Tropical Medicine & Community-Based Care on the Coast of Mexico
Puerto Escondido was named one of The New York Times top 52 places to travel in 2017 (#32). Venture south to the coast of Mexico to immerse yourself in rich Oaxacan culture and language and get acquainted with life in a small, tranquil coastal city, nestled against the breath-taking Sierra Madre del Sur mountain range.
Mexico, the most populated Spanish speaking country in the world, retains influences from Mayan and Aztec culture, as well as remnants of European colonialism. Mexico has experienced rapid changes over the past century, including industrialization, urbanization, and movement towards a more open democracy. Yet far from Mexico’s developed urban areas is the southern state of Oaxaca, home to four magnificent mountain ranges and various indigenous populations. Oaxaca is one of the most underserved regions in the country, with 52% of Oaxacans living in rural areas. An estimated 42% of Oaxacans have no access to healthcare and in 2012 the maternal mortality rate of 103 per 100,000 live births was nearly double that of the country's rate. The average Oaxacan lives on less than $1.25 a day.
Puerto Escondido, meaning hidden port and commonly known as Puerto, is an idyllic setting on the southern coast of Oaxaca, home to over 45,000 inhabitants and spectacular tropical beaches, coastal lagoons, and a vibrant night life. It has preserved its small town charm, reliant on local fisheries and markets, even as a popular surf hub for some of the world’s most renowned surfers. Yet despite the idyllic setting, health challenges such as mosquito-borne illnesses, malnutrition, diabetes, obesity and cardiovascular disease, as well as the persistance of social challenges, such as alcohol consumption, teen pregnancy and domestic violence. It's not uncommon for teenage girls in Oaxaca to marry due to cultural attitudes, adherence to traditional gender roles, and lack of education. In addition, corruption in the political system imposes significant hardships on Oaxacans, including severe shortages of supplies and an inability to retain well trained health professionals, which further augments the barriers Oaxacans face in ensuring their right to quality care.
As a CFHI participant you will dig deeper into the healthcare system and Oaxacan culture by learning from local health professionals through rotations in government run primary care clinics known as Centros de Salud. You will experience a more intimate and personable experience with preceptors and patients, and also visit a secondary level hospital, as well as a reputable traditional midwife, who is widely respected in Puerto Escondido and neighboring communities. The focus of the program is on community-based care and access to primary care services provided to low-income populations. It's also an opportunity to understand access to care as related to socioeconomic status and how it differs between Puerto's low-income and high income populations.
CFHI participants live with a local family in Puerto Escondido, take Spanish language classes, and are encouraged to take advantage of local beaches for surfing and enjoy "coastal life".
Clinical Rotations & Public Health Placements
This program offers a survey-type experience of the healthcare system in Oaxaca. You will likely be assigned to one clinical site per week, including a number of the Centros de Salud and the hospital. The traditional midwife visit and vector control program are activities that will be infused into your program, but that do not require a full week's commitment.
Clinical rotations typically occur in 4-hour shifts during the morning time. This allows time for lunch and language class in the afternoon. A 4-week program will provide approximately 80 hours of clinical rotations. Should you require additional hours you may have to forfeit language classes to attend the second clinical shift.
Centros de Salud | Government Primary Care Clinics- Located in and around Puerto, from Bajos de Chila to Santa Maria Colotepec, these first level, government-run primary care clinics provide comprehensive care-prevention, health education, disease detention and treatment, and reproductive health. CFHI participants will learn from local health professionals through rotations in a variety of different specialties including pediatrics, obstetrics and gynecology, emergency medicine, and preventive medicine to increase understanding of community-based care in low-resource settings.
General Hospital- This secondary level, government-run teaching hospital is the main referral hospital in the coastal region and serves insured and uninsured patients. It has capacity for 30 beds. CFHI participants have the opportunity to shadow local healthcare professionals in the emergency department, general surgery, pediatrics, internal medicine, and obstetrics and gynecology.
Traditional Midwife Visit- Travel to the outskirts of Puerto to visit a well-known traditional midwife, who has been practicing community-based midwifery for over 60 years. She will share knowledge of medicinal herbs and birthing techniques that have been passed down for several generations and show CFHI participants a traditional birthing room. Midwives are highly respected community members, often considered leaders, and provide family planning services, prenatal and postnatal care, in addition to attending births.
