Using “Under the Mesquite” to Help Medical Students Gain Cultural Awareness

We are always excited to hear about uniquGuest Bloggere ways in which our books are being used, and were thrilled to come across this review of Under the Mesquite that outlines how to use the book in a very special way: to help medical students gain cultural awareness and insight into the experiences of patients from different backgrounds. Author Mark Kuczewski kindly gave us permission to cross-post this review from the Reflective MedEd blog.

Helping medical students to gain cultural awareness and insight into the experience of patients and families from backgrounds different than their own is no small task.  And the search for poignant materials that are easily fit within the demanding environment of a medical school curriculum is never-ending. The good news is that I can unequivocally recommend Under the Mesquite by Guadalupe Garcia McCall (Lee & Low Books, 2011). This narrative will help students to gain insight into the meaning of illness within families, especially within the context of a particular contemporary newly-arrived Mexican-American family…

The author, known as “Lupita” within the story, recounts experiences from her high school years when her mother suffered from cancer and underwent extensive treatment, sometimes for long periods at a medical center far from home. Because the author’s father accompanies his wife on these journeys, Lupita, the oldest daughter, takes on responsibility for the family. We are treated to her perspective in coping with her mother’s illness from spy work to find out the secreto that the adults guard in their hushed whispers to the difficulties that come when her parents are away such as being unable to keep order among her siblings. Lupita paints a portrait of a prudent family that begins a savings account with the birth of each child but whose resources are exhausted by the medical bills leaving her struggling each day to procure food to put on the table. And we come to know the importance of the arts, acting in school plays and writing in journals, as means to channel her anxieties and craft something beautiful.Under the Mesquite cover image

Of course, the particular flavor of the narrative comes from the perspective of one who has significant roots on both sides of the border. She simultaneously gives us a window into the challenges of growing up bicultural and navigating the conflicting demands of loyalty to la familia that nurtured her and pursuing the dream of achieving a different kind of life that is available in the new world. The author lets us taste the bittersweet nature of this ambivalence both in her day-to-day growth as she is accused by her adolescent peers of trying to be something she is not as she loses her accent and in the more profound and cyclical heartbreak of separation. She relates her grief at abandoning her precious sunflowers when her father uproots her from her familiar home in Mexico and she in turn must break his heart as she heads off to college to pursue her dreams.

In sum, this book is among the most usable I’ve found with medical students for two reasons. First, it meets the main requirement of being an enjoyable and quick read. This autobiographical account is most likely to be devoured within a single day.  The author is a superb writer and some of our medical students repeatedly commented that they wish she said more in most passages. Second, she enables us to easily identify with her struggles. Because all adults were once adolescents, we have a framework regarding the struggle for self-discovery and identity into which her cultural context is infused. She enables us to access the different through the familiar. Guadalupe Garcia McCall is a first-rate guide and mentor to those of us who seek insight into the Mexican-American experience and the particular strengths and means of coping that a family steeped in this hybrid culture might possess.

Mark G. Kuczewski, PhD, is the Chair of the Department of Medical Education and the Director of the Neiswanger Institute for Bioethics at the Loyola University Chicago Stritch School of Medicine.


Purchase Under the Mesquite by Guadalupe Garcia McCall here.

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