Direct
Democracy and Health Care in Zapatista Land:
A
Doctor’s Experience on the Day of Political Transition
by
Michael Kozart
12-24-07
It
is October 8, 2007. From my perch in the health infirmary
(casa de salud) of the Zapatista village of Emiliano
Zapata, I can see straight across the open plaza to where
the day's festivities are just beginning. People are
assembling next to the building where the Autonomous
Council meets, and it is the transition of this council,
an event that occurs once every three years, that accounts
for the fiesta, which began yesterday and ends tomorrow.
Today is the official sign-off day, where the outgoing
Council members hand their responsibilities to the
incoming members, and the ceremony is a somber one,
preceded by a Catholic mass and the singing of the
Zapatista hymn, as well as the hoisting of two flags: one
of Mexico and one of the EZLN, the Zapatista Army of
National Liberation.
The
village of Emliano Zapata is the seat of local government
for the surrounding Zapatista municipality of San Manuel.
Zapatista land is basically organized into five different
regions called caracoles, each of which consists of a
number of municipalities. Each caracol is governed by a
board (the Junta of the Good Government), which consists
of representatives from the autonomous councils of all the
municipalities that make up a given caracol. The Spanish
word caracol has multiple meanings. Literally it
translates as a snail or conch shell which evokes the
image of a home or, alternatively, in the case of the
conch, the horn blast that calls Zapatistas together for
events and encuentros. The spiral image of the shell is
also symbolic of the human heart in Mayan belief, which
implies that the caracol is the central organ of Zapatista
life. The political bodies of the caracol, the junta
and the autonomous councils, mediate disputes, establish
development projects, manage economic cooperatives,
oversee education and health care, etc. It is little
wonder that the three-year transition of the Autonomous
Council is a very important event and that San Manuel has
pulled out all the stops for this fiesta. Later today
there will be a basketball tournament featuring teams from
villages all over the municipality, and then, at night,
music and cumbia dancing until the wee hours of the
morning.
My
role today is to be stationed in the casa de salud, for I
have come to Emiliano Zapata as a medical doctor
interested in the Zapatista health care system. I am also
part of a group called the Chiapas Support Committee (CSC),
which has been invited by San Manuel's autonomous council
to participate in the festivities. The CSC is a non-profit
organization that has worked for years to support key
development projects in San Manuel, the most recent of
which has been the construction of a pharmacy warehouse (farmacia
bodega), which now proudly sits beside the house of the
Autonomous Council. Within months this sturdy concrete and
cinderblock building will be stocked with medications and
medical supplies that will be made available at affordable
prices to the people of San Manuel, and indeed to everyone
in the neighboring region whether or not they are
Zapatista, because the Zapatistas hope projects like the
bodega will benefit the entire region. As the famous
Zapatista slogan states, everything for everybody, nothing
for ourselves (para todos todo, para nosotros nada).
Since
my current visit to Emiliano Zapata coincides with the
fiesta of political transition, there are health promoters
from all over San Manuel present in the village today, and
I am able to talk with them about the kinds of public
health problems they are seeing, how they provide care
with so few resources, and their vision for a future
health system in Zapatista land. Their main constraints
are the lack of money to purchase medical supplies and
limited access to hospitals. The closest hospital to San
Manuel lies in Ocosingo, a city of about 35,000
inhabitants about a three- hour drive from Emiliano
Zapata, assuming the dirt roads are passable and
reasonably dry. There is also another hospital in
Altamirano, about a six-hour drive from the village, run
by the Sisters of Saint Vincent de Paul. Getting to either
hospital is difficult under the best of conditions, and a
veritable nightmare in the midst of a medical emergency.
The promoters talk about their dream of an ambulance,
fully stocked with emergency equipment, as well as the
enhancement of a central clinic located in La Garrucha,
the village where the Junta meets. They also speak about
their legacy of traditional Mayan medicine, and their hope
to cultivate and spread knowledge of medicinal herbs, both
as a means to maintain aspects of indigenous culture and
to achieve health care sustainability.
