Chiapas, Mexico — Our last weeks in Central America have flown by. (I say Central America, because these last weeks have taken us to Guatemala and Nicaragua as well.) And yet, as the end draws so close, we remember that each ending represents an opportunity to begin.

In Chiapas, our goodbyes will be sad only because of the friends we have made. We are sure to leave pictures printed for promoters and directors of EAPSEC. Our thanks to them is unmatched. We are also excited to continue working in Santa Ana upon returning to California. We will complete the circle of exchange by sharing with Latino Health Access what we learned from the promoters in Chiapas. We also look forward to sharing with our fellow medical students, at UCI and everywhere, the value of binational exposure and the need to address the social determinants of disease.

Our experiences started a year ago in Santa Ana as we sought to expand our definition of health in a globalizing world. We found that health has many meanings. Frequently, we think of health as the absence of disease. And yet, as we ponder the social determinants, we must yield to a broader concept of health that includes justice and equality. For example, earlier this year, the United Nations issued a declaration against the Mexican government for carrying out involuntary sterilization of indigenous women in Chiapas. We can all agree that involuntary sterilization is a poor health outcome. We can also agree that no pharmaceutical panacea exists for such disease, because the roots are embedded deep in the substance of our society, not in physiology. Why are women targeted instead of men, when a vasectomy is as medically feasible as a hysterectomy? In the case of these women, is there illness caused by some phenomenon of microbiology? The answer, of course, is no. In lieu of physical pathology, it is social germs these women have inherited.

In Nicaragua, we discussed with the Ministry of Health the terms and possible sites of a pilot program for cervical cancer. Their response was positive. The trip was a step forward towards implementation. We also proposed the Pan American Health Organization as a potential partner, who brings to the table a newly developed vaccine for the Human Papilloma Virus, a prerequisite for cervical cancer. Although our plans are temporarily impeded by the upcoming presidential election, we are all optimistic that regardless of the outcome the project will continue advancing.

In closing, we would like to thank those individuals at UCI who so graciously afforded us the opportunity to share our adventures through their Web site. We would also like to recognize the support that the School of Medicine has provided, especially the deans and PRIME-LC faculty. Many thanks are also due to participants at Dartmouth’s School of Business, Harvard’s School of Government, Partners in Health, Long Beach School of Public Health, and most especially, our final thanks go to the health promoters of Latino Health Access and EAPSEC who give their hearts daily to improve health and social justice in their communities.

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Chiapas, Mexico — Rosario is a community of less than one hundred people in the mountains of the South. On our way there, as we stopped to stare at the Pacific Ocean from one of the taller peaks, I asked how far Rosario was from the nearest town with paved streets, Belisario Dominguez. Their answer told me a great deal. No one had even heard of it.

Arriving in Belisario Dominguez a day early, we prepared the materials and agenda with the more experienced health promoters. To arrive we had to drive one hour from Belisario, and then walk for over an hour through the riverbed that was swollen by Hurricane Stan last year. While walking, we passed a clinic of the national Mexican Social Security Institute (IMSS) program, which insures health care to certain contracted employees. This picture speaks a thousand words: the clinic used to have five rooms and now has only one, the rest having washed away in the river. So difficult was the path through the riverbed, that at one point, our friend Aurelia fell in, soaking her entire body and pack.

This area of Chiapas is known to have a Mam heritage, an older culture that disappeared years ago when Mexican President Porfirio Diaz outlawed the speaking of their language Mam. This story is very infrequently recognized and most people here have no knowledge of why they call themselves Mam without any trace of their language. In a more recent assault on their communities, the national powers that be recently amended the constitution to do away with the ejidos community model of land possession (see Articulo 27 of Mexico’s constitution). Now the communities are divided into small parcels, individualizing a powerful aspect of social structure – land. They say the reason is a plot between the government and international companies to make the valuable land of Mexico more vulnerable to international enticements. An assay of international companies in the area corroborates that claim (see Dick Cheney’s Haliburton and Pemex for a quick example).

