Rural Health and State Construction in Post-Revolutionary Mexico: The Nicolaita Project for Rural Medical Services

I.

In the nineteen twenties a group of graduates from the Colegio de San Nicolás and the Universidad Michoacana in Morelia, the capital city of the state of Michoacán, drafted a program for the economic and social development of the countryside that, in the next decade, influenced federal policies and ideas about health care. This article examines the ideas and efforts of two Morelian physicians, Jesús Díaz Barriga (1891-1971) and Enrique Arreguín Vélez (1907-1989) who, during the 1920s and early 1930s, developed an incipient system of rural health in Michoacán. In 1935 they organized the First Congreso of Rural Hygiene, an event which they hoped would launch a state-managed system of rural health, and eventually the socialization of medicine in Mexico.

The conference succeeded in highlighting the need to bring modern medicine to the countryside; it also opened a national debate about the character of professional services in post-revolutionary Mexico. The debate revealed the ways in which the left and right foresaw professional services in a modern society, as well as the tensions between provincial and federal policymakers contending to turn their own agendas into national policy. Yet the discussions also made clear that beyond ideological and geographical differences intellectual elites across the country shared basic preconceptions about the inclusion of rural dwellers and indigenous groups in a modern society. These preconceptions also affected the professional role that male doctors hoped to assign to their female colleagues.

The intellectuals from Morelia had come to power as a result of the 1910-1917 Revolution, which started in December of 1910 when Francisco I. Madero called for a rebellion against the regime of Porfirio Díaz (1876-1910). Landless peasants, industrial workers, and petite bourgeois joined the struggle. After ten years of open warfare and heightened popular mobilization, the central state of Porfirian at times had ceased to exist while military-men and local power-holders dominated the regions of a fragmented nation. ¹ By 1920 federal authorities were striving to reconstruct the central state's institutions as well as its administrative and political procedures. To succeed in this difficult task they also needed to forge a national discourse that would appeal to the organized and armed popular sectors which had entered the political arena. ²

The issuing of the 1917 Constitution represented a major step in the construction of a shared sense of national identity. The Constitution promised land redistribution, workers' rights, and anti-clerical educational policies. It also created an interventionist state that would look after economic growth, implement and enforce land, labor, and educational reform, and guarantee the good health of every citizen. However, in the midst of financial hardships, international pressure, and internal divisions, the national administrations fell short of enacting the Constitution's principles. ³

In the mid 1920s President Plutarco Elías Calles (1924-1928) made health concerns a part of his attempt to centralize political power and bring about economic development. ⁴ Regarding the peasants as backward and ignorant, hygienists in Mexico City began to work to impose their own European-inspired views on sanitary and health practices across the nation. ⁵ These tendencies became even more pronounced under the influence of the Rockefeller Foundation, which by the late 1920s enjoyed great influence within the Departamento de Salubridad Pública. However, early health policies focused on urban areas and, in an effort to guarantee the well being of the economy, on the export-related regions. A few demonstration programs were implemented to show the benefits of modern medicine, but they still left most of the rural dwellers with no modern medical services. ⁶

The central state's disregard for the peasants' health mirrored the Callista general policies, which after 1925, favored foreign investors, Mexican capitalists, and landowners. ⁷ By the early 1930s...