[ WRITING ] Chiapas health workers strike against reforms

[Article originally published in ROAR Magazine]

Workers of the Chiapas Health Jurisdiction have been on strike for one month, in protest against the structural reforms the government intends to pass.

It isis 8:30 pm and the nurses are just starting their 12-hour shift. “There are three teams. Now we have a 12-hour shift, until 8 am tomorrow morning, and then we come back 24 hours later,” one of them explains. Workers from different health institutions of the city of San Cristóbal de las Casas have organized the distribution of supplies in the tents blocking the road to the Woman´s Hospital and the Health Jurisdiction. During the long shifts, “some bring coffee, some bring food, and others come with hunger,” says another nurse, laughing.

DSC03331
Nurses on strike

Workers of the Health Jurisdiction of Highlands Chiapas, which is comprised of workers from 18 municipalities have been on strike for over one month, in protest against the eleven structural reforms the government has been trying to pass. In particular, they explain that the so-called “universalization of healthcare” which would merge the different public healthcare institutions of the country would have disastrous consequences in Chiapas, one of Mexico’s poorest states.

The current universal healthcare (Seguro Popular) covers about 300 procedures. The previous program covered over 3,000. “And with this reform, there will be barely a hundred procedures covered, leaving out chronic illness such as diabetes and acute conditions like cancer,” a union representative explains. And in a country with vast income disparities, universal healthcare’s unique cost for uncovered procedures would not be accessible to poor peasants living in the states of Oaxaca (where the police repression led to 12 dead, a hundred wounded and 25 disappeared in Nochixtlan a few weeks ago),Guerrero (where 43 students were disappeared in September 2014) and Chiapas. The biggest health costs will thus be shouldered by patients themselves, and not by the state.

The privatization of healthcare is in line with international reforms promoted by lending agencies, such as the World Bank and the Inter-American Development Bank, and will benefit those already in the business of health, like the Mexican telecom magnate Carlos Slim. “This is a model that does not fit with the reality of Mexico, and what we as workers are starting to implement are local consultations with lawyers, researchers, and activists to find a new health model” decries another union leader at a press conference on June 30. Protesters are also calling out to the state’s lack of knowledge and interest in the operating conditions of the health institutions. “In the hospitals here, we lack medicine and even machines. Sometimes there are not even syringes. The only thing doctors can do is fill out prescriptions and send patients to buy out-of-pocket medications in pharmacies”. In the face of such shortages, staff members often help out their poorest patients by paying the costs out of their own pocket.

IMG_2123
Sign of protest outside of the Health Jurisdiction.

The discontent with the law is plenty: “For those of us who will be retiring, we would only be getting 1,080 pesos a month (about 60 USD)” explains one healthcare worker. “Our colleagues working in laboratories will be judged on their productivity, not on the number of hours; in order to comply with their goals they will have to either work more hours or increase the number of patients per hour,” describes another.

Even though the Highlands’ Jurisdiction is the only union on strike in the state so far, health workers from all over the country marched in protest on June 22. In Chiapas, teachers, families, students and residents of different districts of the city have shown solidarity with the movement: “Night after night, people from the barrios bring us coffee and show their support.”

Twenty-two days after declaring a “Permanent Assembly,” the 2,500 workers stand firm. So far, the health reform has been paused, “but this does not mean that it will not be reactivated,” cautions the union representative, “we will not dismantle our Permanent Assembly.” The health workers say they have learned a lot from the teachers, who have been mobilizing against radical changes in the education system as well. “We are barely learning how to walk. But we will walk together with the teachers and peasants.”

[ PUBLICATION ] Les sages-femmes traditionnelles du Chiapas : Une approche holistique de la grossesse et de l’accouchement

[Originally published in Grandir Autrement, Hors-Série n9, 2015]

« Le don qu’a la sage-femme lui a été donné par Dieu. Ce n’est pas quelque chose de facile, d’accompagner un accouchement ; ce n’est pas pour n’importe qui… Car l’objectif principal est la vie du bébé et de la maman. Les sages-femmes travaillent jour et nuit, à n’importe quelle heure ; il y a constamment du travail pour les sages-femmes, et c’est maintenant qu’il faut transmettre ces connaissances pour le bénéfice de la maman et de sa famille. (…) Il ne faut pas perdre ces traditions médicinales, car elles se transmettent de génération en génération »

Ces paroles d’une sage-femme Maya ont été prononcées lors de la rencontre de sages-femmes traditionnelles de l’Organisation des Médecins Indigènes de l’Etat du Chiapas (OMIECH) en Février 2014. Depuis plus de trente ans, OMIECH compile et défend les savoirs des médecins traditionnels Mayas (Tseltals et Tsotsils) – guérisseurs et sages-femmes – depuis plus de trente ans, face à une médicalisation grandissante de la grossesse et de l’accouchement au Mexique (où près d’une naissance sur deux se fait par césarienne[i]). En effet, les aides gouvernementales aux familles pauvres obligent les femmes à pratiquer le suivi de leur grossesse par un médecin plutôt qu’une sage-femme traditionnelle, et à accoucher dans un milieu hospitalier plutôt qu’à leur domicile – ce qui est pourtant la norme culturelle. Pourtant, les sages-femmes traditionnelles restent des alliées incontournables pour les femmes de leur village. Elles connaissent parfaitement les conditions de vie de ces dernières, et savent les conseiller sur le plan nutritionnel, psychologique et physique. Elles n’hésitent pas non plus à marcher plusieurs kilomètres, quel que soit le climat ou l’heure du jour ou de la nuit, afin de répondre à l’appel d’une future maman.

