Getting to know the Sierra Madre and Compañeros en Salud

Compañeros en Salud (CES) was founded some years ago by Daniel and Lindsay Palazuelos and Hugo Flores, who had been working providing medical care in poor areas of Chiapas, Mexico. Now a part of the Partners in Health network, CES supports Mexican doctors who chose to spend their social service year in rural communities of the Sierra Madre region of the state of Chiapas, caring for around 25,000 patients.

I’m going to be volunteering with CES for the next three months, and I’m still learning about all the things do. Here’s a little exposition on the wheres and whats of the organization.

‘Beyond mountains, there are mountains.’ Translation: as soon as you think you’ve solve one problem, here comes the next one!

The Sierra Madre and our communities

The Sierra Madre de Chiapas is a mountain range that runs along the Pacific coast from Oaxaca and northern Chiapas down to Guatemala, El Salvador, and Honduras. The mountains form the watershed between the Pacific and Atlantic oceans in this narrow part of Mexico, and include several volcanic mountains.

They are also immensely beautiful and richly biodiverse. Several of the communities CES works with in the Sierra Madre are located inside a natural biopreserve called El Triunfo. El Triunfo is one of the last remaining preserved cloud forests in Mexico, host to threatened species such as the quetzal, the tapir, the cougar, and the spider monkey. I haven’t seen anything more interesting than mules and rabbits yet, probably because I haven’t actually ventured into the forest, but I’m going to keep up hope!

The extent of my wildlife sightings so far.

The economy in the Sierra Madre is largely dependent on coffee growing, and you can see coffee plants growing along the mountainscape are you drive along the narrow, winding roads to the communities here. People drink coffee like water, even the children. You are more likely to get a carafe of coffee than water with your lunch, and it’s the first thing anyone offers you if you visit their home.

Coffee beans drying in the sun. We’re in coffee selling season right now, but soon it will be time to plant the next crop.


The Mexican doctors who work in the rural clinics in each of the communities CES supports are here as pasantes, doctors who have finished their internado (something like the first year of residency in the United States, though it includes rotations through various medical disciplines) and have to complete a mandatory year of “social service.” This system of social service for doctors was established in Mexico in the 1930s, in response to the dearth of doctors in rural and indigenous regions (wouldn’t it be great if we did this in the U.S?) Several other Latin American countries have similar models of mandatory social service for medical students, residents, or medical professionals.

One of the pasantes in his clinic.

Social service takes many forms, including teaching, research, work in urban areas and direct care in medically underserved rural areas. The last option — spending a year providing primary care in a low-resource rural area — often means that a new doctor with minimal experience is left alone in charge of a rural health center. In fact, about a third of primary care centers in Mexico are exclusively covered by pasantes.[1] Many of these health centers depend on the pasante system to remain staffed. In addition to the frustrations of lack of support, pasantes in can also experience personal risks in more unsafe areas.[2][3]

Given all the frustrations of the pasantía, it’s maybe unsurprising that, increasingly, students are choosing non-rural options for their social service year. One of the doctors at CES mentioned that she was the first person in her school who was announced to be going somewhere other than Mexico City for her social service year. ‘Todos lo aplaudieron por su valentía’ — everyone applauded her for her courage — said her classmate, who is also working with us.

The pharmacy in Plan de la Libertad. Medications for these communities is supplied by the Mexican Secretary of Health and supplemented by Compañeros en Salud.

One of the wonderful things Compañeros en Salud is transform the rural service pasante year into a valuable experience where student doctors can consult with more experienced medical staff, are provided with supplies they need to take care of their patients, and work in an environment where they can become better doctors while providing quality medical care. The long-term relationship CES has with the communities it serves also helps diminish the negative effects of having constantly rotating medical staff in their health centers. The pasantes I’ve met this week are all wonderful, energetic people who truly care about social service. It’s been great getting to know them, and I’m excited to start visiting them in their clinics.

Some of the awesome CES doctors, off duty.


CES also trains and pays women in some of the communities to work as community health care workers, who visit patients with chronic illnesses like diabetes and hypertension, checking on their health and adherence to medication. The accompañantes know their communities intimately, and can provide long-term support and knowledge of patients they work with. I’m going to talk more about accompañantes in my next blog posts, because I will be working with some of them as we start training them to visit patients with depression and other mental illnesses.

Jaltenango de la Paz.

Jaltenango: the hub for our spokes

Our main office is located in Jaltenango, a town of about 10,000 people. We get to the communities we work in from Jaltenango either in a CES pickup truck or using public transportation. When going to one community to another, I’ll generally be transiting through the Jaltenango office, where I’ll get to enjoy the lovely benefits of hot water, flushing toilets, internet, phone service, a bed, and cuisine that is not rice and beans. The dorms where I live are located in the second floor of the house where our office is. It’s a wonderful cozy setup that makes the staff here as much family as coworkers.

Working from home is pretty easy when you live at work.

If you think the work CES is doing sounds cool, please consider donating! Here is a link to my fundraising campaign for Partners in Health: