The killing of a young doctor in Mexico has led recent medical school graduates to demand changes to a system that often leaves them exposed to danger in remote outposts during the first year of their careers as part of the country's medical training system.
Dozens of medical school graduates in white coats marched in Mexico City Wednesday to protest the violence their colleagues face.
On July 15, 24-year-old Erick David Andrade was shot to death in the northern state of Durango as he was treating a patient. He was days away from finishing the mandatory term of barely paid "social service" required of Mexican med school graduates before starting an internship or residency.
"I am a medical school graduate. Why are you going to kill me?" read a sign held by one of the marchers. "A dead doctor can't save lives," read another.
Mexico has long had problems attracting medical workers to remote areas and rising gang violence has made that worse — for established as well as beginning doctors. On July 11, an anesthesiologist for a rural government hospital was shot to death at her home in the neighboring state of Chihuahua.
In July 2021, a doctor was killed on a highway near Jerez, Zacatecas, after she apparently failed to stop at a drug gang's checkpoint. That same month two paramedics were murdered while transporting a patient in the same violence-plagued northern state.
President Andrés Manuel López Obrador has cited that reluctance to serve in such areas as justification for importing doctors from Cuba, the first of whom arrived last week.
"Violence gets bad and there are regions where people are in danger," he said earlier this year. "The professionals, the doctors, don't want to go there, even though there are jobs open."
Monica Armas, a recent med school graduate who is finishing up her social service — a program instituted in the 1930s that gives young doctors a stipend of about $150 per month — was one of those demonstrating in Mexico City.
The Cubans "are not the solution we need," she said. "We need a reform of the whole structure, the social service, the whole infrastructure at rural health centers."
Andrade was staffing the lone clinic in Pueblo Nuevo, a small town near the Sinaloa resort of Mazatlan in an area dominated by the Sinaloa cartel. Armed men entered the clinic, an argument ensued and two of the men opened fire on Andrade, killing him.
The motive was unclear, though in other cases doctors have been attacked by gunmen angry that physicians were unable to save injured gangsters or by hit men intent on finishing off a patient they were treating.
Durango state authorities later promised to install emergency call buttons and security cameras at the lonely clinic and have occasional police patrols, but area doctors say it clearly is not enough.
"Over the last few years, it has become a regular occurrence for doctors and nursing staff to risk their lives when they accept, usually out of necessity, a job in one of the outlying towns in the state," the Durango Medical Association said.
Eva Pizzolato, a member of the Mexican Association of Medical Graduates in Social Service, said the current system isn't helping new doctors, or their patients.
"All of the country's rural clinics are staffed by at least one recent graduate doctor doing social service, a doctor who doesn't have a degree yet, who doesn't have the supervision of a fully trained doctor, and doesn't have the equipment and supplies need to provide care," said Pizzolato.
The new doctors "suffer threats from organized crime," Pizzolato said, and "there is a constant fear that the doctors could suffer because of threats from within the communities" they serve.
Mexican medical associations have complained that bringing in Cuban doctors just masks a problem of safe, decently paid jobs in rural areas.
Brian González, a fourth-year medical student at Mexico's Polytechnical University who joined the demonstration, said the Cuban doctors "unfortunately are also in danger. It doesn't matter whether they are foreigners, Cubans, or Mexicans."
Health Secretary Jorge Alcocer has refused to consider changes.
"This is an academic necessity that, on principle, cannot be canceled," Alcocer said days after the killing of Andrade. "It is not advisable, it isn't appropriate to suspend such an important training process for young doctors at the point of graduating, but security conditions can be reviewed."
He implied that doctors will just have to put up with the danger.
"We cannot, whether it be with doctors or specialists, leave unstaffed areas that ... are more remote or don't have entirely safe conditions," Alcocer said.
Armas urged deeper changes.
"This is a structural problem that demands a structural solution — not sending medical school graduates as sacrificial lambs," she said. "The graduates are suffering from a lack of safety, and the people they are serving aren't getting quality care."