Preclinical
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Barrio Tlaxcala: The Importance of Service and International Perspective in Medical School


I began volunteering at an interesting time in Chiapas. My medical school was gracious enough to let me participate in a year-long project in Mexico between my second and third years working and teaching for VIVA, an international volunteer group lead by Darinel Ballianas.

In June of 2013, Mexican President Enrique Pena Nieto began introducing laws to restructure the educational and health systems of the country. If passed, they would further privatize the country’s health care industry, making health care less affordable to the average citizen. They would also introduce educational reform that would begin to dissolve the teachers unions, which have been very strong, and would increase emphasis on teacher evaluation, discipline and control.

The result was a countrywide protest at the end of July 2013. More than 100,000 teachers protested, expressing their fear that the new laws would be used to fire or otherwise discipline teachers and permit the state to hire new teachers with less seniority, earning lower salaries. As a result of the strike, schools were shut down and children were to stay at home.

A prompt solution was needed, especially in struggling Chiapas, where many people — especially the indigenous, and even more so women — are unable to exercise their right to an education for many reasons. Poverty forces children to work in order to improve their family’s standard of living. It is very common to see children of four or five years of age selling artisan goods or candy to tourists on the streets to support their families’ economic situation. In addition, many isolated communities do not have the adequate infrastructure to provide education (lack of classrooms, furniture, books, basic services, and teachers, together with overcrowded classrooms).

As a result, almost 17 percent of the population over age 15 did not attend school at all, 37.13 percent of the population over 15 did not finish primary education, and 10.6 percent of the population between five and 14 years old do not attend school.

Chiapas has the country’s highest illiteracy rate: 17.8 percent of the population 15 years and older cannot read or write, and 32.5 percent of the indigenous population is monolingual, the highest percentage in Mexico.

My first class consisted of five students. All were there of their own accord and interested in learning English. We worked for two hours on vocabulary before their parents came at the end of the day.

The next class, two days later, had doubled in size to 10 students.

The following week, the teacher’s strike began and around 17 students were now in my English class.

In that span of a week and a half, I had assumed responsibility for the only formal education these children would have. Needless to say, I was worried about being able to handle the responsibility.

The various ages and learning levels of the students presented an interesting challenge. The youngest student in the class was five, while the oldest was 14. Some of the students had jobs in supermarkets or sold items on the street to support their families. Some were Indigenous and others were Mestizo, which here in Chiapas carried a social significance.

Several weeks passed in this format, and the class of 35 students consistently showed up to continue learning. About this time, Darinel Ballinas, the head of this branch of VIVA, suggested that we stage an event to demonstrate what the children had been learning to their parents and other interested members of barrio Tlaxcala.

We spent two weeks of dedicated study for this event. The children worked extremely hard writing stories in Spanish and learning phrases in English; some even learned to juggle in order to make the event more fun for their parents.

The Friday before the festival, all of the students showed up to clean the classroom and decorate for the festival. Every one of the students participated and put so much effort into this event.  After the festival, many parents approached me and expressed their gratitude for my help in the neighborhood during this strike. One father was on the verge of tears as he thanked me for helping contribute to his daughters’ education while the teachers were struggling to get back to the classroom.

Viewing the hard work of the children and experiencing moments like these helped me understand better that the stress and struggle of the previous months had been worth it. We were indeed contributing in a meaningful way to the education and wellbeing of the children here in Tlaxcala.

My final class for barrio Tlaxcala was on Dec. 13, 2013. Instead of having class, we threw a party for the children. The children performed a play in celebration of the Virgin of Guadalupe and then together we filled and broke two clay piñatas. I had the honor of raising the second piñata for the children.

The night came to a close drinking ponche and singing traditional holiday songs. It was a bittersweet feeling as I thanked all the teachers, students and their families for their hard work and participation in the Tlaxcala School over the past six months. I said my goodbyes, hugged my students, shook hands with the parents, helped clean the classroom, and locked the door.

It is difficult to measure all that I learned from this experience. I have only begun to reflect on how this will affect my future, as a physician and as an individual. A theme that reoccurs to me has to do with the amount of care required for the health of a child as he or she grows. Simply identifying pathology and giving appropriate treatment are very small albeit important parts of the equation. A daily schedule, access to education, sound parent-child relationships, nutritious food, and a safe environment are all vital to a child’s mental and physical health.

On the one hand, this seems obvious, but working in a setting where these requirements are not met underscores the essential nature of these components. These are very important lessons for me to learn, as they can be directly applied to patient populations with whom I intend to work in the United States. This year I have certainly been working in an environment that contrasts with the rigors of a medical school curriculum. But all that I have experienced will affect my education and practice for years to come.

Stefan Czestochowski (1 Posts)

Contributing Writer Emeritus

University of Tennessee College of Medicine


Stefan is a Class of 2016 medical student at the University of Tennessee College of Medicine.