This month, my anxieties about Mexican medicine have been swelling at about the same rate as my belly. If this continues, I’ll be immobile by the Day of the Dead.
Michoacán’s outrageously good ice cream, which is sold on every street corner as if to torture pregnant women, may have much to do with the burgeoning belly. And lately, a movement that goes by the unfortunate name of “the Rejecteds”—or, more correct in English though harsher than the Spanish, “the Rejects”—is making headlines that fuel my fear. As someone with a growing stake (twenty-two weeks!) in Mexican health care, I confess that I am inclined to second the rejection of the Rejecteds.
La Jornada Michoacán tries to be more neutral: The Movimiento de Aspirantes and Rechazados (MAR) have taken over the offices of the Facultad de Medicina, delaying the school year for 55,000 students across Michoacán’s public university system. Dialogue between administrators and the MAR is ongoing, but the Facultad de Medicina is resolute in maintaining its 500-seat cap on incoming students, who are accepted based on entrance exams, which are monitored by student organizations to ensure objectivity and fair play.
Yes, the Rechazados are made up of would-be university students who have been rejected from medical school; their ranks total 1,500 in Michoacán this year. Similar movements exist across Mexico, including the MAES in Mexico City. Their argument is that public higher education should be a right and not a privilege. They want Mexico’s public universities, including the Facultad de Medicina (rumored to be one of the easiest entry points to the university system) to accept more—or even all—of their applicants.
Usually, I love an underdog. And student-movements calling for egalitarianism are particularly endearing. ¡Que viva la revolución! Except that this time, as I gnaw on my fingernails and rub my dancing tummy, my knee-jerk, American response is as follows: Accept everyone who applies to medical school? Are they insane???
Even the current cap of 500 sounds disturbingly high. By comparison, public universities in the state of South Carolina, which is only slightly larger and more populous than Michoacán, seat about half this many students each year. Walking around Morelia, the largeness of this number is made more conspicuous because medical students don’t dress like college kids in the U.S. (and they are college-aged, there is no undergraduate degree that precedes professional schools in Mexico). They don’t even wear scrubs, but dress in all white and coats besides. So the city is teeming with kids dressed like doctors.
Granted, a generation ago there were “doctors” in Mexico who were doctors by their own decree (see, for example, David Sklar’s memoir La Clinica), and I suppose that having a surplus of trained, if slightly less excellent, doctors is not quite the same thing. But wouldn’t swinging wide the doors of a medical school cause a backslide into Mexico’s chaotic past? Wouldn’t it pull resources from the students with the most potential and diminish the value of a medical degree? And if the universities remove or reduce their standards, how will an uninformed patient like me determine whether a doctor is any good?
This is, of course, when I realize that there are compelling political arguments to be made in favor of the Rechazados. For one, in his New Yorker article on Michoacán’s drug cartel (May 31, 2010), William Finnegan references the seven million Mexicans (nearly double the total population of Michoacán) who are known as “Los Ni Ni,” young people who are neither enrolled in school nor employed. While the Rechazados are motivated to pursue a professional career and hold high school diplomas, couldn’t they too be forced into this limbo of neither/nors? The economy is in the toilet, jobs are scarce, and low wages are, well, really low. Think of arriving at this point when you’re eighteen, finish high school, and don’t quite make the cut for one of the coveted university seats. Being a Rechazado is not a case of having a dream deferred; it is the sort of dead end that might drive young Mexicans into the ranks of organized crime, or northward to the U.S. border. Would greater inclusion in higher education productively occupy a crucial swathe of the population during their most volatile years, and if so, is it worth it?
But medicine? I ask. Why not let them engross themselves in subjects with which they can do no physical harm—like literature, for example, or geography, or art history, or philosophy?
Isn’t medicine supposed to be exclusive and elite? After all, reasonably qualified students are rejected from medical schools across the U.S. every year (and without a peep of protest!). Isn’t this how we know that our medical system is excellent? That we all have doctors who are better than average?
Or do those mediocre Rechazados have a point here as well? What is the problem with widely disseminated medical knowledge? And what would it look like in the U.S. if there were twice as many, if slightly less excellent, doctors? Would we pay less for a check-up? Would we wait less and see more of our doctor? Would our doctor remember from one visit to the next that our pretty child with the unisex name is actually a boy? Would we run into our doctor at the bowling alley instead of the golf course? Would more doctors accept Medicaid? And, for doctors themselves, would the life become more balanced and normal and conducive to happy, lasting marriages?
In any case, as of this week the Rechazados have relinquished their hold on the Facultad de Medicina here in Morelia. The university has agreed to implement a program in nutrition next year, and to make those courses available at some of the University’s satellite campuses around Michoacán. The Facultad de Medicina has kept their 500-seat cap. I should feel better, I suppose, that the Rechazados’ primary demands have been rejected.
But mostly, I feel like eating ice cream.