Ekip Solid: A Conversation With Dr. Valeria Macías

As a young girl growing up in Monterrey, Mexico, Valeria Macías was inspired by many women in her community. But her grandmother has a special place in her heart.

“She has always had her doors open for those who need support,” Macías says. “She is a person that is always willing to help…ever since I was little, I had the feeling that this is my vocation: to serve.”

It’s a calling that Macías has carried with her through the years—to medical school, to the rural clinics of Chiapas and, now, to her role as executive director of Compañeros En Salud, as Partners In Health is known in Mexico.

Her grandmother’s example has been a source of strength and solace as she has led the organization, both in the quiet, day-to-day work of strengthening health systems and in the midst of crises, from an 8.1-magnitude earthquake to the COVID-19 pandemic. Through it all, Macías has demonstrated courage and compassion, drawing strength from the many women who touched her life—and seeking to nurture that strength in other women.

For International Women’s Day, we sat down for a conversation with Macías, where she shared her reflections on a range of topics, from her career to gender equity to the importance of self-care. This conversation is part of our ongoing series Ekip Solid, or “Strong Team” in Haitian Creole, a series that highlights PIH global leaders who are experts in their field.

You started your career with PIH in 2012 as a pasante—one of the first clinicians to complete their service year with Compañeros En Salud. What did you learn from that experience? How did it prepare you for where you are today?

When I started out at Compañeros En Salud in 2012, there were no more than 10 people in the organization, and it was really my first year working as a doctor, in a rural community. In Mexico we have to do this social service year before you can graduate as a doctor. You can do research, you can do rural social service, or you can do outreach, which can be more administrative. To tell you the truth, I really wanted to do it in a community, particularly a rural one, and that's how I found Compañeros En Salud.

At that time, I knew nothing at all about what Compañeros En Salud was, what it did, and I'd never heard of Partners In Health, the international parent organization. I knew nothing about global health or social medicine. All I knew was that there was injustice in our health system—in the way we provided medical care to our patients and in the inequality between the public sector and the private sector. I had a strong desire to do my service year in an area where there are usually no doctors.

I think spending a year doing social service in an area which has been marginalized completely transforms the way you learn medicine and the way that you provide services, because when you're there for a whole year, you become immersed in the everyday problems of that community and you see just how difficult it is for them to access medical care.

I think that everyone who goes through their social service with Compañeros En Salud, once they return to residency or continue working with patients in other settings, it's not the same anymore. You don't just see the illness anymore, but the patient—and all the social determinants that come along with that patient.

While a supervisor of other pasantes, you founded Compañeros En Salud’s “Right to Health Care” program, which helps patients in rural communities receive referrals for advanced care at hospitals and pays for their housing and transportation. What inspired you to start this program and why it is so important?

During my year of social service, I saw that, as a primary care physician in a health center, there are many things you still can't do. You can’t do surgery, you can't treat cancer, you can't treat illnesses that require a specialist or sub-specialist. So, I think that what most motivated me to start the program was being there every day, giving consultations, and seeing that I could not solve these problems even though, in theory, Mexico provides universal health coverage. And every time that I sent my patients to the hospital for any surgical problem, it ended in failure, really. It ended in failure because the patient went in and, for one reason or another, was turned down for consultation or surgery and they were still charged. That's why my colleagues and I decided to launch the Right to Health Care referral program.

To this day, the program remains very important. The truth is, we don't realize how difficult it is for a patient to access a consultation with a specialist. But when you accompany a patient to their consultation, you see all of the barriers that are being put up—from distance to food costs and lodging to hospital bureaucracy. So an essential part of what we do is paying their non-medical costs. And we walk side by side with the patient and teach them how the health system works, where to make appointments, how to move around in the hospital, and where to look for support. Having someone there who knows the system and can advocate for the patients makes a big difference. Since we started this program, it has helped hundreds of patients receive care, from surgery to cancer treatments to fitting of prostheses. This program is vital to getting patients the treatment they deserve.

During the 8.1-magnitude earthquake that struck Chiapas in 2017, you were director of our secondary and tertiary care programs. In your role, you supported our clinicians as they delivered care during crisis, including those who helped a woman in labor during the quake. What did you learn from this experience of leading amid crisis and how has it prepared you for our current COVID-19 emergency?

At that moment, all kinds of things happened. Inside Casa Materna, one of the doctors from the Secretariat of Health stayed to look after a patient in labor, which was happening just at that moment. The 'LEOs' were also there, who are the obstetrics nurses, supporting the doctor. They all stayed there and said, no way were they going to leave—the patient comes first. I think that the biggest thing I learned was, more than anything else, that solidarity and that connection that I still have with all the partners, in the health sector, that we are all striving towards the same mission.

When there is a crisis, I think it is very easy for it to permeate and to make us all enter our own personal crises. I don't know how to describe it, but it destabilizes everything that you are living through and everything that you are working for. You start to see everything as temporary. It's easier to get weighed down by everything you're living through. But I think the most important thing is to remain calm, try to see things objectively and from a distance, and give support to everyone who is working with you. That psycho-emotional support is extremely important, because your way of thinking and seeing things can be affected.

As a leader you have to keep guiding, you have to keep going, and you have to be able to see what can be solved at that time and give support to your colleagues.

