Advances in Zapatista Healthcare
xyz | 23.03.2009 18:36 | Zapatista
ZAPATISTA HEALTHCARE ADVANCES
Article by Hermann Bellinghausen, originally published in Spanish in La Jornada.
Ejido Morelia, Chiapas, 25th February 2009
At least in theory and in speeches, the basis of public healthcare lies in prevention. The Zapatista autonomous healthcare system has built up, during more than a decade, a wealth of experience (much more than an experiment) which confirms this basic principle. The people in resistance operate a system of healthcare “without the bad government”, and often they do it better. Medicine for the poor is not necessarily poor medicine.
No Zapatista support base child remains unvaccinated, says Jose, health co-ordinator for the Caracol of Morelia, with such certainty, and so calmly, that we ask if he is sure they haven’t missed one. “Every two months, brigades go to all the municipalities and regions, and if one child is still unvaccinated because they had a fever or were away last time, this time they have their vaccinations. They all have a card covering all stages up to four years of age”.
He clarifies that to achieve such a complete coverage, they are not asking for any help from the government, but they receive help from doctors who support them from cities like Altamirano, Palenque and Comitan, and from international solidarity groups “which have organised very well for this”. This preventative healthcare system continues in school and keeps the children free from tetanus and other illnesses. It is also directed at mothers and pregnant women.
He describes how health is co-ordinated in the Caracol, respecting the culture of the people. In this zone, recently re-structured into three large municipalities and a dozen autonomous regions, there is a clinic in each of these locations. Most are modest, but function permanently, in the hands of at least four promoters who work from eight in the morning until ten at night, and are still on duty when they sleep there.
“We treat all who ask for help, even if they are not Zapatistas. Sometimes patients come to us who have been to the government clinic but were not treated, or it closed at two in the afternoon and they had no medicine”. The presence of all the members the Good Government Committee (JBG) and other members of the health commission gives authority to his words. There are almost twenty people present, including a large number of women of different ages.
Each region has a medicine chest looked after by the health promoters. “There is always at least one kit, but in most cases more”. These have been built up over the years, with regular workshops for learning and evaluation. This is strengthened, because the idea of autonomous community healthcare is central to education, not only in the schools, but also in the communities. It should be pointed out that in the Caracol of Morelia, every community has a functioning school.
“The promoters give talks in the communities. They teach that they should have toilets in the houses, they should keep the floors clean, they must dispose of rubbish, wash their hands, drink only boiled water. And talks are given on nutrition.”
In this zone, where tzeltales, tzotziles and tojolabales live together, malnutrition is a less pressing problem than it is in other indigenous areas of Chiapas. “We weigh the children, and keep a record of each one, and if we see that there is a problem, we teach the mother how to better feed the child.”
In these communities, going to the clinic is a bit like going to school: the promoters always explain the illness and its symptoms to the patients and their families.
When asked if there are epidemics, he quietly answers no. “We are aware that there is tuberculosis in parts of Chilon, but we have very few cases, and they are all being treated in the Comandanta Ramona municipality”. He admits that there is still chicken pox, “but not much”. He remembers in past months an outbreak of whooping cough in Cancuc (which is in the highlands, not part of this Caracol): “none of the sick children were Zapatista”.
ZAPATISTA COMMUNITIES ACHIEVE SELF-SUFFICIENCY IN HEALTH SERVICES
Article by Hermann Bellinghausen originally published in La Jornada
Autonomous municipality 17th November, Chiapas, 27th February 2009
“The health situation of our people has changed, not because of what the government has done, but because of to what we have done for ourselves. Now cases of diarrhoea, which used to kill so many children, are scarce, and when they do occur, we isolate and treat them. So now our children are not dying.”
“Even so, the practice of healthcare is difficult”, says Jose, responsible to the health commission of the Caracol. “Every workshop or training session must respond to the needs of each community. And it is through the work of the promoters that we communicate what makes our people become ill”.
