When Alfredo Cortés arrived at a tiny clinic for his year of social service, which is required of all medical students in Mexico, he found that he had no mobile phone or Internet access, only a radio.
He lived alone in the clinic, a simple house in a rural community in the state of Michoacán, where the police were conspicuous by their absence. In the early hours of a spring morning in 2020, he was awakened by the noise of trucks and banging on the front door.
Several armed men ordered Cortés to go with them. When he refused, a pickup truck sped away and quickly returned with a man bleeding profusely from his belly. They had shot him.
As Cortes went to work, one of the men pointed a gun at him and yelled, “Save him!”
The patient needed surgery, but the clinic lacked basic supplies, so all Cortés might do was bandage the wound and warn that if the man did not receive treatment elsewhere he would die.
“They point their guns, they scream, they communicate on the radio and you don’t know who they’re talking to,” said Cortes, now 26, who later learned the man had survived. “It’s a very tense situation.”
Today these stories are common among medical students in Mexico.
Medical students protest in Durango this week demanding an end to the social service program.
(Fermin Ricardo Soto Munoz / For The Times )
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.
The shooting death of a medical student last week inside the hospital where he worked in the mountains of Durango state sparked protests from medical students across the country. Some marched in white coats and carried banners that read: “We are not your cheap labor” and “No more social service, they are killing us.”
Student murders appear to be rare, but university officials, acknowledging widespread complaints regarding the program, have begun to acknowledge that the program has become unsafe.
“This scheme is a total anachronism and must be changed,” said Dr. Luis Carlos Hinojos, director of the medicine school at the Autonomous University of Chihuahua.
He said the university has tried to place more students in safer urban locations and relocate those deemed at risk. After a doctor was shot dead this month in the Bocoyna municipality, which has been the scene of clashes between cartels, six students who were to start working there were reassigned.
Mourners carry a banner and a portrait of Eric Andrade Ramírez as they leave the funeral mass in his honor last Sunday.
(Fermin Ricardo Soto Munoz / For The Times)
The government defends the program, which dates back to 1936 and graduates some 18,000 students each year. Mexico’s Health Secretary Jorge Alcocer told reporters this week that authorities would review security conditions, but that social service is an “academic requirement that, in principle, cannot be cancelled.”
“It is not advisable to suspend this training process that is so important for doctors,” he said. “We cannot ignore the most remote areas that do not have conditions of total security.”
In addition, the program has been a crucial source of medical care in rural areas. For every 10,000 inhabitants, Mexico has 24 doctors – not far from the US figure of 26 – but they are highly concentrated in the cities.
In May, President Andrés Manuel López Obrador announced that the country would fill the gap by hiring Cuban doctors, prompting criticism that the real problem was security.
A medical degree in Mexico begins right following high school and typically lasts six or seven years, the last of which is dedicated 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 the place 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 the clinics, problems that, according to students and university authorities, have long been known but have not been adequately addressed.
Locals tend to view students as fully trained doctors, leading to situations where newcomers can draw the ire of the community when they are unable to save a patient.
“They will 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 Cinthya Flores, president of a national association that represents medical students. “It will be the doctor’s fault.”
Andrade’s mother, María Paula Ramírez Yáñez, bends over her body as her father, José Mauricio Andrade Ávila, her sister Suhey Andrade Ramírez and a family friend, Cecilia Ramírez, left, stand by her side at her funeral .
(Fermin Ricardo Soto Munoz / For The Times)
Dr. Jorge Valdez García, president of the Mexican Association of Medical Schools, said that sometimes universities are not given enough time to carefully choose their places and that conditions can change quickly, as when a cartel reaches a community.
“That has happened many times,” he said. “No one intends to send them to unsafe 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 leave severed heads. on the street.
“We were always worried regarding our safety,” said Adonai Esparza, 28, who served in 2019 at a rural clinic in northern Michoacán that has seen cartel-related violence related to the avocado trade.