We enjoyed our time in Rosario immensely. Jamie lost a pint of blood to mosquitos. Adam lost three. As for myself, I discovered that fleas can penetrate three layers of clothing AND a mosquito net.

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Chiapas, Mexico — Three days ago, we arrived in Acteal for a health promoter conference. Health promoters from the entire state attended, representing their respective groups in communities from as far as 10 hours away. For the past three days, in Spanish and Tzeltal, we have participated in prayer, political discussions, public health strategy, and entertainment. Among popular topics were the recent presidential elections, which were marred by suspicions of fraud in the electoral process. Since the elections, more than three million people have marched in protest of the results that award the presidency to Felipe Calderon of the incumbent PAN party. Interestingly, political discussions in Mexico almost always intertwine with American ideals. For example, the fact that President Fox’s 2000 presidential campaign was financed by American companies no doubt related to his executive position over all of Mexico’s Coca Cola industry. In many ways we were able to participate and contribute to the conversation from a U.S. perspective.

Promoters were amazed to hear that we (and our PRIME-LC crew) have dedicated ourselves and careers to serving Latin American immigrants in the U.S. They were even more amazed to find that health promoters exist in poor communities in the States, a land so frequently portrayed in movies, magazines and popular press as the great pillar of the “first world.” But then again, all that press comes from us. Perhaps their greatest astonishment was that we worry about the provenance of immigrants, and the communities they saw themselves forced to abandon.

There is value in their smiles. There is value in their laughter. There is value in their curious eyes. There is value in the meals we shared together. All of which they so willingly shared. None of which we will ever deserve.

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Chiapas, Mexico — Jeff Sachs, an economist working towards the United Nations Millenium Development Goals, recently published a book, The End of Poverty, in which he discusses death in the third world from diseases for which affordable cures already exist. Stupid deaths; that’s what he calls them. Stupid that our global society sanctimoniously allows 24,000 people to die every day from hunger and diarrheal disease, in an age of unmatched wealth. Paul Farmer, the world-renowned medical anthropologist, said the following, “in a world of such opulence, to neglect the battle towards equitable access [to health] is in itself an abuse of human rights." In this entry, I will briefly describe three case studies from my experience in Chiapas over the past six months to illustrate the nature of suffering from preventable illness.

“Felipe” I met Felipe, as I’ll call him, in March in northern Chiapas. He was left to die by his family upon learning he had tuberculosis. His sister left him to protect her children from this devastating illness. We found Felipe lying on his back, never to walk again. He was so malnourished that he vomited any food we fed him. He couldn’t even swallow vitamins or undergo liquid replacement therapy. His case was never recorded by Mexico’s celebrated TB program, a convenient method of statistical insurance. He passed away last month, too poor and abandoned to deserve life-saving treatment.

“Alejandro” Two days ago, Alejandro was carried into Amatan’s clinic by three friends. He was lifeless, formless. Even in a chair, helping hands had to keep him from falling to the floor. The diagnosis was easy: typhoid. It struck me as strange, since two days before leaving the United States I received my mandatory booster from UC Irvine’s student clinic. What factors contributed to this disparity in outcomes between Alejandro and myself? What aspects of our global society guard me from risk, while leaving him not only vulnerable to exposure but also bereft of treatment? We began his treatment that same day. After a hard fight, he will live.

“Lita” The day we arrived in Chiapas, I received a visit from one of my dearest friends, who I will call Lita, because she has practically adopted me as her grandson over the past two years. She is of indigenous Tzeltal ethnicity, and speaks only slightly more Spanish than I speak of Tzeltal, her language derived from Mayan. Our verbal communication is limited to a vocabulary of no more than 15 words, so our relationship has been my greatest lesson in nonverbal cues. Lita had a large bruise on her right hand and a new two-inch scar on her forehead. It turns out that three weeks ago, she was run over by a motorcycle. No insurance plan provided care and since very, very few medical facilities are sensitive to her culture and language, she never solicited a doctor’s help. Interestingly, in Los Angeles County, (excluding the elderly) motor vehicle accidents account for more Latino deaths than any other cause of mortality.

