Can Doctors Become Agents of Social Change in Mexico?
April 09, 2018
By Jorge Herrera, CECYPE General Director (Clínica de Enfermedades Crónicas y de Procedimientos Especiales, Morelia, Mexico). Mr. Herrera is also a graduate of Clarkson’s Caribbean Research Ethics Education Initiative (CREEi) and is currently a student in the Bioethics Program’s Master of Science in Bioethics.
The disturbing image shown was taken by a concerned citizen and was spread by social media. It shows Irma, a member of the Mazatec community in Oaxaca, Mexico. The Mazatec community is one of the most impoverished in Oaxaca, which is one of the poorest states in the otherwise rapidly industrializing country of Mexico.
Irma arrived at her community health center in the middle of the night in labor. After hours of asking for help, Irma ended up giving birth alone while squatting in the health center’s yard, unattended by any clinic staff. Her child came into this world unattended, on the wet grass, in the cold light of dawn.
Due to the resulting scandal after Irma’s story went viral on social media, the authorities of the health center tried justified their actions by saying that Irma and her husband did not speak Spanish. The health center staff, it was claimed, could not understand what Irma was asking for.
Irma’s story garnered national attention, including an appearance on national TV. In response, the Oaxaca state health minister promised that Irma and her son would receive the best care, the Director of the health center that so failed Irma was fired, and the doctors at the clinic were sanctioned.
Unfortunately, the story of Irma is repeated frequently in Mexico. Human rights activists have documented at least 20 similar cases, testifying before the Inter-American Commission on Human Rights that, from their point of view, there is a systematic problem of prejudice and cruelty towards indigenous women within the Mexican public health system.
Irma’s story also illustrates the magnitude of needed social change in Mexico, but this change will be difficult to carry out because of the racist and classist social structure so deeply embedded within that country’s historical and cultural milieu.
Mexico is a country of 120 million inhabitants, of whom 50% live below the poverty line. Of these, 11.5 million live in conditions of extreme poverty. They are mainly indigenous people who live in remote places in the mountains or are homeless on the streets of big cities like Mexico City, Guadalajara and Monterrey. They are largely invisible because nobody wants to see these hungry, malnourished, and barefoot people, carrying their children on their backs and begging or selling candies or crafts on the terraces of restaurants, at the entrance of the shopping malls, or in front of tourist attractions.
It is only during political campaigns do these poorest of the poor stop being invisible when, in exchange for their votes,cynical politicians offer them a little food, some cardboard sheets for their roofs, a few clothes with campaign slogans, and numerous promises that are rarely fulfilled. Enrique Peña Nieto, the current president, was elected with large support of this population but, five years into his six-year presidency, has only fulfilled 40% of his campaign promises to them.
Discrimination against poor and indigenous groups in Mexico is not only palpable but well documented. The results of the 2016 National Discrimination Survey found that 20% of respondents from these groups did not “feel comfortable” with their skin color, 25% said they felt discriminated because of their physical appearance, and 55% recognized that others look down upon them because of their skin color. The results of the survey also found that there is a direct relationship between this pervasive discrimination and extreme poverty. When asked what they consider to be the greatest disadvantage of being indigenous, 43% of respondents considered discrimination in the first place, followed by marginalization and poverty (21%), exclusion (6%), and illiteracy (4%).
Returning to the case of Irma, however, we should expect better. We expect doctors and nurses to have a different and non-judgement attitude toward the needs of patients, regardless of their race, ethnicity, or social status. According to the late American bioethicist Edmund Pellegrino, former Director of the Kennedy Institute of Ethics, the telos (ultimate goal) of the relationship between the health professional and the patient should be the patient's good. Patients go to see health professionals because they are worried about a physical or physiological symptom that makes them feel anxious, dependent, disabled or vulnerable. The health professional makes the promise to use their specialized knowledge, learned skills and clinical techniques, and personal commitment to the art of healing to attempt to improve the patient’s condition.
Notably, the lack of resources in remote and poor places like the Mexican state of Oaxaca can make it difficult or impossible for health personnel to fulfill this promise. At the same time, my personal experience as a Mexican citizen leads me to believe, in cases in which the health staff violates this promise as they did with Irma, they do so because of a contempt towards the patient due to his indigenous or poor condition. The 2012 Report on Discrimination in Mexico (Health and Nutrition) provides evidence to support this suspicion: 72% of the indigenous population surveyed has been discriminated against by clinicians when they sought medical attention through Mexico’s public health services.
Historically, doctors used to be a moral touchstone and guiding force for Mexicans. In rural villages, the three most-respected people used to be the teacher, the priest, and the doctor. In the 1960s, for instance, doctors began the push for democratic change in the country by demanding improvements in their working conditions and salaries. This physician-lead movement unleashed a social reaction that opened Mexico’s democratic process to the wider public, after it had been closed for 50 years.
Unfortunately, many things have changed since that revolution. As the National Survey of Discrimination suggests, although Mexico has started to look at that country’s social structure to combat historically and culturally ingrained discriminatory behavior against indigenous populations, much more is required.
It is my hope that Irma’s case will lead Mexican doctors, acting in accordance with the oath they made when they began their professional career and the professional code of medical ethics that unites them in a community based on the moral values of benevolence, respect for human life, and the vulnerability of the sick, will again become leaders in the effort to heal Mexico’s citizenry of the rampant racism and classism that afflicts it. This could begin with the concerted effort to ensure that every future child of Irma and other members of the indigenous community receives a warm and loving welcome.