Rezo
Dessin d’Alice Bafoin

Les mains au cœur de la pratique

Dans les villages des Hauts Plateaux du Chiapas, les sages-femmes traditionnelles accueillent plus de 70% des naissances. Leur principal outil de travail, ce sont leurs mains, qui, par le toucher, peuvent donner une date d’accouchement prévisionnelle, dévoiler le sexe du bébé, ou détecter un mauvais positionnement et replacer le bébé correctement. Mais les sages-femmes se basent également sur leur ample connaissance de leur écosystème et des propriétés des plantes médicinales, qui leur ont été transmises par les générations précédentes et au travers de leurs rêves, afin d’accompagner les femmes de leur communauté tout au long de leur grossesse, au cours de l’accouchement et pendant le postpartum.

Ainsi, dans les montagnes embrumées de cet Etat du Sud-Est du Mexique, les femmes Mayas qui se rendent chez leur sage-femme lui racontent les mauvais rêves qu’elles ont pu avoir, parlent de leur relation avec leur époux et leurs beaux-parents (chez qui les jeunes couplent habitent durant leurs premières années de mariage), et décrivent ce qu’elles ressentent dans leur corps. Ces conversations permettent à la sage-femme de conseiller la maman sur les aliments qu’elle devrait consommer, lui prescrire des recettes à base de plantes, d’expliquer au papa et à la belle-famille comment prendre soin d’elle, et parfois organiser une cérémonie afin d’éloigner les mauvais esprits et tranquilliser la famille.

L’importance de la chaleur

Pour les Mayas, la femme enceinte accumule de la chaleur au cours de sa grossesse. Lors de l’accouchement, la perte de sang équivaut à une perte de chaleur, un refroidis- sement qui peut être dangereux pour la maman. Le bon déroulement de l’accouchement est intimement lié à la création et au maintien d’un environnement chaud, qui rééquilibre la balance chaud/froid dans le corps de la femme. La sage-femme, qui s’est déjà rendue au domicile de la famille lors de visites prénatales, a repéré les plantes présentes aux alentours, et apporte dans son sac celles qui n’y sont pas et dont elle aura besoin. Les membres de la famille aident la sage-femme en faisant chauffer l’eau pour les différents thés et lavements, et maintiennent la chaleur de la pièce en alimentant constamment le feu. La future maman ne se dénude pas, elle garde sa blouse et sa jupe pendant le travail et l’accouchement. Elle alterne les positions, la plus classique étant d’être accroupie accrochée au cou de son époux, lui-même assis sur une chaise. Chez les Catholiques, la sage-femme accompagne l’événement par des chants, bougies, et prières. Après la naissance de l’enfant et du placenta, la maman reprend des forces en consommant un bouillon de poulet. Le placenta est enterré près de ou à l’intérieur de la maison. Après le repas, la sage-femme nettoie la pièce et les draps, et fait des recommandations à la famille sur les aliments à consommer. Elle reviendra rendre visite à la maman et au nouveau-né pour des visites postpartum dans les jours qui suivent.

Ces différents éléments thérapeutiques – chaleur, plantes, prières – ainsi que le respect de l’intégrité du corps de la femme (les sages-femmes effectuent peu ou pas de touchers vaginaux) contrastent avec le traitement que reçoivent les femmes qui accouchent dans les hôpitaux publics. Face à un personnel qui très souvent ne parle pas le Tsotsil ou Tseltal, seules dans un environnement froid, la modernité se paie au prix du confort et du respect du corps. C’est pour cela que de nombreuses femmes et familles refusent de se rendre à l’hôpital, malgré les pressions gouvernementales.

DSC02831

 

Des ponts pour l’avenir

Malgré des études démontrant la sécurité d’un accouchement à domicile planifié pour les grossesses normales[ii], la médicalisation de l’accouchement est un phénomène global. En France, les changements timides tels que l’ouverture de maisons de naissance, ne doivent pas faire oublier la persécution que subissent les sages-femmes pratiquant l’accouchement à domicile[iii]. En France comme au Mexique, les sages-femmes et les familles s’organisent afin d’offrir aux mamans un accouchement ailleurs qu’à l’hôpital, et de préserver des savoirs respectant la physiologie du corps. Basée à Rennes, l’Association Mâ organise des échanges interculturels sur le sujet, en mettant en parallèle les luttes françaises et chiapanèques et en aidant l’Organisation des Médecins Indigènes du Chiapas à continuer d’organiser des rencontres de sages-femmes traditionnelles, afin que les bébés du Chiapas continuent à être accueillis par de si bonnes mains[iv].

