Community self-defense, capitalism and COVID-19

On the evening of April 27th, I received a message from my compañero Jaime Montejo. He was letting me know, through his life partner and his partner in struggle Elvira Madrid, that he had been diagnosed with pneumonia caused by COVID. They were trying to get him into a public hospital. 

They sent me a photo of his triage sheet (a classification based on the seriousness of the patient’s illness) from the National Institute of Respiratory Illness (INER), in Mexico City. In the section on his vital signs, it showed oxygen saturation levels of 78 percent. One of the signs of the seriousness of COVID-19 is low oxygenation, and anything below 90 percent is a general parameter for hospitalization. Jaime’s count is well below that.

Elvira informed me that they were trying, for the third time that night, to get Jaime into a hospital. I can hear tiredness and worry in her voice. I know that she’s also got symptoms, but the one who needs help urgently is her partner. A volley of frantic messages between myself and other doctors begins. I’ve never worked in Mexico City, and I don’t know what the best strategy is to make sure Jaime gets the attention and treatment he needs.

Jaime Montejo (far right) and Elvira Madrid doing solidarity work in the streets of Mexico City. Photo: Brigada Callejera.

My colleagues in Mexico City advised me to review the app that the municipal government has created to orient the population regarding the availability of hospital beds in hospitals run by the Health Secretary, the Mexican Social Security Institute (IMSS), the Civil Service Social Security and Services Institute (ISSSTE) and the city government. I take down notes on which ones appear in green and yellow. Among the hospitals where Jaime’s insurance applies, few have room.

I again speak with Elvira. She sounds exhausted and outraged. She says that she has just been told by the personnel of the INER, where Jaime is, that the two options I mentioned might have beds available according to the app actually have no beds. It’s impossible that the app is actually up to date on the exact number of beds available. My frustration grows. I go back to consulting with my colleagues. Oxygen saturation of 78 percent is a certified emergency. Would an IMSS hospital actually reject Jaime under those conditions, even if he isn’t a policyholder?

I work in an emergency room in an IMSS hospital in the state of Veracruz, and I know that in my hospital, he wouldn’t be turned away. That said, I don’t know what the policies of attending to COVID patients are in Mexico City. 

But there’s consensus among my colleagues: he should be accepted, at least long enough to receive initial treatment. I suggest to Elvira that they take him to the IMSS hospital in Villa Coapa, which is the closest to where they are. It’s 11pm. Elvira writes back: “I’m on my way.” And I wait.

Meanwhile, my colleagues and compañeros continue to send messages. I ask them to let me know if there’s another option. That’s how we’ve resolved emergencies in other cases, joining forces through our support networks. How else?

Amiga, were you able to enter?” I messaged Elvira at 12:55am. She wrote back: “No, we’re on our way home.” My heart sunk. I told her I would keep asking other people I know to try and find a way to get Jaime into hospital. I couldn’t imagine what they’re feeling.

As it is, Jaime’s oxygen level being so low produces anxiety. How is he doing? I ask myself. Jaime is a person who, at 56 years old, is known for struggling for the collective rights of those in the most difficult circumstances, including those with health conditions. 

Now he needs something so minimal from this system because of the physical precarity he is living. How can we name the phenomenon for someone who doesn’t receive the attention they require? Is it negligence? Is it systematic and imposed death? Omission? Classism? No matter what we call it, it is more than a simple pandemic.

On television and in social networks, the federal government continues to publish declarations and COVID data about how and when to seek treatment at a hospital. But there is a huge disconnect between the official reports and what is being lived from below. Dr. Eva Tovar Hirashima, an emergency doctor, wrote the following on her Facebook wall:

It would be interesting if [during the daily COVID briefing] a reporter asked for the microphone and patched in a colleague outside a hospital, interviewing someone who has a saturation level of 80 percent, with a bleeding digestive tube, who was just turned away for the third time from emergency, and who is going all over looking for somewhere that will take them. I wonder what that person will think when Dr. López-Gatell explains the urgent symptoms with clarity and tells those experiencing them to go to the hospital or to the clinic or to call 911 or to open the Susana Distancia app. What will that person think when they hear the authorities saying things that, though they sound coherent, don’t appear to apply to the majority… In English it’s called gaslighting. In Spanish it’s called a daily report.  