As we celebrate International Women’s Day, we look to women who inspire us—colleagues, friends, trailblazers, mothers. Who are some women that inspire you and why?

One of the women who has absolutely always been an inspiration for me is my grandmother. She is a woman who has always been ready to serve others. She has always had her doors open for those who need support. She is a person that is always willing to help and always happy, always smiling, always thinking about others. So, that is something that inspires me a lot, and I think that ever since I was little, I had the feeling that this is my vocation—to serve.

On a bigger scale, I think that the woman who I grew up identifying with, or the woman that I always dreamed about knowing or having as a friend one day, was Mother Teresa of Calcutta. There was a strong religious presence in my childhood, and she was one of the first women I could see having a big impact. I could learn from her story and see everything she had achieved. Later, I had the opportunity to go to India and see her work and volunteer in the same organization, which by then had spread to a lot of different areas. It was a very enriching experience, being able to see everything that had been achieved, because it obviously wasn't just her—she organized a group of women to, to serve a pretty impoverished and marginalized population. As a woman inside the church and standing out like that, she was an example of a fighter.

In a world where women face sexism and injustice at home, in the workplace, in the hospital room, and beyond, how do we build a safer and more equitable environment for all women?

Content warning: rape.

That's a very important topic and very difficult these days, especially with the situations we are faced with in Mexico. Just a couple of weeks ago, we started to receive reports about the passing of a medical intern who was carrying out her social service and was attacked and raped by one of her colleagues inside the same health center. (This woman was not working with Compañeros En Salud and the attack did not happen in one of our health centers.) It's something that is extremely normalized.

I think it's very important to have a position of zero tolerance and to have consequences for actions. These days, any woman in Mexico, doctor or nurse, is afraid to get into an elevator, because if there is a male doctor there or someone else, she's going to suffer some kind of abuse and we cannot allow that. We have to make changes and it is super important that we all demonstrate strong leadership. In order to stop this, we have to have zero tolerance for any type of harassment or exploitative behavior. And we have to invite all our male colleagues and patients to self-reflect and relearn masculinities so that we end this machismo in Mexico, which we, both men and women, perpetuate.

How do you think gender roles affect the way women perceive themselves professionally?

I think it is a challenge being a woman, to be considered with the same seriousness. I believe that one has to keep working on it, to be listened to, and to have that confidence of being able to represent one's experience in the best way. There is this very strong conception of "my role is to stay at home" and "my role is to take care of my children" and, therefore, those capacities that they know they have are not dedicated to professional life, but to home life. And it's not bad—I grew up with friends saying "the only thing I want to be is a mother" and that is very important and very good and I have a lot of respect for moms. But I think it is very important that men also understand that housework and raising children and a family, in the end, are roles that must be taken on together, as a couple.

The most important thing, as a woman, is to become aware of your social construct— that gender role that has been imposed on you—and then ask yourself what you really want to do.

It requires a lot of introspection and to deconstruct ourselves as women—understanding those choices that I am making and why I am making them. It is a daily task to reflect on why I am acting the way I am acting or why I am having these reactions to work situations that can lead me to understand how the gender role impacts my professional and personal life and if there is something I can change about it.

From your perspective, what are the most important actions that should be taken to empower girls and young women in marginalized areas such as the ones in which we work?

It is vital that women have equal opportunities to access education at the primary, secondary, high school, and university levels. It is very difficult in these areas to really be able to devote yourself to a professional career—what many of these women lack is support from their parents. There is always a tendency to support the men instead of the women.

Another important action would be to create jobs. It is astonishing to see how few job opportunities there are in the region. As a result, it is very difficult for the women to be independent and able to empower themselves economically. And not having economic independence means you have many more challenges when it comes to making decisions and being able to move forward from different situations.

Lastly, I think that women should be given advantages. For example, giving a preference to women for certain opportunities, whether it be for studies or work. At Compañeros En Salud, for example, we search for female partners or collaborators, if there is any opportunity out there. Because it is one thing to educate and another thing to open up job opportunities—if you have a diploma and no job, it becomes complicated.

You must be very busy these days, but what do you like to do in your free time? How do you rest and take care of yourself during this pandemic?

It is very important to disconnect from time to time—turning off the cell phone and taking a few moments or a few hours for myself or with my partner. I try to be very aware of how I am feeling day-to-day. When I feel very overwhelmed, I look for those spaces for, first, meditation and second, exercise. If I don't do any physical activity in a week, I can feel stress all over. I like to ride my mountain bike a lot, look for trails, and just ride and be out all day with nature. It gives me a lot of energy. I like a lot of other activities too, such as scuba diving, walking, and hiking.

In my free time at home, I really enjoy watching television, reading, and listening to music. My partner is a musician, so we sit and listen to music, drink a glass of wine, and read a little. I also manage my schedule, balancing not only the work part, but my personal and spiritual part to ensure that I am covering all the areas of my life. I think that it is very important that all areas are taken care of so that one can be balanced. It is very important that you are well in order to be a good leader and so that you can set this example for your team members. If you are running nonstop and don't take your time and space, it is much easier to become overwhelmed and explode and make decisions that are probably not the best. We need that tranquility and to take those spaces. It’s crucial.

 

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