Nestled deep in the heart of the Sierra Madre Occidental, Copper Canyon is home to Mexico's most longstanding indigenous Indians: the Rarámuri, commonly known as the Tarahumara. The landscape's rugged beauty has earned itself the name Copper Canyon, not after the mineral, but for the radiant colors that reflect off the canyon in the sunlight. It is here that I joined Dr. George Wortley and our team of three others in an effort to provide what is realistically the area's sole source of medical care. Doctor Wortley has traveled to the Copper Canyon twice a year for almost 20 years. He is so enthusiastically greeted that one town has built him what is, by a large margin, the nicest house in their village: the "Casa de Horge." It is here that wilderness medicine and primary care merge. Wilderness Medicine is commonly defined as medicine practiced in an area that is at least one hour away from definitive care. The Tarahumara are full day's drive away and that's if they have access to a car.
Getting to see patients wasn't always easy; River-crossing.
Since the 16th century, in a land affectionately known as the Sierra Tarahumara, the Tarahumara have lived in caves, cliff overhangs, and small wood and stone cabins in remote areas. Bartering is more common than pesos and their native Uto-Aztecan language is still widely spoken. Their livelihood depends on adequate rainfall providing enough maize and beans, and many still practice transhumance. They live a simple life, free of most modern technologies, with primitive living conditions. That is not to say that there is no western influence. Since the building of the Chihuahua al Pacífico railway, increased contact with the outside world has harbored a western influence. Many roads are being built even within the steep canyon walls. Subsequently, terrain so treacherous it was once unsuitable for horses or mules is now driveable. As a byproduct of their increasing popularity, it is said that their way of life has changed more in the last 20 years than in the last 300 combined. The Tarahumara are becoming increasingly dependent on outside influence and in doing so are becoming increasingly unhealthy. Chabochi - literally, anyone who is not Tarahumara - are changing not only the landscape but also their culture. On trails more than a day's hike from the nearest road, discarded empty soda bottles and scattered candy wrappers shatter any romantic but naïve notions of a life free from westernization.
Once home to over one million Tarahumara, the Copper Canyon is currently home to approximately 60,000. Their survivalist existence has lead to a steady population decline, with starvation, cold, tuberculosis and dehydration claiming countless lives. Malnutrition, poverty, sexual abuse and alcoholism are commonplace. The average life expectancy is a shocking 45 years old, 30 years less than Mexico's average 75-year life expectancy, and less than any country included in the World Health Organization's 2011 census. There is no term for hypertension in Tarahumara. However, alta presión, diabetes and obesity are becoming more common as outside influences increase. The statistics are staggering: 50 percent of children die before the age of 10 and there is a 40 percent infant mortality rate. Contributing to a high infant mortality rate is the lack of obstetric care in the Canyon. Traditionally, women are left to deliver their babies alone in the wilderness braced between two small trees. Hygiene is poor. Substance abuse is rampant and contributes to the high prevalence of the sexual, physical, and emotional abuse. Tesguïïno, the staple alcoholic beverage, plays a central role in social celebrations and religious observances. Inebriation is a religious experience in itself and is seen as the soul leaving the body. Anthropologists estimate that approximately 100 days of each year are spent either drinking or recovering from tesguïnados, or drinking parties.
The Sierra Madre is amongst the world's most productive drug-growing regions. The growth and trade of marijuana, heroin and opium in the region has caused a widespread fear of violence. Tarahumaran men are known to provide cheap labor and are sometimes killed for refusing to aid drug kingpins. A family we worked with closely had recently lost a son as a direct consequence. Sadly, as the government attempts to halt drug production by spraying herbicides, they kill not only the intended drug fields, but also the Tarahumara's crops.
Dr. Wortley working with patients at the school.
The team organizing medications in the clinic.
There is no word for love or hope in the Tarahumara language. However, that is not to say that steps are not being taken to change this. Tarahumara Ministries is the only ministry that has ventured in to the Canyon and stayed. Their central location, a school at the bottom of the canyon that we used as our base, provides food, shelter and education to approximately one hundred children. The ministry is a place the Tarahumara trust and look to for extensive help. Mediating the immediate needs caused by extreme poverty and isolation is a priority. Lack of water availability and food supply is only one challenge to overcome. Social infrastructure, poor family support and lack of medical aid are all daily concerns. They aim to build a medical clinic, as well as a fourteen bed women's shelter, to provide refuge to women suffering from violence and discrimination. With the steady decline in population due to malnutrition and illness, a health clinic would quite literally save lives. While Tarahumara Ministries has made an incredible impact, preventable illnesses still claim the lives of most of the population.
