By Jorge Herrera, CECYPE General Director (Clínica de Enfermedades Crónicas y de Procedimientos Especiales), Graduate of the CREEI Program, Student of the Master of Science of Bioethics of Research – Clarkson University
Irma is a Mazatec indigenous, poor among the poor, who arrived at the health center of her community one night in pain of childbirth.
After hours of asking for help, Irma ended up giving birth alone squatting in the health center yard. Her child came to this world on the grass in a cold dawn.
The image was captured by a citizen and was spread by social media. Due to the scandal, the authorities of the health center justified their actions saying that Irma and her husband did not speak Spanish, and health center staff could not understand what she was asking for.
Irma’s story garnered national attention including an appearance on national TV. In response, the Oaxaca state health minister promised that Irma and her son would receive the best care, the director of the health center was fired, and the doctors were warned.
Unfortunately, the story of Irma is repeated frequently in my country. Human rights defenders have documented at least 20 similar cases and testified before the Inter-American Commission on Human Rights that from their point of view, it is a systematic problem of prejudice and cruelty towards indigenous women in the Mexican public health system.
Irma’s story illustrates the magnitude of needed social change. This change will be difficult to carry out in Mexico because even those of whom we expect different moral conduct are embedded within a racist and classist social structure.
Mexico is a country of 120 million inhabitants of which 50% live in poverty. 11.5 million Mexicans live in conditions of extreme poverty. These are mainly indigenous people who are confined to remote places in the mountains or abandoned in indigent conditions on city streets. They seem to be invisible because nobody wants to see them hungry, malnourished, and barefoot, carrying their children on their backs, and begging or selling candies or crafts to the terrace of the restaurants, to the entrance of the shopping malls, or in the tourist attractions. Only during political campaigns do they stop being invisible, when in exchange for their votes the politicians offer them a little food, cardboard sheets for their roofs, clothes with campaign slogans, and many promises that are rarely fulfilled. For example, Enrique Peña Nieto, the current president, who has only one year left of the six of his presidency has only fulfilled 40% of his campaign promises.
Discrimination is not only palpable but well documented. The results of the 2016 National Discrimination Survey show that 20% of respondents do not feel comfortable with their skin color, 25% said they felt discriminated because of their physical appearance, 23% said they were not willing to live with someone of different “race” or culture, and 55% recognized that others are insulted because of their skin color. The results of the survey also show that there is a direct relationship between discrimination and poverty. When asked what they consider to be the greatest disadvantage of being indigenous, 43% of respondents considered discrimination in the first place, followed by marginalization and poverty (21%), exclusion (almost 6%), and illiteracy (4%).
However, we expect doctors and nurses to have a different attitude toward the needs of patients. According to Pellegrino the telos (the ultimate goal) of the relationship between the health professional and the patient should be patient’s good. Patients go to the health professional because they are worried about a physical or physiological symptom that makes them feel anxiety, dependence, pain, disability or vulnerability. The health professional makes the promise to direct their knowledge, technique, and personal commitment to attempt to improve the patient’s condition.
Notably, the lack of resources in remote and poor places can make it difficult or impossible for health personnel to fulfill their promise. At the same time, my personal experience, as a citizen of this country, makes me suspect that in many cases in which the health staff violates their promise, they do so because of a contempt towards the patient due to his indigenous or poor condition. The Report on Discrimination in Mexico 2012 Health and Nutrition, provides evidence to support my suspicion: 72% of the indigenous population has suffered discrimination when they have sought medical attention in public health services.
Historically, doctors have been a moral reference for Mexicans. In rural villages, the three most respected people used to be the teacher, the priest, and the doctor. In the 1960s, doctors began the democratic change in the country by demanding improvements in their working conditions and salaries. This medical movement unleashed a social reaction that achieved the democratic spaces that had been closed for 50 years.
Many things have changed since that medical movement. The National Survey of Discrimination suggests that at least we have begun to look at our social structure to try to combat discriminatory behavior. But more is required.
It is my hope that Mexican doctors, acting in accordance with the oath they made when they began their professional career and the medical ethics that unites them in a community of moral values based on the virtues of benevolence, respect for human life, and the vulnerability of the sick will again become a guide to heal the Mexican citizenship of the rampant racism and classism that afflicts us. This could begin with the concerted effort to ensure that every future child of any other Irma receives a warm and loving welcome.