Psychologist Ivana Cervín Marín and mental health activities manager Laura Moreno work in Doctors Without Borders/Médecins Sans Frontières (MSF) mobile clinics across Guerrero state, Mexico. Each month they visit communities affected by extreme violence related to the drug trade in the region. Here, they describe the challenges of working in the state and the needs of the population they serve.
Ivana Cervín Marín: Working in Guerrero makes me feel like I’ve lived in an alternate reality. Mexico City feels like a bubble. The reality is this, it is here, it is this situation, and it is Guerrero state who has been historically punished and, faced with a new threat, has said "enough."
The people, of course, have been forced to adapt psychologically to this new threat, to the violence: they may become aggressive or violent and suffer a lot from it. But it is an adaptive response to this new environment.
We have seen everything—missing children, kidnappings, torture, sexual violence, sexual violence with minors, pregnancies in minors, many children exposed to traumas.
I remember one boy who was about six years old, his grandfather was murdered by the criminals. They came back again and threatened his father and the mother. This boy, he now suffers post-traumatic stress. He improved a little, but then the narcos returned, they tortured the father with cables, et cetera. The kid shows avoidance; hypervigilance; anxiety; sudden, unstoppable crying.
Guerrero state, Mexico: "People are turning their backs on what's happening here"
Then there is institutional violence, kids being let down by the school system in general, although it is largely thanks to teachers that the social fabric does not completely fall apart; the work they do is very important. We also work with them, to help them, and train them in emotional intelligence, to support each other, to create support networks for the kids [and] for the communities.
The people and the communities we serve in Guerrero are very grateful. When we go back to the same town for our monthly visits, the people tell us "it's good that you haven't forgotten us." Because that's how they feel: forgotten.
Laura Moreno: In Guerrero we provide primary health care and mental health care (both individual and group) and psychosocial activities to people affected by the violence in the region, to strengthen patients’ coping mechanisms and help rebuild the social network damaged by violence. This can be challenging, as we only visit each community once a month because of the volatile context. Individual consultations can’t be long. There are also other challenges, like our visits coinciding with sowing or harvesting times or the day they receive public aid and they have to go to collect it.
We carried out 1,270 consultations in 2017. We treated people who have been through very traumatic experiences. Some have had family members killed and others have family members forced into criminal gangs. People in Guerrero are tough, but if the fear and violence persist, the fabric of society could be torn apart. This is why providing mental health care is so important here. The support we give helps to strengthen people’s coping mechanisms, so that they can manage their emotions in times of uncertainty and violence.
We are also very concerned about serious psychiatric patients. The isolation that some communities face has enormous repercussions for them and their families. They are excessively vulnerable.