Secretaria de Salud | Vector Control Program- This government run maintains rural health campaigns along the Oaxacan coast. The Ministry of Public Health teamed with community members to raise awareness about the dangers caused by mosquitoes and how to prevent malaria (more prevalent in remote locations in Oaxaca), dengue, chagas, and chikungunya. Since 1980, the Vector Control Program, or Coordinacion de Vectores, initiated by the federal and national governments has dramatically reduced infection rates by enforcing educational campaigns focused on prevention and implementing effective treatment planning strategies for those infected with vector-borne diseases. CFHI participants may have the opportunity (depends on availability) to join in this preventive vector disease control program by spending time "in the field" within various communities shadowing local healthcare personal in charge of prevention initiatives.
If you're interested in incorporating this opportunity into your program please contact a CFHI staff member in advance of your start date.
Opportunidades (currently known as Prospera)- Participants may also take part (depends on availability) in an internationally recognized community health educational program-Opportunidades-a comprehensive government assistance program geared towards women and aimed at decreasing poverty and improving health and education. The success of this program has lead to it being replicated in other locations around the world.
*Please note that civil or political demonstrations are known to occur throughout Oaxaca. Public demonstrations or strikes are almost always peaceful in nature and it's a rare occurrence for these to pose a real threat to the safety of CFHI participants. However, there is potential that your daily schedule may be impacted if these arise unexpectedly. CFHI local Coordinators in Puerto Escondido will do their best to account for any disruption to your schedule, but we nonetheless ask that you remain patient and flexible. The Coordinators will also advise you during orientation on how to respond in the event that you encounter a public demonstration.
CFHI is considered a global health ethics leader therefore CFHI programs uphold strict standards and comply with all local laws regarding student involvement in health settings. Your experience on the program depends on your previous clinical training (if applicable), Spanish level, and the relationship you build with your supervising preceptor. Above all, YOU are the most important factor in making the CFHI experience as fulfilling as possible by being respectful, culturally humble, inquisitive, and open to the wide variety of learning experiences which you will encounter.
Puerto Escondido, commonly known as Puerto, is situated along Oaxaca’s majestic coastline. Mexico’s southern state of Oaxaca is best known for its indigenous peoples and cultures, representing 34.2% of Oaxacans, the most populous being the Zapotec and Mixtec. Four vast and ancient mountain ranges converge in Oaxaca-Sierra Madre del Sur, Sierra Madre de Oaxaca, Sierra Norte, and Sierra Altravesada - which helps to explain why 53% of Oaxacans live in rural areas that remain largely inaccessible. Just beyond the Sierra Madre del Sur lies the sweeping Pacific Ocean and a lively little coastal town of 45,000 inhabitants, Puerto Escondido.
Puerto is unique in that it retains its charm as a small fishing village and market town, even as a popular surf hub that has a pumping Mexican pipeline. Surfers and travelers from around the world flock here for spectacular beaches, tropical weather and daily sunshine, a relaxed pace of life, an energetic nightlife, and all the richness of Oaxacan culture and cuisine.
Things to Do
CFHI participants have free time during most evenings and weekends and are encouraged to organize weekend trips to nearby destinations and take part in cultural activities offered within Puerto Escondido.
Puerto is an ideal place to relax and enjoy the slow pace of life. Its many pristine beaches - Playa Zicatela, Carrizalillo, Principal, and La Punta - offer majestic spots for sunbathing, surf and body board lessons, a chance to swim with sea turtles, or go spear fishing. Wake up before the sunrise to join a boat ride from Playa Principal to go fishing or see dolphins in the southern Pacific Ocean. Stroll down Playa Zicatela’s promenade - the main drag - to buy local crafts, visit the many cafés and restaurants along the beach, relax in a hammock, or take a stroll over rocky oceanside cliffs to look out at the ocean from Puerto’s well known lighthouse. Even though it’s easy to keep busy in Zicatela or La Riconada, it’s well worth your time to visit El Centro, home to most of Puerto’s true natives. When the sun goes down, night life in Puerto is full of energy, with plenty of festivities to join in on. About an hour outside of Puerto, visit Manialtepec or Lagunas de Chacahua National Park for boat tours around mangroves to observe birds and other wildlife and of course, for more good surf.
We recommend purchasing a traveler's guide, such as Lonely Planet, before your travels to prepare yourself and make the most of your time in Oaxaca. There's plenty to do!
