Health Care Organized from Below: The Zapatista Experience

In his December 24 communiqué, Comandante Moises of the Zapatista National Liberation Army (EZLN in its Spanish acronym) invited the people of the world to the first “Encuentro de los Pueblos Zapatistas con los Pueblos del Mundo” (Meeting of the Zapatista Peoples with the Peoples of the World). He said: “We are only trying to show what we are building, with many difficulties, but also with many desires constructing another world, one in which those that command, command obeying.”

These meetings – held in Oventic, Chiapas December 30 to January 2 – marked the first formal sharing of experience between the five councils of good government from Zapatista communities and visitors from around the world. More than 2000 people from 48 different countries attended, according to the official registration count. The Zapatistas hosted six coordinated sessions to discuss autonomy and self-government, women’s issues, education, land and territory, art and alternative communication, as well as health.

Health care in the indigenous communities of Chiapas has long been neglected by the Mexican government.. A shortage of medical supplies and transportation, the loss of traditional medical knowledge, barriers to sexual education and the hazards of dependence on foreign aid were some of the issues raised by the five participating councils of Good Government (“Juntas de Buen Gobierno”) and visiting delegates at the December 31 session on health. The Zapatista communities have thus organized their own health care network, and called in help and resources from other organizations in solidarity throughout Mexico and the world.

Celia, a coordinator of health from the northern zone of Oventic, noted how resources from abroad have boosted autonomous health projects. Built in 1991 by local Zapatista communities with aid from foreign donors, the hospital of Guadalupe in Oventic is the pride of the local communities. Functioning without any government support, this hospital provides service to those suffering discrimination in state-run institutions. Karina, a member of the Junta de Buen Gobierno and representative in the area of health from the Caracol 1 at La Realidad, also acknowledged international investment in the health system.

Toward Ongoing Solidarity
The Zapatista health care system has been widely recognized nationally and internationally as having brought treatment and medicine to more rural indigenous men, women, children and elders than the government and private sector ever did. By training local “health promoters” from the ranks of the communities the effort has also excelled in preventative medicine, health education and preservation of herbal and other traditional forms of medicine. International solidarity has allowed the communities to construct clinics and purchase equipment and ambulances. But the lack of follow-up by some solidarity organizations has also stalled or suspended important projects after they were begun.

For example, during a recent visit by your correspondent to a Zapatista community in the canyons region, a local health promoter warned against developing a dependence on foreign assistance. Speaking with The Other Journalism, the health care promoter noted that modern facilities require continual investment in order to operate. The issue goes beyond one-time infusions of funds. This is the case with one small clinic in the Cañadas de Ocosingo. A plaque commemorating aid donors hangs on a wall of the one room clinic with fading paint; the pharmacy sits empty. This community, along with others in this canyon, cannot fully exploit such clinics without electricity to run refrigeration for volatile vaccinations. This is a problem that foreign aid organizations by themselves cannot solve.

The three ambulances sitting next to the Guadalupe clinic are a reminder of the disparity within Zapatista communities. Though the ambulances line up at Oventic, often they are unable to reach outlying areas. This problem was graphically illustrated during my stay at the above mentioned community. Late at night a woman seven-months pregnant arrived at the community to await transportation to the autonomous hospital at the Caracol of La Garucha to receive medical attention related to abdominal pains she was experiencing. However, the soul ambulance for the four municipalities situated 5 hours away at La Garucha never arrived. In this case, it was finally the healing knowledge of the local promoter of health, employing a natural painkiller that allowed the patient to return home the next day. Karina reminds the audience of the critical lack of medical transportation in many of the municipalities. “We had to carry our sick for days, they could not receive medical attention. This is why many of our grandparents died, trying to reach a doctor in the cities far from our communities. This experience taught us to teach ourselves and to organize for ourselves.”

It is exactly that traditional knowledge that is so important to the communities. In his address to the people of the world gathered at the four-day gathering at Oventic, Roel from the Caracol (municipal seat) situated in La Realidad, promotes traditional medical knowledge as a means for indigenous communities to recover control of their health care. He reminded that great wisdom is not learnt in schools or in books but “is the inheritance that has been left to us by our grandfathers and grandmothers…” The recovery of such knowledge is a central aspect of the Other Health’s emerging agenda. The use of traditional plants and practices avoids developing a culture of dependence on state or private clinics that discriminate and marginalize indigenous poor communities.

In a moment of solidarity with indigenous peoples of Chiapas, Kamahus, a speaker from the First Nations of Canada, recounted her own story of struggling to maintain traditional methods of healing and specifically her experience with ancient practices of childbirth. In her words, “the genocide of the conquest of America of the north tells a similar story of the loss of our grandmother’s knowledge in the area of midwifery. Generations of the absences of traditional midwives left her alone without someone who could accompany her as she delivered her own children by a clean stream in the mountains.” The story she told resonated with the experience of the indigenous women of Chiapas.

Dialogue and Participation Essential to Health
Representatives from the five Zapatista regions noted the importance of maintaining a continuing and open discourse on complex and sensitive subjects of sexual health. Health education, particularly sexual health, was a topic of particular interest among many of the national and international participants present. The discussions that took place, between Ingenious and non-indigenous participants, demonstrate that ideas (and not just funding and technology) flow in and out of Zapatista territory, and have influence on such issues as sexual education and women’s rights to control their own bodies.

One of the first questions dealt with was abortion. The response from the panel of Zapatista speakers was clearly guarded. According to a Zapatista representative on the panel, the practice of abortion is neither endorsed nor condemned in Zapatista territory, but arises in situations that are best avoided by preventative measures and education. “Women don’t practice [abortion], nor do they search it out. Moreover, it is more a matter due to the circumstances that result in spontaneous abortions.” Such a statement seems to leave the official Zapatista policy of abortion unclear. (The Zapatista Women’s Law, made public in 1994, states: “Women have the right to decide the number of children they have and care for,” but does not explicitly mention right to abortion.) Perhaps the response was somewhat due to a misinterpretation of the question, or perhaps the response was a diplomatic effort to avoid disturbing a gendered power relation. The sentiments expressed throughout the panel lays out a progressive health platform, however it is clear that some of the main hurtles to women’s health remain set by a system of patriarchy left as inheritance by a Spanish conquest. Many conferees agreed that the education and participation of women in this matter are essential to the overall health of the community.

From inside his cell at the penal de Santiaguito, Dr. Guillermo Selvas Pineda, arrested last May in the central Mexican town of Atenco as he sought an ambulance for wounded student Alexis Benhumea (1984-2006), sent a hand-written message of goodwill to the growing interest in health. As one of the first doctors to work with the insurgents in the mountains, he knows the suffering that has been experienced by Zapatista communities. He invited other doctors to join the growing number of people from outside and inside the region who are working to build an autonomous health service, one of the key political goals of the Zapatistas movement.