FROM THE FIELD

Vol. III, No. 2: Summer 2004

Dr. Francisco Hernandez

and

The Mexican Health System Crisis

George Colman

The Mexican social security health system was established in 1943 and though considerable attention was paid to the event in the papers of the capital, those living in the village of San Juan Osolotepec in the distant, southern mountains of southern Oaxaca heard nothing about it.

It was therefore unimaginable when a male child was born to the Hernandez family of that remote village in 1950 that the boy would one day leave his pueblo and become a doctor in one of the nation's hospitals.

Unimaginable also because the boy's future had already been determined. He would follow in the campesino footsteps of his father, suffer a few years of primary school, care for the goats, grow corn, beans, and a little coffee, get married to a village girl in the village church, have the inevitable children, take them to the priest for baptism, work hard, continue the traditions, die where his ancestors died and leave his bones in a village grave before he had lived 50 years.

It was, unexpectedly, the village Priest who nudged destiny aside. Having baptized the recently born Francisco, the good Father watched closely as the child grew into an unusually curious and bright eight-year old. Concerned for the future of the Church and the best education of a promising child, he suggested to the parents that the boy be enrolled in a Catholic school in the city of Oaxaca. If the child were placed in the right environment, he assured them, he might become a Priest, the first from their mountain village and a blessing to the family.

The parents respectfully welcomed the Priest's concern for the child's future and just as respectfully declined. Young Francisco would not be going to the city. They reminded the priest that the boy was the oldest child in the family and his future was beside his father in the fields. In any case, schools cost money and the priest knew perfectly well the family had none, knew that money hardly existed in the village, surviving as it did on subsistence farming and barter.

Firm in his cause, the priest persisted. He returned a few weeks later and told the parents he was prepared to pay for all the child's expenses: transportation, education, room and board if they would allow Francisco to take advantage of the opportunity he offered. The parents talked to the child and were somewhat surprised to learn that he liked the idea. A few months later, an eight year old boy walked out of the mountains of Oaxaca and, except for the occasional visit, never returned.

As the Priest anticipated, the boy did well in school and moved on to Seminary where he studied Latin, a bit of Greek, and the writings of the church fathers. By the age of 14, however, his imagination had been vigorously stirred by six years of city life and city friends preparing for what sounded like exciting lives as lawyers, teachers, and doctors. Doubts surfaced, second thoughts intruded, and alternatives were pleasantly imagined. Francisco Hernandez' life-compass swung away from the priesthood toward the related but quite different vocation of medicine and healing.

Graduating from Oaxaca's public schools with a fine academic record, he moved on through Medical school, an internship in a local hospital and a year's social service on Oaxaca's Pacific coast. The eight year old from San Juan Osolotepec had become Dr. Francisco Hernandez.

Good fortune and a good record favored him. In the year he became a doctor, the Mexican Social Security administration, which covers about 50% of the Mexican population, announced competitive examinations for twenty new positions opening in Oaxaca. Hernandez took the exams, was one of twenty doctors selected from 400 applicants, and began his life's work in Oaxaca's Social Security hospital as a specialist in Family Medicine. As such, he is one of the Doctors that all patients go to first for evaluation and treatment or referral to a specialist. For a quarter of a century, he treated 20 to 25 patients every working day of every week.

Then, four years ago, his life changed dramatically. His union asked him to serve as its press officer and editor of its magazine. The idea appealed. It would be stimulating, he thought, to take up a new challenge. It would also be useful because the union represented all doctors, nurses, pharmacists, therapists and all other men and women working for Mexico's Social Security system, a system that was on the verge of bankruptcy.

Hernandez agreed and was immediately involved in the all-absorbing, day and night struggle to preserve a health-care plan that serves 50 million Mexicans and has contractual responsibility for the pensions of the 350,000 physicians, nurses and health care workers employed by the system.

The facts as Dr.Hernandez sees them are these:

1.When Mexico's Social Security System was founded in 1943, the average life-expectancy of Mexicans was 45 years. The majority of those who worked for the system therefore died before or soon after retirement so payroll deductions providing for their pensions were sufficient.

Over the past forty years, however, the life-expectancy of Mexicans has risen to 75 years instead of 45 and payroll deductions no longer cover the rapidly rising costs.