With a hint of irony, he says that where the government see an autonomous clinic, they put an IMSS one in competition. At first the new clinics gain ground, because they promises much, and share programmes, but soon it can be seen that they do not provide proper care, they lack medicines, and do not have, or use, proper equipment.
“Also, the government seeks to buy the promoters with money, and if they do not accept, they discredit them to the compas and create problems with people who are neither patients nor part of the resistance. But we are here for our consciences, not for money”.
“At any time, there may be some cases that require hospitalisation or specialist treatment. There are ambulances at the autonomous clinics, or at least a vehicle, to transport them to the San Carlos hospital (Altamirano) or the civil hospital in San Cristobal de Las Casas, but we also have our own surgeries in the autonomous hospitals at Oventik and San Jose del Rio”.
“The promoters care for pregnant women, and almost all the companeras give birth in their communities, and, if they can, in their own homes, attended by a promoter. If it is a difficult birth they are brought to the clinic, which has a gynaecological room. The care of women also includes cervical cancer testing, and prevention and treatment of infections. The treatment is ongoing”.
“In the zone of the Caracol of Morelia, there are about 200 health promoters, who cover different areas, such as women’s health, dental treatment or general consultation. The co-ordination of the regions making up the area known as Tzotz Choj dates from 1999. Before this, each region” organised itself, ever since the uprising of 1994, or in some cases before that, says Jose.
“The clinic of the municipality 17th of November, El Salvador Corazon de Jesus, was established in the community of Morelia years before the uprising, and has never stopped functioning. Equipped with a consulting room, pharmacy, basic laboratory for testing, gynaecological room and dental clinic, it is composed of five buildings and is served by four promoters who are rotated every four days”.
“All the clinics, about twelve in this Caracol, have a pharmacy with basic medicines. The basic health centres and first aid kits in the communities are supplied by the autonomous clinics. Another constant is the development and clinical use of medicinal herbs: syrups, ointments, dyes, disinfectants and other natural products which form part of the pharmacy”.
The Zapatistas purchase medicines that they do not produce themselves. Therefore, patients must pay a very low price which is equal for all. The fact that the modest autonomous economy functions outside the state capitalist system does not prevent it from being an economy in formation.
From time to time there are rumours and official pressures to send health brigades to Zapatista villages, based on the supposition that the infants are not getting vaccinated. In this aspect, as in many others, the Zapatistas officially do not exist. No matter how careful the Zapatista system is with its records and registers, if the institutions do not know of them, they consider that they do not exist.
This also happens during the census. Hundreds of Zapatista villages and communities that have been in existence since 1994, and that in some cases constitute whole autonomous municipalities, do not exist either, neither for the official figures, nor for the academics who delight in minimising the Zapatista movement through ignorant and headstrong ideologies. For these people, nothing exists outside government registers, records and programmes.
THE ZAPATISTAS HAVE ERADICATED ALCOHOLISM AND DRUG ADDICTION
Hermann Bellinghausen, La Jornada. Originally published in Spanish.
Autonomous municipality Lucio Cabanas, Chiapas, 6th March 2009
An indisputable achievement of the Zapatista communities in the field of health is the eradication of alcoholism over the last 20 years, which is to say very quickly. The differences this has made to everyday family and community life are profound and result in less violence, which is in itself an indicator of better health, even more so in indigenous communities knowing the destruction alcohol causes in these, always bad for their health.
It is recorded in articles and stories: the Indians are kept quiet with alcohol. Fernando Benitez visited these same people in Chiapas in the 70s and found them prostrate, humiliated, without dignity, in an epidemic of drinking. Today this is never seen in the communities in resistance. The numerous festivals which have taken place here over the last 15 years, visible or quiet, big or small, always involving dancing until dawn, take place without a drop of alcohol. On a national level this is absolutely exceptional, where carnivals and national holidays are ruined by posh (home-brewed spirit), aguardiente or synthetic brandy. And without travelling far, this can be seen happening every weekend.
By not drinking, the campesinos, particularly the men, eliminate the risk of illnesses common among indigenous peoples: ulcers, cirrhosis, malnutrition and machete wounds resulting from alcohol-induced quarrels. These are not reflected in the health indicators of government institutions, but their effects on public health are spectacular, as can be clearly seen.