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Chiapas, Mexico — This week we find ourselves close to Chiapas’ northern border, in a community of less than 500 people, called Amatan. Here we live and work in a community clinic that receives patients from about 25 even smaller neighboring towns. Here Jamie learned to slice and dice a chicken, fresh from the market.

Adam and I learned to mix cement “a la mexicana” so we could help the local health promoters build a kitchen sink, counter and shelf out of the cement. The locals were quick to notice how clumsy we were with tools, but were graciously patient with us. The only tools we had used in the past year of medical school were pencils, pens and an occasional scalpel in the anatomy lab. It took two days to complete the cement work, then we left the plumbing to a pipe specialist.

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Chiapas, Mexico — This weekend Jamie, Adam, myself and our seven UCI guests visited health promoters from the community of Acteal. Fernando, our native health promoter guide, met us early in the morning in San Cristobal to accompany us on the two-hour journey through the windy roads of the highlands. So windy, in fact, that we made stops both on the way there and back to accommodate disgruntled stomachs. One student, in particular, vomited during both stops. The governing body of this town received us with arms wide open. We were immediately invited to meet the directors of the non-governmental organization to which Fernando belongs called Las Abejas. During this meeting, they recounted the history of their group.

Las Abejas was formed around a civil dispute in 1992 that revolved around a woman’s ability to own land. Although that civil dispute eventually brought assassination and violence to their group, Las Abejas declared from the beginning that they would not respond to violence with violence. Their first pacifist protest, a march to San Cristobal, made a public statement of nonviolent resistance. They have never deviated from their nonviolent philosophy.

As they recounted to us, on December 22, 1997, between 30 and 40 men from an armed paramilitary group working in conjunction with local, state and federal authorities entered an Abejas prayer meeting and massacred 45 unarmed civilians including 21 men, nine women (five of them pregnant) and 15 children (two under the age of one). The massacre lasted six hours, while federal police waited just outside the community to scurry away the bodies upon completion of the deed. To this day, the Mexican government has not prosecuted the instigators of this event. There was a quiet reverence in Acteal that made each conversation more meaningful, that made us want to choose each word very carefully.

The counterinsurgent “low intensity war” being waged against Chiapas’ poor was not free of American intervention. Most of the military leaders were flown to the United States for special training. And the table is set for more. Returning from Acteal we passed five active military outposts and two humvees full of armed soliders on the road, something that makes me think it might be appropriate for us to critique our own concept of “peace.”

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Chiapas, Mexico — This Saturday seven students from UC Irvine’s School of Medicine visited us in the Highlands of Chiapas. They came by bus from Cuernavaca, Mexico, where they spent six weeks in a summer program that emphasizes Spanish language acquisition, Latin American anthropology and clinical exposure with physicians in Mexico’s public health clinics for more than 100 hours. Yes, they are members of Irvine’s PRIME-LC 2006 entering class.

PRIME-LC remains a new program, 2006 being only the third matriculating class. Yet even in its infancy, it has already inspired similar programs at other UC campuses including San Diego, San Francisco and Davis. PRIME-LC has set a precedent for specialized medical training that addresses social causes.

It goes without saying that we were elated to spend time with our newest comrades. UCI’s chapter president of the International Federation of Medical Students (IFMSA) recognizes this as the largest group of Irvine’s medical students traveling together abroad this summer. In four quick days we covered lots of ground, visiting cultural sites including small communities, churches, markets and local non-governmental organizations dedicated to improving health conditions.

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Chiapas, Mexico — Less than 15 minutes from Mexico’s border with Guatemala lies one of Chiapas’ main tourist attractions: the Lagos de Colon, a small cluster of lakes that form part of the larger Lagos de Montebello. We saw numerous species of fish, birds, insects and even an alligator when we visited.

