SAN CRISTÓBAL DE LAS CASAS -- Amidst broken windows and makeshift walls, sewer rats play among boxes of nutritional supplements for malnourished babies and nursing mothers.
This is the clinic at the Municipal Recreational Center (CEDEM) in San Cristóbal de las Casas, Chiapas, where more than 33,000 of the city’s poorest residents obtain medical services each year.
The bulk of the CEDEM clinic’s patients participate in Oportunidades, a government program with the stated mission of “promoting human development among the population living in extreme poverty.” The program offers a range of services to marginalized families including scholarships and cash to defray food and electricity costs. Oportunidades participants receive free health services including prenatal care, nutritional assessment and prevention and detection of cervical cancer.
The health services provided are obligatory for families enrolled in the program. If someone misses scheduled doctor’s appointments, their monetary aid is docked or eliminated.
But many of the families who receive help from Oportunidades complain that they receive substandard treatment at the CEDEM clinic, and that the clinic’s offices and examining rooms are dirty and unhygienic. Complaints about pap smears are particularly common, with many women saying that the tests, essential in the detection of cervical cancer, provoke pain and bleeding, and many say they have never seen their test results.
In light of the clinic’s conditions, these families find themselves in a tough situation. If they stop going to their appointments at the CEDEM clinic, they will lose the much-needed monetary support. But some say the care that they receive there causes more harm than good.
Last year, Maria Estela Constantino Zuñiga, 44, had a pap smear at the CEDEM clinic that she said provoked discomfort and bleeding for more than two weeks after her appointment. “I was in pain. My uterus was very sore. I was like this for at least 15 days,” she says. Clinic staff, she said, gave her no explanation for the pain and never gave her the test results.
In April, Zuñiga went back to the CEDEM clinic for another pap smear. This time, there was no pain or bleeding, but she says the test was performed on a bed with no stirrups. Zuñiga is a large woman and when the nurse asked her to hold her legs up so she could give her the test, she could not physically do it.
“How do you expect me to hold the position if there are no foot supports? You'll have to lend me your shoulders because I can’t do it alone,” she told the nurse who treated her.
Another CEDEM Clinic patient, Maria Vasquez Martínez, 23, also experienced a painful pap smear. Vasquez Martínez went to her scheduled test in the fall of 2006. She says she felt pain as the nurse removed the instruments from her body. Vasquez Martínez left the clinic bleeding with a sharp pain in her lower abdomen.
Vasquez Martínez said the clinic facilities are subpar, “The health center is always dirty. There’s no one who cleans it.