Access to Healthcare for Mexico’s Most Isolated: A Movement and Model for Change

2017

Above a small natural bay set deep in the Sierra Occidental mountains in the state of Nayarit, Mexico, a small line of people in dark blue shirts winds up the rocky terrain of a steep hillside. They carry heavy backpacks and balance objects above their heads, choosing their steps carefully. A member of the group takes a final look back to the two boats docked in the bay to confirm that all of the supplies have been removed and receives a thumbs-up from a petite woman standing next to the boat guides.

The woman is Carolina Zuheill Rosales, and she is the convener of this group of 20 medical professionals who are climbing to set up a temporary health clinic in a town known as Zapote de Picachos. While she is the leader of the group, she is most often found at the back of the line or on the fringes of the crowd, making sure that all runs smoothly and that the needs of the community are being addressed. The group, organized by the nonprofit that Zuheill founded called GUIMEDIC, is completing an arduous journey to reach this community: a four and a half hour drive from Mexico’s second largest city, Guadalajara, then 40 minutes in small boats on the Rio Santiago and, finally, a 35-minute hike carrying all the supplies for the clinic. The community is composed of around 80 Huichol indigenous families, many of whom will never leave its bounds, and they whisper to each other in their native Huichol language. Zuheill finally comes over the rocky path to the clinic building, flanked by two men from the community carrying colorful, side-slung bags with hanging tassels. Women and young girls in vibrantly colored skirts sit on the low walls of the courtyard watching as the clinic operation is set up.

The group, composed mostly of medical students from Guadalajara, will be responding to the primary medical concerns of those in this community, giving long-term vitamin shots, and checking in with patients with ongoing conditions and treatments. They will do this for four hours in the sweltering heat and then pack up again to begin the journey back to the boats, into the cars, and over now-dark roads to Guadalajara. Zuheill will say her goodbyes and smile softly as women from the community slip beaded jewelry into her pockets; she will tell them not to worry, that she will return next week and probably again a month after that. Even after an 18-hour day and hours of intense diagnosing and treatment in the clinic, she will send each of her volunteers off with a smile and a heartfelt “thank you.”

 

Providing Multidisciplinary Support for Mexico’s Most Isolated

Carolina Zuheill Rosales, 31, is a family doctor by training and will receive her master’s degree in health management from the Universidad del Valle de México (UVM) in 2017. In 2011, when she was just 25, she founded GUIMEDIC, which seeks to bring high-quality medical support to those living in extreme poverty and isolation in her native Mexico. Under her leadership, the impact of the group has ballooned in recent years; in 2016, the network of more than 1,200 volunteers served over 55,000 people in five Mexican states. They also conduct urban clinics, develop educational materials, and advocate for updated government policies that will make medical care more accessible for these populations.

“This work is not for those who have a problem with difficult conditions,” Zuheill says. In any given week, she might spend half-days seeing patients in urban clinics that serve the poorest of the poor in Guadalajara, meet with corporate and pharmaceutical donors, convene meetings of volunteers, and then devote her weekends to traveling to the most remote locales she attends to, often arriving by boat, hiking, or small airplane, sleeping in a tent at night and running clinics all day.

She has always focused her work on the populations that are most forgotten by society. When she was 19 years old, she chose to go to a remote village in mountainous Jalisco for the year of mandatory medical practice she needed to do in order to continue with her studies. When she arrived, there were no supplies or other doctors in the house-like structure meant to serve as her clinic. In the first week of her service, a young mother brought her weeks-old baby who had been sick its entire life to the clinic. With no medicines or supplies to provide treatment, Zuheill watched the baby die in her arms.

“In that moment, I saw the reality,” she says. “This venture started with the simple question: Why were people living in a different way than me, with different standards of health?” Since that moment, Zuheill has been on a mission to provide access to medical care to Mexico’s most isolated populations. She works mostly with indigenous groups, who make up 21 percent of the population and often speak their own languages. The Mexican government recognizes 62 indigenous languages, and in many of the communities GUIMEDIC works, most of the older women don’t speak Spanish and are dependent on the men who leave the village – and can communicate in Spanish – to translate for them.