We visited these lakes more than two weeks ago on our way through the border region. Perhaps the most interesting part of our trip was a small group of 12 quiet, mysterious visitors to the lakes. Quiet, so as to minimize the sounds of their accented Spanish. Mysterious, because they didn’t swim or even stop to admire the lakes. They entered the park through the bushes from the West, and disappeared just moments later into the bushes in the East. So swift was their passage, that I almost didn’t have time to question their strange presence. It was Leonel (also in the picture), a representative from EAPSEC, who answered my stare with a whisper, “They’re immigrants from Central America.”

Chiapas forms the mouth of an underground immigration highway through Central America. A mouth that each year vomits hundreds of thousands of destitute travelers into Mexico, en route to the United States. By using the imagery of vomit, my wish is not to denigrate the inspired cause of said travelers, but rather to draw attention to the illness that produces such movement. In medical terms, “vomiting” refers to emetic discharge, the culmination of digestive expulsion resultant of gastrointestinal pathology.

Let’s define the digestive system as Central America. Over the last twenty years, our neighboring Latin American system has demonstrated chronic pathology, thrusting millions of people through Chiapas into American communities. There are many driving forces for this pathology, the more popular being employment and opportunity. Over the past three decades, immigration issues reached new heights in the press. And yet, the ill conditions of Central American countries rarely (if at all) is discussed on CNN as relevant subject matter in the debate on immigration. Take Mexico for instance. The U.S. media neglected to report that in May of this year, riots broke out around Mexico City that resulted in police hostages, various civilian deaths, more than 100 political prisoners, and more than 30 women sexually assaulted by Mexican federal police forces. (See articles in Jornada and from a human rights organization.) Less than 60 days later, 92 people were hospitalized in Oaxaca City, Oaxaca, (Chiapas’ border state), after police squads used excessive force to maintain “crowd control” during a peaceful protest of teachers in the city square. Only one death was recorded in Oaxaca: a woman who lost her baby after a blow to the abdomen from a policeman. (See article in Jornada .)

As medical students we are taught that if a patient enters the clinic with symptoms of vomiting, an effective evaluation/treatment will seek to identify the cause of symptomotology. However, recent U.S. legislation proposes investing billions of tax dollars in fortifying a wall along our southern border with Mexico. Returning to our clinical scenario, this would be the equivalent of using duct tape to seal the patient’s mouth shut, to prevent further passage of that which the Mexican system seems to reject (or oppress) … its citizens.

This entry attempts to advance the agenda that we consider in earnest our role in Mexican and Latin American politics, recognizing responsibility for past interventions and the propaganda of neglect. Topic for reflection: If Latin American corruption is the culprit, how have we reacted to it? Have we rejected it? Have we tolerated it? Have we neglected it? Have we embraced it? Have we perpetuated it? Topic for reflection: In what way do U.S.-financed wars in Chiapas, Guatemala, El Salvador, Nicaragua, and U.S. assassinations in Panama, Nicaragua, etc. play a role in the chronic oppressive pathology that causes immigration movements to the United States year after year?

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Chiapas, Mexico — “Salidas a Tijuana” translates to English as “Departures to Tijuana.” Interestingly enough, similar travel agencies dot the countryside in the southern regions of Chiapas. I took this picture in Ciudad Cuautemhoc, 15 minutes from the Chiapas-Guatemala border. While covertly transporting illegal immigrants through Mexico constitutes a serious crime, it would seem that overt transportation mocks impunity.

Since that day I have crossed the Guatemalan border twice. On the first occasion, less than 15 meters inside Guatemalan territory, we found three men, recently “deportados” from Mexico. These men traveled from Central America in search of the American dream: employment, opportunity, progress … escape. But from what? On my second crossing, two hours inside Guatemalan territory, I witnessed the gathering of a crowd along the shallows of a river running slowly outside of Huehuetenango. I joined the rest of the passengers, pressing our faces to the glass windows of the bus. Our eyes eventually spotted the attraction, a dead body floating down the river.