2. Because the 50 million Mexicans served by the system are living longer, they come to social security clinics and hospitals for a longer period of time and with different, more expensive problems. When Hernandez began work as a doctor, the major problems treated were gastrointestinal and respiratory. Longer life-expectancy means that more and more patients are coming with degenerative problems of the heart, the kidneys, the joints and the bones. There are also the entirely new and expensive medical treatments required by AIDS.

3.The union believes the crisis has been created not only because of longer life-expectancy but also because of faulty administration by the managers of the system. “Where did all the money go?” they ask. The fact that Mexicans were living longer was certainly obvious to everyone. So why didn't management see the obvious years ago and develop a plan for dealing with it before the system reached its present, near-terminal status?

4. The income necessary to support the system is regularly lower than expectations because too many employers avoid the payments legally required of them by submitting false accounts relative to their employees.

5.Government sponsored health care systems and the rights of labor are currently threatened by a United States led campaign advocating the “privatization” of government services and “labor reform legislation” that reduces the ability of workers to organize in unions so that corporations can do as they please regarding wages, benefits, and working conditions.

Protesting against all attempts to break the unions, privatize health care and education, and generally reduce the living standards of workers, fifty-thousand members of Oaxaca's major unions recently marched together through the streets of this city and occupied its center in order to make public their commitment to affirm and preserve the following hard-won rights of employees:

• the right to establish contracts through a collective bargaining process;

• the right to employment stability;

• the right to equal pay for equal work;

• the right to end discrimination by social class, sex, religion or political conviction;

• the right to salaries that provide workers and their families a decent living;

• the right to strike and be represented by the union of their choice.

As for the immediate, desperate crisis in the Social Security system, the managers have proposed that union members pay 6% of their income toward a pension instead of the present 3%, therefore providing the additional funds necessary to fulfill its contractual obligations. On this point, the union is in agreement.

Managers, however, also propose that the increase to 6% be followed by a 1% increase each year until payments reach and stabilize at payroll deducations of 15%. They also propose that instead of a government-managed pension fund and instead of a government assured pension to workers upon retirement, that workers' payroll deductions toward pensions be placed in the hands of investors and that each worker's pension be whatever his particular investment has earned for him or her in the market over the years of his or her employment.

And to all those proposals the union is united in firm opposition and in affirmation of the principle of solidarity: the pension fund should be managed in a way that promotes the welfare of all the workers, equalizing risk and gain as much as possible, and leaving no one entirely to the mercy of the market.

In response to the union's refusal to sign on for payroll deductions of 15% and its rejection of individual accounts with private investors as the basis of the pension plan, the managers of the Social Security system are now preparing to declare the system “insolvent” and unable to continue providing health services to 50 million Mexicans or pension payments to its 350,000 employees.

If and when that announcement is made, the union will immediately strike and close the system down.

A health care catastrophe is in the making here. Proposals and counter-proposals continue to be urged and debated behind the scenes but official management and union positions are, at this moment, locked.

+++

JUST AHEAD OF THE CURVE

Michele Gibbs

This Juneteenth we recognize another African born in America who has chosen freedom over spiritual death. With the publication of QUITTING AMERICA (Dutton Publ., Feb. 2004), Randall Robinson, founder of TransAfrica, lifetime activist on behalf of human rights and self-determination for the people of the African Diaspora, in the forefront of the Reparations Mvt. in the U.S. has become the first black man of note since James Baldwin to feel obligated, not only to leave the U.S. (many have left), but to explain why in print.

Both the similarities and the differences are instructive. Both men were shaped by a thorough grounding in Christian ethics from birth. Thus, it is no surprise that the standard to which they hold nations, people, and themselves is a moral one. This stance propelled them into the struggles of their respective generations and kept them there.

Writing in the New Yorker in 1961, when the Civil Rights Movement was cresting, U.S, involvement in VietNam was still covert, and America's first serious self-examination since the Civil War was under way, James Baldwin thought it was still possible to passionately exhort the dominant culture to “snap out of it,” and it would. In 2004,Randall Robinson is convinced it won't. The Republic has become an Empire and Robinson writes with the profound regret of the exhausted negotiator with the willful ignorance of the powers that be.

