By managing mobile medical teams that serve women in remote Mexican villages, Delia Villalobos is breaking the traditional silence that surrounds reproductive health care.
Delia believes that in order to maintain good health and prevent illness, women must have a positive attitude towards themselves. In Mexico politics, religion, and tradition discourage women from asserting control over their health. Poor health is a cultural problem -- one of beliefs, values, inhibitions -- as much as a structural problem caused by poor services and infrastructure. Delia is changing both cultural and structural aspects of Mexican medicine by sending mobile clinics into remote rural areas, where health care is scarce. The medical teams treat women and prepare them to set up ongoing community health services. In addition to offering reproductive health services, they run workshops in which women can discuss openly their sexual health and train local health promoters who continue community care and education.
Women in rural Mexico suffer the twin exclusions of distance and silence. Living far from clinics and hospitals, they simply don't have consistent and reliable access to professional health care. The government can't afford to build, staff and supply clinics to serve the small client bases in remote mountain districts.
But the need for health care is great. According to official estimates, the State of Michoacán has the third highest rate of deaths caused by undetected cervical-uterine cancer. The State also lacks prevention and treatment for sexually transmitted diseases: 90 percent of women suffer from vaginal infections, hemorrhages, tumors, and fibroids. Though the government tries to care for rural women, it tends to look only at health services and not at health education.
However, silence may be the real killer, for even where health care exists, women may not feel free to use it. Gender politics, religion, and legal issues combine to promote sexual ignorance and discourage women from taking control of their own health. Growing up in a patriarchal culture, women learn to satisfy the needs of others and are not taught to have power over their own decisions or bodies. Conservative religious values inculcate a sense of shame in women about their bodies, and inhibit open discussions about sexuality. A woman who has an abortion feels that she can never step inside a church again.
Government family-planning programs, which address some elements of reproductive health, don't deal with these cultural issues and don't make health education their goal. For example, the government recommends pap smears, and might require that a woman has one before she can access other services; but these programs don't explain to women what a pap smear is or why it is important.
Delia's mobile medical team addresses the problems of distance, silence, and shortsightedness. The team, which has four health promoters, one doctor, one lawyer, one social worker, one trainer and one researcher, now serves thirty villages in Michoacan and plans to expand. By bringing pap smears, contraception, diabetes prevention, and other medical and psychological services, Delia minimizes the problem of remoteness.
Of course, new attitudes towards health and sexuality are not distributed from the back of a van. The team will reach its farther goal, replacing silence with confidence, by gradually raising the capacity of rural communities to broach women's health as a suitable topic for public discussion. Delia and her colleagues hold workshops in which women talk about sexuality, reproduction and preventing disease -- perhaps their first experience discussing such things openly. Talk leads to action by allowing the team to identify new local health promoters to be trained in community health care. Training will include diagnosis, therapy, massage, bioenergetics, and the use of local medicinal plants. While Delia is first concentrating on women's health, she plans to train both men and women as health promoters. Sexual diseases, pregnancy, domestic violence and disparity between the sexes are issues for entire communities to deal with.
The team pays for its work with donations and by charging for its services on a sliding scale. At present, she has funds from a German foundation, the State Ministry of Social Development, and the Center for the Support of Indigenous Groups.
Delia plans to expand nationally and internationally, and is now recording her team's experience in order to produce a replicable project. Her team is developing indicators to measure impact and provide better information. She plans to disseminate information about their work using state, regional, and national health networks, regular meetings, and the media. She has consulted with health organizations in the states of Oaxaca, Hidalgo, Guerrero, Puebla, and Sonora. In addition, she expects her community health promoters to multiply the program to other states beyond Michoacán, one community at a time.
In Delia's very traditional family, women were expected to do all the housework and serve the men. As a child, she considered becoming a nun because she wanted to travel. In her world, married women couldn't travel. She dreamed of becoming a journalist or psychologist, but ultimately attended secretarial school. She married at nineteen and had her first child within a year. The early death of a brother caused her family to move back to her childhood state of Michoacán. There she got involved in community work carried out by the Liberation Theology movement.
Two important events inspired her work on women's health. After suffering violence and repression in her own marriage, Delia divorced, but was left to support her three children alone. This transition made her begin to think about the plight of all women. Around the same time, Delia discovered that her mother had cervical uterine cancer. Luckily, they caught it early enough to save her mother's life, but her experience with doctors and disease made Delia realize that many are not so lucky.
Delia became a health advocate. She began working in a community development health care organization ten years ago. Throughout the years she has been a leader in community development, and has attended sexual and reproductive health conferences and programs at the national, regional, and international levels.