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Honduras, Chiapas, Mexico — Our first assignment takes us away from our base city of San Cristobal. We arose at 5 a.m. to drive 14 hours to a cluster of towns in the mountains to the south. We have been in the mountains for four days. Yesterday, the winds were so strong that entire fields of milpa, or corn, were blown to shreds. Four trees within 15 meters of our lodging were uprooted. The rain doesn’t simply fall out of the sky here. It plunges in at a 15-degree angle to the ground, approaching horizontal. It was a fascinating storm. I assumed that because the rains were so fierce, mosquitoes would pose no threat. (How can a mosquito fly through a storm that fells trees???!!!) At any rate, I elected to not use repellent last night, and left my legs exposed for three hours. This decision was less than wise – more accurately approaching stupidity. This morning I counted 47 mosquito bites on my right leg between the knee and ankle. The corresponding region of my left leg fell behind with only 46 pink dots. I guess if nothing else it serves as a practical case study that random chance really does statistically favor a 50:50 distribution given equal odds of probability. Of course, looking back on it now, flipping a coin 93 times could have yielded a similar result.

The most heuristic benefit of the storm yesterday was the impression it left in my mind of how the weather is indelibly fused with the livelihood of the people here. Frequently, we were forced to work around the rain. This morning we walked down to the local clinic from which the health promoters work. In the two acres surrounding the clinic, there were 400 people housed temporarily in rooms made of a material that most closely resembled egg carton. These 40 or so families were displaced from their homes during Hurricane Stan last year. (You may remember reading about it in relation to the threatened safety of American tourists in Cancun.) Each family had a dirt floor about 10-feet square, in some cases a bed, carton walls and ceilings, and one community latrine (for all 400). As I reviewed their makeshift homes, I tried to imagine what the previous night’s storm must have been like for these families, especially the children. As the thought became incomprehensible, I tried to imagine the hurricane that through bad luck had wretched their homes away in the swollen river. Then I wondered why such images were never shown on Fox News, or CNN or in any major media in the United States. Are we egocentric? Are we ethnocentric? Or is just more exciting to watch the rich and the famous than the poor and destitute? Does such logic lead to uncomfortable questions? Or merely uncomfortable answers?

Let’s finish on a positive note. We have succeeded with our prophylactic Pepto-Bismol. Thus far, despite significant transitions in our diets, not one of us has fallen ill. Jamie and I are happy to report healthy tummies (are you reading this, Mom?!?!). And Adam appears to possess a cast-iron stomach of unmatched digestive capacity.

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San Cristobal, Chiapas, Mexico — Jamie writes again to share her perspective of our experiences:

Three days ago we arrived in Mexico. Sleep-deprived from our last frenetic days in California, we were excited to finally reach our destination, the Highlands of Chiapas. We flew into the newly constructed airport in Chiapa de Corzo, whose indigenous etymology gives the state its name, originating from the ancient Chiapan society. Although Chiapa de Corzo is many times smaller than the current capital city, Tuxtla Guttierez, it was the first state capital recognized by the Spanish government in the New World. Two months ago, I flew into Tuxtla, the state’s largest modern city. A week ago, we flew into Chiapas’ new commercial airport, in the underdeveloped capital of old, Chiapa de Corzo. This newly constructed airport, reclaimed by history’s irony, drives our attention away from the hustle and bustle of modern metropolitan life and shifts it back to the roots of a colonial society in the 1500’s; to a transition in economy, culture, ethnicity, religion and politics.

As we stepped off the plane, we were reminded that the world was not always as it is today. It became what it is. It is not only important but necessary to reflect on the life that once was and the demented transition into today’s social ambience. As Chiapas moves into the 21st century, its struggles today resemble those of the conquest era — structural violence, economic exploitation, marginalization and racism. The Highlands of Chiapas remain vastly underdeveloped with an ethnic makeup of more than 85 percent indigenous people and more than half being monolingual non-Spanish speaking. Since the greatest indicators of public health are often rooted in the what, why and how of social change, our arrival in Chiapa de Corzo was the perfect preface to our seven-week stay.