In addition, there is a total absence of consumption or sale of drugs, which are also not permitted in the autonomous communities. A return to alcoholism accompanies people in divided communities and has been a major instrument of counter-insurgency since 1995.
The mural on the front of the autonomous clinic Hope of the Poor, painted by the health promoters themselves, surrounds the entrance to the facilities, which are as poor as the name suggests, but so clean they dazzle the eyes. Its main part is like an open book of instructions for the path of good health. It is also a painting that could be exhibited in a museum, even though it only speaks of personal and community hygiene, toilets, ways to dispose of waste, tie up animals, sweep the porch. All are expressively illustrated.
Those on watch, a young boy and a girl, very astute Tzotziles, allow La Jornada to look round the facilities. A substantial clinic, equipped only with an examination table and basic instruments; under the glass of the desk there is a large photo of Dr Ernesto Che Guevara. A gynaecological room for care in pregnancy, birth and examinations. A dental area. A pharmacy for the most basic needs, clean and tidy. “We are on duty here and at home” affirms the health promoter. “We rarely have a doctor, but we accompany anyone who needs to go to hospital”. The vaccines for the autonomous municipality are also distributed from here.
On a seat from the back of a bus, propped against the wall at the entrance, a sign reads “waiting room”. They show us the laboratory where tests are done, urine tests, the Barr test for tuberculosis, stool and smear tests. It grows dark. An Indian family rushes in with a crying baby. The promoter takes them in to the consulting room.
“This is the ambulance” says Irma, the promoter, pointing to a reconditioned combi now suitable for transporting patients. She has been a promoter for many years and seems to enjoy it. If anything stands out in the Zapatista autonomous clinics, it is the absolute lack of negligence or neglect: the communities would not allow it.
Three figures appear from the darkness of the streets: one of them wrapped up. He is an old man with severe breathing difficulties. Irma says goodbye and takes the old man into the clinic. There are nights here when nobody sleeps, just like in big hospitals.
Article by Hermann Bellinghausen, originally published in Spanish in La Jornada.
Ejido Morelia, Chiapas, 25th February 2009
At least in theory and in speeches, the basis of public healthcare lies in prevention. The Zapatista autonomous healthcare system has built up, during more than a decade, a wealth of experience (much more than an experiment) which confirms this basic principle. The people in resistance operate a system of healthcare “without the bad government”, and often they do it better. Medicine for the poor is not necessarily poor medicine.
No Zapatista support base child remains unvaccinated, says Jose, health co-ordinator for the Caracol of Morelia, with such certainty, and so calmly, that we ask if he is sure they haven’t missed one. “Every two months, brigades go to all the municipalities and regions, and if one child is still unvaccinated because they had a fever or were away last time, this time they have their vaccinations. They all have a card covering all stages up to four years of age”.
He clarifies that to achieve such a complete coverage, they are not asking for any help from the government, but they receive help from doctors who support them from cities like Altamirano, Palenque and Comitan, and from international solidarity groups “which have organised very well for this”. This preventative healthcare system continues in school and keeps the children free from tetanus and other illnesses. It is also directed at mothers and pregnant women.
He describes how health is co-ordinated in the Caracol, respecting the culture of the people. In this zone, recently re-structured into three large municipalities and a dozen autonomous regions, there is a clinic in each of these locations. Most are modest, but function permanently, in the hands of at least four promoters who work from eight in the morning until ten at night, and are still on duty when they sleep there.
“We treat all who ask for help, even if they are not Zapatistas. Sometimes patients come to us who have been to the government clinic but were not treated, or it closed at two in the afternoon and they had no medicine”. The presence of all the members the Good Government Committee (JBG) and other members of the health commission gives authority to his words. There are almost twenty people present, including a large number of women of different ages.
