Charting healthcare's course in rural México
By Catherine Dunn Original Print Publication: June, 2007
Calnali, Hidalgo – Dr. Sarah Stelzner sifts through a bin of prenatal vitamins and digs out two red satchels, gifts for the mayor and his secretary, whom she’ll be meeting this Sunday afternoon in March. But first, the thin, dark-haired pediatrician begins her rounds. She stops at the local market, introduces her colleagues to a town doctor, and swings by the Centro de Salud, where tomorrow she’s giving a diabetes talk.
Along her route a near-toothless woman in a green turban gives her a fierce hug, a 7-year-old girl requests a pair of shoes for her sister, and a young man asks if the doctors will visit the neighboring village of Papatlatla.
Everyone knows Sarah, though later, sitting in front of the mayor in his office, she tells him: “We don’t know much about the community.”
For nine years Sarah has been one of the master planners of a trip that shuttles doctors, dentists and medical and dental students from Indiana University to Calnali, a 3,985-person pueblo in the coffee highlands of Hidalgo, one of Mexico’s poorest states. Normally her squad runs a week-long clinic, dispensing basic fixes like Advil and antacids while the dentists fill cavities in clinics assembled on basketball courts.
But this year the group is pairing with public health students to field community-wide survey, trying to learn how to build better long-term health care infrastructure, she says, “instead of landing in our spaceship once a year, doing our thing and moving on.”
Down the street from the mayor’s office, the dining room in a yellow house is mission control for the week. Here dental students inventory and sterilize supplies and the surveyors prepare interview notes.
Juana Watson grew up on this lot when it was dirt floors. She built a bigger house on the site for her parents, later adding space for the volunteers she brings to her hometown every year. In Indiana she is the senior advisor for Latino affairs to Governor Mitch Daniels; in Calnali she is hostess and guide, washing dinner dishes and reminding volunteers to brush their teeth with bottled water.
She tells a Dickensian story of escape from poverty. On the false promise of a teacher, her father dropped her off at a government boarding school. The school wouldn’t admit her but she stayed and lived on cafeteria leftovers for a year until they finally did.
“All my cousins got married at 13 and had 10 kids,” Juana says. That would have been her destiny had she stayed in Calnali; she tries to change the fate of others in her hometown by coming back.
Calnali’s Centro de Salud is a lowslung, threadbare building with no practicing specialists, and no lab; rather, the staff focuses on the prevention of hypertension, diabetes and diarrhea. On Monday morning, Cristina Hernández Anaya, 26, and her son, Manuel, 5, come to pick up a children’s nutritional supplement, and Domingo Llamas Maynes, a chatty 4th year med student, plucks them for a survey.
Do you dance, he asks Cristina.
No, she smiles.
Do you participate in community groups?
Yes, at the school, in talks at the clinic.
Do you share remedies with your neighbors?
Do you share recipes with your neighbors?
Yes, she says, her flan, a concoction of Nescafe, vanilla, eggs, milk and sugar.
The interviews continue here, at the school, in the mayor’s office, the students quarrying for the details of a remote town etched into steep hillsides.
It’s Wednesday, and Juana is driving to Mexico City for an appointment with Hidalgo’s lieutenant governor. She’s been waiting for this chance, this woman who once told her father she’d meet Mexico’s president – and did.
In Calnali, Juana says, the first assumption when kids got sick was that they would die. She was visiting her parents once when her then six-monthold daughter came down with a cough.
Her father asked: “Did you already baptize your daughter?”
“I freaked out,” Juana recalls. “She wasn’t even that sick.”
But she made the long trip by taxi and bus to Mexico City so her baby could be examined. “I could afford to take the taxi, see a doctor and buy the medicine,” she says.
“There’s so much there that can be built upon. ” Two months after the Calnali mission, Sarah Stelzner is back in her IU office.
Isolation from specialists and higher- level hospitals “is a frustrating thing for people,” but, she points out, Calnali’s basic care, like classes and vaccinations at the clinic, is good.
So far, the group has presented their research twice, and has approached pharmaceutical companies about donating money and supplies to the town. In August, Hidalgo’s secretary of health will visit Indiana to discuss the findings.
Before taking the survey, “we had no idea. We had assumptions about what existed,” Sarah says. “I think I was surprised by why we hadn’t done |the survey| earlier.”