We were reminded upon arrival that during the wet season it only rains twice a week in the Highlands ... from Monday through Thursday and from Friday through Sunday. All joking aside, it was raining when we got here and it’s raining now. We soon met with the directors of EAPSEC (Equipo de Apoyo en Salud y Educacion Comunitaria). EAPSEC is a non-governmental organization that works on the cutting edge of public health and community empowerment in low-resource areas. Their current directors are formally trained in the areas of allopathic and homeopathic medicine, dentistry, herbal medicine, acupuncture and health promotion. EAPSEC’s public health campaigns are especially attentive to social equality, human rights and political activism. As we would soon see, they take great pride in working with communities that have been abandoned by Mexico’s public health system. The directors narrated to us the birth of their organization in the 1980’s, when the Guatemalan civil war expelled more than 50,000 refugees into Chiapas’ bordering jungles. In the midst of this public health nightmare, EAPSEC emerged as an organization dedicated to serving those whom society’s piety fails to recognize. Since then, EAPSEC has developed 18 manuals for community health specific to the needs of Chiapas. They have collaborated for more than a decade with Dr. Paul Farmer’s Partners In Health in Haiti and in Boston.

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Santa Ana, Calif. — Once again, here is my friend Jamie McGuire:

We continued our experience with Latino Health Access through more personal engagement of the promoter activities. As the promoters know the culture, language and everyday life of their participants, they know how to answer their concerns, challenge misconceptions while remaining sensitive, and find sustainable ways to ensure information they provide remains appropriate. For example, in the aerobics classes for children that are over weight and at risk for diabetes, the promoters make sure the classes are both fun and easy for the children to replicate at home. The promoters understand that there is little recreational park space and that the streets sometimes are not safe, thus the focus on home-based activities. We were able to participate in the charlas they give to community members about what asthma is, how it is exacerbated and how to prevent asthma attacks. The lectures are creative, interactive and audience friendly. We were curious how the participants received us as medical students whose main purpose was to observe and ask questions; one woman commented that she was flattered and honored that we took the time to listen to her story and answer her questions surrounding medicine.

I feel our most noteworthy experience with LHA has been interacting with the promoters on a personal level, hearing their stories and dreams for their community. Being a promoter is an empowering job to have in a community like Santa Ana where many of its problems are impossible to ignore. The opportunity to give back and work to improve their home and people is significant for these promoters; they continuously express their gratitude for being able to work in solidarity with their fellow community members and health promoters.

We were invited to attend the promoter training, which lasted two days; it was both an emotionally and intellectually stimulating event. The director of LHA will not let anyone else train the promoters because she believes that the philosophy and unity must come straight from the leader in order to be truly internalized. Watching America (the director) engage the promoters, the challenging questions she asked, and her ability to elicit critical thinking enlightened my perspective of how doctors should engage their patients to effectively help people live healthy lives. The activities we did to strengthen communication and initiate more self-reflection allowed me to see what types of skills are necessary to fight injustice and disparity in communities like Santa Ana. America also has an incredible ability to solicit reflective experiences from the promoters that serve as great examples of how one should work in one’s community. As a student trying to understand Santa Ana, these testimonies were priceless and more educational than any anthropology or sociology class could offer. America pulls much of her perspective on how to empower Latinos from her extensive analysis of Paulo Freire, a Brazilian academic dedicated to empowering the poor and illiterate of Northern Brazil. Her use of active participation and the manner in which she draws out critical thinking influenced me immediately to start reading Pedagogy of the Oppressed. Our experience with LHA serves as an important foundation for our next look at the promoter model in Chiapas.

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Santa Ana, Calif. — My colleagues and I realize that any one experience we have together can be interpreted in quite disparate ways given our different backgrounds. Therefore, I’ve asked Jamie McGuire, another second-year PRIME-LC student, to write this entry from her own point of view to emphasize the importance of perspective:

Over the last nine months, we have been developing a relationship with a local non-profit, Latino Health Access, in Santa Ana. They recognized years ago that Latinos living in Santa Ana have great difficultly accessing health care, and they suffer from a distinct set of diseases such as diabetes, obesity and hypertension. In response to this disparity in health care, LHA developed a health promoter and educational program to challenge the persistence of such diseases. The health promoters are community members who have been specially trained to reach out to other members of the community to encourage healthy living and provide a link to services.