Each region has a medicine chest looked after by the health promoters. “There is always at least one kit, but in most cases more”. These have been built up over the years, with regular workshops for learning and evaluation. This is strengthened, because the idea of autonomous community healthcare is central to education, not only in the schools, but also in the communities. It should be pointed out that in the Caracol of Morelia, every community has a functioning school.
“The promoters give talks in the communities. They teach that they should have toilets in the houses, they should keep the floors clean, they must dispose of rubbish, wash their hands, drink only boiled water. And talks are given on nutrition.”
In this zone, where tzeltales, tzotziles and tojolabales live together, malnutrition is a less pressing problem than it is in other indigenous areas of Chiapas. “We weigh the children, and keep a record of each one, and if we see that there is a problem, we teach the mother how to better feed the child.”
In these communities, going to the clinic is a bit like going to school: the promoters always explain the illness and its symptoms to the patients and their families.
When asked if there are epidemics, he quietly answers no. “We are aware that there is tuberculosis in parts of Chilon, but we have very few cases, and they are all being treated in the Comandanta Ramona municipality”. He admits that there is still chicken pox, “but not much”. He remembers in past months an outbreak of whooping cough in Cancuc (which is in the highlands, not part of this Caracol): “none of the sick children were Zapatista”.
ZAPATISTA COMMUNITIES ACHIEVE SELF-SUFFICIENCY IN HEALTH SERVICES
Article by Hermann Bellinghausen originally published in La Jornada
Autonomous municipality 17th November, Chiapas, 27th February 2009
“The health situation of our people has changed, not because of what the government has done, but because of to what we have done for ourselves. Now cases of diarrhoea, which used to kill so many children, are scarce, and when they do occur, we isolate and treat them. So now our children are not dying.”
“Even so, the practice of healthcare is difficult”, says Jose, responsible to the health commission of the Caracol. “Every workshop or training session must respond to the needs of each community. And it is through the work of the promoters that we communicate what makes our people become ill”.
With a hint of irony, he says that where the government see an autonomous clinic, they put an IMSS one in competition. At first the new clinics gain ground, because they promises much, and share programmes, but soon it can be seen that they do not provide proper care, they lack medicines, and do not have, or use, proper equipment.
“Also, the government seeks to buy the promoters with money, and if they do not accept, they discredit them to the compas and create problems with people who are neither patients nor part of the resistance. But we are here for our consciences, not for money”.
“At any time, there may be some cases that require hospitalisation or specialist treatment. There are ambulances at the autonomous clinics, or at least a vehicle, to transport them to the San Carlos hospital (Altamirano) or the civil hospital in San Cristobal de Las Casas, but we also have our own surgeries in the autonomous hospitals at Oventik and San Jose del Rio”.
“The promoters care for pregnant women, and almost all the companeras give birth in their communities, and, if they can, in their own homes, attended by a promoter. If it is a difficult birth they are brought to the clinic, which has a gynaecological room. The care of women also includes cervical cancer testing, and prevention and treatment of infections. The treatment is ongoing”.
“In the zone of the Caracol of Morelia, there are about 200 health promoters, who cover different areas, such as women’s health, dental treatment or general consultation. The co-ordination of the regions making up the area known as Tzotz Choj dates from 1999. Before this, each region” organised itself, ever since the uprising of 1994, or in some cases before that, says Jose.
“The clinic of the municipality 17th of November, El Salvador Corazon de Jesus, was established in the community of Morelia years before the uprising, and has never stopped functioning. Equipped with a consulting room, pharmacy, basic laboratory for testing, gynaecological room and dental clinic, it is composed of five buildings and is served by four promoters who are rotated every four days”.
“All the clinics, about twelve in this Caracol, have a pharmacy with basic medicines. The basic health centres and first aid kits in the communities are supplied by the autonomous clinics. Another constant is the development and clinical use of medicinal herbs: syrups, ointments, dyes, disinfectants and other natural products which form part of the pharmacy”.
The Zapatistas purchase medicines that they do not produce themselves. Therefore, patients must pay a very low price which is equal for all. The fact that the modest autonomous economy functions outside the state capitalist system does not prevent it from being an economy in formation.