One night, a teenager came in with a knife wound to his hand. Esparza began to attend to him when he heard several cars arrive.
The boy’s father, a drug boss in the area, came in with two armed men. He asked regarding his son and when he left he told Esparza: “Don’t worry, you’ll be watched and protected.”
“After that, I felt a little strange,” Esparza said. “I realized that she had security, but not what I expected.”
Medical students in the state of Durango are calling on authorities to better protect students completing their year of mandatory community service.
(Fermin Ricardo Soto Munoz / For The Times)
Hilary López, 27, who did her service in 2020 in the state of Quintana Roo, quickly learned to prioritize certain patients: those a nurse told her were relatives of drug traffickers.
In one incident, a man who arrived following midnight insisted that he examine an elderly woman who had fallen in her home. When López explained that she might not leave the clinic with a stranger, he returned 15 minutes later with a gun.
“Doctor, are you going to come or are you not going to come?” he said.
Lopez called the nurse to calm the man down and convinced him to stop threatening her. But while he was out of town, armed men from the community surrounded the clinic and threatened to burn it down following one of his patients died of COVID-19. The nurse warned her not to come back, and Lopez found a new location and changed her phone number.
“I disappeared from the map,” he said.
These types of cases hardly ever make the headlines. The medical student murders are a different story, but two recent cases have brought the issue into the public eye.
The first victim was Luis Fernando Montes de Oca Armas, 23, who was finishing his service at a hospital in Huejuquilla El Alto, in the state of Jalisco, in June 2021, when he left to accompany a patient in an ambulance to the neighboring state of Zacatecas.
Luis Fernando Montes de Oca Armas, a student at the Autonomous University of Guadalajara, was murdered in Zacatecas while doing his social service in 2021.
(Courtesy of José Fernando Montes de Oca Padilla)
On the way back, he sent a disturbing voice message to his father.
“There’s a truck here,” he said. “Surely they’re going to kidnap us or something, I don’t know.”
His father called his son-in-law, Juan Carlos Galaviz, who discovered the riddled bodies of Montes de Oca and the ambulance driver on a road next to the abandoned vehicle.
Then, last Friday night, several men arrived at a rural hospital in Durango where Eric Andrade Ramírez worked. They appeared to be under the influence of drugs.
The details of what happened next are unclear, but at one point at least one of them pulled out a gun.
Family and friends attend Andrade’s funeral.
(Fermin Ricardo Soto Munoz / For The Times)
Andrade, 25, was killed just days before his service was due to end in El Salto, a logging town an hour and a half drive from his home in the city of Durango.
After the murder, some medical students from Durango abandoned their posts and swore not to return.
“How is it possible that we are providing a health service to take care of others, but nobody protects us?” asked Daniel Ramírez, 27, a colleague who decided to leave his assignment in a town in Durango where, according to what he said The drug traffickers were in collusion with the police.
Dr. Martín Gerardo Soriano Sariñana, rector of the Autonomous University of Durango, where Andrade was a student, said some 180 students will be reassigned from their posts. He pledged to develop “community service programs for our students that do not put their safety at risk.”
At Andrade’s funeral Sunday followingnoon, classmates dressed in white lab coats wept silently as they watched his casket being lowered into a grave as a 13-person band played. His friends described him as a charismatic person who loved norteño music and organized parties.
Family and friends attend Andrade’s funeral.
(Fermin Ricardo Soto Munoz / For The Times )
His brother, Luis, 29, said Andrade had spent his last year very unsettled as armed men frequently showed up demanding treatment.
“I lived in fear,” Luis said. “I didn’t want to do the service.”
His sister, Suhey, 24, the youngest of the three brothers and also a medical student, is scheduled to begin her community service on August 1 in a town on the outskirts of Durango city. She is reconsidering it.
“Right now I feel hate towards medicine,” he said.
The clinic where his brother died, a single-story white building, is closed. In the foyer, a bouquet of flowers and candles lie on the floor next to a large stain of dried blood.
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