About the La Garrucha Health Project

Message from Community Health Organisation of the Indigenous Maya of the State of Chiapas (OSIMECH)

Brothers and Sisters of New Zealand, we send you a cordial revolutionary greeting on behalf of the Coordinators and Health Authorities who are working in Caracol III of the La Garrucha Tzeltal Selva Zone.

Our policy, and the way of health of the communities in resistance, is to be able to live a dignified life without becoming ill or dying from preventable or curable illnesses. It is important therefore that we know how to look after ourselves; that we have the knowledge and materials needed to cure our illnesses; that we have good health education; to have clinics, hospitals, medicines, herbs, doctors, midwives, promoters, osteopaths who work with one heart respecting the desires and culture of the people.

This is the health for which we fight as Zapatistas and the health which our indigenous people in resistance hope to achieve.

In this organisation we work together to create health and to be healthy as individuals and as a people. Only if we all have good health can we collectively work with strength, truth and dignity to fight for the rights of indigenous Mexicans and others, and not fail our people as the bad government has done, leaving them with the worst poverty; dying from malnutrition and other curable and preventable diseases, and without the right to organise.

There are many needs that that form part of the construction of the Autonomous Zapatista Health System. Between us all we will try to help the people in resistance who with our rebellion will awaken us to seek a world in which many worlds fit, to grow from below and to the left.

It is all our word which we express to you brothers and sisters of a country that we don’t know, but we do know that our heart is with you and yours with us, and we greet you with happiness and have faith in your strong hearts.

With a dignified heart we ask for the resources that will strengthen our fight for a better world. The part that our brothers and sisters of New Zealand give will help in five specific areas: capacity building of General Health, vaccination programme, operating costs, prevention brigades, and medical campaigns.

Greetings to all, and to all we wish good health from our dignified rebel lands, Zona Selva Tzeltal.

Julio Jiménez Hernández
for
Community Health Organisation of the Indigenous Maya of the State of Chiapas (OSIMECH) San Cristóbal de Las Casas

The Wellington Zapatista Support Group

We work to raise funds to support the La Garrucha Health project, and raise awareness of the Zapatista struggle. For more information or if you would like to get involved please visit our blog http://www.floweroftheword.wordpress.com or email us on zapatistasolidarity(AT)gmail.com. If you would like to recieve invites to our events and news updates (around 3 emails per month) then send a blank email to altavoz-subscribe(AT)lists.riseup.net.
Other Groups Supporting the La Garrucha Health Project

Latin American Solidarity Committee
Venezuelan Support Network of Australia
Venezuelan Support Network of Aotearoa/New Zealand (Christchurch)
Christian World Service

Background to the La Garrucha Health Project

In January 2006 Julie Webb-Pullman (JWP) was in Chiapas, Mexico covering the opening of La Otra Campaña as a special correspondent for independent internet news site Narconews. In the second week of the campaign, one of the leading figures in the Zapatista movement, Comandanta Ramona, died of kidney failure on her way to hospital. JWP began researching the health situation in Chiapas, and made contact with an NGO who had been working in the area since 1994. In April 2006, an approach was made to the Junta de Bueno Gobierno (JBG) de La Garrucha (Council of Good Government of La Garrucha) regarding a potential contribution from New Zealand to address the outstanding health requirements in the Cañadas region of Chiapas. The Junta advised that the relevant communities had prioritised their needs, and identified the most pressing as a health clinic, a pharmacy warehouse, and an emergency vehicle to transfer seriously ill and injured persons to the nearest tertiary health services (several hours by mostly dirt roads).

The clinic, pharmacy, and emergency vehicle were all to be situated at the community of Emiliano Zapata, in the municipality of San Manuel, Caracol of La Garrucha. They form part of a wider community health system designed to benefit not only the Zapatista supporters who live in the numerous indigenous communities in this zone, but also anybody else who seeks assistance from them.