Early the next morning we start looking for a hospital bed for Jaime again. At 8am I get a message from Elvira. “Everything was full, everything that is happening and everything I saw is so sad.” Then, they didn’t pick up my calls. I worried that Jaime was getting worse. I get news that he could be admitted to another hospital. I try and send the information to Elvia through other contacts. 

At noon, a compañero wrote to say that Jaime and Elvira were in the General Hospital, and that Jaime might get a bed. I feel a first wave of relief. Days later, I learned that Jaime had tried to get a bed in 17 public and private hospitals, beginning on April 26. When he was finally accepted into the General Hospital, his oxygen saturation was 58 percent. “I saw many waiting, and I saw many people die,” Elvira told me. 

Close friends of Jaime hoped he was receiving adequate treatment, that his body would respond and survive this onslaught, as he has so many times in his life. We hoped that Elvira could rest and be looked after. Those were the wishes of those who have known these two exemplary compañeros through the years.

Over the next few days, there are intermittent updates from the compañeras from the Elisa Martinez Street Brigade in Support of Women, an organization dedicated to helping sex workers, which Jaime, Elvira and others founded in the 1990s, after making contact with sex workers while studying Political and Social Science at the Autonomous National University of México (UNAM). 

The Street Brigade, la Brigada Callejera, now has more than 25 years of experience accompanying and organizing with sex workers in México City and in Tapachula, Chiapas, on México’s south border. 

Their struggle has been fundamental in guaranteeing more safety for sex workers, trans people, migrants, and people living with HIV and AIDS. The Brigada Callejera has pushed for access to health services on behalf of those who have been marginalized, oppressed and forgotten by the state and society.

Among a multitude of actions carried out by the Brigada was the creation of a line of condoms and clinics to provide health outreach for sex workers. They also managed to have sex work recognized as a legal activity in Mexico City. The Brigada has been able to listen to sex workers, not as victims but as political actors with their own voice. This became a key moment in cementing their practice of political learning through listening.

When the COVID pandemic arrived to Mexico, Jaime and Elvira didn’t shy away from doing everything they could so that sex workers would not end up without income or housing. They organized a community kitchen and delivered foodstuffs, as well as pressuring politicians in Mexico City so that they would attend to the basic needs of workers. It was during these activities that they were infected with coronavirus.

On Tuesday, May 5th, I received a call from a doctor and comrade from the state of Guerrero. He was one of the people who has been looking out for Jaime from a distance. We spoke briefly about other things, and then he asked: “are you sitting down?” My pulse and my breathing slowed. I knew the words that came after would affect me, and my body imperceptibly prepared for the blow. 

He told me that Jaime died early that morning. We talk some more. He tells me to rest, that I shouldn’t go in to work, and he hugs me with his words and his tone of voice. We hang up. I rest my head on the wall and cry. 

The days to come are days of collective tears. There is a surge of rage through the thick air, a pain shared by so many. We write to each other. We hug from a distance. Many share their concern for Elvira. Days pass and we still can’t accept a world in which Jaime isn’t there to face down, together with us, the injustices of the system that left him adrift.

Until the last breath of his life, Jaime accompanied those who have been marginalized in Mexico City. He did what he knew was right, dignified and just, and he knew the risk it represented. That’s how COVID-19 found him: carrying on in profound coherence. Walking in community. 

It’s not that Jaime didn’t understand the directions to stay at home. Rather, he understood all too well that there is no possibility of quarantine for the most vulnerable. And he refused to allow them to be alone. 

Days before, Jaime wrote the following words to Sergio Rodríguez: 

Sergio. I write to let you know that Jaime and Elvira are in quarantine with all the symptoms of COVID-19. We couldn’t not fight the last battles, we were in the streets with the community kitchen, handing out condoms, accompanying people with HIV to the Condesa clinic so that they could re-start their treatment and so that COVID-19 didn’t infect them in no-man’s land. We cannot give attention to the sick from the comfort of our homes. Every struggle has its risks, and mitigating the disadvantages was the only thing we could do.

