The Struggle to Create a Pharmacy Bodega in San Manuel And an Autonomous Health System: Bull to the Soft War

by Michael Kozart

Over the past 8 years the Chiapas Support Committee (CSC) has been actively participating in development projects in the Zapatista municipality of San Manuel, in the caracole of La Garrucha. In close coordination with the Good Government Junta in La Garrucha, the autonomous council of San Manuel, and regional Zapatista health promoters, the CSC has helped launch a number of projects to improve healthcare for San Manuel, the most notable of which has been the construction of a pharmacy warehouse (bodega). The goal of this project is to render medications more readily available to the residents of San Manuel.

The idea of a pharmacy bodega rose from the problem many Zapatistas face when trying to get medications for common ailments. Commercial pharmacies are often too far away from Zapatista base communities, and the journey to get medications can be treacherous at times of heavy rainfall or hostility with anti-Zapatista groups. It is also expensive to travel into the city. For this reason, many compas have had to forego essential treatments for both chronic and acute conditions.

While the pharmacy bodega remains a high priority project for San Manuel, it is instructive to consider the challenges that have arisen along the way to bring this project to full fruition. These challenges reflect some of the deeper difficulties the Zapatistas of San Manuel, and arguably all Zapatistas, face in their struggle to create an ideal autonomous health system at a time of increasing resistance from counter-revolutionary forces waging a so-called “soft war” against the Zapatista movement. This struggle also offers reason for optimism from an unlikely source: a herd of cattle.

The Background to Zapatista Healthcare

The 1994 Zapatista Uprising was based on a number of core values, perhaps the most basic of which was political autonomy for the Mayan peoples of Chiapas, the recovery of a self-sustaining agrarian economy centered on recuperated ancestral land, and advancement of basic living standards.

The development of a Zapatista health system has been one of the most basic objectives of the uprising. In terms of these core values, the objective has been to achieve an autonomous health system that is not beholden to “outside forces”, that is sustainable within the indigenous Zapatista economy, and that provides all Zapatistas with equal access to superior health care that is modern in its biomedical scope, and at the same time inclusive of ancient Mayan healing traditions.

In San Manuel, the health system has evolved substantially in recent years. A newly created clinic in the village of Emiliano Zapata, the seat of the municipality’s autonomous council, provides a centralized hub for healthcare for the entire municipality. Relatively advanced primary care can be delivered in this clinic. It is also a meeting spot for regional health promoters to receive training and share skills. The brand new buildings of the clinic in the center of the village stand as a testament to how far the Zapatistas have succeeded at developing local infrastructure for improved standards of living.

The Pharmacy Bodega Project

The idea of a pharmacy bodega in San Manuel was modeled along the lines of the highly successful general grocery bodega that the CSC also helped sponsor. The warehouse has enabled necessary supplies to be more readily available to the people of San Manuel, thereby reducing the risk, hardship and cost of shopping in distant non-Zapatista towns. The pharmacy bodega was supposed to parallel the general warehouse, making medications more readily available to the residents of San Manuel. However, a number of challenges have slowed the pace of the project.

The first and most obvious challenge is that although the building to house the medications is complete, its shelves are bare. The problem is that some of San Manuel’s villagers are simply too poor to afford basic medications, and when faced with choices between food, clothing and shelter on the one hand, and medications to manage chronic disease like hypertension or diabetes on the other, the villagers naturally prioritize the former. Development of the pharmacy bodega, like the health system as a whole, reflects the overall economy. Until there is more wealth generated by and for the Zapatistas, the ability to expand the health care system will be fraught with difficulty.

It is important in this regard to note that while the Zapatista health system provides essential services free of charge to all who can’t pay, it still depends fundamentally on the ability of patients and their families to cover the cost of care. The only other source for financial support involves aid from outside organizations like the CSC. Although this aid, carefully coordinated and managed by agreements with the autonomous council and the Junta, has spurred successful development of major Zapatista civil projects, it is the ultimate aim of the Zapatistas to achieve a self-sustaining system that is sustainable without outside support.

Another challenge facing the pharmacy bodega comes from the concentrated forces of the Mexican state and federal government. In recent years, in attempts to woo Zapatistas away from their base communities, and to raise the popularity of the mainstream Mexican government, there have been extensive efforts to develop regions of rural Chiapas. Roads, concrete foundations, new schools, electrical lines, and finally, “free government clinics” have been provided free of charge to some of the poorest communities.

Bull to the Soft War

One might reasonably ask the question that if the goal of healthcare is healthcare itself, why should the Zapatistas have reservations about utilizing government sponsored clinics? The answer to anyone familiar with the root cause of the Zapatista rebellion is obvious. Autonomy.

The Zapatista revolution is fundamentally a struggle to re-empower Mayan communities with authority over their own land, their own ways of life, their ways of governance. While there is virtue in the availability of “free” health care, particularly for life threatening conditions, the Mexican government sponsored clinics are nonetheless backed by groups whose interest is to seize back the recuperated Zapatista territories. Any doubt about this proposition quickly vanishes when one tours the non-Zapatista regions of San Manuel and sees that those villages most hostile or opposed to the Zapatista movement are the ones receiving the government handouts—the paved foundations, the schools, the TV satellite dishes, and of course the clinics.

This is the soft war. The Mexican government—both state and federal—have launched an attack without guns or bombs. Their line of offense is to offer the Zapatistas a taste of the medicine that they’ve been unable to fully provide for themselves, but at the price of leaving their own health care institutions, and indeed their civil society, behind. There is little doubt that many Zapatistas have been forced to visit these clinics. And there is little doubt that faced with the choice of going to their own clinics, or those of the Mexican government, the Zapatistas would choose their own in a heart beat—if only the medications were available.

It is somewhat disheartening to walk through the rooms of the pharmacy bodega in San Manuel and see that there are no meds, no shelves even to hold the meds. It is sadder yet to talk to the chief health promoter in the clinic and learn how few medications there are to support the health needs of the thousands of people who compose the municipality.

The autonomous council of San Manuel realizes right now the time may not be right to purchase medications in bulk supply for the community. They have invested the funds that the CSC sent to purchase medications in cattle. At first glance, this may strike one as incongruous. Why cattle?

It is obvious: The value of a fully matured steer or bull is more than twice that of an immature calf. It may take three or four years for the calf to grow to full maturity, but in that time the municipality will be adding wealth. It will be developing its economic base to subsidize the cost of medications so that one day the dream of the pharmacy bodega will be realized, and Zapatistas will not be placed in the awful position of having to purchase food rather than medication.

So the Zapatistas are saying bull to the soft war. They merely have to wait till their steers are old enough to be sold for the medications that will support a truly autonomous health system in which there will be enough wealth to provide medications to those who cannot pay.

Three or four years may be a long time to wait for this to happen, but to anyone familiar with the Zapatista revolution, the mantra has always been “poco a poco” (little by little).

Michael Kozart is a Medical Doctor who runs the “A Street Clinic”, a homeless outreach clinic in Santa Rosa, and has collaborated with the Chiapas Support Committee for four years.


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