MEXICO CITY — Dr. Espinoza, a general practitioner in a rural patch of Chihuahua state in northern Mexico, was at home recently when a gunman showed up at his door. A gang member, the gunman told him, had been badly wounded in a shootout and needed immediate help.
It was not the first time Espinoza had been ordered at gunpoint to provide medical care. There is no option. So he went to the injured man’s home.
“They abduct you, and you have to go,” said Espinoza, asking that his full name be withheld for fear of reprisals. “When an armed group comes for you, you know it’s not going to be good.”
Doctors and other health care workers are increasingly being ensnared in the violence as criminal organizations across Mexico seize more territory, creating a severe doctor shortage in parts of the country where the dangers are most pronounced.
In the northern border state of Tamaulipas, doctors are being kidnapped to tend to gang members wounded in battle. In the state of Guerrero, criminal groups charge medical clinics a monthly extortion fee. And in Zacatecas state, medical staff were killed because they transported enemy cartel members to a hospital, according to health care workers.
The situation has become so dire and the lack of health care workers in certain areas so significant that it led the federal government last month to say it would recruit 500 Cuban doctors to help fill the gaps in poorer communities.
“A doctor that just graduated is afraid to practice in rural areas,” said Dr. José Luis Pérez Ávalos, director of medical studies at the Mexico City-based Autonomous Metropolitan University in Xochimilco. “Because crime has permeated everywhere.”
Espinoza said that when he arrived at the home of the injured cartel member, he found the man bleeding profusely from a gunshot wound to his arm. After managing to stop the bleeding, the doctor was allowed to return home.
Every day, in order to visit patients, he must pass a checkpoint in his hometown controlled by drug traffickers.
“Wherever we go, we are made to get out of our vehicles, and they’ll shoot us if they like,” he said, referring to himself and his medical colleagues. “We need more protection, more security, but we don’t have that.”
Soaring job vacancies for doctors and nurses in rural areas because of the surging violence has led to a lack of access to health care in some of the poorest parts of the country.
There are some 50,000 openings for medical personnel in Mexico, many in impoverished regions, President Andrés Manuel López Obrador said recently, though experts say the actual number could be far higher.
Growing insecurity along with low salaries have prompted doctors and other health care workers to quit their jobs, leaving unfilled positions in clinics from the northern states of Tamaulipas and Chihuahua to the southern states of Chiapas and Oaxaca, according to health care experts.
Government officials also questioned the sense of professional responsibility of doctors unwilling to work in rural clinics.
“They forget about a patient’s primary right, which is to be cared for wherever they are, and it’s because of this that we needed to resort to contracting foreigners,” Dr. Jorge Alcocer Varela, Mexico’s secretary of health, told reporters at a recent news conference.
The announcement about the Cuban doctors provoked outrage among many Mexican doctors, who said the problem was not a lack of physicians or an unwillingness to work in rural communities, but the life-threatening conditions they must work under.
“That was an ideological and political decision,” Dr. Germán Fajardo Dolci, director of the medical faculty at the National Autonomous University of Mexico, said of the move to recruit Cuban doctors. “It is not a technical, scientific nor rational decision, from the perspective of managing a health care system.”
Fajardo Dolci said personal safety is the top worry of many doctors. “It is a huge concern across the entire profession,” he said.
Last July, a doctor was hacked to death with a machete outside his home in the state of Puebla, according to local news reports. In January, another doctor was shot dead in the state of Chiapas during an armed robbery. And in April, gunmen shot and killed a doctor in Coahuila state while he was operating on a patient, according to local reports.
The escalating violence has also made life harder for residents, health care experts say.
In the community of Guajes de Ayala, in the mountains of Guerrero state in western Mexico, violence drove out a nurse, leaving the health clinic with no medical staff to care for nearly 1,600 residents in the region.
One resident, Andrea Arrollo Pérez, 34, was three months pregnant late last year when she started bleeding, became feverish and felt terrible pain in her uterus. A cartel had blocked the road to the next nearest clinic, six hours away, so Arrollo Pérez resorted to home remedies.
After a week of severe blood loss, Arrollo Pérez took the only option left: a day’s ride on horseback, through the mountains, to another clinic. When she got there, the doctor told her she would not have lived had she waited much longer. But she had miscarried, as she feared.
“It is a helpless feeling knowing that I lost the baby because of so much criminality and a government that does not support us,” she said.
Overall, the country does not have a physician shortage. There are 2.4 doctors for every 1,000 residents in Mexico, according to the National Institute for Statistics. That is more than most countries in Latin America, and just below the United States, which has 2.6 doctors per 1,000 inhabitants.
Still, the Mexican government recently launched a website listing more than 13,000 vacant medical positions across the country, many in areas experiencing significant violence.
Aside from addressing violence in rural areas, health care experts say the government needs to raise salaries and ensure that hospitals and clinics have basic supplies. Fajardo Dolci said postings in rural areas are often low-paid temporary contracts.
The median salary for general practitioners in Mexico is equivalent to roughly $15,000 a year, and many doctors from large metropolitan areas see little incentive to risk their lives to practice in regions ridden with violence.
Despite the dangers, some doctors — including Espinoza, who grew up in the mountains of Chihuahua — are committed to staying. “It’s very risky,” he said, “but I love my profession.”
Dr. Adonai Esparza, 28, a doctor in a clinic in the state of Michoacán in western Mexico, was working last year when a local gang boss arrived late one night, surrounded by armed guards.
The man had been shot four times in the stomach and was in grave condition. His bodyguards had a stark warning for the surgeon and Esparza: Save him or die.
The boss was eventually transported to a hospital hours away, where he died.
“You feel vulnerable, afraid, fragile,” Esparza said. “The doctors there are used to this. But no one should be accustomed to this.”