JWP returned to New Zealand in April and following a public meeting, the Wellington Zapatista Support Group was formed. JWP returned to Chiapas in May 2006 to meet with the Junta to discuss their needs and formalise a project. However, a Red Alert in place between May-December 2006 prevented formal discussion at this time. JWP instead lived in several communities in La Garrucha working as a human rights observer for FrayBa, and in Oaxaca and Mexico City.
In January 2007 JWP returned to La Garrucha to meet with the Junta, at which time the emergency vehicle project was discussed, and in August 2007 JWP met with both the JBG of La Garrucha, and the members of the Health Committee of the Autonomous Municipality of San Manuel. The Health Committee continued to discuss and revise their priorities, and in September invited JWP to meet with all 50 of the health promoters from the La Garrucha zone to discuss the project with all in the zone.

Current Situation

The Health Committee advised that the health clinic and pharmacy discussed in April have been funded by international groups and are progressing well – the pharmacy building has been constructed, and it is currently being stocked. The health clinic is under construction and is expected to be completed by July 2008. The clinic will have limited in-patient facilities (5 beds for men and five for women), but will include a laboratory, traditional natural medicines, a general outpatient service, a women’s health service including reproductive health services and a birthing unit, and accommodation facilities for family members as well as facilities for training and education of both health personnel and members of the communities. When the new clinic opens, several promoters will be required to work in it, which will leave gaps in their communities that must be filled by newly-trained personnel.

The 50 health promoters at the September meeting advised that the priority now is therefore the continuation of training for health promoters and health promotion activities. Whilst an emergency vehicle is desirable, vehicles are available in the communities that can be used to transport people in emergencies, but there are no resources for 2008 for general health training. They also need basic first aid training, and some will need more advanced training to be able to work in the new clinic, where some surgical procedures will be performed, in addition to inpatient care and outpatient and emergency clinics. They also require more specialised training in areas of particular need, such as first aid, parasitic diseases, skin problems and respiratory illnesses, in addition to the sexual and reproductive health workshops proposed by the Committee.

The Junta advised that they welcome co-operation with New Zealand co-ordinated between JWP and OSIMECH, to address their need for training workshops for health promoters in 2008. They advised that to conduct monthly workshops for all the health promoters of the zone, and to train more to replace those that will work in the clinic, will cost at least USD$10,000. They consider the doctor at the La Garrucha clinic can provide general training, but specialised areas such as reproductive and sexual health are better provided by personnel from the San Cristobal de las Casas branch of Marie Stopes International, and other specialist areas by other suitably specialised practitioners. All facilitators and trainers brought to La Garrucha will be qualified in their particular area, and either be local Mexicans or volunteer foreigners.

The Health Situation in Chiapas

• In rural areas, where the indigenous population exceeds 70%, there is one doctor for every 25,000 inhabitants.
• More than one million Chiapas residents lack access to health centres – and the population of Chiapas is only 3.8 million!
• In rural areas, the population does not receive the minimum recommended daily intake of protein and calories.
• 71% of the indigenous people of Chiapas suffer from malnutrition, which is the sixth leading cause of death for all ages.
• 33% of indigenous children suffer from extreme malnutrition.
• The other main illnesses/diseases in the indigenous communities are preventable, and include diarrhoea, intestinal parasites, acute and chronic respiratory diseases such as TB, skin parasites, typhoid fever, skin mycosis and Hepatitis B.
• Many women die from pregnancy and birth related problems.
• Accidents are frequent, usually machete wounds sustained while working in the fields.
• Although the Mexican government is putting some health services in some communities, it is doing this only through organisations in political agreement with it, and which it can regulate through its international donors. This means that not only do communities in resistance who are building their autonomy as indigenous people not receive these public funds, but also that many of the resources that arrive in Chiapas do not support direct community involvement in the development and provision of their health services.

The Situation in La Garrucha

La Garrucha is one of five Caracoles, made up of 4-5 autonomous Zapatista municipalities each with up to 40 communities within it.
Community activities, and peoples’ roles in them, are linked to a set of values which are manifest in the project design and governance structures that make up the Zapatista civil branch:

• community empowerment;
• creation of a regional support structure;
• creation of a regional local knowledge- and skills-base;
• incorporation of local and regional traditional skills and
• experience in forming the content of these projects.

For example, education and health care are being provided in both local indigenous and Spanish languages, and traditional herbal remedies and midwifery practices are being taught alongside “Western” medicine and acupuncture.

