Physician Activists and the Development of Rural Health in Postrevolutionary Mexico

In 1930 the governor of Michoacán, General Lázaro Cárdenas, dispatched a small plane to bring ailing Dr. Teodoro Gómez Aguilar back to the state capital in Morelia. Suffering from a severe bout of malaria, Aguilar had to ride a mule for a day in order to reach the landing strip. The day-long mule ride and plane trip was the fastest way out of Apatzingán, the town where the twenty-eight-year-old physician had been working since Cárdenas created a hospital there in 1928. ¹

Teodoro Aguilar's journey is an example of the difficulties that academically trained professionals confronted when working in the Mexican hinterland. At the same time, it shows the concern of the Cardenista administration in creating modern medical services in the countryside. Finally, the story illustrates the commitment to ideals of social justice of doctors like Gómez Aguilar and his colleagues from the Colegio de San Nicolás de Hidalgo. Inspired by the promises of the 1910-20 revolution and a radical educational background, these doctors were eager to devote their professional skills to social change and economic development.

This essay explores the motivations and efforts of the Nicolaitas, a community of medical doctors from the Colegio de San Nicolás in Morelia, Michoacán, who strove to spread scientific health services to rural areas during the 1920s and 1930s. ² The professionals from San Nicolás were part of the postrevolutionary Mexican left. Led by General Francisco I. Múgica, radicals across Mexico believed that the 1910-20 revolution should usher in not only a constitutional republican system but also a dramatic transformation of social and economic relations. ³ They succeeded in including their ideas in Mexico's 1917 constitution, which promised the implementation of land reform and workers' rights. The constitution also provided for educational reform along the lines of so-called socialist education. This notion embraced a wide variety of meanings, from the secularization of education to the construction of a classless society through educational reform. ⁴

The constitution of 1917 made public health the responsibility of the federal state. The graduates from San Nicolás, who despite their federalist sentiments believed that Mexico's progress required a strong central state, agreed with this idea. But they carried the notion of the right to health further. Impressed by the apparent successes of the Soviet Union, and in the midst of the highly mobilized social environment of Michoacán, the Nicolaitas regarded public health programs as a form of wealth redistribution. They were especially concerned with living conditions in the countryside, where more than 60 percent of the Mexicans lived, and argued that poor health and deficient sanitary conditions were examples of social injustice. Their experience as rural doctors enabled the Nicolaitas to develop an agenda for rural health, making the extension of modern health services to rural dwellers part of the radical program for land redistribution, labor reform, and socialist education.

During General Cárdenas's 1928-32 gubernatorial term in Michoacán, the Nicolaitas became his close advisers, following Cárdenas to Mexico City when he was elected president of Mexico in 1934. In doing so the graduates from San Nicolás, and especially Drs. Jesús Díaz Barriga and Enrique Arreguín Vélez, played a crucial role in drafting and implementing an innovative and socially oriented system of rural health. Their projects, however, also revealed the contradictions that plagued socialist intellectuals in postrevolutionary Mexico.

Among the projects that the Nicolaitas inspired were the Servicios Médicos Ejidales (medical ejidal services). This program aimed at ending social injustice in rural areas by linking the expansion of modern medicine to agrarian reform. It also sought to transform the peasantry into modern citizens. At the same time, the doctors from San Nicolás, like other experts working in health matters in Mexico at the time...