Zuheill has built GUIMEDIC from the ground up and has grown its operations significantly, mobilizing doctors and nurses who donate their time and skills, pharmaceutical companies who give excess drugs to the cause, and other nonprofit organizations that provide spaces and support.

Turning the Traditional Healthcare Model Upside Down

“We are not egotistical about the work we do,” Zuheill says of her network of more than 1,200 volunteers. “We do this out of a genuine care for people.” That care is reflected in the one-on-one interactions that GUIMEDIC volunteers have with their patients, and Zuheill believes it is a way of working that is essential if you want to serve hard-to-reach populations and is also a vital part of being a medical professional.

Most of the volunteers that work with GUIMEDIC heard about the organization by word of mouth and were drawn to the opportunity to put their skills to use in extreme environments where help is most needed. They are urban doctors who take time out of their practices to donate a few hours a week, nurses and dentists who let patients pay what they can, inspired by Zuheill’s access-for-all approach, but mostly they are medical students drawn to the intensely pragmatic nature of the work.

“The experiences that medical students can have with GUIMEDIC are unbeatable,” Luis Alvarado said. Zuheill’s passion for educating the students who join her clinics is palpable. She allows them to do all initial examinations, gives advice on diagnosis and treatment, and challenges them to make the final decisions about patients. This kind of autonomy is different from what students can gain in the classroom or even in urban internships.

“Carolina is an inspiration to me,” said Diana Sánchez, a medical student at a large public university in Guadalajara. Some version of this sentiment was shared almost universally by the group. “She does it all.” “There’s no one else like her.” “She is a hero to all of us.” These phrases come up again and again when people are asked to describe GUIMEDIC’s leader. For her part, Zuheill hopes she is contributing an extra layer to the medical education of these students and that it will catalyze them to action for a long time to come.

“Our volunteers share my passion to help and empower,” she says. “We are building a movement and model for how health services in underserved areas can be provided.”

A Network of Support

“Carolina is an amazing professional but even better person,” said David Eugenio Guzman Treviño, Rector of UVM’s Campus Zapopan in Guadalajara. “She is always placing the community at the center of what she does and pushes our organization to look for new ways to serve the people around us.” UVM has been integral in Zuheill’s growth of GUIMEDIC, first supporting her in 2013 as a Premio UVM fellow, where she was recognized with other young social entrepreneurs in Mexico, and now educating her on the structure and management of health organizations in her master’s program.

“All around the world, YouthActionNet is reaching people in remote areas who have a wide diversity of needs through our local and global fellows,” said Sandra Herrera, director of social responsibility for Laureate Mexico and director of Premio UVM. “What Carolina is doing in Mexico is an example of how a simple approach applied in an innovative way can create major impact.” Premio UVM is a local YouthActionNet program, part of the network of more than 15 such institutes hosted on Laureate campuses worldwide carried out in partnership with the International Youth Foundation. Every year, they select and support local fellows who are the founders or co-founders of unique social change ventures. When Zuheill was selected, she was not yet a Laureate student, and it was her first introduction to the Laureate network.

“Premio UVM showed me that there were other young people working in communities for a better future,” she says. “Both this fellowship and the Laureate Global Fellowship opened doors for me and helped me to feel part of a global community working for change.” When she entered the master’s of health management program at UVM, it was because she felt the need to learn the formal policies and systems that are so often overlooked by entrepreneurial ventures, all with the goal of making more impact than she has already.


A Belief in the Long-Term Undertaking of Making Change

“This is a long-term undertaking if we want to achieve our desired impact,” Zuheill says. In a quiet moment of reflection driving back from a clinic at the far reaches of Guadalajara, she describes the impact her family and their faith have had on her life, something she reaches for when the work is arduous and the impact seems far off. She describes a mother and father who both overcame great challenges to build lives of purpose: a father who rose out of poverty and told her never to fear vulnerability, but to find strength in knowing you can always press on, and a mother who was passionate about learning and challenged herself even later in life.

Zuheill still thinks often about that founding question behind GUIMEDIC and the good fortune she had to be born to the parents she had, and with the education and support she received. Does your experience of access and support have to be different based upon where you are born in Mexico? Or could a new model of healthcare and education stretch to all corners of the country? With Zuheill and GUIMEDIC at work in communities all across Mexico, that new model might just be in reach.