Each community has a micro-clinic, and a main clinic is under construction in Emiliano Zapata. The clinics are all staffed by health promoters, who are members of the community and continue with their work in the fields and homes in addition to their health practitioner responsibilities. They receive training in health care from NGOs such as Doctors Without Borders and Marie Stopes International, as well as the doctor working in the La Garrucha clinic, and international volunteers. There are currently 255 health promoters with various degrees of training and skill – some very experienced with 15 years or more of service provision in their communities, others with only a few months training.

What La Garrucha Health Project Activities we are supporting

1. Continuing the capacity building of the General Health Promoters.
Advanced promoters serve as capacity builders of general health in order to train new promoters for the future. To assist provision of capacity building and workshops, we pay for transport for the promoters to go from their community to the capacity building centre, often several hours travel away. We also pay for food at the workshops, educational materials, and the production of training materials and manuals for workshops and curriculum development.

2. Continuing the Vaccination Campaign
The four Autonomous Municipalities of the Rebeldes Zapatistas (MAREZ) do not have the funds to continue the vaccination campaign in 2008. This is an activity that should not be stopped, especially for children less than five years old. The funds we contribute go towards the costs of the purchase and transport of vaccines, maintaining a vaccination register and the cold chain; food and petrol for the vaccination brigades; and capacity building vaccination workshops in the municipalities and in the zone.

3. Operation Expenses of the six Regional Clinics
We help pay the operating costs of the Regional Clinics. These are a high priority as they are the only facilities within several hours drive and although currently operating, they lack many basic necessities.

4. Continuation of the Prevention and Promotion Brigades
In the communities the expenses are principally for transport, food, and educational materials for Health Promoters to carry out public health promotion and education campaigns within the communities. These include more broad subjects such as sanitation and hygiene, as well as specific campaigns on issues such as reproductive, sexual, maternal, child, and oral health.

5. Solidarity Health Brigades
We help pay the transport costs within Chiapas for doctors and nurses from other Mexican cities and States, and from overseas, who are brought in to train the health promoters – these health practitioners donate their services but their travel, accommodation and food costs within Chiapas must be borne by the communities, which can barely support their own members, and our funds assist with supporting the extra burden placed on their meagre resources.

The Autonomous Zapatista Health System In The Tzeltal Selva Zone (La Garrucha)

Organisation of the Tzeltal Selva Zone Health System

• 255 Health promoters – 10 women and 245 men in General Health
• 47 Women promoters and midwifes of Sexual Reproductive Health
• 7 Trainers of Sexual Reproductive Health
• 18 Trainers of General Health
• 23 Municipal Health Coordinators
• 8 People responsible for the Vaccination Campaign
• 7 Municipal Health Advisers
• 4 Zone Coordinators
• 4 Members of the Council of Good Governance
• 4 Autonomous Municipal Council
• 5 Members of Osimech Selva
• 103 Community Health Centres
• 75 First-aid stations in the Community Health Centres
• 12 Cold Chain Centres of Refrigeration to preserve vaccines
• 1 Vaccination Campaign every 2 months throughout the whole Zone

There are 1120 consultations each month (13440 a year) in the 10 Regional Health Clinics in the Zone, serving 182 communities (approx. 40,000 people).

History of the Selva Zone Health Projects

Health Profile

Illnesses common in this region are primarily due to the conditions of extreme poverty, marginalisation and exploitation in which the people have lived for many years. Whilst the prevalence of illness is not as bad as before the January 1994 uprising, there are still unacceptably high levels of parasitic infections, respiratory infections, pulmonary tuberculosis, urinary tract infections, skin infections, anaemia and malnutrition, complications of pregnancy and childbirth, traumatic injury, cuts, wounds, and workplace accidents, osteomuscular problems, and malaria.

Vaccination: Selva health services began with basic capacity building in general health, prioritising capacity building and carrying out vaccination programmes in the Zone, and providing medical attention in micro-clinics and community health centres in the four municipalities. They provide medicines which are managed with revolving funds, whereby International solidarity groups donate the first lot of medicines, which are then sold to patients, and the money from sales is used to purchase more. Solidarity organisations have also helped with the construction of some clinics.

