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INTRODUCTION
It was a long time coming,
this very terrible break between AIDS officials in the government of
Oaxaca and the members of our organization, the Frente Común Contra el
SIDA (Common Front Against AIDS). Thirteen years, in fact. During that
time the relation had been on-going, if sometimes rocky. Then our
organization brought to their attention the lack of medications for AIDS patients in our state. The
director of the state AIDS council, COESIDA, reacted first by ignoring
our comments. When we continued, she then began moves to discredit our
organization and later to hinder our work. The naming of Oaxaca as host
for the national AIDS convention last year brought the matter to a head.
There could be no criticism of government officials in Oaxaca.
This corresponded with the now well-known
government movement against the people of Oaxaca and the brutal wave of arrests,
disappearances and political assassinations which followed.
Fifty-six opposition
leaders were killed in 2006 alone.
It was a long story, as I
say, and complex. The following are excerpts from my journals during
those years.
THE FIRST SURVEY OF
PATIENTS
By the year 2001, our
organization was operating a small program of paying the reimbursement
of travel tickets for patients from out of town who needed to come into
Oaxaca each month for their appointment with the doctors at COESIDA and
receive their medicines. It was well known that the new medicines,
especially the so-called “cocktail of three,” which was very expensive,
must not be interrupted or taken irregularly by the patient because the
body will build an immunity to the medicine and it won’t work. Then the
doctor must prescribe a new combination of the “cocktail” for it to be
effective. In poor areas of already scarce resources, of which there
are many in Oaxaca, this can mean patients going without their medicines
and getting sicker and dying.
The project had begun in
our old offices on Alcalá with a few patients, first “Chole”, and then a
couple others. But soon word was out and more patients heard about this
“free money” for their bus tickets, and then COESIDA began sending their
patients to us, and soon the project grew to reimbursing the tickets of
about thirty-five patients. We felt good about the program but it was
costing us a lot, at one point around six hundred dollars per month.
That was as much as our rent!
Well, we managed to find
the money somehow and also got to know the patients, who were all really
nice and, of course, very grateful always. And we started talking with
them and asking them how they were doing and how was their treatment at
COESIDA. We soon began to realize that the patients were getting
different medicines, some good, some not so good, including some were
receiving none, told to come back next month.
Worse, we found many of the
patients with no idea what their medicines were for. Some, receiving
AIDS medicine, that is the antiretroviral “cocktail,” and understood
what they had, but many, receiving pills for diarrhea or simple vitamins,
thought they were receiving AIDS medicine. Some patients even spoke of
the “cure” they had received and show us their pills. We didn’t have
the heart to tell them otherwise.
We made a few phone calls
to friends or acquaintances at COESIDA and been told, “Well, there
aren’t enough for everyone, you know,” or “We’re doing the best we can,
Bill.”
We decided to look at the
patients’ treatment a little closer.
*
* *
We began an informal survey
of the patients we had coming to us, as I say around thirty-five, with a
simple form we made, what medicines they had received, how they rated
their attention, what was the name of their doctor, and such. The
patients were more than happy to answer our questions and even show us
the bottles of medicines they had received. We calculated the results
immediately: around 30 per cent were receiving a full “cocktail of three,”
9 per cent were receiving the cocktail “irregularly,” that is not every
month, 24 per cent receiving only one or two medicines and fully 36 per
cent were receiving no AIDS medicine at all.
* *
*
Back in our office, we
rethought our strategy. First was the obvious: we had our data, our
facts; many patients were NOT receiving the medicine they should.
Further, we certainly had sufficient support from the
local press to go ahead and tell our story.
And so, we sent the guys
around with the camera and took some photos of the COESIDA offices and
their clinic, and sent out the first of our press releases, stating
clearly that not all the patients of COESIDA were receiving the
attention they should. We wrote a great letter to the editor of La
Jornada in Mexico City, easily the most prestigious in the country. We
faxed it off and it appeared the following day. Suddenly there was lots
of talk. The local papers were calling for interviews and articles were
appearing. We sat back and awaited the results.
* * *
THE SECOND SURVEY OF
PATIENTS
We soon received a visit
from our friend, Dr. Miguel Angelo Ramírez Almanza (BELOW). He had been
one of the founders of the Frente and our first president of the board.
He had always been a strong supporter, and during the years had risen to
a fairly high position in the Secretary of Health. He could not believe,
he said, the situation with the medicines and that something should be
done to follow up. He offered to talk to his boss, the Secretary, and
others who should know about this and see what action should be taken.
He asked for copies of all our data and promised to talk with us again
in a few days. His intervention would prove to be decisive.
He came over to our office again a few
days later and said that he had spoken to the Secretay of Health, Dr.
Rafael Aragon Kuri (BELOW), who said that he was interested in seeing this
problem addressed. Dr. Ramírez was to arrange a meeting with him and
with us and with COESIDA.
A few days later, he
called to say that COESIDA had agreed and was planning to have a
breakfast meeting to discuss this matter, in, it so happened, one of the
most expensive restaurants in town. They had the day and the time all
set and had made reservations at the restaurant.
Well, we thought about it
for a couple hours and reported back, No thank you! We would prefer a
simple meeting of twenty minutes, to lay out our case and hear what they
had to say. If they had extra money for pay big, fancy breakfasts, they
should spend it on buying medicine for patients who need it, we said.
I reported some of this to
Mary Jane Mendoza at the gallery, always a great supporter. “Good for
you, Bill!” she said, “There’s too many breakfasts in Mexico. Too, many
times they think everything can be glossed over with a fancy breakfast
or a big dinner, and all their problems will go away!”
