clearly small for his age.
When it came time for the exam, Wilmer clung to his mother and whined. Arrieta spoke to him in a soothing, playful tone, which made him relax long enough for her to finish the exam. She handed López two boxes of medication—one to reduce any future fever, and the other an antiprotozoan (assuming the reason the boy had diarrhea was due to contaminated drinking water)—and carefully explained how to deliver the drugs. Then she repeated her instructions, using even simpler Spanish.
“Whatever you need,” Arrieta said before the two left, “I’m here to help.”
Arrieta is among a group of 11 doctors fulfilling their social service year with Compaňeros En Salud, as Partners In Health is known in Mexico. She had only been working two months in Monterrey at the time of the mother and son’s visit. Yet it had been a wild ride so far. She had helped a teenage mother deliver her baby, patched up car accident victims, grieved the death of an elderly cancer patient, and sent two other patients down the mountain—a three-hour ride by car—to receive specialized care for a miscarriage and a severely mangled finger.
Her PIH supervisors assured her this was not typical. But what is typical in a community that hadn’t received regular, high-quality health care until recently?
Working in rural, marginalized communities was nothing new to Arrieta, who had volunteered with other social justice organizations. “I saw that each lacked a lot of things, but something they lacked was really central, and that’s good health,” she said. “If people aren’t healthy, you can’t ask them to learn or think differently, or not to drink alcohol, or that they imagine or write.” So she decided the best way to truly help would be to get a medical degree and to use it where it was most needed.
My entire medical training was in preparation for this year.
Arrieta fell in love with rural Chiapas during her first year of medical school while vacationing there with family. (Her father had grown up in Tuxtla-Gutiérrez, the southern state’s capital.) In her fifth year, she took a residency in a provincial hospital, where she knew resources and staffing would be limited, so that she could get the most hands-on experience possible.
Meanwhile, she contacted colleagues working with PIH as first-year doctors, or pasantes, to see if that was the best fit for her government-required social service year. They described the experience as culturally immersive, challenging medically, and personally enlightening. Good health, they learned, is not just about having access to clinicians and medication; it’s also intimately linked to food, housing, employment, the environment, and a myriad of other factors—all of which combine to make providing health care in poor communities a challenging endeavor.
Arrieta was sold. She applied and was one of four from her university to win a coveted spot.
“My entire medical training was in preparation for this year,” she says.
But as much as Arrieta prepared, nothing could match the reality of being a community’s sole doctor. She learned that lesson her first day on the job, when a little boy arrived to her clinic with a dislocated elbow. If she had been in a hospital, she would have sent him to orthopedics for an x-ray and to have it set. But such a call in Monterrey would have required long-distance travel. She’d need to find someone with a car to drive him and his family there. Or she’d have to ask them to walk three hours down a steep, winding dirt road to the nearest community with regular transportation, where they would then hitch a ride to a hospital in the valley.
Arrieta turned for advice to Dr. Fátima Rodriguez, her PIH predecessor who was staying for two weeks to smooth her transition to the community.
“'They can’t go down,’” Arrieta remembered Rodriguez telling her. “And I said, ‘Well, in theory, I can fix it.’"
“'So do it.’” Rodriguez had told her.
While Rodriguez held the boy steady, Arrieta grabbed his arm, said a quick prayer, and yanked. The boy’s elbow popped back into place.
Health is a human right and it should be universal. Here, the people don’t live that.
Arrieta’s learning curve has been steep ever since. She credited Rodriguez and PIH supervisors for shepherding her through tough spots, either virtually or through regular visits. International residents— such as Dr. Elisabeth Poorman from Cambridge Health Alliance, who stayed with her for two weeks in March—have provided further mentoring. And end-of-the-month seminars in Jaltenango, PIH’s headquarters in Chiapas, are opportunities for her and other pasantes to troubleshoot particularly tough cases and discuss how medicine and social justice are intertwined.
Ultimately, she said, “you learn from practicing and applying medicine.”
And that’s something she does 24 hours a day, seven days a week. “In the beginning, patients arrived and knocked on my door at 10 p.m. and said, ‘Ay, my fingernail hurts,’” Arrieta joked. “So you have to draw the line and say, ‘Look, if it’s an emergency, I’m never going to deny you care. But if not, then go to the clinic during visiting hours.’”
One saving grace is that Arrieta lives with the family of Doňa Anastasia López, one of two remaining traditional midwives in Monterrey. The family buffers late-night requests, and also provides a home-away-from-home filled with children, laughter, and companionship. “Isolation can weigh you down” she said. “I really miss my family. Having the children here helps me a lot.”
Many pasantes use their social service year to decide on next career steps. Arrieta doesn’t think medical specialization, the path most traveled, is for her. One thing she does know for sure, though, is that she despises how medicine is practiced in hospitals. “I don’t like to be closed up in a hospital; I don’t like to have 10 minutes for each patient.” She thinks the Mexican medical system is broken, because it focuses too often on caring for chronic patients and too little on prevention and primary care.
“Family and clinic doctors are only there to hand out medicine,” she said. “There isn’t a relationship with the communities or with the patients, because you have 50 patients to see every day.”
There has to be another way, Arrieta said, and she wants to help find it. A master’s degree in community development and health seems to her like a logical next step. What she has seen so far confirms her belief that “health is not a privilege,” she said. “It’s not something that should be reserved for people who can pay for it or live in the cities. Health is a human right and it should be universal. Here, the people don’t live that.”
Now that’s changing, with Arrieta and PIH.
Dr. Martha Arrieta listens to the heart of Rolando Morales, who lost sight in his left eye 10 years ago.
Her last patient of the day walked into her exam room. He wore dusty sneakers, was missing a front tooth, and had pulled a black cap over the left side of his face.
Rolando Morales, 36, slumped in the chair next to Arrieta, who asked him how she could help.
“I came so that you could bring me back my sight,” Morales said, pulling off his cap to reveal a milky blue cloud where his left iris used to be.
Ten years ago, he explained, someone sliced his eye in an accident on el otro lado, or “the other side.” (That’s what he and other migrant workers call the United States.) He went to a local emergency room, but all they gave him were eye drops and told him he’d completely lost vision in his left eye.
Arrieta had him sit on the exam table and shone a light directly into the damaged eye. “Negro” was all he saw, but she noted that his retina still looked intact. He knew it was highly unlikely he’d see again, but was hoping to get a prosthesis. Ashamed of his appearance, he always wore a cap to mask his eye.
“Whenever I walk down the street, people think that I’m a bad person,” Morales said. “I don’t want to be this way.”
Arrieta explained that, with her PIH colleagues’ help, she could get him an appointment with an ophthalmologist in Tuxtla. He would have to gather proper documentation to apply for seguro popular, government-provided health insurance. Once he did that, it still might take some time, since there was only one ophthalmologist in Chiapas. And surely there would be a long waiting list. But would he like to try?
Morales’ shoulders relaxed and he flashed a crooked smile. “A lot of time has already passed,” he said. A few months was nothing compared to 10 years of partial blindness and social isolation.
Arrieta nodded knowingly: “We’ll see what we can do.”