Interview with Gabriela Soto Laveaga, author of “Poverty Alleviation from the Margins: Mexico’s IMSS-COPLAMAR as a Challenge to Global Health and Economic Models, 1979–1989”
Gabriela Soto Laveaga is professor of the history of science and Antonio Madero Professor for the Study of Mexico at Harvard University. Her current research interests interrogate knowledge production and circulation between Mexico and India, medical professionals and social movements, and science and development projects in the twentieth century. You can read her article “Poverty Alleviation from the Margins: Mexico’s IMSS-COPLAMAR as a Challenge to Global Health and Economic Models, 1979–1989” in HAHR 102.4.
1. How did you come to research the IMSS-COPLAMAR health-care program at the heart of your article?
In the summer of 1995, I applied and was selected to be part of a binational research team between the UNAM Institute of Chemistry, the Museum of Man in San Diego, and, if I recall correctly, the National Institutes of Health. Also participating in the research project was the director of Mexico’s Medicinal Plants Herbarium, Maestra Abigail Aguilar. It was the summer after my first year of grad school and, though I had several ideas, I did not yet have a firm doctoral research project. In other words, it was perfect for me to go to Mexico for three months and take part in previously unknown (to me) experiences, such as the herbarium practice that I mention in this article or shop in the Mercado Sonora, which I believe is still the largest market for medicinal plants in Mexico, with a group of physicians participating in the course. Furthermore, we visited the pharmacy that has both pharmaceuticals and medicinal plants in Puebla. That was the first time that I not only heard about but was able to see what was left of IMSS-COPLAMAR in action. I was amazed by what I was seeing and though I could also grasp how unusual this was, I did not yet have the skills to put this in larger conversation with global trends. So while this was fascinating and though I presented the work in a conference and a later workshop, a variety of other research paths drew me away from this project. To say that that summer influenced my thinking and my trajectory as an academic is an understatement. Participating on that research trip was one of the wisest decisions of my academic career. My dissertation, first book, and more than 20 articles can trace their origin to something I learned that summer. Furthermore, after more than 25 years I remain in close contact with Maestra Aguilar (formerly of the national herbarium) and Dr. Ricardo Reyes Chilpa (of the Institute of Chemistry) among other Mexican colleagues who long influenced my thinking. I started this essay years ago but put it aside while I finished other projects. To return to it, to finally finish it as a different, more mature researcher, was something I wanted to do for a long time.
2. What challenges, if any, did you face in assembling the source base for studying this relatively recent program? What was the most surprising source that you found?
The question of methodology is a great one. While I was fortunate to see—via that fortuitous research trip—some of what IMSS-COPLAMAR attempted on the ground, it was not always easy to find the voices of beneficiaries in archival material. To understand what this shift (i.e., expanding an understanding of what was valid medicine and medical practice in rural areas) meant to physicians and researchers such as Abigail Aguilar, I relied on interviews with, for example, anthropologist and physician Dr. Roberto Campos, who as a medical student and later physician was part of the clinics I describe in the archive. Some of these interviews don’t make it into the article, but I needed to understand where to look and what to look for. In other words, understanding their enthusiasm for the program was invaluable for it helped me understand the program at a level that I may not have been able to grasp solely from the archival material of a defunct initiative. So the greatest challenge was finding evidence of what I was hearing in the archive, especially an archive that had so much material but wasn’t quite organized. Moreover, I did not have the luxury of time. I could only go to Mexico for short trips of ten days or so, which, when faced with material that is not catalogued or organized, is a challenge. Because the research guide was not accurate, I was fortunate to have the aid of Lorena Rodas, an UNAM undergraduate at the time, whom I hired to photograph the covers and table of contents of books from the library and first few pages of documents in folders. Though I had a vague sense of what was there, I needed concrete names of books or files to direct here what to photograph. I would go through, for example, pictures of books on shelves or covers of file folders and then send her a list. It was slow going but it would have been impossible to complete this without her help photographing in the archive.
3. Your article intriguingly situates the IMSS-COPLAMAR’s development and demise simultaneously in regional, national, and global scales. What is to be gained by approaching Mexican history with these multiple scales in mind?
Earlier I mentioned that when I first learned of IMSS-COPLAMAR I did not yet have the broader knowledge to connect this to, say, histories of global attempts to build primary care centers or place the experience in conversation with global initiatives such as the Declaration of Alma-Ata. But this is essential knowledge that connects the experience of a rural community in, for example, San Luis Potosí with specific regional demands, national aspirations, and global dictates. Once you see how these realities are tethered by practice or ideology you get a different vision of Mexican history, specifically the role of Mexico at a global scale. This is something that I also did in my first book on Mexican campesinos, steroid hormones, and global pharmaceuticals. But, and this is important, this is not solely a history of medicine or history of science; it is Mexican history, and I firmly believe that having this article come out in the HAHR as opposed to a history of medicine journal illustrates how essential questions of health were to the formation of a modern Mexican nation.
4. What lessons do the IMSS-COPLAMAR program hold for contemporary health policy?
I love this question. It would be terrific for public health officials and for policy makers to study, really study, a program such as IMSS-COPLAMAR. This project was remarkably ambitious but on the ground some of the most impactful changes may have been perceived as small rather than revolutionary, and yet these deceptively simple changes had the greatest impact (i.e, communal gardens of medicinal plants). The initiative was not just tackling problems; it was creating new ways of understanding Mexican rural spaces. That level of ambition and breadth of coverage (social, cultural, and economic) at a national and community scale is seldom attempted so comprehensively. I spoke about one such change years ago as part of a plenary talk at the American Association of Historians of Medicine and if I could change anything about the article, it would be to have included that example. I will add it now. When Dr. Roberto Campos, then a young physician, spoke about his time in a clinic in the Yucatan Peninsula, he mentioned how one clinic had a significant rate of postpartum infections and complications for both the mother and infant. With a new mindset they were able to see the clinic in a different light. New mothers were lying on narrow beds with mattresses covered in the heavy vinyl common in hospital furniture. That protocol might have worked for Mexico City, where the dictates were coming from, but it did not for this region where temperatures coupled with humidity hovered around 100 degrees. To think about the community meant to think about locale-specific needs, so instead of beds in the maternity ward of this COPLAMAR-inspired clinic they opted to hang hammocks. For, you see, in this area of the world people were born, slept, hung out, made love, ate, napped, and died in hammocks. As soon as they made this switch, infection rates in the maternity ward went down. Quite simply a one-size-fits-all solution could never work with such site-specific differences.
It was not simply about health or the medical centers, but it was about community empowerment. We often think of the transformative role that education had on the Mexican countryside, but as life-altering (literally) was access to health care. What is there to learn? Policy makers can suggest, but it is dialogue with communities that brings about lasting change. This was a health program devised by Mexicans, for Mexicans, and with input from both humanists, social scientists, and health professionals. That is also crucial.
5. Is this essay part of a broader project? If so, would you mind giving us a preview? If not, what are you working on for your next project?
Some years ago I thought I would write a monograph about IMSS-COPLAMAR—there is so much to write. I gathered quite a bit of archival material, visited several sites, and spoken to people, but I was sidetracked by two other monographs that I have been trying to complete for more than a decade now (advice to junior scholars: do not work on two thematically and geographically different books simultaneously). I might still write a couple of articles about midwives, medicinal plant gardens, etc. My next project is an ongoing project on Mexico-India and solutions to end global hunger.
6. Read anything good recently?
I was teaching an undergrad seminar on “Food, Science, and the Invention of Global Hunger” and I read Kregg Heatherington’s The Government of Beans about soybean monocropping in Paraguay. I highly recommend it.