Reflection from AC4 Fellow, Laura Vargas

My name is Laura Vargas and I am a Doctoral Student in Social Policy and Policy Analysis at the Columbia School of Social Work. Over the course of almost nine weeks I traveled more than 5,500 miles to conduct qualitative interviews with dozens of medical professionals. I travelled to sixteen different municipalities located in five states throughout Mexico . The overarching questions of my research are focused on how community violence affects health care service utilization. If service utilization is affected by violence, how can the health of individuals be affected by violence? The choice of sites for conducting interviews was largely based on locations that have experienced some of the country’s highest levels of violence in the past decade.

Photo of Research Sites by State. Research was conducted in the states of Baja California, Chihuahua, Guerrero, Michoacán and Tamaulipas.

In 2006, Mexico declared a War on Drugs, also sponsored and promoted by the United States. Since then, many states in Mexico have experienced an exponential growth in homicide rates, kidnappings, extortion and other high impact crimes. Since the War on Drugs started in Mexico, more than 100,000 people have been killed as a result of the drug related violence. In Ciudad Juarez alone, one of the sites where I conducted interviews, there were more than 3,500 homicides in 2010 and the homicide rate peaked at 229 per one hundred thousand. That same year, New York City (with more than six times the population as Juarez) had a homicide rate of 6.5 per one hundred thousand.

Health care service providers are aware of how violence affects their communities. Many health professionals are also victims or have family members who have been the victims of extortion, kidnappings and homicides. Some doctors for example, told me that because they are perceived to be a profession that “makes money” they or their family members were targets of extortion or kidnapping. Such events leave a lasting impact in the medical professions. Many medical professionals told me, for example, that hospitals located in areas that have high levels of violence do not have enough specialists because they have a hard time recruiting specialists to live in those locations.

In some communities, when the levels of violence were at their highest, some facilities would limit their hours or close their doors temporarily. People in those communities, many of them rural or marginalized, would have to go to another facility (sometimes having to travel a long distance to do so). People limited the number of trips taken on highways and would avoid driving after dark. In fact, in many of the sites I visited, people adopted measures such as limiting outings, limiting night life activities to social gatherings in homes, teenagers drove less, and people used public spaces less. Many of the doctors I spoke with also told me they had stopped conducting home visits because they believed the risk was too high or they would feel unsafe providing their services.

Photo of abandoned businesses on the main street of one of the research sites. Owners abandoned many of these businesses because they were unable to pay extortion fees. A few days before I was there, a high ranking authority of the state had visited this small city, and that is why the façades were recently painted different colors; seemingly trying to mask a reality for the political class that is difficult to ignore for the members of this community.

This research has been a journey to explore what is not known or remains silent about the consequences of violence on the health service utilization and health of communities. Violence has generated fear and a feeling of being unsafe in many parts of Mexico. This journey has been about learning how entire communities adapt to feeling unsafe. Many of the people I interviewed said that unfortunately, this feeling of fear and lack of safety was also due to the fact that they could not trust the institutions of local public security to keep them safe. Corruption and impunity are also a part of the violence that happens in many communities. It was sad to hear that people feel defenseless in the face of violence and impunity. Some people migrated from their communities to other parts f the country or the U.S. because of concerns about violence, but many have stayed and they have adapted to living with insecurity.

Silence in many communities grows as a part of the adaptation process. It is a silence that is the product of an environment of mistrust and fear that has required many, especially in rural or marginalized communities, to live with violence. Normalizing violence then becomes a necessary coping mechanism for many people living and working in these communities, including health professionals. My journey as a researcher explores the ways in which this adaptation to violence in communities affects medical professionals and service utilization. Also important, though, to understand how the violence that has been a part of Mexico’s reality for the past decade may have consequences for the health of individuals.

Despite the adversity that violence represents, and sometimes because of it, people need access to health care. Medical professionals are one of the first (and sometimes the only) point of contact that Mexican people have with public services. Medical professionals are a vital part of the social services provided in the country. Yet few medical professionals I interviewed told me they felt protected as service providers. Migration of medical professionals to cities or communities that are perceived to be safer is not uncommon as a response to not feeling protected in their profession. The accounts of the committed health service professionals working in many communities in Mexico are invaluable to my research as I seek to understand more about the relationship between violence and service utilization, and ultimately, the health of individuals.

The actual physical journey of traveling to these locations was demanding, and sometimes, emotionally draining. However, I felt inspired by the work of countless health professionals that are there, in solidarity, with their communities. I am thankful for the support of the AC4 Fellowship, as it was an invaluable experience and, of course, will be a vital part of my dissertation.

Author: Laura Vargas is pursuing her doctorate in the School of Social Work focused on Social Policy and Policy Analysis.