So a simple meeting was
planned. Dr. Kuri couldn’t make it (Gee, what a surprise!) but there
would be Dr. Ramírez, the Doctora Gabriela and perhaps someone else from
COESIDA, and Ayax and myself from the Frente, and that would be all. It
would be held in the headquarters of the Secretary of Health.
I was a little nervous, of
course, but I didn’t look as bad as the Doctora Gabriela, already seated
when we arrived, alongside Dr. Sandra Pérez, one of her assistants.
Dr. Ramírez opened with a
few comments and turned to me and Ayax. We brought out our graphics of
the sample survey of 33 patients, and noted that only 39 percent were
receiving a cocktail of three.
They became very defensive.
No, we were wrong, they said. We didn’t know what medicines we were
talking about, the patients were not answering us truthfully, and
finally that our small survey was not representative of their patients
as a whole.
We looked at each other and
replied, “Well, then the only way to know is to survey all the patients
and learn the truth.”
“Yes, that would be best,”
said Dr. Ramírez.
Gaby gasped.
We were prepared. I
brought out a sample questionnaire, asking for no name, but a complete
list of the medicines received by the patient.
“Fine,” said Dr. Gaby,
grabbing the questionnaire from my hands, “we’ll ask them.”
“No,” I said, looking at
Dr. Ramírez for reassurance, “WE should ask the patients; the Frente
Común should conduct the survey.”
“Yes, of course,” said Dr.
Ramírez, “that would be more appropriate. Can you do that, Bill?”
And so it was arranged that
the Frente Común would conduct a complete survey of all the patients of
COESIDA; that we would be standing in the entrance to the clinic and
that they would present each patient to us after each appointment. We
would be there from 8:00 in the morning until 4:00 in the afternoon,
everyday for one month, starting on the first of March, a few days away.
They glowered at us and
silently walked out of the meeting.
“Well, Bill,” said Dr.
Ramírez, “is that what you wanted?”
“I guess so, Doctor,” I
replied.
* * *
In all, 145 patients were
interviewed. Many expressed their deep thanks that we were doing this
and wished us well.
And we were able to show
that still only around 41 percent of the patients were receiving a full
cocktail of three, very close to our original survey. On the first day
of April, we sent four pages of graphs and numbers (BELOW) to all
involved and Dr. Ramírez planned a follow-up meeting.
That meeting, with much
the same people as before, took place in the COESIDA offices. This time
Doctora Gabriela was in charge. She slowly announced: they had done
their own survey, she said, and she handed us a set of graphics. It
showed very different results: fully 100 percent were receiving all
their medicines and fully 100 percent were “very satisfied” with their
treatment.
I looked at Dr. Ramírez.
He started to speak.
“But, that’s beside the
point,” interupted Dr. Gabriela, “we have just received more medicines,
from the federal agency, enough for 50 more patients. Now there are
sufficient medicines for all the patients who need them.” She stood and
walked over to a large number of boxes, indicating, “Here they are.”
She scowled at us.
Nancy later said, Bill, you
should have asked to look in the boxes; they could have been refried
beans!
So, without acknowledging
our survey or its results, the authorities of COESIDA had indeed come up
with additional medicines for almost all the patients who needed them.
It was made clear to us that we would not say another word, and we
didn’t. But it made us feel pretty good, and I imagine the patients
pretty good, too, to have resulted in more and better treatment for our
people.
* * *
THE NATIONAL AIDS CONVENTION
IN OAXACA
...
* * *
AN
UNHAPPY CONCLUSION
There is no question the
Common Front Against AIDS has become another casualty of the corrupt and
repressive government of Oaxaca. High officials in the health
department have no interest in the health of the people. The current
Secretary of Public Health, appointed by Ulises Ruiz, in one short year
has become one of the wealthiest men in Oaxaca, recently buying an
enormous mansion in San Felipe de Agua, the rich enclave a dozen miles
north of Oaxaca city. The director of COESIDA, Gabriela Velàsquez, is
the wife of the largest contributor to the
political campaigns of both ex-governor José Murat and current governor
Ulises Ruiz.
Ulises himself was head of
security for José Murat during the first wave of political killings that
swept Oaxaca several years ago. In the past year alone,
fifty-six opposition figures have been assassinated by the state. Five indigenous leaders were killed on the
very weekend we
received the final threat from COESIDA.
This is not a government to
be criticized.
* * *
On Sunday was the incident.
We later met and it was agreed I would sign a document with the
government promising to have no part in the national convention, to
cease activities concerning HIV/AIDS in Oaxaca, to not speak with the
media, and to not mention the above "incident."
* * *
Shortly after, there appeared the following comments
from Internet Website, RealOaxaca, by Stan Gotlieb:
" ...Whether in the streets of New York by
uniformed police, or Oaxaca's state university by
unidentified "porros" (non-students hired to go in and
kick ass), against demonstrators, dissenters, or
journalists, the goon squad is a standard response of
tyrannical bosses aiming to bust up unions, secret
governments suppressing dissent, or any one of a hundred
different kinds of "troublemaker". Dictatorships and
would-be dictatorships all honor similar terroristic
methods for controlling their populations. Hardly a
country in the world that doesn't unleash the dogs (figuratively
and/or literally". We all "know" such things go on.
However, there's "knowing" and then there's "knowing".
When the knock comes on your very own door, your world
changes forever. Last month, they came knocking on the
Frente's door. They showed up at Condón Mania, the
highly successful store that sells condoms at just
enough over cost to stay in business. They gave a
little demonstration by smashing the windshield on one
of the workers' car. They gave everyone some advice
about how to avoid these kinds of visits in the future.
..."
* * *
At this point we do not
know the future of our organization. Our activities have been greatly
reduced during the past year and look to be further diminished. If need
be, the organization is well prepared to discontinue its existence at
any time.
* * *
Bill Wolf
Oaxaca, Mexico
January, 2007
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