Brenda Granados, Director of Tarahumara Ministries, commented on the social situation. "Being a girl in the Tarahumara, it's like being born a slave. When they start growing, when their body starts changing it's almost certain that every girl is going to be raped."
Rosenda, our guide and a native Tarahumara, shared her personal experience. "Sometimes, when husbands go drink they get violent. They mistreat their wives. They hit them. The men feel bigger and women do not have authority to defend themselves. I had the experience on my dad's behalf. I couldn't really feel much because from a young age this happened. One of my aunts forced me to go with a man. From that, I had my first baby. I was 16. The man was 35." After the man deserted, leaving her starving with two small children, she found Tarahumara Ministries, where she has lived since and is now an integral member.
Dr. Wortley working with patients at the school.
Pastor Tomas, the founder of Tarahumara Ministries, also commented. "The Tarahumara are dying hungry, cold and sick. We see men treat their ladies so poorly, and this is why the women's shelter will be a great thing. Because those ladies - if we don't help them, they die."
We worked late nights and early mornings. Sometimes we hiked for hours, only to wait for patients who had never gotten the message we were coming. While staying at the schoolhouse, we treated 100 school children over the course of a couple of hours. Approximately 30 of them were visibly ill. Upper respiratory infections, impetigo, lice, poor dentition and conjunctivitis were exceedingly common. We applied a fluoride varnish to each child's teeth and also supplied them with a year's worth of vitamins. Many of the adults who came to us complained of myalgias, arthritis and backache. For this we could only give them ibuprofen. It was interesting to note that the further our patients lived from roads, the fewer cavities they had. Presumably they had less access to sugary foods. We hiked long hours to wait in vast grassy fields, where our patients would appear silently, one-by-one, until the field was awash with colorful skirts and scarves.
Katie providing a fluoride varnish.
Bacterial conjunctivitis case.
The clinics were always mostly woman and children; men rarely came to the clinic, unless accompanying a child. Doctor Wortley attributes this to women working harder on a daily basis and the stoic male culture. He also added that many of the women's symptoms could be linked to depression, which we did not treat. "It's hard being a women in the Tarahumara, but we can't change their circumstances."
Dr. George Wortley preparing the clinic.
Our patients approached us shyly. Children hesitatingly peeked their head around the door or gathered on window ledges so they could make quick getaways should we notice them watching us. Patient-doctor communication was difficult. Few Tarahumara speak Spanish and English was non-existent. Both patients and doctors used extensive body language, and the few bilingual Tarahumara translated each patient's complaint to Spanish. We had a limited array of medications available. Many donated medications were nearing expiration or were unwanted in the states. For example, we used chloramphenicol to treat bacterial conjunctivitis in many of the school children. Chloramphenicol is a broad-spectrum antibiotic but is known to cause aplastic anemia, bone marrow suppression and gray baby syndrome. However, it is still first line for bacterial conjunctivitis in the developing world.
Patients in the clinic.
Some of our patients left a lasting impression on the team. Marcela, clearly older than the majority of her tribe, had lost count of her age long ago. Much of her arms, face, and stomach were crusted over with an extensive assortment of infected plaque-like growths. Our team proposed leprosy, impetigo and eczema with secondary infection as possible diagnoses. She received a three-week course of doxycycline with a topical steroid for what was presumed to be eczema with secondary infection. She responded to treatment very well, as evidenced by her before and after pictures.
Marcella 3 weeks post-treatment.
An important take-home message from the trip is that food really is the best medicine. The international hunger relief agency Stop Hunger Now supplies affordable food to the world's most impoverished areas, including the Copper Canyon. It was through this organization that Dr. Wortley was introduced to the Tarahumara and started his long history of service. Ray Buchanan, the founder of Stop Hunger Now and a former patient of Dr. Wortley, told him about the Tarahumara and Pastor Tomas' work in the Canyons over a routine appointment twenty years ago. Curious, Dr. Wortley traveled with Ray to Copper Canyon to see for himself. He has since returned twice each year to continue his life-saving work in the Copper Canyon. Dr. Wortley has blended family medicine and wilderness medicine into one, and has saved countless lives in the process.