From time to time there are rumours and official pressures to send health brigades to Zapatista villages, based on the supposition that the infants are not getting vaccinated. In this aspect, as in many others, the Zapatistas officially do not exist. No matter how careful the Zapatista system is with its records and registers, if the institutions do not know of them, they consider that they do not exist.
This also happens during the census. Hundreds of Zapatista villages and communities that have been in existence since 1994, and that in some cases constitute whole autonomous municipalities, do not exist either, neither for the official figures, nor for the academics who delight in minimising the Zapatista movement through ignorant and headstrong ideologies. For these people, nothing exists outside government registers, records and programmes.
THE ZAPATISTAS HAVE ERADICATED ALCOHOLISM AND DRUG ADDICTION
Hermann Bellinghausen, La Jornada. Originally published in Spanish.
Autonomous municipality Lucio Cabanas, Chiapas, 6th March 2009
An indisputable achievement of the Zapatista communities in the field of health is the eradication of alcoholism over the last 20 years, which is to say very quickly. The differences this has made to everyday family and community life are profound and result in less violence, which is in itself an indicator of better health, even more so in indigenous communities knowing the destruction alcohol causes in these, always bad for their health.
It is recorded in articles and stories: the Indians are kept quiet with alcohol. Fernando Benitez visited these same people in Chiapas in the 70s and found them prostrate, humiliated, without dignity, in an epidemic of drinking. Today this is never seen in the communities in resistance. The numerous festivals which have taken place here over the last 15 years, visible or quiet, big or small, always involving dancing until dawn, take place without a drop of alcohol. On a national level this is absolutely exceptional, where carnivals and national holidays are ruined by posh (home-brewed spirit), aguardiente or synthetic brandy. And without travelling far, this can be seen happening every weekend.
By not drinking, the campesinos, particularly the men, eliminate the risk of illnesses common among indigenous peoples: ulcers, cirrhosis, malnutrition and machete wounds resulting from alcohol-induced quarrels. These are not reflected in the health indicators of government institutions, but their effects on public health are spectacular, as can be clearly seen.
In addition, there is a total absence of consumption or sale of drugs, which are also not permitted in the autonomous communities. A return to alcoholism accompanies people in divided communities and has been a major instrument of counter-insurgency since 1995.
The mural on the front of the autonomous clinic Hope of the Poor, painted by the health promoters themselves, surrounds the entrance to the facilities, which are as poor as the name suggests, but so clean they dazzle the eyes. Its main part is like an open book of instructions for the path of good health. It is also a painting that could be exhibited in a museum, even though it only speaks of personal and community hygiene, toilets, ways to dispose of waste, tie up animals, sweep the porch. All are expressively illustrated.
Those on watch, a young boy and a girl, very astute Tzotziles, allow La Jornada to look round the facilities. A substantial clinic, equipped only with an examination table and basic instruments; under the glass of the desk there is a large photo of Dr Ernesto Che Guevara. A gynaecological room for care in pregnancy, birth and examinations. A dental area. A pharmacy for the most basic needs, clean and tidy. “We are on duty here and at home” affirms the health promoter. “We rarely have a doctor, but we accompany anyone who needs to go to hospital”. The vaccines for the autonomous municipality are also distributed from here.
On a seat from the back of a bus, propped against the wall at the entrance, a sign reads “waiting room”. They show us the laboratory where tests are done, urine tests, the Barr test for tuberculosis, stool and smear tests. It grows dark. An Indian family rushes in with a crying baby. The promoter takes them in to the consulting room.
“This is the ambulance” says Irma, the promoter, pointing to a reconditioned combi now suitable for transporting patients. She has been a promoter for many years and seems to enjoy it. If anything stands out in the Zapatista autonomous clinics, it is the absolute lack of negligence or neglect: the communities would not allow it.
Three figures appear from the darkness of the streets: one of them wrapped up. He is an old man with severe breathing difficulties. Irma says goodbye and takes the old man into the clinic. There are nights here when nobody sleeps, just like in big hospitals.
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