Insurgent Love

I don’t know if Jaime would have survived COVID-19 if he would have received medical attention from the first moments he experienced breathing trouble, or if traversing the city during three days with dangerously low oxygen saturation guaranteed his passing. 

During the last months that I have been helping patients affected by COVID and studying the experiences of specialists from countries hit hard by the illness, I can confirm that the early diagnosis and treatment of hypoxemia are among the most important factors in improving a patient’s prognosis. “The disease course is not inevitable,” wrote US emergency doctor Richard Levitan on Twitter. “Earlier diagnosis and treatment (oxygen, positioning maneuvers, tracking biomarkers, [treatment with] anti-inflammatory agents) has much better outcome.”

Jaime was denied the medical attention he needed. He should never have been denied medical attention with such a low oxygen saturation, his family should never have had to take him from one place to another on their own. Health services should not depend on knowing people who can advocate for adequate care. No health institution should deny emergency attention. Health services should be free and of high quality for all. 

The denial of service caused emotional and physical trauma for Jaime and Elvira. The failures of a health system which has been dismantled and left precarious leaves profound marks on the population which go beyond the morbidity and mortality that are registered in statistics. By the intentional design of the political and economic system, the health system in which I work reproduces the logic of necropolitics, in which the bodies of many are considered excess. 

Over the last months, the federal government headed by Andrés Manuel López Obrador and civil servants from the health institutions have appealed more than once to the virtuousness (nobleza) of health care workers in their attempts to deal with the crisis of the pandemic. 

The generalized experience of health workers over these months has been one of anguish, exhaustion, anger and profound disappointment, as they have been obliged to work without adequate equipment. For the first time in what might be a long time, during this pandemic, health workers have also had to accept a reality in which we too are disposable. 

The war is elsewhere

There have been frequent references to war during this pandemic. Health workers have been compared to soldiers. The coronavirus has been called a stealthy, well prepared and merciless enemy. But I don’t believe in that paradigm. I don’t think COVID-19 is our enemy, or that the pandemic has brought war to our lives, and I dare to imagine that Jaime would agree with me.

I think he, together with sex workers, people with HIV and AIDS, migrants, thousands of victims of enforced disappearance, assassinated human rights defenders, the children of the mountains of Guerrero trapped by the opium poppy harvest, maquila workers in the north of the country, the hundreds of thousands of people who don’t have a dignified wage and lack social security or a dignified retirement, the victims of torture and extrajudicial assassination carried out by police and soldiers, together with the thousands of health workers who experience, every day, the weight of not having enough equipment or supplies to provide quality health services to our patients, would agree with me: for centuries in Mexico we’ve been subject to a war.

Were this not the case, Jaime Montejo would not have been in the streets of Mexico City, trying to diminish the intensity of the symptoms of this war. In the US, COVID has disproportionately impacted African American communities, in Mexico, it has most impacted the most vulnerable people. This propensity is rooted in conditions of profound social, political and economic inequality, not in genetics. We were in a war, long before COVID-19. Jaime, like many of our colleagues, lost his life because of this war.

Just a few months before the first case of COVID-19 was announced in Mexico, I was in a community in the state of Guerrero, in a workshop organized by the Community Health Brigade 43, to which I belong. I remember having thought and shared then with the others that we had to prepare ourselves in health knowledge for a moment when it became impossible to leave the community.

At that moment, the major concern that brought about my reflection was the repression and violence that is lived in the region: war. I never thought it would become reality so quickly, much less because of a pandemic.

Maybe in a few months, the COVID-19 pandemic will “pass.” There will be secondary outbreaks, and isolated or group cases. But the war that many call “normality” will become even harder. There are reports of regions in Mexico where people are close to going hungry. Those who have foregone treatments because of suspensions of health services related to the pandemic will likely experience relapses and worsening of their illnesses. Mental health will deteriorate collectively. The population control measures that were implemented during the pandemic will likely continue as norms. The global recession has already begun. 

What can those of us working from below do now?

