El día en que cambié la neurocirugía por la salud global

The Day I Made the Decision to Switch from Neurosurgery to Global Health

02.6.2015

I was sixteen when I started my medical studies. For some reason, I was always the youngest student in the class throughout my whole academic career. The truth is that—while I sometimes found the environment to be challenging—my classmates tended to stick to well-trodden paths and did not get into analysing their own personal aspirations or spend much time reflecting on the power of translating ideas into radical actions that could make real changes in their environment.

I found it very hard to understand why the people had infectious diseases that could only be transmitted in a situation where the basic chain of sanitation was flawedLike many other countries, Mexico has a rigid educational system oriented towards an authoritarian model that trains people to think unidirectionally; in other words, it teaches them that they should always wait to be told what they should do. My medical training was no exception to this rule.

From the very first day of our medical studies, what was drummed into us was that our aim should be to become specialists, that we should focus on organs, that we should divide the human body into different parts and attribute disease to a functional imbalance in a particular organ, a problem which—once diagnosed—would be treated with drugs.

I was fascinated by the thrilling world of neurosurgery and, in student groups, I soon got involved with a group of brilliant teachers and colleagues and worked with them on local initiatives, national competitions and even research projects. Based on this experience, my plan once I completed my training as a general practitioner was to do a postgraduate degree in neurosurgery and pursue a career in the subspecialty of paediatric neurosurgery.

Why in the 21st century are people still dying of diseases for which the basic treatment is oral hydration? However, fate intervened in the form of an opportunity to complete my mandatory year of social service in the Sierra Madre de Chiapas working with an NGO called Compañeros en Salud, Mexico A.C., an affiliate of Partners in Health. (In Mexico, anyone who wants to qualify as a Surgeon and Obstetrician after completing a medical degree must first do one year of social service.) All of a sudden, I was plunged into the contrasting colours of the mountains and surrounded by the ecological diversity and magical landscapes of rural Chiapas. I got to know an amazing group of people—doctors from Mexico and the US who had followed their hearts and were putting their time, knowledge and talents at the service of the health of the local population. Every day I learned from my new mentors. Every day I received another dose of inspiration and learned about the science of global health, an area previously completely unknown to me.

Laguna del Cofre was the community that witnessed my transition from medical student to general practitioner, the place were I became responsible for the health of children, pregnant women and old people in a health centre serving approximately 2000 people. That was how I first started to become involved in the community, to live like the local people, to have a good time and keep company with them in their day-to-day lives and activities.

Every day brought a new challenges, which all had one thing in common: a shortage of resources. I found it very hard to understand why the people had infectious diseases that could only be transmitted in a situation where the basic chain of sanitation was flawed. I witnessed the deteriorating condition of children whose growth was stunted from an early age because their families lacked the means to obtain the food they needed to ensure an adequate intake of calories and basic nutrients. I was frustrated time and time again by a broken health care system when I tried to refer patients to a second or third level of care. I discovered how mental illnesses, and many other types of disease, were totally ignored by the agendas of the Ministry of Health.

Chiapas not only taught me how to survive, it also inspired me to put at the service of others my talents, my profession and myself, because it is in the service of others that we find ourselvesThat was when I began to formulate a number of difficult questions. Why in the 21st century are people still dying of diseases for which the basic treatment is oral hydration? Why are health care and medical professionals not trained to understand the complexities of the system and to find real solutions for our vulnerable populations? Why does the place where a person is born still determine their physical and mental development?

At the end of my first year in Chiapas, I decided stay on for a second year working as an area supervisor. I wanted to achieve more and have some influence on the stakeholders and decision makers. Without realising it, I was no longer just a doctor working in the Sierra, I had become a godfather to a bunch of children who had very complex histories considering their young age. The people in the communities continued to invite us into their homes, offering us their coffee and even bringing us into their kitchens to share their festivities and memories, which I will carry with me forever.

One day, we had to accompany a team going to collect a patient in one of the villages furthest from the district centre. On the way (about 4 hours from the office), one of my colleagues—passionate in his enthusiasm for the struggle for health equity and social justice—started the discussion about whether global health was about driving across the mountains to deliver medications, or whether it was about patching up the gaps in the referral system with our own vehicles by using them as a kind of ambulance or taxi to transport patients, or whether global health should be about talking to the Ministry of Health because “they do not understand what happens in the communities”. It was at that moment I decided to stop what I was doing and to start looking for answers to all the questions that had been weighing me down for nearly two years.

And that was how I started on a different postgraduate adventure. I looked into a number of possible courses and the Master programme offered by the Barcelona Institute for Global Health was the one that appeared to be most in line with my particular interests and to be a programme that would allow me to build most effectively on my clinical background. The incredible contribution of the institute to world research, the calibre of the teaching staff and of the training modules have provided many answers and tools that I can use to engage with health as a global public good, as a question of social justice and as a universal right.

Finally, it is not important where we acquire our knowledge. Medicine, and our role as doctors and agents of change, must always be guided by our patients, especially those in vulnerable situations like my patients in Laguna del Cofre, like my “children”, like all those sometimes designated as the “end-users” of the service chain. This transformative experience has reminded me of the real function of medicine and also of the mission of each and every one of us in this world. Chiapas not only taught me how to survive, it also inspired me to put at the service of others my talents, my profession and myself, because it is in the service of others that we find ourselves. And yes, global health is a difficult field, but as one of my tutors said to me: if the task was easy, it would already have been done; the fact that it is complicated means that we have to work to find ways to do it.

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[Luis Gerardo Castillo Cavazos is a Mexican doctor currently studying the ISGlobal-University of Barcelona Master of Global Health.]