Guerrero, one of Mexico’s most forgotten states, is finally getting a little bit of the attention it deserves. Guerrero is not Mexico’s poorest state, but this is largely due to the fact that Acapulco and a few other resort towns awash in cash skew the state’s average income upwards. Poor people living in rural Guerrero are as poor as the poorest Mexicans anywhere. Maternal mortality in Guerrero’s most neglected region, the hard-scrabble mountains that border Oaxaca, is four times the Mexican average. Dispersed populations often have to walk hours to receive education or health services.
Last year, the community of Mini Numa, in what has long been one of Mexico’s poorest municipalities (and Guerrero’s poorest), Metlatónoc, decided they had had enough. The municipality of Metlatónoc has never had a proper health clinic. The Fox administration made some advances on this front, donating a few trailers which have served as the health clinic for the last few years. Last year, when I visited the region, plans to build a US$100,000 clinic were finally under way.
However, people living in the small community of Mini Numa still have to walk as far as two hours to get services in the municipal capital. And they often find the clinic closed when they arrive. At least five preventable deaths occurred last year as a result of the combination of long distances and closed clinics. Arguing that the lack of a clinic in their community violates their right to health (and life), the community is making waves by filing a suit against the government, with the help of the widely recognized NGO Tlachinollan.
Guerrero’s poor are finally front page news in national newspapers, and the President has even been forced to respond by pledging to send doctors southward. But now what? The state of Guerrero argues that the community of Metlatónoc is too small to place a clinic there; the Secretary of Health only places clinics in communities of a certain size and distance from other clinics. Although this argument has tended to be dismissed, it is not without merit: there is no sense in building clinics in every tiny community or throwing up a new clinic every 5 feet. Doing so implies a huge resource investment and ambiguous payoffs.
The community of Mini Numa does not have a right to a health clinic. Nor does any Mexican. They do, however, have a right to decent health care. The question is how to provide it. It would be too bad if this case turns into a silly argument about whether Mini Numa deserves a health clinic. Mexico has many dispersed communities like Mini Numa. They cannot all have health clinics. A better solution to the problem of providing services to such communities would be to create a reliable, public, subsidized transport/ambulance system that could respond quickly to emergencies and transport families to the nearest clinic. This implies improved road and vehicle infrastructure. It is not cheap. But, unlike building a clinic in every backyard, it might be effective.
However, the rot, of which Mini Numa’s unfortunate deaths are a symptom, runs deeper. Even if families in Mini Numa could get to the clinic in Metlatónoc in a split second, there would often not be anyone there. This too happens all over rural Mexico. Why? Because Mexico has a faulty labor relations system and many doctors do not show up for work in poor rural communities. No one pays much attention to what these doctors do, and if anyone dares to question them, the union usually backs them up. Furthermore, health clinics in these areas often fall quickly into disrepair. Doctors don’t work to keep them up, and municipal presidents are busy buying off voters and investing in church bells. Mexico’s decentralized health system allows everyone to pass the buck when people die, as they have in Mini Numa, as a result of these failures.
The President can send a doctor. He can even promise to build a clinic in Mini Numa. These are band-aid solutions. Mexico, like many other countries, needs deep-rooted labor reforms, centralization of key health goals and responsibilities, major investments in infrastructure, and a creative set of regulations to deal with dispersed communities. Mini Numa’s brave attempt to use the courts to change Mexico is a golden opportunity. Let’s hope it isn’t squandered.