Unlike Baldwin, whose voice rose as one among millions in positive movement together, Robinson characterizes his testament as: “a single candle guttering in an angry wind of national hysteria” rendering “white Americans brainless and insensate.” From bad manners to bad policy he describes a nation of people in psychotic denial of the causes for their past and present supremacy of power. Anecdotal, yet undeniable, the evidence mounts up and Robinson is forced to conclude: “I no longer grind my heart against the cold rock of a sightless soul. I know now that this America...uncoupled at last from its glittering spiritual anchorage, could never confess any wrongdoing, small or large, old or new, the powerful feeling now, more than ever, no need to learn, in the nation's middle age, the painful craft of moral honesty.”

You could say, using Esther Phillip's distinction, that American society has passed “ from ignorant to ig'nunt.” Which is to say, from not knowing to not wanting to know. In this state of mind, it cannot ‘self-correct.' And, most damning of all, says Robinson, “Americans don't know how to be equals. No, I am not referring to the less important vagaries of material difference, economic or military, but rather to human equality... The American mind cannot wrap itself around notions like this; hence Americans, including black soldiers who are little more than agents of the American empire, feel just fine about doing anything to anybody.”

Whether in the Caribbean, Iraq, or Washington, D.C., the boots and straps offered by America are those applied to the subjects' backsides, not the shoes ‘all God's chillun” are entitled to wear.

These truths jump into sharpest relief, of course, from ‘abroad.' Where Baldwin's spiritual alternative and vantage point crystallized in the international cosmopolitan community of writers and artists in search of personal truths rendering all borders permeable, Robinson comes to rest on the periphery of modernity. His home is now a small island, one of a string, where clocks don't count, but consciousness does. Where time is not money and all that you have that counts is your soul.

Like many of us who have voted with our feet over the last 25 years and chosen life contexts which eschew excess, the hegemony of the cash nexus, and where people and technology are humbled regularly by nature, Randall Robinson has found balance, renewal, and strengthened direction in the Caribbean. He champions this life, not as an escape from ‘social responsibility', but as a route to it. Those familiar with more than the region's beaches, appreciate that the intellectual, artistic, and political wealth of the Caribbean community have been the source of all transformative political and artistic movements in the last 200 years in this hemisphere. All initiated by ‘people of color.'

Mostly black. Think about it. His move is also an organic entry into this circle of energy. In this Middle Passage corridor memory remains intact and informs daily action and imagination. One's humanity {for a change} is taken for granted. And there is even time and space for healthy childhood. This last point is critical.

Randall Robinson leaves America both to save himself and for the sake of his 12 year-old daughter. He realizes like Baldwin, [ “The American Dream and the American Negro”, 1965] that “What the system does to the subjugated is to destroy his sense of reality.....In the case of the American Negro, it comes as a great shock to discover that the country which is your birthplace and to which you owe your life and identity has not, in its whole system of reality , evolved any place for you. The disaffection and the gap between people, only on the basis of their skins, begins there and accelerates throughout your whole lifetime. You have been through a certain kind of mill and the most serious effect is again not the catalogue of disaster...the millions of details twenty-four hours of every day that spell out to you that you are a worthless human being. It is not that. By that time you have begun to see it happening in your daughter, or your son, or your niece or nephew....But what is worse is that nothing you have done, and as far as you can tell nothing you can do, will save your son or daughter from having the same disaster and coming to the same end.” By 2004, Randall Robinson's daughter's generation is not only deemed ‘worthless'; it is the preferred target for extermination. Young black men, in particular, are a “menace to society.” ‘Man-boy', as Robinson personifies the youngbloods, “ knows this, but not how he became this. He really doesn't give a fuck, either. He knows his name, but not who he is. He simply cannot remember. His memory was stolen from him. Not his memory of contemporary cultural facts, but his memory of a cultural tradition to which he once belonged in the long stream of time.... But that was long ago. And he doesn't know a damn thing about anything except that he is cold in Rochester and feels the grip of the wind.”

But the world is not Amerika and Robinson votes for future possibility based on all that life in the U.S. insists we forget. He also offers his path as an urgent reminder to homefolk. In the words of Henry Dumas, “We have a journey to take, and little time. We have ships to name, and crews.”

Who feels it, knows it. Shine swims on, bro. You are not alone.

+++

GALLERY: JUNETENTH 2004

The Sower

“...Before escaping, the female slaves steal grains of rice, corn, and wheat,

seeds of bean and squash. Their enormous hairdos serve as graneries.

When they reach the refuges in the forest, the women shake their heads

and thus fertilize the free land.”

- Eduardo Galeano, MEMORY OF FIRE, Vol. 2