A great resource to connect you with local activities is the Oasis Language & Surf School, owned by the Local Coordinator, Soledad, and where you'll be taking Spanish language classes.
Accommodations & Homestays
Participants stay with homestay families, chosen and screened by the CFHI Local Coordinator, nearly all of whom have been working with CFHI for many years. Homestays are located in Bacocho and Rinconada, both middle to upper class residential neighborhoods, as well as El Centro, a busy part of town where many Puerto natives reside. All homestays are located in close proximity to the language school, allowing participants to walk to language classes and meetings with ease, and accessible to public transportation to travel to and from clinical rotations.
CFHI participants are frequently housed with others in the same homestay to share in the experience, but will always have their own room. All homestays, as well as the language school, have reliable wifi access, although speeds may vary.
Homestays provide a unique opportunity to learn about local culture and practice Spanish skills on a daily basis in an informal setting. Accommodation includes two meals per day. Puerto has a diverse selection of restaurants, ranging from inexpensive and casual to more formal and pricier options. This is an aspect of Puerto to be enjoyed, as the food scene is noteworthy (for all palates and preferences) and worth exploring.
At the welcome orientation, participants will be instructed on recommended transportation from homestays to clinical rotations and getting around Puerto.
Eligibility: Who Can Apply?
This CFHI program is ideal for students who have a foundation in Spanish and have an interest in health and medicine in small town and rural settings. Non-students are also eligible. The program offers an overview of primary and secondary level care through visits within a hospital and primary care clinics, as well as Spanish language classes with an emphasis on medical Spanish. To confirm whether you're eligible to apply, please read CFHI's general eligibility requirements.
Minimum Language Required: Beginner 1 Spanish or Above
Beginner 1 Spanish: “I can speak a little and understand at times if people speak slowly and clearly.”
- I can understand and use familiar everyday expressions and simple phrases to get across basic needs.
- I can introduce others and myself. I can ask and answer questions for example where I live, people I know and things I have.
Leading this program on-site are our on-site partners (see Local Team tab), all of whom share Spanish as their native language, but may speak English as well. To provide authentic learning experiences translators are not provided. Daily interactions will be in Spanish, but CFHI’s local team is able to support and help you through your experience.
All CFHI participants applying to programs in Latin America will evaluate their Spanish language skills as part of their application. This information will then be shared with the on-site partners. A placement test will also be given at the start of the program to ensure you're learning at the correct level. Most important is your general ability to communicate verbally with those around you and to be proactive in speaking Spanish, versus accuracy with grammatical tenses. All CFHI Latin America programs include Spanish language instruction on-site.
Not sure about your Spanish level? View a full list of CFHI’s language levels for all Latin America programs on our Spanish Level Guidelines page.
Participants should arrive in Puerto Escondido (airport code "PXM"), on the program start date and will be picked up from the airport by a CFHI representative and taken to the language school to meet with the Local Coordinator, Soledad, or to their homestay depending on arrival time. Since Puerto's airport is small and only accepts national flights you will have a connection in Mexico. It's usually most convenient and cost effective to travel through Mexico City's Benito Juarez International Airport (airport code: MEX). Domestic airlines, including Interjet and VivaAerobus, offer flights to daily to Puerto and at low cost (depending on time of year). Travel time from Mexico City to Puerto is about 45 minutes.
A welcome orientation and dinner will take place the Sunday after arrival. As best as possible, it's preferrable to arrive on the program start date, or a Saturday if you've been granted an alternate start date, or Sunday morning or early afternoon, since orientation typically takes place on Sunday (late afternoon).
Visas are not required for U.S. citizens staying less than 6 months in Mexico. More information on travel and logistics will be provided by CFHI after acceptance into the program.
CFHI Program fees include the majority of your on the ground costs. As a nonprofit, CFHI strives to keep fees low and offers fundraising opportunities, such as scholarships, discounts. We also encourage you to visit our funding opportunities webpage.
- Guidance from CFHI staff in San Francisco before departure
- Program-specific materials with information on making travel arrangements, visa requirements, recommended immunizations, etc.