The
need for a self-sufficient health system is not just a
function of the geographic and financial inaccessibility
of vital medical services. There is also the harsh
political reality that confronted the Zapatistas when they
first rose up in 1994 and which persists today. The Mayans
who formed the EZLN faced imminent displacement by
large-scale ranchers and industrialists who were (and have
been) intent on using ancestral Mayan lands for private
gains. The North American Free Trade Agreement, which went
into effect on New Year's day 1994, would have paved the
way for the appropriation of resource-rich regions of
Chiapas by outside investors, forcing villagers off their
land and into the swelling class of landless low-wage
earners crowding Mexico's maquiladora sector. In 1992, in
an act of naked aggression against the indigenous people
of Mexico, then president Carlos Salinas modified one of
the key provisions of the Mexican constitution that had
been enacted after the Mexican revolution of 1917 to
forestall the displacement of native communities from
their land. The famous Article 27 expressly
prohibited the sale or transfer of land that was held in
common. Salinas made it possible for these land tracts, or
ejidos, to be sold (or, more properly, seized) to enable
the industrialization of the countryside and to spurn
Mexico's integration in the global economy under NAFTA.
In
1994 the Zapatistas finally said enough, moving to reclaim
land that had been taken away from them or that they were
in danger of losing. The struggle continues today in the
form of military checkpoints, harassment, discrimination,
and in some cases outright hostility perpetuated by
paramilitary organizations that are backed by wealthy
ranchers. The ranchers in turn exert enormous influence
over the state government of Chiapas, which the Zapatistas
simply refer to as the "bad government." Not
surprisingly, many Zapatistas feel uncomfortable about
traveling outside the safety of their communities to seek
health care in government-sponsored clinics and hospitals
in neighboring cities like Ocosingo, which happens to be
the seat of local power for the bad government. In fact,
during my present visit to Chiapas, elections were held in
municipalities throughout state, and in the municipality
of Ocosingo, the reigning PAN party president was
reelected, all but insuring the legacy of bad government
for the region.
As we sit and talk in the casa de salud, the current
Zapatista plan for health care in San Manuel is described
to me. It involves the construction of a number of
clinicas, which are much more substantial than the casas
de salud. The one that I'm in is a rough wood hut with a
cement floor, several shelves for medical supplies, and of
course no electricity. In fact, there is no electricity in
the village, and this is ironic given the presence of
newly erected electric power lines alongside the main road
through the village. I was told that this is merely one
example of the corrupt nature of the bad government.
Electric power is granted as a political favor, not as a
right.
There
is also a clinica being built in Emiliano Zapata supported
by another NGO from the Basque country of Spain called Paz
y Solidaridad. This clinic, when complete, will complement
the farmacia bodega, transforming the village into a hub
for health care in the entire municipality. However,
everything that happens in the near future, as I am told,
will depend upon the ongoing collaboration between the
Zapatistas and outside organizations because buildings,
medications and medical supplies cost money, of which the
Zapatistas have very little. In fact, when we arrived in
Emiliano Zapata two days ago and I toured the casa de
salud, there were hardly any medications to be had. The
local health promoter of the village informed me that they
were desperately in need of antibiotics, especially ones
to treat infectious diarrhea.
Yesterday
I traveled with the health promoter all the way to
Ocosingo to purchase medications with money that the CSC
had raised. By Zapatista standards, this was a vast sum,
about 600 U.S. dollars. Although I was a bit
disappointed about missing the first day of the fiesta in
the village, the long drive gave me a chance to ask a lot
of questions. I was especially curious about the
importance of the fiesta and how much that reflected the
importance of the Zapatista political process. He told me
that elections for the incoming autonomous council had
taken place three months ago and that they were the result
of an elaborate process involving many meetings and
discussions about the future of San Manuel, and indeed of
the entire Zapatista movement. I was told that everyone
voted. There was never a question of not voting. Nor
was the voting a question of money and fundraisers,
expensive ads and flashy stump speeches. It was the
product of simple town hall meetings and serious
discussions. And the more we talked, the more it occurred
to me that what seemed to be of importance for this fiesta
was the political process itself, the fact that people had
come together to directly shape their own future. The
autonomous councils and juntas are the Zapatista
government, and it is truly a government built from below,
or "below and to the left" as the
Zapatistas say. All this was in stark contrast to the
flashy, money and political machine-dominated elections
that recently took place in the parallel bad government
system of Chiapas, which resulted in yet another cycle of
corrupt leadership for the municipality of Ocosingo.
