ED KASHI

Remedios Ramirez Facio (73) lives with her husband on a small plot of land in Atitalaquia, a village in the state of Hidalgo in Central Mexico. When a Human Rights Watch team visited their modest home on a warm Sunday in late August 2014, Ramirez’s energy level was remarkable for a woman whose pancreatic cancer has metastasized to her lungs and liver. A few weeks earlier, suffering from severe abdominal pain and nausea, she had no energy and had lost her will to live. Ramirez attributes her remarkable turnaround to the fact that she is now receiving palliative care at Mexico’s National Cancer Institute in Mexico City. As Ramirez puts it, [with palliative care services, including seeing a physician, psychologist and nutritionist] I have come back to life.

But there is a complication. In all of Hidalgo, home to more than 2.5 million people, there is not a single public hospital that offers palliative care; many of the local doctors have no idea what palliative care even is. Thus, Ramirez has to travel every few weeks to go to the National Cancer Institute, a trip that takes almost the entire day. Luckily, the local community clinic tries to make an ambulance available to people who need to make the long trip to hospitals in Mexico City for medical care. The ambulance picks up Ramirez at around 4:30am and usually does not get her back home until around 4:30pm. The round-trip cost of 200 pesos (about US$15) is more than Ramirez and her husband normally spend in weeks.

Doña Remedios, 73, who has pancreatic cancer, poses for a photo with her daughter, Orlanda Hernandez Ramirez Remedios, 44, at their family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Doña Remedios, 73, who has pancreatic cancer, poses for a photo with her daughter, Orlanda Hernandez Ramirez Remedios, 44, at their family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Doña Remedios and her daughter, Orlanda Hernandez Ramirez Remedios check in at the National Cancer Institute to receive palliative care and pain medicine in Mexico City, Mexico on Sept. 1, 2014.

Doña Remedios and her daughter, Orlanda Hernandez Ramirez Remedios check in at the National Cancer Institute to receive palliative care and pain medicine in Mexico City, Mexico on Sept. 1, 2014.

Doctors and nurses tend to patients in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Doctors and nurses tend to patients in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

The daughter of palliative care patient, Samuel Mora Calderon, 70, cries and clings to her ailing father as he withers away from melanoma at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

The daughter of a palliative care patient, 70, cries and clings to her ailing father as he withers away from melanoma at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A palliative care patient, 70, spends his final hours in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A palliative care patient, 70, spends his final hours in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Doña Remedios, 73, attends a service at the Church of San Miguel Arch Angel in Atitalaque, Mexico on Aug. 31, 2014.

Doña Remedios, 73, attends a service at the Church of San Miguel Arch Angel in Atitalaque, Mexico on Aug. 31, 2014.

Dish-ware hangs on the wall at the family compound of Doña Remedios in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Dish-ware hangs on the wall at the family compound of Doña Remedios in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Adriana Lucia Preciado Perez, 40, is photographed at home in Guadalajara, Mexico on Aug. 30, 2014. Her father passed away last year from cancer.

Adriana Lucia Preciado Perez, 40, is photographed at home in Guadalajara, Mexico on Aug. 30, 2014. Her father passed away last year from cancer.

Adriana Lucia Preciado Perez, 40, looks at her parents' wedding album with her younger sister, Martha Elizabeth Preciado Perez, 30 and their mother, Guadalupe Teresa Perez Lopez, 69, at their home in Guadalajara, Mexico on Aug. 30, 2014. The father of the family died last year from cancer.

Adriana Lucia Preciado Perez, 40, looks at her parents’ wedding album with her younger sister, Martha Elizabeth Preciado Perez, 30 and their mother, Guadalupe Teresa Perez Lopez, 69, at their home in Guadalajara, Mexico on Aug. 30, 2014. The father of the family died last year from cancer.

Dr. Gloria Dominquez Castillejos, pain clinic director, speaks with a patient in Hospital Doctor Angel Leano in Guadalajara, Mexico on Aug. 29, 2014.

Dr. Gloria Dominquez Castillejos, pain clinic director, speaks with a patient in Hospital Doctor Angel Leano in Guadalajara, Mexico on Aug. 29, 2014.

Juana Hernandez Bautista, 49, suffering from breast cancer, waits with her husband in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Juana Hernandez Bautista, 49, suffering from breast cancer, waits with her husband in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A nurse checks on a patient at the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A nurse checks on a patient at the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Dr. Sylvia Allende, Director of the Palliative Care Unit, takes care of of a patient, along with her colleagues, at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Dr. Sylvia Allende, Director of the Palliative Care Unit, takes care of of a patient, along with her colleagues, at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A man watches as his daughter, 34, is treated for leukemia in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

A man watches as his daughter, 34, is treated for leukemia in the Palliative Care Unit at the National Institute for Cancer in Mexico City, Mexico on Aug. 28, 2014.

Doña Remedios, 73, sits pensively at home in her family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014. Remedios is suffering from pancreatic cancer.

Doña Remedios, 73, sits pensively at home in her family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014. Remedios is suffering from pancreatic cancer.

Doña Remedios spends time at home with her daughter at their family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Doña Remedios spends time at home with her daughter at their family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.

Doña Remedios, prepares to begin her early morning trek to the National Cancer Institute in Mexico City with her daughter on Sept. 1, 2014. She had an appointment at the hospital, but the ambulance was not available for transportation.

Doña Remedios prepares to begin her early morning trek to the National Cancer Institute in Mexico City with her daughter on Sept. 1, 2014. She had an appointment at the hospital, but the ambulance was not available for transportation.

Doña Remedios and her daughter proceed on their arduous trek to the National Cancer Institute in Mexico City to receive palliative care and pain medicine.  They start the journey at 4am at their home in Colony Dendho in Atitalaquia and then have to walk for 30 minutes to catch a series of 4 buses for a total journey of 4-5 hours.

Doña Remedios and her daughter proceed on their arduous trek to the National Cancer Institute in Mexico City to receive palliative care and pain medicine. They start the journey at 4am at their home in Colony Dendho in Atitalaquia and then have to walk for 30 minutes to catch a series of 4 buses for a total journey of 4-5 hours.

As her illness progresses, Ramirez’s condition is likely to deteriorate, making the trip increasingly hard. No matter how difficult it is to face her own mortality, Ramirez says she feels grateful that the doctors have spoken with her openly and with empathy: “It gives me more desire to live.”

As her illness progresses, Ramirez’s condition is likely to deteriorate, making the trip increasingly hard. No matter how difficult it is to face her own mortality, Ramirez says she feels grateful that the doctors have spoken with her openly and with empathy: “It gives me more desire to live.”

Watch the film here.