When Alfredo Cortes arrived at a tiny clinic for his year of community service required of all medical students in Mexico, he found that he had no cellphone or internet access — only a radio.
He lived alone at the clinic, a simple dwelling in a rural community of Michoacan state where police were a rare sight. In the early hours of a spring morning in 2020, he was roused from sleep by growling trucks and pounding on the front door.
Several armed men ordered Cortes to leave with them. When he refused, one truck sped away and quickly returned with a man bleeding heavily from his belly. He had been shot.
As Cortes got to work, one of the men trained a gun on him and shouted, “Save him!”
The patient needed surgery, but the clinic lacked basic supplies, so all Cortes could do was bandage the wound and warn that if the man didn’t receive treatment elsewhere he would die.
“They’re pointing their guns, they’re shouting, there are people communicating by radio, and you don’t know with whom,” recalled Cortes, now 26, who learned later that the man had lived. “It’s a very tense situation.”
Such stories are common among Mexico’s medical students these days.
Mandatory service has long been part of the government’s effort to improve healthcare in isolated communities. But as drug cartels and other criminal groups have increased their footprint across the country, it has become an increasingly dangerous rite of passage.
The shooting death of a medical student last week inside the hospital where he worked in the mountains of Durango state sparked protests by medical students across the country. Some marched in white lab coats and carried signs that said, “We’re not your cheap labor” and “No more community service, they’re killing us.”
Killings of students appear to be rare, but university officials, acknowledging widespread complaints about the program, have started to say that it has become unsafe.
“This scheme is a total anachronism and should be changed,” said Dr. Luis Carlos Hinojos, the director of the medical school at the Autonomous University of Chihuahua.
He said the university has tried to place more students in safer urban locations and relocate those deemed to be in danger. After a doctor was shot and killed this month in the municipality of Bocoyna, which has seen clashes between cartels, six students set to start work there were reassigned.
The government defends the program, which dates to 1936 and graduates about 18,000 students each year. Mexican Health Secretary Jorge Alcocer told reporters this week that officials would be reviewing security conditions but that the community service is an “academic requirement that, in principle, cannot be canceled.”
“It’s not advisable to suspend that process of formation that’s so important for doctors,” he said. “We can’t set aside the most far-away placements that don’t have conditions that are completely safe.”
Moreover, the program has been a crucial source of medical care in rural areas. For every 10,000 people, Mexico has 24 doctors — not far behind the U.S. figure of 26 — but they are heavily concentrated in cities.
In May, President Andrés Manuel López Obrador announced that the country would fill the gaps by contracting Cuban doctors, prompting criticism that the real problem was security.
Medical school in Mexico starts right after high school and usually lasts six or seven years, the last of which is spent doing community service, which can entail conducting research or working in clinics. Typically, the government determines what slots are available and leaves it to the schools to fill them.
Students with the best grades get the first pick of assignments, so those with lower averages tend to get the most dangerous jobs. They sometimes work without supervision or outside contact and live alone at the clinics — problems that students and university officials say have long been recognized but not adequately addressed.
Locals tend to view the students as full-fledged doctors — and that leads to situations in which the newcomers can incur the wrath of the community when a patient can’t be saved.
“They won’t say the clinic doesn’t have the resources, the clinic doesn’t have an ambulance, the roads aren’t accessible, the routes aren’t easy,” said Cinthya Flores, president of a national association that represents medical students. “It’ll be the doctor’s fault.”