Tuesday, October 19

The isolated Sierra de Guerrero resists the coronavirus pandemic without doctors

The door of the makeshift Médecins Sans Frontières (MSF) health center creaks open, kicking up a cloud of dust. It has been closed for two months, since the last visit by the toilets. Among the cabinets with old medications and expired vaccines, the team rushes to set up the practice in the dark room of moldy concrete. Outside, the few inhabitants of this region west of the Sierra de Guerrero, near the border with Michoacán, bypass the checkpoints of the armed groups to sit in the waiting room, eager to see a doctor after so long. José Pérez, a farmer who comes for a check-up, has a slight cough that alerts a doctor. With a calm gesture, he tells her to cough into his arm. “Let’s hope it is not the covid disease, the one that abounds so much out there,” he says amid the laughter of the patients who witness the scene. The virus has not penetrated this community, protected by the lack of access by paved roads, harassment by armed groups and the good health of its residents who do not usually wear face masks.

Pérez remembers the last nurse who worked in town. “Antonia was called. Good people, but he left us alone ”. His patient records, dated 2015, line the abandoned fridges of the practice. Pérez has heard of the coronavirus on the news. “It is a very bad disease, who knows how it is spread,” he exclaims. However, he is not afraid of covid-19, the disease that has claimed the lives of almost 118,000 people in Mexico, of which around 2,600 have been in Guerrero.

The town commissioner details from anonymity that Antonia stopped visiting them two years ago. “The hospital for which he worked told him that it was no longer safe to climb the mountains,” he says. Last year, his counterpart in the next town was assassinated by armed groups, which is why he asks that his name and the location of his town not be revealed for fear of revenge. The health center of this community is one of the six reported as closed medical units in the municipality of Petatlán, on the Costa Grande. Throughout the region, there are a total of 11 clinics that stopped operating for “security reasons,” according to reports from the State’s Medical Care subdirectorate. Despite the impossibility of detecting cases and treating them, the commissioner assures that they are not worried about the virus. “Only people enter here and the few that we are know each other, we do not need a healthy distance,” he says.

In the municipality of Petatlán and in the adjacent one of Coyuca de Catalán, where the communities visited by MFS are located, there are currently 20 and 24 active cases of coronavirus, respectively. The number could be higher if the infections are not being registered due to the lack of health services. Dr. Julio Violante is also concerned that with the temperature changes of this time there is a wave of flu or influenza and they will not be able to distinguish them from covid-19 due to the lack of evidence. “We could not know because we do not have specialized equipment, only primary care,” he laments. Added to technical difficulties are the superstitions of the population, victims of fake news that come to them by WhatsApp. Many believe that the virus is injected by the government to decimate pensioners, that doctors infect it on purpose, or that in hospitals they will become more seriously ill. In addition, to avoid encountering armed groups, they evade going to the hospital despite the consequences.

– So, in the event that a serious case of covid appears, what could be done?

– Many times patients decide to stay home and it is a form of euthanasia, a quiet death.

The reasons for the virus not having crossed the walls of the mountains are various and relative, according to Violante. In the first place, it points to the chronic isolation that these communities suffer from violence. “There is a dispute between different armed groups that sometimes get the support of organized crime to finance their battles,” he says. He does not know exactly what groups they are, since patients speak with great suspicion of them, as one who lives under the threat of an omnipresent but intangible enemy. Suspicions point to militants from the Union of Peoples and Organizations of the State of Guerrero (UPOEG) and brawls between families.

The fight for the territories to control the production of wood, avocado or marijuana keeps the access routes to the towns guarded and controlled at the point of the AK-47 rifle. “Neither the teachers nor the priests arrive here because of the harassment,” says Violante. In addition, this violence dissuades the residents themselves from leaving the borders of their communities, since crossing areas dominated by the group contrary to the one that reigns in their community is a mortal risk. With almost no human traffic, the chances of the virus entering the neighborhood plummet.

The difficult access by roads also works in favor of the community to prevent infections. The hundreds of kilometers of dirt that must be traversed involve several hours of travel in specialized vehicles, only accessible to a few. In the rainy season, when the routes turn into slippery rivers of mud that flow into dizzying cliffs, only a few people dare to venture down them. This involuntary protection is also one of the reasons why the sanitarians assigned to these villages resign from their posts after a few months. “Pregnant women and the sick should go to the nearest hospital, which is about ten hours away,” Violante points out. The cost of the trip reaches 5,000 pesos (250 dollars) between gasoline and accommodation, the amount that a rural family needs to live for three months.

The lifestyle and diet of the sierra have also played an important role in the resistance of the population, according to Violante. As they do not have access to large stores or a supermarket, most are self-sufficient with their crops of corn, beans and vegetables, while the meat is obtained from hunting or their own livestock. “They live from cultivation, so we have not detected serious patients with diabetes or hypertension as happens in cities,” he clarifies.

However, natural retaining walls and violence are not infallible. Four hours from the town where Violante attends, Dr. Sibalahums Diaz recalls how he had to deal two months ago with the only cases of coronavirus in the entire region, some peasants who traveled to the city market defying the checkpoints. “It was strange because here we are isolated, people do not leave because of violence,” he details from his clinic, the only one operating in hundreds of kilometers around. His patients, frightened by hospital videos on social media, refused to go to a specialty center and were treated in isolation. Fortunately, they did well and did not initiate an outbreak.

Díaz works at the clinic alone. The last nurse left after violent incidents that frightened the community. The town is in the battle line of two armed groups and the shootings are becoming more frequent and bloody. “Without going any further, on August 25 a confrontation with shots began that lasted from ten in the morning until six in the afternoon,” he says. A few meters from its center, the charred ruins of several houses are evidence of a struggle that forces several families to become displaced, decimating the population of these communities. Among the black remains of the furniture turned to ash, only the metal cutlery and some photos have survived the fire of the messages of power from the armed groups. This situation of violence has led Díaz, who accepted the job 10 years ago to defend the right to universal health, to want to request the transfer.

–And what will happen to your patients if you leave?

“I want to believe that they will send another doctor.”

That hope is what a neighboring avocado community still has. Neighbors organized to build a clinic more than a decade ago with their own resources. However, the doctor sent by the Ministry of Health only lasted one year. Since then, the inhabitants of the town have resisted with home remedies, like Juana Núñez Pérez. She is one of the oldest women in the community, to the point that she says she does not remember her age, but with a gesture of contempt she says that she is not afraid of the virus. Desperate, she shows some pimples that have appeared on her neck and that despite adding mezcal every day, they do not go away. You will have to wait at least another month or two for MSF to visit the village.

José Luis Arriola Lagunas is one of the community’s social leaders. He has come out on several occasions to lift the trail of corpses left by the clashes in the streets and ensures that the virus is the least of the concerns for his people. Now that the Army, which was sent to appease the violence, is leaving the community; They hope that the confrontations will return to star in their routines. “We trust them less and less [al Ejército], especially after the ‘Cienfuegos case’, but when they are sent the shootings stop for a few months ”, he explains. Arriola acknowledges that he has considered leaving the town to become one more displaced person after having to hide from the bullets with his children in the only concrete room in the house. However, like all the inhabitants of this rural area, he is determined to stay and change things with the avocado cultivation. Hopefully, the business will encourage the construction of asphalt roads, promote inland tourism, and allow their offspring to stay in town without suffering so much violence. Asked if he thinks that with the construction of roads they will send doctors and teachers to serve the people, he smiles patiently. “Everything is possible”, sentence.


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