We
returned to Emiliano Zapata with boxes loaded with
medications, and today I will be doing health
consultations. In fact, although most of the people in the
village are assembled at the political transition
ceremony, a rather long line has also begun to form
outside the casa de salud. We have arranged that I
will see cases throughout the morning and early afternoon,
and that I'll work with two health promoters at a time. I
am quite excited about helping, and learning, for already
in my discussions with the promoters I've been impressed
with their level of medical knowledge and their practical
solutions to common health matters. As necessity is the
mother of invention, they have evolved many creative
clinical techniques. I am currently trying to grasp
the mathematical formula they use to figure out pediatric
antibiotic dosing. It is like nothing I've ever seen
before. I compare their values to the ones I usually get
from reference books, and I see that they are all
consistent. I'm impressed! I'm hoping to use this formula
when I return home to the clinic I run in California.
With
the medications we bought in Ocosingo, we begin our
consultations. The first patient is a middle-aged woman
with very high blood pressure. She explained that she had
received a prescription from a doctor in Ocosingo but did
not have the money to buy the medication from the
pharmacy. Fortunately, we had purchased some anti-hypertensives
and were able to write a prescription for her. She
immediately asked how much it would cost. It is at this
point that my first real lesson in Zapatista health care
occurred. I had assumed that medications we purchased
would be passed onto the compas free of charge. However,
the promoters explained that it is customary to pay for
medications because this is what keeps the clinics going.
It is what enables them to purchase more supplies.
Zapatistas generally have very limited means to acquire
real money, and the economy (at least in San Manuel) is
based around subsistence farming. Nonetheless, it is
possible to earn some cash from the sale of surplus beans
or corn, or farm animals like pigs, chickens and cows, or
from small manufactured goods like hand-woven garments or
hand-stitched shoes. The point of all this, as it
was explained to me, is sustainability. Each individual is
expected to earn what they can to survive, and by paying
for their own needs, they help to subsidize a system of
care that can provide for everyone. Collectively, through
projects like the farmacia bodega, the Zapatistas are
doing whatever they can to lower the cost of essential
goods, but the entire system rests upon each individual
effort to obtain these goods for oneself, so as to enable
the system to purchase goods for everyone else who can't
afford them. In the end, perhaps because it was the day of
the fiesta or perhaps because the village had such an
abundance of new medications, we ended up giving most of
what we had out for free, but not without this important
lesson drummed into me by each of the promoters: the goal
was for everyone to do the best they can to provide for
themselves and, in so doing, to provide for everyone.
We
left Emiliano Zapata the next day, just as the basketball
tournament was in its final few rounds. The cash prize for
the winning team would be 400 pesos (about forty dollars),
and by the looks on the faces of the players, it was
obvious that this was a very serious purse. As we made our
way out of the village along a steep dirt road, it
occurred to me that there was something organic about the
entire experience. The fiesta of political transition was
essentially a celebration of autonomous political
empowerment, of direct democracy, and the health care
system too was predicated on the effort of individuals to
contribute to the collective system. The Zapatistas do not
govern from above, and the people do not expect handouts
or, for that matter, to be lifted from their suffering by
any outside force. Rather, the government arises from
villages, just as the health care rests on what each
individual can contribute to the system. All this makes
sense in terms of the spirit of communalism, of indigenous
solidarity. In the end, I keep coming back to the image of
the heart, the symbol of the caracol. The logic of the
system seems to be that each individual makes a
difference. No one is obscure, and no one is superfluous.
Everyone works hard because they are all part of one very
actively beating heart, and this heart is beating, I
believe, for everyone.
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