As a doctor, I have had the experience of working inside the state health system and autonomously, building community health. I hope that in the coming days, months, and years, we find ourselves bringing to life the profound lessons that Jaime’s life and death leave us.

These months of the pandemic have made clear that if we don’t take the urgent task of weaving our networks of solidarity seriously, we will be increasingly vulnerable to the expressions of a system that distributes death: pandemics, military repression, displacement, death from curable illness, hunger, lack of water, precarious work, environmental destruction, and so on. 

In a talk I gave to medical students at the UNAM last year, I spoke of the importance of defining which side we’re on. The experience of this emergency has brought me back to that proposal. As part of the health sector, we are subject to abuses of authority from above, inadequate working conditions, budget cuts, reduced salaries, uncertainty, and worsening conditions for retirement. That said, we have to have clarity and honesty with regards to how we have participated in the reproduction of this violence. 

Who decided to prioritize the life of Jaime on April 27th and 28th, and who decided not to respond to the needs of the human being in front of them? Where have we been as a sector as the other sectors in the country have been under attack? When was the last time we marched or protested for the rights of the people more generally, and not just for salary raises or to protest the increasing number of legal demands against us? For the right of our patients to health? When was the last time we joined the efforts of family members of the disappeared, took a position against feminicides, or demanded universal health?

The gap between health care workers and the rest of the population has increased over the last decade. The era of uprisings when white coats walked shoulder to shoulder with other marginalized groups has long passed.

Given that, it is important to share the historical context of the events which took place at the Hospital de las Americas in Ecatepec, in Mexico State. There were demonstrations that stemmed from the frustration of huge segments of the population, who shared the belief that patients were being killed inside the hospitals. 

Though this seems ridiculous to those of us who work as health professionals, we should interpret these protests through an understanding of what the population generally has experienced in their interactions with the health system over past years. Instead, health workers reacted by disparaging the people of Ecatepec, calling them violent, ignorant, “nacos,” and even calling for them “not to be given medical attention,” showing that we’re not listening. 

It is assumed that as health workers, we are those closest to the human condition and the experience of illness. Why aren’t we the first to recognize and to speak out against inequality and systemic violence? Why, in a country where two thirds of the population works in the informal sector, have health care workers not pressured the federal and state governments to provide the economic and social support necessary so that the most vulnerable can quarantine? 

Now that we’ve experienced the reality that we can get sick and even die, many compañeros have felt some of the vulnerability that predominates in the lives of many Mexicans, with or without the pandemic. Will we be capable, as a sector, of developing a critical eye and building bridges among those under attack?

In an unusual way, the pandemic has put us as health workers in a situation in which we could die just for carrying out our work, and in which our rights as workers are rolled back and pushed outside of the priorities of neoliberal logic. This, far from making us exceptional as heroes, should bring us closer to the experiences of many workers in other sectors in the country. The clinical encounters in the context of the pandemic have become windows into the vulnerability that the majority of people in Mexico face.

The Community Health Brigade 43, in which I participate, was born in large part out of the experiences of negligence, racism, classism, and gender violence that inform the encounters of the people of central Guerrero with the health care system, but they’re not only present in that part of the country.

The experience of Jaime and Elvira are proof of that. In the heart of the experiences of community health –of which the work of the Brigada Callejera, the Community Health Brigade 43 and the Zapatista health system are part– another reality is affirmed: making community heals. It is the best option for those of us who believe and defend health for all. 

Are we going to wait until the next pandemic and hope that the structures that are set up from the perspective of the utility of bodies will look after us? Or will we start to dignify our territories and our lives with holistic social self-defense that include training in health care that is centered on life? We’ve always had the choice. Just as they’ve always made war. 

Before his death, Jaime left us with a solid example to follow when he said “After COVID-19, the class struggle will deepen in every corner of the world, and we’ll be there to keep struggling and destroying this system of death.”

Click here to read part of a broadcast on the impacts pandemic by Jaime Montejo.

Translated by Toward Freedom with permission from the author. Read the Spanish version here

Author Bio:

Mandeep Dhillon is an emergency room doctor based in the state of Veracruz and a member of the Community Health Brigade 43 in Tixtla, Guerrero.