The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

In this chapter, Garcia visits New Mexico two years after she concludes her research. She follows up on her former research subjects and Nuevo Día. While Garcia previously lived and worked in the Española Valley, she avoided using her neighbors as subjects for her research. Nearly all her neighbors used heroin, and she knew which ones were more dangerous than others. Garcia later reads about her neighbors in a national newspaper. Their two-and-a-half-year-old son, Danny, had a cold, and Danny’s father first tried to stop his son’s crying by administering children’s cold medicine. When he continued to cry, he rubbed alcohol and then heroin on Danny’s gums. The child’s death earned national attention.

Nuevo Día was forced to close as a detoxification clinic in 2006 after only two years of operation. However, it was permitted to remain open as a center for recovery; it could still run its rehabilitation groups but could not administer anti-opioid medications. Garcia learns that Nuevo Día lost credibility for its inconsistent practices and lack of qualified medical supervision. She suggests that this view of Nuevo Día reveals a bias about citizens in the region:

The idea that Nuevo Día lacked credibility and that it was, like its patients, ‘unstable’ revealed long-standing cultural assumptions about the Española Valley—that it was essentially premodern and its people irrational and untrustworthy (186).

When citizens learned that the region’s only heroin detoxification clinic would be closed, emergency meetings were held to train locals on caring for people with addictions and administering life-saving treatments. Institutional failure places the burden of care on families, where complicated ties to drug use already exist. The war on drugs and the increased privatization of medical care in the 1990s streamlined addiction services while failing to consider context. One father tells Garcia that he knows learning how to administer Narcan, which can restore breathing after an overdose, will not save his son from the reality of drug addiction; however, it is the only resource available to him.

Garcia highlights the disparity between drug treatment in the Española Valley compared to the surrounding wealthier regions. The burden of care in Española Valley is placed upon families who are already experiencing loss and economic hardship, and expensive treatment centers open in other regions are inaccessible to them. One woman named Adela opens a detoxification clinic in her home. She only has enough resources to assist individuals through the initial days of withdrawal, after which they are dismissed so the bed may be filled by someone else. Adela relies on donations from her patients and locals to get by.

Clinics like Nuevo Día are assessed by outside reviewers who do not understand the intricacies of the region and culture: “Absent from these discussions were the historical, social, and economic underpinnings of addiction and mental illness among New Mexico’s citizens” (187). After Nuevo Día’s closure, individuals with drug addiction who were on the detox program’s waitlist for months were told to find service elsewhere. Some were sent to Albuquerque, where the waiting list was up to six months.

Garcia notes that the instability of privatized and institutionalized care mirrors the instability of drug use. One example of this is a woman who shares how the drug court system has left her with two equally unappealing choices: She may either remain on house arrest with her parents, from whom she experienced abuse in the past, or leave her children behind to receive care at a program in Denver. Neither option considers the context of her life or how these treatment plans contribute to her sense of loss.

While eating at a taco stand, Garcia spots Bernadette and Eugenia. She quickly determines that they are there to meet someone to buy heroin. Bernadette tells Garcia that they are doing okay and implies that their heroin use is an inevitable part of their lives. Garcia sees the pair again a few hours later at the rehabilitation group. The facilitator is weary and runs the meeting poorly. After the meeting, Garcia drives Bernadette and Eugenia home. While Bernadette sleeps in the backseat, Eugenia directs Garcia to take her to her childhood home, now occupied by someone else.