Autonomous healthcare in the Zapatista communities: “You can’t think about health and not think about the river.”

This article is based on information provided by a compa who has been working to train health promoters in two different areas of Chiapas. He stressed that he could only discuss healthcare in two of the five caracoles, the self-governing geographical regions into which Zapatista territory is divided. Each caracol is autonomous; they all start from the same idea – land and freedom – and the same principles, based on democracy, liberty and justice, but each area has developed distinctly, with a different programme, and a different way of doing things.

Healthcare in the first caracol.

In the area where the compa worked first, the people decided to start by creating a big central health clinic. This clinic now serves hundreds of communities. Health promoters from these communities continue to come to the central clinic for training in ways to support people’s basic health needs. The next stage was the creation of smaller micro-clinics, and finally, simple basic ‘health houses’, or consulting rooms, were set up in the majority of the communities. These are often run by only one health promoter, who comes from that community.

If a patient can’t be treated at the ‘health house’, they go to the micro-clinic, or if the promoters there cannot deal with the case, the patient is then referred to the main central clinic. The aim is not to rely on the government at all, but some cases still really need treatment at the state hospital, which is often not an option due to the cost, the distance, and for political reasons. Although full autonomy is not achieved yet, the promoters are doing very well, and starting to develop more specialist care particularly in the care of the eyes and the ear, nose and throat, as well as in women’s health.

In the main clinic, there is a laboratory where analysis of samples can be done. There is a special women’s consulting/maternity/birth room run by women health promoters. There is an operating theatre, a pharmacy, a 24 hour emergency room and a room for treating eye problems. There is a herbolarium for herbal medicines, most of which come from local plants. The Zapatistas here remain desperately short of medicines, equipment and resources, but despite this, they continue to strengthen their health service.

This area is the poorest region of Chiapas, there is a greater shortage of food, poorer crops, less land, and difficult cold, often wet, weather. Yet, in this caracol, the health system has been taken on board very well, and the number of health promoters has increased substantially in the last eight years. They continue to go on training courses run either by the communities, or by international groups.

Health promoters

The health promoters are chosen by the communities. They are chosen because of their commitment and desire to learn, and often because they can speak, and perhaps write, in Spanish, although many are not fluent. Many of the training courses are in Spanish, with translators to translate into the appropriate indigenous languages. The health promoters are all volunteers and receive no salary. It is not easy to be a health promoter: they have to give up their daily work helping to provide food for the family, and they usually have to work in their second language.

The training courses are for one week every month. The promoters have to leave their homes, and support and feed themselves while they do the courses, which shows how deeply they believe in what they are doing. They then take the knowledge they have learned back to the community. After two years of training, most health promoters can identify six or seven of the common illnesses.

Health promoters live and work in the clinic, treating people during the day, and being on call for emergencies at night. The more experienced health promoters pass on their knowledge to other local indigenous people who are training to be health promoters. Being a health promoter involves taking on and promoting a new concept of, and approach to, healthcare and treatment, a mixture of their own indigenous culture with western medicine. “We aim not only to treat illnesses, but to create a better system of health, one which respects Maya culture, an autonomous health system”.

Healthcare in the second caracol

In the second area where the compa is working the situation is totally different. The healthcare system here is based on health promoters, and ‘health houses’, tiny surgeries, trying to support the communities. There are no main clinics.

The reality of the illnesses present is determined by the lack of safe water, the insects, and the weather which varies between hot, wet and cold. The houses are very basic structures offering little protection from the climate, with the result that pneumonia is one of the main killers.

The health promoters are trying to control illnesses and promote good health in an area where there was previously no knowledge of clean water or of hygiene. They are trying to change peoples’ habits and develop preventive healthcare, but this is very difficult. There is less knowledge and experience in healthcare here than in the highland zone, which is comparatively quite advanced and specialised. The health promoters here are aged between 10 and 76, and many have little knowledge, but it is very good to see them working in a new and different concept of health.

For many years, people have been told that the plant medicines don’t work, and they have learned to “want the tablet”. This is an example of the damage that can be caused by western culture. The training courses use a mixture of both traditional and western medicine, but in some places the traditional knowledge has been lost, and is having to be re-learned.


In Chiapas, many indigenous people die of curable and preventable diseases. They are desperately poor, and lack clean water and sewerage. They suffer from chronic ill-health, malnutrition and hunger. Many have open fires in their houses and no ventilation. There are therefore a very high percentage of people suffering from parasites, diaorrhea, skin problems, malaria, tuberculosis, and other gastro-intestinal and respiratory conditions. Some of the worst problems are respiratory ones, due to their poor living conditions; the children develop pneumonia, and the women chronic bronchitis. There is a lack of knowledge of and treatment for, women’s health, and many women die in childbirth and children die before the age of five.

Many communities still have traditional bonesetters, mountain healers, and midwives. In some places, they are regaining the knowledge of using plants as medicine, and returning more to the old ways.

The emphasis throughout is on preventive medicine, promoting good health, teaching people how to maintain good hygiene and have better nutrition, “looking after each other to keep ourselves well”. The best medicine for illness is the community; by having a collective approach to healthcare, working together and organising, they can support and care for each other.

Health is not only related to the individual, but to the whole community. It is based on the relationship between the worlds and on respect for the earth. The souls of the dead are under the ground and all living things are connected. “You can’t talk about health and not talk about the river”.

Government healthcare

A consultation with a doctor would cost the equivalent of 10 days’ family income, the medicine 2 days more, and usually the time and distance to a surgery would make a visit impossible anyway. The government has also attempted to copy the Zapatistas by setting up clinics in indigenous communities, but these normally have no doctors, health promoters or medicines at all, as doctors don’t want to work in these communities, and the treatment is not free.

The care offered to indigenous people by government hospitals is both inadequate and expensive. They will often ask a patient if they are Zapatista, and refuse to treat them if they are. An offer of treatment can therefore be based on political grounds. Indigenous people are given no respect in these hospitals, and suffer ill-treatment and discrimination, with no understanding of their language or culture.

The community is everyone : the Zapatista miracle

Zapatista healthcare is completely independent of all government funding and control; they have developed their own autonomous forms of health, democracy and decision-making. In Zapatista clinics and health houses people are treated with respect, love and responsibility. Because the health promoters are local, people can be talked to in their own language, by someone who understands their needs and culture. In the government hospitals, indigenous people are discriminated against, misunderstood, ignored. Many non-Zapatistas now come to the Zapatista centres for treatment, knowing they will not be turned away.

This means that, in a country where most people, particularly indigenous people, cannot afford medical treatment, which may not be available to them anyway for political reasons, Zapatista healthcare is open to everyone. Non-Zapatistas only pay for the basic cost of medicines or any materials needed; the treatment is free. Healthcare is for all, without distinction. The paramilitaries who have attacked the community with firearms still get treated; the compa watched a promoter treating the man who had just shot and killed the promoter’s brother, without hesitation or rancour. “We are all brothers and sisters”.


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