Life at a community health clinic in rural Mexico

By Katie Morales, IGHS master's student

Katie Morales, UCSF Institute for Global Health Sciences master's student
Katie Morales

For my master’s capstone project, I’m located in the town of Autlan de Navarro in southwest Jalisco, Mexico. It’s a quiet tranquilo town, surrounded by mountains, with quintessential cobblestone streets and baroque-style churches. It’s the kind of town where everyone smiles and addresses you as you walk by, and, when they discover you are a foreigner, they go out of their way to make you feel comfortable.

In one of my first experiences in Autlan, I was asking around at the mercado for the infamous Torta ahogada, a sandwich drenched in flavorful hot sauce. Although the local market did not sell this specialty, a woman working at one of the food stalls had me sit, gave me agua de Jamaica and called around town until she found a Torta ahogada and had it delivered to her stand. She then demonstrated the correct way to eat it, completely drowning the sandwich in the hot sauce until you have a bit of a sandwich soup—absolutely delicious.

My background prior to entering the global health master’s program was in nursing. I’ve worked in multiple capacities within the healthcare system, but most recently as a nurse practitioner in a community health center in San Francisco. For my capstone research project, I was excited to have the opportunity to see the inner workings of a health clinic in Mexico and to focus on my passion, which is the management of non-communicable diseases (NCDs) in underserved communities. This project involves looking at costing and charting data to determine the burden of NCDs at the Tiopa Tlanextli health center.

Two murals on side of Community Health Center building in Autlan MexicoMexico has seen a rise in NCDs, such as type 2 diabetes and cardiovascular and kidney disease. Obesity-related illnesses account for 28% of all deaths in Mexico yearly, and type 2 diabetes is one of the leading causes of mortality among adults, with the prevalence estimated at 9.4% in 2016 (according to the ENSANUT 2016 diabetes statistics and the article Obesity-promoting factors in Mexican children and adolescents: challenges and opportunities).  In my first week here, I hit the ground running and started reviewing charts, shadowing clinic staff and absorbing as much information as I could. I quickly found that the diabetes data I needed would be much harder to find than originally anticipated, and I had to start thinking of other possible indicators of chronic disease to evaluate, such as blood pressure, BMI and family history. My experience has been an ongoing reminder that working in global health requires endless flexibility and patience.  

As my project continues to evolve, I’ve learned that regardless of culture, language or country, there are some similarities in the human condition that transcend borders. Analogous to my clinic in San Francisco, here the staff turnover is high due to low pay; marginalized populations will forgo their health needs to pay bills and feed their family; diet modifications are impractical suggestions to poor families; asymptomatic conditions such as hypertension can be ignored and mental health remains stigmatized.

I recently shadowed a seasoned Tiopa nurse who has been at the clinic for several years, longer than most. As she sees patients and takes their vitals, she simultaneously provides another invaluable service in her exam room: brief counseling sessions. She asks how patients are, talks about stress and anxiety management and the importance of managing chronic diseases. I’m reminded of the important role a health center can provide for a community and that it is sometimes these recurring small moments that eventually get through to patients.  As the mountain of obstacles looms ahead, I’m uplifted by these small moments and by the people I’m meeting along the way who are part of this work.