[i] Chiffres de l’OCDE sur le site de l’association Césarine http://www.cesarine.org/avant/etat_des_lieux.php

[ii] Janssen, Patricia A., Lee Saxell, Lesley A. Page, et al. 2009. Outcomes of Planned Home Birth with Registered Midwife versus Planned Hospital Birth with Midwife or Physician. CMAJ : Canadian Medical Association Journal 181(6-7): 377–383.

[iii] Les Femmes sages. Syndicat National des Sages-Femmes pour l’Accouchement à Domicile http://snsfaad.weebly.com/

[iv] Pour plus d’information, vous pouvez consulter le Blog de l’Association Mâ http://blogdelassociationma.blogspot.fr/ et la page Facebook de la Section Femmes et Sages-Femmes d’OMIECH (en Espagnol) https://www.facebook.com/areademujeresomiech

[ WRITING ] Notes from the field

(Published in the Council on Anthropology and Reproduction Newsletter 22(2), 2015)

“Oh, I see, so you want to be a partera (midwife)” is the typical response I hear after explaining the purpose of my visit; that I am doing dissertation research to document how midwives live and work. Although I try to explain my research goal in terms of “helping raise awareness on the difficulties parteras are facing,” I am always met with this same response “so you want to learn how to become a midwife?” And as I have gotten to met parteras and aspiring midwives, I must admit that there is not always a clear difference between what I do and how I act and what they do and how they act: asking questions about pregnancy care, sitting in on prenatal consults, taking notes on almost everything the partera says… There is a thin line between participant-observation and midwives’ apprenticeship model. And indeed, I have been learning a lot about how parteras work and live, but also a hell of a lot about plants given in pregnancy care and massage techniques.

Since October 2014, I have been in San Cristóbal de Las Casas, Chiapas, conducting dissertation fieldwork and volunteering for the Women and Midwives’ Section of the Organization of Indigenous Doctors of Chiapas (OMIECH). As a volunteer, my work consists mainly of two tasks: administrative tasks (aka looking for funding) and logistical support during events and workshops. Since 1985, OMIECH has been strengthening Mayan medical knowledge and organizing health workshops in indigenous Tseltal and Tsotsil communities of Chiapas. Even though I am in Chiapas, some of my notes echo those of Kara E. Miller (Fall 2014 Newsletter). Here too, the parteras – who are referred to as Traditional Birth Attendants in international documents – are frustrated with the lack of possibilities to transfer their skills to the next generation. This is why the Women and Midwives’ section organizes workshops focused on reproductive health, and care during pregnancy, birth, and postpartum. These workshops are open to all members of the community where they take place, and aim to perpetuate botanical and medical knowledge by transmitting it to younger generations.

DSC_0055

Picture 1. Tsotsil partera during a community workshop. Photo by author.

The loss of knowledge is accelerated by various factors (young people’s migration, midwifery not an attractive profession economically), one of them being the medicalization of birth. The push to send women to birth in hospitals comes with a deligitimation of indigenous parteras’s knowledge as “not-modern”. Through conditional cash-transfer programs (documented by Vania Smith-Oka in the state of Veracruz), women are pushed to have their prenatal visits and give birth in hospitals. Parteras, on their end, have to attend trainings given by the Health Secretary. These trainings have emerged in the 1980s, and intensified in Chiapas under the pressure of reducing maternal mortality rate to comply with the Millennium Development Goal (Chiapas has one of the highest maternal mortality rates in Mexico). Indigenous traditional midwives either have to follow the trainings or stop practicing. This can have dramatic consequences in places where they are often the only health care provider in their communities.

As I jot down notes during an interview or observation within these different settings, I feel a thrill of delight when their words echo one another. But then I realize this means that these state policies are really achieving great changes for parteras. And like Sisyphus, tirelessly, my colleagues at OMIECH reweave what is being unwoven: traditional medical knowledge, but also, and as important, pride in it and trust within the community.

While “in the field”, my notes are scribbly at times, crystal clear at others, but rarely absent. I try to type them regularly, as a good apprentice-anthropologist, but have stopped feeling guilty when I could not do so. It took me a few months to be able to “let go” and admit there will always be an event I will miss, a trip I cannot make… At my mid-point in the field (already), I have just started to take drawing classes, which helps me expand the range of my notes, when words fail to describe a hand gesture, or when I do not know the terminology for this exact point on the belly that needs to be massaged. These classes have made the familiar look different, and made me look at people in a new way, which in turns adds more depth to my notes.

Life in the field intertwines professional, political and personal spheres. The friendships I have built through this research promise to impact both my career and personal life. As we were searching for plants in the garden of the organization for an upcoming booklet publication, my colleague Micaela corrected me as I got the name of the plant wrong, once again. I could sens, for the first time, an impatient tone in her voice. I pause and I suddenly realized that although I am not studying to become a midwife, every one of the parteras I have met have been a teacher to me, training me a little bit, sharing their story, their tortilla and their endless knowledge. I am looking forward to learning a lot more in the next five months I will be spending with them and I hope my dissertation will bring them knowledge they can use in their struggle.