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morning conference on 6 September 2022 dealt with traditional medicine (TM) specialists in their capacity as human resources for community action in primary health care.
The Undersecretary for Prevention and Health Promotion of the Ministry of Health (Ssa), Hugo López Gatell, presented the terms that seek to modify the regulatory framework on midwifery in Mexico –announced a long time ago– without documenting progress, responsibilities or when it will be seen. the incorporation of TM to the National Health System. María Elena Álvarez-Buylla, from Conacyt, presented the research to scientifically endorse the implementation of TM regarding the arsenal of herbal resources. Then, Zoé Robledo, general director of the IMSS, affirmed that “we want to present how midwives have been integrated -for 43 years- in the process and in the Comprehensive Health Care Model (MAIS) of the IMSS-Bienestar (IMSS-B ) since its birth as Coplamar”.
It would be expected that, next, he would expose the specific strategy that operationally incorporates TM. But not! Robledo presented a video specifying that the MAIS links
medical/preventive actions with community participation, providing free services (first and second level) with assistance/preventive network and promotion/education actions for health. And, since health care is the responsibility of all
, community knowledge is also integrated by providing care in native languages with bilingual staff. We count, she assured, with the support
solidarity of 754 traditional doctors and 6 thousand 664 rural voluntary midwives.
In addition to avoiding recognizing that what remains of the original MAIS is, strictly speaking, just a ruin (see Sánchez, Leal, Escobar and León, Community action in the IMSS-B: Operational visions of the other story2021), more than numbers, Robledo had to explain what community action does and why he promoted TM from the beginning: what, how and why these doctors and midwives do.
The work of these specialists has changed over the years. Today, traditional doctors number less than 800, but their rescue from the abandonment to which they were confined by the medicalization of the MAIS imposed by neoliberalism is recent. The TM meetings were suspended in 2010 and reactivated in 2022. They seek meetings between allopathic/institutional doctors and the TM to facilitate referral/counter-referral of patients to the hospital level for the benefit of community care. Every time that the traditional therapist –knowing the local diseases– operates as a bridge with the institutional doctor. It will still be necessary to evaluate the true operability that these meetings have recovered.
In the case of midwives, today it would be enough to consult them about the treatment they receive: they are prohibited from attending and they are only allowed to refer pregnant women. The figure reported by Zoé Robledo is far from the 7,700 of the historical census. Are they being discharged for refusing to stop attending according to their tradition and custom right there where there is no other health infrastructure? In addition, those who choose not to leave the trade must now face the way in which they are denied birth certificates.
Responding to the question, how much does a midwife earn?, in another morning conference, on November 1, 2022, Robledo affirms that about 1,500 pesos and we want to increase them
. In truth, they earn 500 pesos a month in four annual payments: a total of 6 thousand pesos. And this depends on resigning from the profession, since only pregnant women are referred to the nearest hospital.
for something the most recent WHO report on maternal death (WHO, Trends in maternal mortality2023) maintains that, every two minutes, a woman dies in childbirth or derived from it due to poor care, while Natalia Kanem, head of the United Nations Population Fund (UNFPA), assumes that the challenge of maternal death consists of invest urgently in family planning and covering the global deficit of 900,000 midwives
.
While neoliberalism opted to collapse the validity, use and practice of TM as a local/cultural model for community health, imposing medicalization, what was put on the table is a complex matter that alludes to the view of the institutional health system on it. .
Beyond the folklore that permeated the visions
neoliberals, the conference also aimed to verify scientifically
the effectiveness of the herbal model. Because how many, of all the academic articles on herbalism, are intended to show that it does work? When the original IMSS-B program had already sufficiently proven the relevance of the mixed health model with local and institutional resources.
So the conference on TM falls far short of community action in primary health care that should strongly guide the semi-urban and urban operational backbone of OPD-IMSS-B.
* UAM-X