Meeting with the Health Promoters of Zapatista Autonomous Municipality ’16 de Febrero’, Chiapas, Mexico
At the Autonomous Clinic “San Antonio de Padova”, Berlin, February 2007
The meeting with the Health Promoters took place just outside the clinic since there is no room within the clinic big enough to hold a meeting of the almost 40 people present. Health promoters are local people who are trained, or are training, to give health advice, medical consultation, medical care.
33 Health promoters are in attendance, of which 2 are “vacunadores”, Health Promoters in charge of the vaccination and monitoring programmes. Most of them had to walk for hours from their village to get to the meeting, some comment they left their village at 03:00 a.m. This is an impressive attendance out of the total of 70 health promoters.
The bulk of this article is a report of what the health promoters themselves said, and there are in addition some explanatory notes by an international worker who has considerable experience in health care in the Highlands of Chiapas.
Outline of areas discussed :
- The health situation in the municipality as described by the Health Promoters
- The government health service
- The health situation: major illnesses and causes
- The clinic in Berlín (one of the 40 villages in the municipality)
- What already exists
- What is still needed
- How autonomous health is organised in the municipality
The newly-built autonomous clinic in ’16 de Febrero’
1. General Health and Health Service situation as described by the Health Promoters
The Government Health Service
“Above all there is the problem that the government health service discriminates against indigenous people.”
The general health and health service situation in the municipality is described by the promoters as difficult. The government’s health service is unsatisfactory and very expensive. One of the health promoters describes the government hospitals as like a white elephant (elefante blanco), it looks good from afar, from the outside, but there is nothing inside, there is no proper health service provided in the clinic. When they go to the government clinics they don’t give them medicines in the clinic (which would be a lot cheaper) but send them to expensive pharmacies. However the owners of the clinic and the pharmacies are the same, it is just their way of making more money.
They often just give medicine to relieve symptoms, not to cure the problem overall, so people end up having to buy more medicines and pay more in the end. (NOTE: Often the doctors in these clinics prescribe more medicines than are needed for the same reasons (money) and also give wrong diagnoses due to a lack of equipment to do the necessary tests or lack of knowledge. This also leads to prescribing unnecessary/wrong drugs.)
The medications that are prescribed are often just “calmantes”, it only calms/suppresses the symptoms but the infection is still there. That is also a way of getting more money, since the people have to come back to the clinic for further treatment.
Moreover a lot of people are discriminated against for being indigenous; this results in them not being treated in the government clinics, and even when they see that they have a serious illness they do not offer them treatment, but send them as far as Tuxtla Gutierrez, the far-off state capital, and they can’t afford to travel that far. They also have to pay for health services since the zapatistas are in resistance and therefore they do not have the “seguro popular” (popular health insurance). The government clinics are mainly interested in the sterilisation of women, but not in other health problems.
(NOTE: It appears that most indigenous people, including non-zapatistas, do not have free access to the health service, as they do not have the “popular insurance”, as this requires contributions to the state which they do not make in general, mainly because of their low income. Health problems are widespread not only among the zapatistas but among almost all indigenous people.)
The Health Situation: Major illnesses and causes
There are a lot of illnesses caused by the lack of health services. Often people are in a situation where there is no clinic nearby. Sometimes grave illnesses need to be cured.
Malnutrition is a general problem causing ill-health.
The gravest illnesses that occur with varying regularity are: infections of the respiratory system, pneumonias, tuberculosis and chronic bronchitis, and dangerous infections of the whole digestive system such as salmonellosis/typhoid fever and intestinal parasites. Malaria is also a problem in some areas (notably in the lower-lying parts of the municipality). Gastric problems are common. In some areas gastric problems arise from chemicals/acids from factories etc. Also salmonella, and other waterborne diseases. Scabiasis, skin diseases and insect-related disease are very common, too.
There is a significant child death rate that is mainly caused by malnutrition and sometimes children die of dehydration (related to vomiting, diarrhoeas, etc.).
Maternal death in childbirth is a major problem as well (e.g. if women giving birth at home haemorrhage, and are unable to reach a clinic in time).
(NOTE: The problem here is not with home births as such but rather with the lack of good transport and access to health facilities, plus lack of equipment to deal with such problems at home.)
One of the crucial problems is the lack of drinking water. Adding to this, waste is not well-managed, it is thrown everywhere.
Respiratory infections are a big problem ie chronic bronchitis, pneumonia, tuberculosis. Causes for infections of the respiratory system include the smoke that is produced by the open fires in the houses (mostly used for cooking) and the poor housing conditions. The housing mainly consists of one-room houses built of wood and with a plain mud floor. These houses do not protect sufficiently against the wind that enters into the house, neither do they protect from humidity or dust during the dry season.
People bathe in the river or stream in their community, and then become ill as these water sources are more and more contaminated because waste is thrown into the river and because there is a lack of a proper sanitary system, so toilet waste etc also ends up in the river. (NOTE: The rivers are also contaminated by the waste produced by some companies that throw their waste in to them and also by the use of chemicals which are prohibited in countries such as the UK due to the dangers to health.)
2. General Situation of the Clinic in Berlin
The Clinic as It exists
“In the autonomous clinic we treat everyone, we don’t discriminate.”
Autonomous health system – offers its service equally to all, everyone is treated the same, including non-zapatistas.