- Airport pick-up upon arrival and transportation to homestay in Puerto Escondido with local CFHI representative
- Welcome orientation and welcome dinner with other participants covering safety, transportation, and other logistics
- Spanish Classes: 30 hours/month of Spanish classes, including medical Spanish instruction
- CFHI Local Team: providing instruction, logistical support, and 24/7 emergency response
- Weekly meetings and lectures on local healthcare system and socio-economic determinants of health
- Placement and coordination of clinical/public health activities
- Housing with local family and two meals per day
- Local cell phone (Nokia basic phone)
- Since a number of U.S. based phone providers offer coverage in Mexico, whether within your current plan or for an additional low cost, you will have the option of using your personal phone or a CFHI local cell phone. This will be discussed further during orientation. Please note that it's imperative that the Coordinators in Puerto can reach you, especially in the event of an emergency. Lastly, CFHI will not be responsible for any additional costs through your personal phone provider. At any time, you can opt to use a CFHI local cell phone.
- International emergency medical and evacuation insurance (you will be enrolled approximately 1 month prior to your start date and once your program fee has been paid in full)
- Access to CFHI alumni-only LinkedIn group featuring news and career opportunities related to Global Health
- CFHI alumni newsletter highlighting events, resources, and ways to stay involved
Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically underserved health systems. Read more.
Dr. Isabel Saucedo- CFHI Puerto Escondido Medical Director: The role of the Medical Director is to arrange clinical and public health placements, supervise the participant experience at these sites, and provide instruction on healthcare topics during weekly meetings.
Dr. Saucedo has worked for CFHI since 2008. She is a Medical Doctor and also has her Masters in Public Health form the National Institute of Public Health in Cuernavaca, Mexico. In addition to her work with CFHI she is the Reproductive Health, Equity and Gender Coordinator for the Oaxaca Ministry of Health. She enjoys working with CFHI students and learning about different health systems. Dr. Saucedo lives in the countryside and loves gardening and raising chickens.
Soledad (Sol) Fernandez- CFHI Puerto Escondido Local Coordinator: The role of the local coordinator is to organize housing, transportation, orientation and weekly meetings. Sol is a great resource for any questions related to navigating Puerto Escondido locale, cultural norms and tips on planning weekend travel.
Sol has worked for CFHI since 2006. She has her degree in Social Communication from the Catholic University of Uruguay and is certified in teaching Spanish as a foreign language. She has worked as a Spanish instructor since 2003 and is the owner and manager of a local surf and language school that CFHI students attend. She believes the benefits of CFHI programs are numerous and enjoys working with CFHI students and creating connections between Mexico and other countries. Sol has always lived near the ocean and her favorite hobby is surfing, which brought her from her native Montevideo, Uruguay to Puerto Escondido where she has lived since 2001.
What Alumni Say
"With subtle lessons in cultural competency, the daily experiences abroad have forever made me a better healthcare practitioner to all patient populations… Now, back in NYC, I realize that I am more understanding of many of my patients, in particular who are immigrants, who struggle with a language barrier, or who are from cultures different than my own. Lastly, I am thankful for the language skills acquired in Mexico during the Spanish classes as well as in the clinics, on the beach, and at the homestay. Knowing Spanish, especially medical Spanish, enables me to provide better care for many of my Spanish-speaking patients and allows me to pursue a greater diversity of career opportunities."
"Completing this program was a life changing experience that I would do again in a heartbeat. It opened my eyes to the disparities present in healthcare. I was also given many unique opportunities to learn about the culture and people of Puerto. Being associated with the Oasis Surf & Language School allowed me to meet a ton of new people and have access to many amazing activities-learning how to surf, freshen up on Spanish, go to the local market, eat amazing local cuisine, release baby sea turtles, visit two different midwives, learn how to cook typical Mexican meals from my host Mom, watch movies along the beach, visit a wildlife refuge, hike along ancient trails, and listen to the stories of some amazing local people."
-Cate Cavanagh, MSc of Global Health Student, Northwestern University (November & December 2016)
"My time in Oaxaca was illuminating in that I could see how different kinds of medicine can coexist. And I also found people that I could relate to, especially in terms of the paradigm shift we want to create. It’s not always easy to merge the old with the new. We need evidence-based practices in healthcare, but we also need the wisdom and knowledge of our ancestors – and we are losing this with each passing generation." Read more from Lori's blog.
-Lori Blake, Nursing student, San Jose State University (January 2016)
"I feel so lucky to have had the opportunity to work with CFHI not once but twice! I learned so much from these experiences that I'm sure has impacted me even more than I know."
-Lauren Sheehey, 4th Year Medical Student, Northwestern University Feinberg School of Medicine (July 2015)