Sandra Peniche Quintal

Sandra Piniche confronts a medical system that has continuously underserved Mexican women; helped to prepare doctors to better meet women’s needs; and trained women to direct their own health care.

In Mexico and all of Mesoamerica, medical systems have struggled to meet the needs of women, failing even to prevent fatal but easily avoidable diseases like cervical cancer. Sandra Piniche created a coalition of public health professionals to prepare doctors to fight cervical cancer and improve their treatment of women. The coalition brings together representatives from civil society organizations, medical associations, and government health services to create training and curricula for medical students and established doctors alike.
Sandra’s programs also prepare women to secure their own health through a participatory diagnostic program that identifies their community’s needs and assets in the field of health care. As they articulate their needs, Sandra partners them with coalition members who can help them meet these needs. Her successes in reducing death from cervical cancer provides momentum for her initiatives to spread in two directions: to address a wide range of issues in reproductive health; and at the same time, expand throughout Mexico toward the whole of Latin America.

The incidence of mortality for women due to reproductive health problems is especially high in Mexico and Central America. For instance, while cervical cancer barely ranks in the top ten causes of cancer-related death among women in developed countries, it is the leading cause in Mexico, killing an estimated 300,000 women each year. As mortality from this disease has dropped in developed countries, mortality has actually increased in Latin America, especially among the poor. These trends occur despite the fact that cervical cancer is entirely preventable, detectable, and curable if diagnosed in its early stages: less than 35 percent of women in Mexico have the recommended yearly examination.

The example of cervical cancer illustrates only a few of the many problems that plague health care delivery for Mesoamerican women. Most problems stem from a lack of understanding and empathy for women’s issues in a medical industry dominated almost entirely by males. Medical personnel receive no training on the specific rights and needs of women dealing with reproductive health issues. Rather than receiving sympathetic care, women often face humiliation or scolding for their sexual behavior when visiting a doctor or nurse. Such treatment, combined with already existing stigma, convinces many women to completely avoid doctors in matters of reproductive health.

Some factors driving the high incidence of reproductive health problems stem from flaws in the structure of the medical system. Federal and state health services tend to mandate care, leaving their citizens unable to arrange preventive or continuing care for their own diseases. Government programs targeting poorer communities ignore—and even push away—local programs and resources that could help to address public health problems. Finally, efforts run by private and public health systems, universities, and citizen sector organizations rarely collaborate. The result is inefficient programs, sometimes working at cross purposes, and failing to significantly address the health needs of Mesoamerican citizens.

Sandra focuses on cervical cancer as an entry point to reforming the Mexican public health system as a whole. Cervical cancer is an ideal first target because techniques to diagnose and treat the disease are readily available but disturbingly underused by Mexican women. Early screening programs partnered with effective treatments can dramatically reduce mortality rates, and they are relatively simple and inexpensive. Perhaps most importantly, the prevention of cervical cancer is a noncontentious issue with the potential for broad public support. While other facets of reproductive health generate controversy and resistance from the church and other conservative groups, none will argue against saving women’s lives by fighting cervical cancer. Thus, in working for five to ten years on the issue of cervical cancer, Sandra can show concrete results and create the structures needed to improve all facets of women’s reproductive health in the region.

Sandra has formed a network of individuals and groups in the state of Yucatan committed specifically to fighting cervical cancer and dedicated broadly to the cause of women’s reproductive health. The group recently carried out a participatory inventory of problems associated with reproductive health care. Armed with this information, its members have begun to address every section in the path from disease toward diagnosis and treatment in which a problem might occur.

To better the treatment of women in Mexican health care, Sandra’s network designs and runs workshops to improve attitudes toward women’s health among the students and administrators of medical schools. They work to alter student curriculum at state medical colleges, train nurses working with the state health care system, and address the lack of accountability for lab technicians working in reproductive health. Building on these efforts, Sandra founded a new program on community health initiatives for women at the medical school in the state capital of Merida, allowing young doctors for the first time to focus their studies specifically on women’s health.

Partners in the consortium also train women and their surrounding neighborhoods to take control of their own reproductive health. Sandra’s training structure places neighborhood representatives at the head of a program to pinpoint their own weaknesses and strengths in dealing with reproductive health issues. In these trainings, representatives gain crucial experience in research and advocacy. Better yet, they learn to identify and take full advantage of the health resources that already exist in their community—the knowledge, human resources, and social capital that on which future programs will depend. Once the community has established its needs, Sandra’s team matches them with a partner from the consortium who can help them meet those needs.

Sandra’s programs now serve the city of Merida and three nearby rural communities. Once she documents the success of the Merida initiative and trains enough local staff to sustain it in the long term, she will begin to spread her strategy across Central America. As her geographic reach grows, she plans to tackle new problems, expanding beyond cervical cancer to address other vital issues related to sexual and reproductive health.

A bold child raised to ride horses and enjoy adventure, Sandra remembers fighting the medical institution from her earliest years. In kindergarten, she refused to receive a scarring polio vaccination in her arm, running away from school when nurses attempted to deliver the shot. Where other children accepted the treatment, Sandra refused to give in and argued with the medical staff until they agreed to give the vaccine in her leg, where scarring would be hidden. Later, in her earliest years as a medical student, Sandra was taken aback by the treatment of women’s sexual health within the medical community. She recalls being shocked during her studies by the absence of a clitoris in her medical textbook.

Her first major entanglement with social problems came in her efforts to give women the option of abortion in times of economic hardship. After years of battles to legalize this practice, the government authorities finally relented and gave women in such situations the right to choose. As soon as they did, however, they erected roadblocks to prevent the procedure they had just made legal. Sandra found it unacceptable to possess a right in theory, but not in practice, so she began to look for ways around government roadblocks. She investigated Mexico’s international obligations and came across a treaty on the rights of women, promising a right to elect the number of wanted children. She wrote letters to several journals and publications announcing her intention to open a legal abortion clinic under the binding rules of this agreement. After years of effort, she succeeded in opening the first legal abortion clinic in the nation.

When a prominent anti-abortion activist began to organize hostile protests against her clinic, Sandra took inventive steps to protect her institution. She recorded his entrance into her clinic and turned the resulting video over to police. Shortly after, he was arrested for trespassing. Days later, when he returned with a group including American and Canadian anti-abortion activists, Sandra called immigration authorities and alerted them to a law that prohibits overly political activity by foreigners. All non-Mexicans present in the group were immediately deported.

For years, Sandra has been aware of the need for dramatic change in the way that her country’s medical system treats women. Three years ago, when Sandra was diagnosed with breast cancer, her treatments brought her in contact with low income women suffering from cervical cancer. As she came to know these women, and to understand their pain—which was completely preventable—she was immediately impelled to act.