The general situation of the clinic in Berlin is that the clinic has been built and is operating, treating patients. The clinic consists of 10 rooms which includes a bathroom, 2 patients rooms, a room planned for traditional herbal and natural medicine, one for gynaecology. There is a small pharmacy, a consultation room and an emergency room. . The majority of equipment (e.g. patient’s beds) that they have in the clinic are on loan, they were supposed to go to a clinic that is being built in another municipality, but has not been built yet.
The clinic has one ambulance vehicle. However, sometimes it takes up to 3-4 hours to get from the most isolated communities by car because a lot of the roads are dirt tracks with a lot of stones and holes. When it rains, often the ambulance cannot pass at all and emergencies cannot be brought to the clinic. Therefore it often happens that patients die on the road.
The zapatista ambulance at ’16 de Febrero’
Non-Zapatistas also go to the zapatista clinics, because there is a better service, and everyone is treated with respect. Consultations are free to zapatistas and cost 15 pesos (less than 1 pound) to non-zapatistas. Medicines are also cheaper, being sold at cost price plus 20% in order to cover rising prices and transport costs, and thus enable the clinic to be restocked with medicines. It is a problem that medication is so expensive. (NOTE: As an example, an antibiotic costs between 50 and 300 pesos and the average earnings of an indigenous peasant are around 30/50 pesos a day.)
What is still Missing
The clinic has been built, however most of its rooms lack the most basic equipment. They are planning to start to work with natural medicine, some of them have already some knowledge, others are learning, we have a room set aside in the clinic for treatment with natural medicine, but are lacking materials and resources. There are a lot of plants around about, and we know which ones we can use for medicines, but don’t have the equipment to prepare them to make all the possible medicines.
What is missing most urgently in the clinic are the following: a bigger oxygen tank, at present there is only a small one, a specialised bed for the emergency room, sterilising facilities and medicine for emergencies such as pain-killers, adrenaline, medicine for allergic and other shocks, antibiotics, etc. For all these things at present they have to go to Oventik, the main zapatista health clinic in the highlands. Need materials for stitches and other minor surgery.
It is planned to build an upstairs floor for dormitories that are urgently needed for the health promoters working there, as well as a training room for courses and workshops that are going to take place in Berlín, the building currently used for training is lent by the community in Berlin. Need a proper kitchen for the health promoters.
In general there is a great need, but also a great vision!
The clinic at Berlin, ’16 de Febrero’, showing the roof where the local zapatistas
hope to build a new second storey of the clinic for dormitories and a training room for the health promoters.
3. How Autonomous Health works in ’16 de Febrero’
The developing zapatista health system is different and offers better treatment and they do not distinguish between mestizos and indigenous people (like they do in the government hospitals).
There are 8 “casas de salud” (small health centres) in 8 different villages in the municipio. 36 villages, the majority, have health promoters, though the aim is that every village should have a promoter. More casas de salud are needed, especially in the more remote villages. Some communities really far from clinic (3 or 4 hours in car) and sometimes when it’s raining it’s not possible to get cars along the road.
There are 70 health promoters in total, of which 18 are women (10 of the promoters are going to start to learn about gynaecology and reproductive health, of whom two already have some experience in the field, they are very soon going to organise workshops in these areas).
There are 3 levels of health promoters. – level one – learning everything, ie attending patients etc level two – know a bit about different illnesses etc level three – able to deal with almost everything related to illnesses, medicines, emergencies, etc. – (NOTE: Experienced level 3 health promoters can become “multipliers”, that is health promoters that can train other health promoters. They provide training in the local languages which is much better than having to do the training in spanish which for most of the indigenous people in chiapas is a second language.)
Promoters work for free, just receive their food, given by the community. There is a lack of economic resources. In order to work in the clinic in Berlin they have to leave their other commitments for the duration, eg their fields. Sometimes promoters feel disheartened, eg by their difficult economic situation, so they have to talk and resolve problems (as in all areas of autonomous work) and the autonomous authorities encourage them to continue with the work. <> “We are all working for the good of the people.”
Preventative medicine is the most important thing in the autonomous health system. The people themselves have to learn about health. Some health promoters are organising talks on hygiene and preventative medicine etc in communities where there are not promoters, but they have to finance it themselves, and there is a lack of resources.
Education is important in order to prevent illnesses, including traditional/natural medicines. – In training course whatever knowledge some people may have is shared with the rest. – Can be difficult to sustain the autonomous health system and to maintain the promoters. – It’s not possible to do it totally alone, need support, need solidarity.
“We are not going to wait for the bad government to provide health care, rather it’s the people themselves who have to organise health care.
Before the zapatistas we didn’t know what health meant, how to prevent certain illnesses, how to prevent more illnesses and diseases from occurring.“Now we are learning how to educate ourselves in these areas and to educate our people.”
To create an autonomous health system is very difficult. The people themselves have to maintain it, without receiving a peso of change. ” We are working for there not to be more illnesses. We can see that, if between us all we get organised, then we can do it.”
Training courses and workshops:
The training and programmes have to keep going because there are great needs to be met, and although a lot of things are still lacking (e.g. dormitories, kitchen, etc.) they are progressing bit by bit. These things cannot be done overnight, but they keep on working and looking ahead. The zapatista health system keeps on growing and improving.