To graduate, Mexican medical students practice medicine at gunpoint

When Alfredo Cortez arrived at the tiny clinic for a year of community service, which is mandatory for all medical students in Mexico, he found he had no cell phone or Internet access—only a radio.

He lived alone in the clinic, a simple dwelling in rural Michoacán where the police were rare. On an early spring morning in 2020, he was awakened by snarling trucks and banging on his front door.

Several armed men ordered Cortes to leave with them. When he refused, one truck sped off and quickly returned with a man bleeding profusely from his stomach. He was shot.

As Cortez got 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 Cortez could do was bandage the wound and warn that unless the person received treatment elsewhere, they would die.

“They point their guns, they scream, there are people who talk on the radio and you don’t know who,” recalled 26-year-old Cortez, who later learned that the man was alive. “The situation is very tense.”

Such stories are common among Mexican medical students these days.

Students are protesting, some are holding a banner.

This week, medical students are protesting in Durango demanding an end to the public works program.

(Fermin Ricardo Soto Muñoz / For The Times)

Compulsory service has long been part of government efforts to improve healthcare in isolated communities. But as drug cartels and other criminal groups have expanded their presence across the country, this ritual has become more and more dangerous.

The shooting of a medical student last week at a hospital where he worked in the mountains of Durango sparked protests from medical students across the country. Some marched in white lab coats and carried placards that read: “We’re not cheap labor for you” and “No more public works, they’re killing us.”

It’s unclear exactly how many students were killed or injured in attacks during community service, but even university officials have begun to acknowledge that the program has become unsafe.

“This scheme is a complete anachronism and must be changed,” the doctor said. Luis Carlos Hinojos, Director of the Medical School of the Autonomous University of Chihuahua.

He said the university was trying to house more students in safer urban areas and relocate those deemed at risk. After a doctor was shot and killed in the cartel-infested municipality of Bocoin this month, six students who were due to go to work were transferred to other jobs.

Mourners hold a poster and a portrait.

Mourners carry a banner and portrait of Eric Andrade Ramirez near the funeral mass for him last Sunday.

(Fermin Ricardo Soto Muñoz / For The Times)

The government is protecting the program, which dates back to 1936 and graduates about 18,000 students annually. Mexico’s health minister, Jorge Alcocer, told reporters this week that officials will review safety conditions, but that community service is “an academic requirement that, in principle, cannot be waived.”

“It is inappropriate to suspend the process of formation, which is so important for doctors,” he said. “We cannot leave aside the most distant objects in which there are no absolutely safe conditions.”

In addition, the program has become an important source of health care in rural areas. There are 24 doctors for every 10,000 people in Mexico, slightly less than in the US (26), but they are heavily concentrated in cities.

In May, President Andrés Manuel López Obrador announced that the country would fill in the gaps by hiring Cuban doctors, drawing criticism that the real problem was security.

Medical school in Mexico begins immediately after high school and usually lasts six or seven years, the last of which is spent on community service, which may include doing research or working in clinics. Generally, the government determines which places are available and gives schools the opportunity to fill them.

Students with the best grades get the first choice of assignments, so those with lower GPAs tend to get the most dangerous jobs. They sometimes work without supervision or external contact and live alone in clinics, problems that students and university officials say have long been known but not properly addressed.

Locals tend to view students as full-fledged doctors – and this leads to situations where newcomers can incur the wrath of society when the patient can no longer be saved.

“They won’t say the clinic has no resources, the clinic doesn’t have an ambulance, the roads are inaccessible, the routes are not easy,” said Cynthia Flores, president of the national association representing medical students. – It will be the doctor’s fault.

Three women and a man next to the coffin

Andrade’s mother, Maria Paula Ramirez Yáñez, leans over his body, while his father, José Mauricio Andrade Avila, sister Suja Andrade Ramirez, and family friend Cecilia Ramirez (left) stand by her side at his funeral.

(Fermin Ricardo Soto Muñoz / For The Times)

Dr. Jorge Valdez Garcia, president of the Mexican Association of Medical Schools, said sometimes universities are not given enough time to carefully select their locations and that conditions can change quickly, such as when a cartel appears in a community.

“This has happened many times,” he said. “No one is going to send them to unsafe areas.”