Capacity building and vaccination workshops are carried out in the different Autonomous Municipalities of the Tzeltal Selva Zone. Vaccination programmes are carried out every two months, vaccinating children less than five years old, the elderly, and pregnant women. The Promoters maintain a vaccination register, a cold-chain, and at the Zonal level they organise the ordering and delivery of vaccines, and coordinate money for food and petrol in the municipality communities during vaccination campaigns and for transporting health promoters to capacity building and municipal workshops.

The Central Clinic of La Garrucha is in the municipality of Francisco Gómez, where health promoters work fulltime in the detection and prevention of illness, and health promotion. An average of 280 – 600 consultations are recorded each month plus 12 referrals to hospitals in the cities of Ocosingo, Palenque, Altamirano, Comitán, San Cristóbal de las Casas, and Tuxtla Gutiérrez. Hospital transfers are by a vehicle and funds from the health project. Some patients pay for hospital transfer to hospital with their own money but many do not have any, and this is an area where the autonomous health system needs to cover costs for those who cannot pay.

Services provided include gynaecology, dental, pharmaceutical, laboratory, general consultation, in-patient care and these will continue to develop in the four autonomous municipalities of the Selva Zone to provide free health care.

Health Promoters do not receive a salary, but only what the communities can give them, such as food and assistance in their milpa. It is very obvious that the people are heavily taxed by great poverty, and cannot provide enough.

Responsibilities and Obligations of Personnel in the Selva Zapatista Health System

The Zapatista Capacity Builders – are responsible for training health promoters in courses and workshops; preparing materials and course outlines; carrying out visits to the communities to reinforce the work of the community health promoters; organising evaluation meetings with the promoters; and establishing processes to coordinate transfers to the various hospitals.

Sexual and Reproductive Health Promoters – are appointed by communities to look after the health needs of women. They work in the areas of cancer screening, pelvic examinations, family planning and birth control, pre and postnatal care, delivery, domestic violence, gender issues, sexually-transmitted diseases, health promotion. Advanced Promoters have been appointed as Coordinators of Sexual Reproductive Health and they receive ‘train the trainers’ training and in many places they work and build capacity together with traditional midwives.

General Health Promoters – look after the ill; attend ongoing capacity building, give health promotion and prevention talks about improving personal and communal hygiene to avoid epidemics, monitor their patients condition, accompany patients during transfer, keep medical records and provide monthly reports, keep the first-aid station stocked with basic medicines, keep the clinic clean. Full time health promoters who work in the municipal or zone autonomous clinics work in the same way, but provide a higher level of medical care, as well as referring patients to hospitals when necessary.

The Community Health Council – is made up of members of its community, and everyone over 16 years of age is expected to participate. The Council is responsible for overseeing the promoters’ work; calling community meetings to oversee the functions of the Health Centres/Clinics; coordinating and helping the promoter find solutions for community health matters.

The Municipal Health Coordinator – is responsible for planning and coordinating the municipal promoters’ work; making follow-up visits to the communities to monitor their performance; and programming the calendar of training and vaccination activities.

The Municipal Health Council – is made up of representatives of every community in the municipality. It has similar responsibilities to the Municipal Health Coordinator, who it appoints, and is charged with them to help find solutions for problems. They are also responsible for communicating with other municipal authorities, supervising construction works and meeting with international organisations working in projects in their municipality.

The Zone Coordinator – coordinates the municipal coordinators to organise activities and monthly meetings; plans activities, and is responsible for submitting reports to the Council of Good Governance of the activities that are being carried out in the whole zone. This person liaises with other organisations or solidarity collectives in matters of health projects.

The Community Health Organisation of the Indigenous Maya of the State of Chiapas (OSIMECH) – is a group of indigenous health promoters principally charged with managing the health projects of the Tzeltal Selva Zone and submitting financial reports to the Council of Good Governance and to funders. They work fulltime on project supervision, budgeting and expenditure, building capacity re administration and supervision of projects; coordinating meetings in the zone and municipalities, and supporting the zone and municipality coordinators.

For more information we recommend:

The official EZLN (Zapatista) site:
http://www.ezln.org.mx

Chiapas Independent Media
http://www.chiapasindymedia.org

Narco News – Independent Journalism from Latin America
http://www.narconews.com

The Flower of the Word Will Not Die
blog of the Wellington Zapatista Support Group
http://www.floweroftheword.blogspot.com