Mass General Brigham's Center of Expertise in Global and Community Health

Enhancing clinical care in rural Mexico part 1

Since working with Companeros en Salud (CES), the branch of Partners in Health that is located in the southern Mexican state of Chiapas, I've had the fortunate opportunity to live with and teach some outstanding Mexican medical students. In their final year of schooling,  all medical students in Mexico complete a "pasantia" -- a year of  service that largely translates into these medical students being posted at rural sites where they serve as the  primary point of clinical  care. To better support pasantes in some of the poorest communities, CES has partnered with the government to provide increased support for pasantes who serve areas of exceptionally increased risk. Currently, CES serves 10 clinic sites spaced throughout the Sierra Madre, providing increased logistical support and mentorship for the Pasantes (and in turn, improving clinical care) in these communities.

In my first week of work, I was stationed in the community of Plan de Libertad, which was really two communities  - "Plan Alto," the main community where we lived and worked, and "Plan Bajo," the smaller community that was a half hour hike down the winding dirt road, through the coffee ranches and solitary homes along the way. In our first week, the Pasante and  I saw a wide variety of cases - adults and children, chronic and acute complaints, surgical, medical, psychiatric, and social. It was striking how competent and capable the Pasante was in his duties, especially for his young age of 24. Functioning essentially as the town doctor, though still not yet having graduated from medical school or having taken his consolidating, final exams, he quickly and creatively dealt with any problem that would arise.  Someone came in with the distal phalange of their finger nearly chopped off from a machete accident - he sewed it all back on. There's no finger splint -- break a tongue depressor in half and make the edge smooth with the sandpaper he keeps in his kit.

The Pasantes are also viewed as outsiders in a way, in that they often come from more urban areas of Mexico - most frequently Mexico City. As with any doctor-patient relationship, it takes time for them to build trust with the local community members. In these small mountain villages of only a few hundred people, the intimate nature of the doctor-patient bond is even more amplified by the physical and social proximity of the Pasante with the other community members. In these communities, an unsatisfied patient likely lives only a few houses down the road or may be the owner of one of the few shops in the village.



The Pasante watching over the community at sunset.