To get their degree, Mexico’s medical students consult at gunpoint

When Alfredo Cortés arrived at a small clinic for his year of social service, which is required of all medical students in Mexico, he found he had no mobile phone or internet, only a radio.

He lived alone in the clinic, a simple home in a rural community in the state of Michoacán, where the police were conspicuous by his absence. In the early hours of a spring morning in 2020, he was woken up by the noise of trucks banging on the front door.

Several armed men ordered Cortes to accompany them. When he refused, a pickup truck sped away and a man was bleeding profusely from his stomach. He had shot him.

As Cortes went to work, one of them pointed a gun at him and shouted, “Save him!”

The patient required surgery, but the clinic lacked basic supplies, so all Cortes could do was bandage the wound and warn that the man would die if he did not receive treatment elsewhere.

“They point their guns, they shout, they communicate on the radio and you don’t know who they’re talking to,” said Cortes, 26, who later learned the man had survived. “It’s a very stressful situation.”

These stories are common among medical students in Mexico today.

Social service has long been part of the government’s effort to improve health care in isolated communities. But as drug cartels and other criminal groups have increased their presence across the country, it has become an increasingly dangerous rite of passage.

Last week a medical student was shot dead inside the hospital where he worked in the mountains of Durango state, sparking protests by medical students across the country. Some marched in white coats and carried banners that read: “We are not your cheap laborers” and “No more social service, they are killing us.”

Student killings appear to be rare, but university officials have begun to acknowledge that the program has become unsafe, acknowledging widespread complaints about the program.

“This plan is completely chronological and should be changed,” said Dr Luis Carlos Hinojos, director of the School of Medicine at the Autonomous University of Chihuahua.

He said that the university has tried to keep more students in safer urban places and move those deemed at risk. Six students who started working there were reassigned after a doctor was shot dead this month in Bokoyna municipality, which has been the scene of clashes between cartels.

The government defends the program, which dates from 1936 and graduates about 18,000 students each year. Mexico’s Health Secretary Jorge Alcosar told reporters this week that officials would review security situations, but that social service is an “academic requirement that cannot in principle be revoked.”

“It is not appropriate to postpone this training process so important for doctors,” he said. “We cannot ignore the most remote areas, where there are no conditions for complete protection.”

In addition, the program has been an important source of medical care in rural areas. For every 10,000 residents, Mexico has 24 doctors – not far from the US figure of 26 – but they are highly concentrated in cities.

In May, President Andres Manuel López Obrador announced that the country would fill the gap by hiring Cuban doctors, prompting criticism that the real problem was security.

Medical degrees in Mexico begin right after high school and typically last six or seven years, the last of which is devoted to community service, which may include conducting research or working in clinics. Normally, the government determines the available places and leaves it to the schools to fill them.

The students with the best grades are the first to choose where they will do their social service, so those with the lowest averages are usually sent to the most dangerous areas. Sometimes they work without supervision or contact with the outside world and live alone in clinics, problems that, according to students and university officials, have long been known but have not been adequately addressed.

Locals view the students as fully trained doctors, creating situations where newcomers can draw the ire of the community when they are unable to save a patient.

“They would not say that the clinic has no resources, that it does not have an ambulance, that the roads are not accessible, that the routes are not easy,” explains Cynthia Flores, president of a national association representing medical students. “It would be the doctor’s fault.”

Dr. Jorge Valdez García, president of the Mexican Association of Medical Schools, said that sometimes universities are not given enough time to choose their locations carefully and that when a cartel reaches a community, things can change rapidly. .

He said, ‘This has happened many times. “Nobody has the intention of sending them to vulnerable areas.”

In interviews, more than two dozen current and former students described harrowing experiences that included walking through cartel checkpoints to get to their clinic, providing medical care at gunpoint, and working in places where Criminals beheaded on the road.

“We were always concerned about our safety,” said 28-year-old Adonai Esparza, who in 2019 served at a rural clinic in northern Michoacan that has seen cartel-related violence related to the avocado trade.

One night, a teenager suffered a knife wound in his hand. Esparza began to look after him after hearing several cars approaching.

The boy’s father, a drug kingpin in the area, entered the area with two armed men. He asked about his son and when he left he told Esparza: “Don’t worry, you will be watched and protected.”

“After that, I felt a little weird,” Esparza said. “I realized I had security, but not what I expected.”

Hilary Lopez, 27, who served in Quintana Roo state in 2020, quickly learned to prioritize certain patients: A nurse told her they were relatives of drug traffickers.

In one incident, a man who came after midnight insisted that he investigate an elderly woman who had fallen into her house. When Lopez explained that he couldn’t leave the clinic with a stranger, he returned 15 minutes later with a gun.

“Doctor, are you going to come or not?” he said.

Lopez called the nurse to calm the man down and convinced him to stop bullying. But while he was out of town, armed men from the community surrounded the clinic and threatened to burn it down after one of its patients died of COVID-19. The nurse warned her not to return, and Lopez found a new location and changed her phone number.

“I disappeared from the map,” he said.

Such cases rarely make headlines. The murder of a medical student is a different story, but two recent cases have brought the issue into the public eye.

The first victim was 23-year-old Luis Fernando Montes de Oca Armas, who was ending his service at a hospital in Huajuquilla El Alto, Jalisco state, in June 2021, when he left in an ambulance to accompany a patient to a neighboring state . Why Zacatecas?

On his way back, he sent a disturbing voice message to his father.

“Here’s a truck,” he said. “Surely they’re going to kidnap us or something like that, I don’t know.”

His father called his son-in-law, Juan Carlos Galaviz, who discovered Monte d’Oca and the bodies of the ambulance driver on a road next to the abandoned vehicle.

Then, on Friday night, the 15th, several people rushed to a rural hospital in Durango where Eric Andrade Ramírez worked. It seems that they were under the influence of drugs.

Details of what happened next are unclear, but at one point at least one of them pulled out a gun.

Andrade, 25, was killed just days before his service ended in El Salto, a logging town an hour and a half drive from his home in the city of Durango.

After the murder, some of Durango’s medical students abandoned their positions and vowed not to return.

“How is it possible that we are providing a healthcare service to take care of others, but no one protects us?” asked by Daniel Ramirez, a colleague, 27, who decided to leave his job in a town in Durango, where he said. The liquor smugglers were in connivance with the police.

Dr. Martin Gerardo Soriano Sarinana, the rector of the Autonomous University of Durango, where Andrade was a student, said that about 180 students would be redeployed from their positions. He “resolved to develop community service programs for our students that do not jeopardize their safety.”

At Andrade’s funeral Sunday afternoon, classmates wearing white lab coats cried silently as they watched his coffin being lowered into the grave as a 13-person band played. His friends described him as a charismatic person who loved Norteo music and threw parties.

His brother, 29-year-old Louis, said Andrade had spent his last years in turmoil as armed men were often seen seeking treatment.

“I lived in fear,” said Louis. “I didn’t want to serve.”

Her sister, 24-year-old, the youngest of three brothers and also a medical student, is about to begin her community service on August 1 in a town on the outskirts of Durango city. He’s reconsidering.

“Right now I hate medicine,” he said.

The clinic where his brother died, a one-storey white building, is closed. In the foyer, a bouquet of flowers and candles lie on the floor next to a large speck of dried blood.