SAN CRISTÓBAL DE LAS CASAS -- Maria Hernández, 29, an indigenous housewife and mother of three, walked two hours from her home in the mountains of the municipality of Teopisca to reach the nearest bus stop. After a 30 minute ride to San Cristóbal de las Casas, Chiapas, she arrived at the Marie Stopes Clinic.
Hernández isn’t the only one who has to travel hours for basic clinic services. Staff members at Marie Stopes say they treat more indigenous people every day, who often come from places as far flung as Ocosingo and Palenque, each a four hour bus ride from San Cristóbal. Indigenous communities throughout Chiapas have little or no options for reproductive health care services. Hernández says she received prenatal care at the clinic starting in 2003, and is at the clinic today accompanying a neighbor with abdominal pain.
The Long Road to Health Care
When the Marie Stopes Clinic first opened its doors in 2000, few of its patients were indigenous. Cultural taboos and long distances prevented men and women from coming to the clinic. But now, thanks to outreach efforts and radio advertising, 40 percent of the Marie Stopes’ clients are indigenous. Most come from remote communities to receive basic services, says Dr. Belinda Calvillo who has worked at the clinic for five years.
That hundreds of people in Chiapas have to travel long distances for routine services is no surprise. The state of Chiapas spends less on health care per capita than any other state in Mexico, according to a 2006 study Excluded People, Eroded Communities by El Colegio de la Frontera Sur and other human and indigenous rights groups.
For most of the women who need to visit the Marie Stopes Clinic, the journey to San Cristóbal isn’t an easy one. The cost of transportation alone is a hardship for many indigenous people, most of whom live in extreme poverty. “I wish there was this kind of service closer to my community so that we didn’t have to travel so far. We are poor. Our husbands earn very little,” says Hernández.
The Marie Stopes Clinic in San Cristóbal is one of three that the British organization operates in Chiapas and one of 393 worldwide. “We decided to open a clinic in Chiapas because it is the state that is most lacking in reproductive health services,” says Calvillo. She adds that she hoped the organization will open clinics in other Mexican states. “There just really aren’t many options or services.”
In the indigenous communities that surround San Cristóbal, adequate reproductive health services are scarce. Even in communities that do have health centers, many indigenous women say that they face language barriers and exhausting waits.
Juana Pérez Hernández, a Tzotzil Indian, is a nurse at the clinic and provides translation when necessary. She says even when services are offered in rural areas people don’t use them. “They tell me, ’The doctors fill me with medicines, but I don’t get better. So what am I supposed to do? I don’t go to the doctor anymore.’ ”
Discrimination and language barriers are also often cited as reasons that people in rural Chiapas don’t seek care. In the Chiapan highlands, where 62 percent of the indigenous population does not speak Spanish, “the lack of health services in the languages of the region is an important cultural barrier to accessing these services,” the Excluded People, Eroded Communities article reports.
Part of the problem, says Hernández, who traveled nearly three hours to get to the clinic, is that the doctors who work in indigenous communities come ill-equipped and infrequently. She says a doctor visits her town once every two months, but when she comes she doesn’t have a space to work and lacks even the most basic supplies like common medicines, examination tools, a bed and chairs.
But Carlos Enrique Castellaños Toledo, director of the government-funded health center at the Municipal Sports Center in San Cristóbal, says that indigenous communities should take responsibility for communicating their health needs to the government. “If the community leaders could get 15 sick people together in one place every day, health services would come much more frequently,” he added.
Originally published 2006 PIWDW