Our goal as PRIME-LC students is to learn the best way to integrate such groups into the health care system, and we believe that learning how LHA works is imperative to our education. We started by attending the board meetings to get a feel for the organization’s goals and philosophies. Founder and director America Bracho welcomed us to participate in anyway we saw fit, because she believes that the PRIME-LC program is another necessary step in bridging those gaps in access that the Latino community faces daily. This was an amazing experience because we got to see how a non-profit is run and funded, understand the politics and hear the passion of those who support the mission. I feel that I learned more about the politics that surround progressive organizations – there is a reason that the Latino community in this city is marginalized, thus watching the board fight the obstacles that perpetuate the poor health of Santa Ana was an important lesson on how a minority confronts the power of a majority.

After the general introduction to LHA, we started shadowing the promoters who are the foundation of the work done by the organization. While a 12-week diabetes workshop was their original focus, LHA has branched out to work with youth empowerment, weight management for children, asthma, domestic violence, older adult health, mental health and addiction. We had a chance to participate and dialogue with the promoters dedicated to weight management, asthma, diabetes and youth empowerment. The manner in which these promoters engage the disparities and attempt to solve them is incredibly progressive and effective. They truly understand what it means to work with – not only for – the people of Santa Ana. I believe health promotion as seen with LHA is one of the ways independence and power can be integrated back into the lives of a population.

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Irvine, Calif. — This summer will take me to various parts of Central America to pursue two projects with a common theme: increasing health among neglected populations. While advances in medical knowledge and technology frequently animate our hopes for new cures and greater possibilities, the simple fact remains that those individuals most in need of care will never receive it. I speak, of course, of our world’s poor.

Starting last November, a team of medical students, under the direction of Dr. Alberto Manetta, began work on a proposal for Nicaragua’s Ministry of Health to implement a cervical cancer prevention program. Women in Nicaragua carry a much heavier burden in regards to cervical cancer and the closely associated Human Papilloma Virus (HPV). This proposal aims to take innovations from recently published protocols in the U.S. to communities in Nicaragua who suffer so disproportionately from this illness. Data from the Journal of the American Medical Association indicates that we will be able to screen more effectively, treat more rapidly, prevent more disease and eliminate thousands of unnecessary deaths. Travels to Nicaragua this summer will ensure appropriate dialogue with our interlocutors within the Ministry of Health on such matters as cultural competency, proper facility, human resources and implementation. An exciting two weeks of the summer, to be sure.

The final seven weeks of the summer you will find me in Chiapas, Mexico, with two of my classmates: Jamie McGuire and Adam Francis. Last September, we began establishing the roots of a Binational Health Promoter Immersion Program. While “health promotion” can cede many meanings, it most frequently refers to lay community workers trained in health prevention strategy, emphasizing needs of the local community. Promoters organize health fairs and field surveys, become politically active and in myriad ways help mend the ill. Through this program, we train and work as health promoters in two disparate locations: Santa Ana, Calif., and Chiapas, Mexico. Santa Ana is an overcrowded urban metropolis. Chiapas is Mexico’s most rural state. These contrasts represent only the tip of the iceberg. Yet, in the face of such differences, health promotion emerges as an important social enterprise, inspiring people to live healthier lives. Recognizing the importance of that inspiration, our experiences will add a gold nugget to or doctor’s bag: the ability to enlist patients, colleagues and ourselves around the cause of health.

Returning to the principal objective, these projects aim to improve health in neglected communities through binational partnership. UCI’s Program In Medical Education for the Latino Community (PRIME-LC) offers a unique opportunity for medical students to collaborate on such projects by bringing together a team of students dedicated to the underserved. While advocacy, scholarship, research and tenacity have all played important roles in our preparation for this summer’s events, initiative has been our greatest ally.

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