In interviews, more than two dozen current and former students spoke of harrowing experiences that included going 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 have always been concerned about our safety,” said Adonay Esparza, 28, who worked in a rural clinic in northern Michoacán in 2019 that saw violence linked to the avocado trade, which was infiltrated by cartels.

One night, a teenager came in with a stab wound to his arm. Esparza began to treat him when he heard that several cars had arrived.

The boy’s father, a local drug lord, entered with two armed men. He asked about his son and as he left, he said to Esparza, “Don’t worry, you will be watched and protected.”

“After that, I felt a little weird,” Esparza said. “I realized that I have security, but not the security that I expected.”

Medical students take to the streets to protest

Medical students in Durango State are calling on authorities to better protect students completing their year of compulsory community service.

(Fermin Ricardo Soto Muñoz / For The Times)

Hilary Lopez, 27, who served in the southern state of Quintana Roo in 2020, quickly learned to prioritize certain patients: those the nurse said were related to drug dealers.

In one case, a man arriving after midnight insisted that she examine an elderly woman who had collapsed in her home and was still there. When Lopez explained that she couldn’t leave the clinic with a stranger, he returned 15 minutes later with a gun.

“Doctor, are you going to leave or are you not going to leave?” he told her.

Lopez called the nurse, who reassured the man and urged him to stop threatening Lopez, who said the fear prompted her to ask health officials for more safety, but nothing changed.

She was out of town when gunmen surrounded the clinic and threatened to set it on fire after one of her patients died of COVID-19. The nurse warned her not to return, and Lopez found a new place to live and changed her phone number.

“I disappeared from the map,” she said.

Such close calls rarely make headlines. Murders of medical students are a different story, and two recent cases have brought the issue to public attention.

The first victim was 23-year-old Luis Fernando Montes de Oca Armas, who was finishing his tour of duty at a hospital in Huejuquilla el Alto, 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, student at the Autonomous University of Guadalajara

Louis Fernando Montes de Oca Armas, a student at the Autonomous University of Guadalajara, was killed in Zacatecas while doing community service in 2021.

(Courtesy of José Fernando Montes de Oca Padilla)

On the way back, he sent his father an alarming voice message.

“There’s a truck here,” he said. “They’re probably going to kidnap us or something, I don’t know.”

His father called his son-in-law Juan Carlos Galavis, who found the bullet-riddled bodies of Montes de Oca and the ambulance driver on the highway next to the abandoned car.

Last Friday evening, several men arrived at the Durango rural hospital where Eric Andrade Ramirez worked. It turned out that they were under the influence of drugs.

The details of what happened next are unclear, but at one point at least one of them drew a gun.

Morgue workers lower the coffin into the grave in front of the mourners

Mourners watch as Andrade’s coffin is lowered.

(Fermin Ricardo Soto Muñoz / For The Times)

Andrade, 25, was killed just days before he was scheduled to finish his tour of duty in El Salto, a logging camp about an hour and a half from his home in Durango.

After the assassination, some of the medical students in Durango left their seats and vowed not to return.

“How is it possible that we provide medical services to take care of others, but no one is protecting us?” asked Daniel Ramirez, 27, a classmate who decided to leave his assignment in the city of Durango, where he says drug dealers colluded with police.

Dr. Martin Gerardo Soriano Sariñana, rector of the Autonomous University of Durango, where Andrade studied, said about 180 students would be redeployed. He promised to develop “community service programs for our students that do not jeopardize their safety.”

At Andrade’s funeral on Sunday afternoon, classmates in white lab coats wept quietly as they watched his coffin be lowered into the grave to the sound of a 13-piece orchestra. Friends described him as a charismatic person who loved norteño music and throwing parties.

Portrait of a young man at a funeral

Mourners attend Andrade’s funeral.

(Fermin Ricardo Soto Muñoz / For The Times)

His brother, Luis, 29, said Andrade spent the last year in a state of unrest as armed men came and demanded to be seen.

“He lived in fear,” Louis said. “He didn’t want to serve.”

Their 24-year-old sister Suhei, the youngest of three siblings and a medical student herself, is due to start her community service in August. 1 in a town on the outskirts of the city of Durango. She reconsiders.

“Now I hate medicine,” she said.

The hospital where her brother died, a dilapidated one-story white building, is now closed. In the lobby, a bouquet of flowers and candles lie on the floor next to a large stain of gore.