Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Book Review of “The Pastoral Clinic” 


Garcia’s ethnography highlights the need for healthcare professionals to foster hope, particularly when working with patients with opioid use disorder. Remember to be kind, patient, and positive with those who are suffering. 

The Pastoral Clinic: Addiction and Dispossesion along the Rio Grande” is anthropologist Angela Garcia’s poignant ethnography sent in Española, New Mexico. It paints a thoughtful landscape portrait of heroin addiction, spanning stories of the suffereing causted by addiction to the eventual dismantling of the city’s only detox center, Nueva Día.  


“I grew up in New Mexico, leaving at the age of seventeen . . . For years I would speak of New Mexico’s distinctive beauty, never of the deep suffering that I knew existed there . . . I recognized that the two were inextricably linked. New Mexico’s landscape makes visible the existence of addiction, and addiction shapes and is shaped by New Mexico’s landscape.” 


The five chapters in the book each deal with a different facet of addiction. The chapter that stuck with me the most was “Blood Relative,” examining the familial context of heroin use. It follows two different pairs of mothers and daughters who use heroin, bringing light to the complexities of companionship, love, and inheritance. It also calls into the question the burden of care and how it disproportionately falls on families, especially in less affluent communities. 


“I asked why she should suffer the consequences if the trailer and the drugs belonged to her mother. Bernadette lit a cigarette and, after a long pause, described to me the “compromiso” (commitment) she and her mother forged long ago–a commitment to ease each other’s pains, to alleviate las malias that are procured by and treated with heroin.” 


The book ends with a depiction of Española’s only detoxification center, Nueva Día. The center has been transformed by patients into fields rich with vegetables, a return to and reflection of the agricultural roots of Española. Yet, among such splendor, a patient asks the author for a way out, or another place to continue her recovery. For the patients of Nueva Día, there were few options and the larger idea of chronicitythat addiction was something that would never leave them, and that they were expected to fail–weighed heavily, as if a premonition that their condition was without end. 


Alma struggled to find a way out, first through the work of recovery and then through the promise of rebirth. But her struggle was undermined by the powerful presupposition of inevitable return: a return to certain historically situated pains, a return to heroin, a return to the clinic.” 


Garcia’s ethnography highlights the need for healthcare professionals to foster hope when working with patients with opioid use disorder. As a medical student, I hope to stay cognizant of the impact that our words have when working with future patients. 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.