I have had the privilege of providing care in communities similar to the one I grew up in but beyond our borders in countries like Sri Lanka, Greece and India. However, my longest stretch of such work was with Hospital San Carlos, a small hospital set in the mountains of Chiapas, Mexico’s southernmost state and home to a large concentration of indigenous populations. Introduced to this beautiful place by our friend Dr. Emily Dow, my partner, Dr. Jyoti Puvvula and I worked there from 2001 through 2010. We would work for two weeks at a time often bringing family medicine residents with us and timing our visits to allow the local doctors to go away to take their specialty entrance exams. We would stay with our DGH “in-community site director,” Dr. Juan Manuel Canales. Dr. Canales is a Mexican doctor with a long history of working with repressed peoples in El Salvador during the civil war; he later moved to Chiapas to work with the Zapatistas. He is also the recipient of the Jonathan Mann Award for Health and Human Rights in 2006. The hospital has a rich history in the region dating back to before the Zapatista uprising of 1994. However, since the uprising, Hospital San Carlos has played an important role in providing medical care to Zapatista communities in resistance. It is a beautiful hospital with pediatrics, obstetrics and an internal medicine ward along with an operating suite. It also has an outpatient and urgent care operation out front. All of the wards are connected by a beautiful garden and a covered pathway that protects you from the seasonal torrential rains. The hospital is administered by the “Little Sisters of Charity”, a Catholic order of nuns. These

are one of the hardest working and most humble people I have ever met. They are also understanding of the hospital’s role in the region.

I remember my first tour of the hospital. I noticed small crosses on the walls, to be expected of course, but I also saw a picture of Che Guevarra in the OR suite! These were my kind of nuns. The nuns also take call and are tireless workers, incredible problem solvers and spiritual supporters for the families. The main groups of indigenous patients were Tzeltal, Tzotzil and Tojolabal. Each group with their customary dress could easily be identified (if you paid attention). They each speak different languages and the nurses and medical assistants served as translators. The non-indigenous or “Ladinos” were from Altamirano and other local towns and spoke Spanish. Patients come from far and wide often traveling for days to get to the hospital and often arriving in the middle of the night. The nuns set up a hostel known as La Quinta for those who came from far away so that they could stay for their evaluation, along with family members of those patients who were sick enough to be admitted to the hospital.

The hours were long and writing notes using old typewriters was challenging but it was also a great opportunity to learn. In the first few years we mostly saw infectious diseases including tuberculosis, hookworm, ascariasis, upper respiratory infections and malnutrition. It was not uncommon to find patients with hemoglobins below 5 (normal is about 12-14) usually from a combination of malnutrition and hookworm. If we had a case of congestive heart failure it was from chagas disease and not from chronic hypertension or coronary artery disease.

In later years however, we continued to see those illnesses, but with the progressive infiltration of soft drinks and other processed foods into even the most remote communities, we started to see more chronic diseases, such as hypertension, diabetes and obesity. Sadly, these are more familiar illnesses for us from the US and a testament to the health struggles of many indigenous

peoples throughout the world.

We would take call, covering urgent care and all the wards; and when we were not on call we would either work in the hospital during the day or the outpatient clinic. The cases were fascinating, but also heartbreaking. Advanced cancers, sepsis and children with parasitic diseases, etc. Working as a team with the local doctors was an opportunity to exchange ideas and learn to practice medicine with limited technology and relying more on physical assessments. There was a strong sense of partnership and our communal dinners were spent brainstorming about our more challenging cases. Often, however, someone would break out a guitar and we would sing (or listen to) songs well into the night. There was an international feel with doctors from the US, Mexico, Switzerland, Italy, Spain and other countries often volunteering at the hospital.

Through DGH we have continued to be in touch with Dr. Canales and support his work. The COVID-19 pandemic certainly has impacted the world’s oppressed peoples disproportionately and the indigenous communities of Mexico have been no exception. In response to the pandemic, the governing leadership of the Zapatista movement decided to seal off their communities to all outsiders until further notice. This means that Dr. Canales has also had to

suspend his community health worker programs within the Zapatista communities. Prior to the pandemic he would supervise anywhere from 30 to 50 health workers spread out in various localities providing badly needed access to care. His schedule was filled providing training sessions, clinical consults and conducting immunization campaigns. The sites are remote

enough to often necessitate an overnight stay. He continues to support these communities instead with telephone consultations and connecting patients with Hospital San Carlos when necessary. He has also redirected his energies to supporting the hospital as a clinician, which is also in dire straits with a lack of providers.

There has been a scarcity of local and international health professional volunteers, especially in this time of COVID-19 and limitations in international travel. There is an urgent need for internists, pediatricians and primary care doctors. Dr. Canales reports that the hospital is now seeking and is able to host volunteer doctors for various lengths of stays. Volunteers are

expected to have a good command of Spanish, are not paid, and must cover the cost of travel and lodging with the nuns during their stay. If there are any doctors or other healthcare providers out there interested in helping, please inquire through the DGH website.

Some of my most fond memories of being a doctor are set in this beautiful hospital. As tired as Dr. Puvvula and I would return home, we were also always inspired.