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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