The Servicio Medico Social as Formative Experience

Steve Server


The servicio médico-social (SMS) was a social service program instituted in 1936 that required medical students at the Universidad Nacional Autónoma de Mexico (UNAM) to spend a period of approximately six months doing medical service, basic sanitary oversight, and ethnographic record-taking in a rural Mexican village.  From the medical faculty, situated a few blocks from the Zócalo, the heart of Mexico City, these student pasantes would have to leave the metropolis to integrate themselves more fully with the true heart of Mexico: its rural denizens.  Rural dwellers suffered crippling poverty, including access to affordable medical care and basic knowledge of hygiene.  The SMS was an ideal opportunity to provide a low-cost, low-footprint curative to this profound and persistent problem of social welfare and infrastructure in a nation whose majority lived in rural environs.  It was also believed that this program would turn greedy physicians in urban areas into “evangelizers of health,” with a renewed commitment to pueblo over profits.  It was thought that the SMS could thus fix moral and practical issues in one fell swoop. 


Many histories of medicine take a very macro-level, institutional approach to analysis of medical programs.  To be sure, this is an important perspective that reveals the relationship between state ideology and the ultimate form that state institutions take.  Within the history of Mexico, this mode of analysis has been a significant one, with a great deal of interest taken in understanding the role of the PRI (and its precursor parties) in political, social, cultural, and economic life in Mexico.  Life under the PRI has recently been understood in terms of a process of negotiation between the state and Mexico’s “citizenry,” with the term “citizenry” serving as an impoverished stand-in word for the vast array of ethnic, socioeconomic, and political groups which constantly contested the terms of citizenship.


My research question aims to supplement these macro-level considerations by a focus on the micro-level questions of experience of individuals.  How did state officials see the SMS fitting into the larger medical school curriculum—and were the experiences that students had in rural areas consonant with the desires of central authorities?  What did students feel about their experience—beyond the intellectual and ideological tenets that the state aimed to transmit to them?  What did it mean for students to see ill health, death, and deprivation first-hand?  How did the emotionally-vivid experiences of the SMS figure in the formation of the young students’ professional identities as physicians?


This summer, thanks to the generous grant offered to me by the Social Sciences Division and the Orin Williams Fund, I was able to engage in some research in Mexico City to begin to answer these questions.  I went to the Museum of the History of Medicine, in the Palace of the Inquisition.  This imposing structure, with its thick wooden doors, used to house the Medical School for UNAM.  These days, in addition to its role as site of the museum, the Palace holds a library and an archive, both of which contain important information regarding the student experience of the SMS.  The Nicolas Leon library holds hundreds of student theses, which contain a vast amount of information regarding life in many of Mexico’s rural corners.  Data directly related to medical practice--water quality, burden of disease, local medical culture, hygiene, and housing—as well as cultural practices—local fashion, industry, and history of the region—fill large dusty tomes in the library.  The Archivo Histórico de la Facultad de Medicina at the Palacio allows researchers insight into day-to-day life within the walls of the medical school.  Its documents contain information about institutional reprimands, syllabi, admissions material, petitions from the students to change the schedule of their exams, etc. 


In the course of my consultation of these rich source bases, I am well-situated to begin to shed light on the SMS not merely as another institution—described by those cold, rigid flow charts that appear in materials produced by Mexico’s Department of Public Health lauding Mexico’s “new orientations” in public health—but rather as the aggregation of a multitude of emotional and intellectual experiences across the great diversity of geographies and ways of life within Mexico.


Steve Server is a doctoral candidate jointly in Conceptual and Historical Studies of Science and in History.