Anne Emanuelle Birn Marriage of Convenience; Rockefeller International Health and Revolutionary Mexico (2006)

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.The First UnitAs extensive negotiations between the IHD and the DSP were underway, the firstcooperative sanitary unit was established in December 1927, well before anagreement was reached.Located in a southern river valley in the state ofVeracruz, the new unit was shared by the towns of Minatitl�n and Puerto M�xico,serving a combined semi-urban population of 25,000.Puerto M�xico (todaycalled Coatzalcoalcos) was the state s second largest seaport and served a vitalpurpose each time the port of Veracruz was disabled by unrest, not an infre-quent occurrence in those years.Unlike the previous yellow fever and hookworm efforts, the new unit was notbased on a pact of RF Mexico cooperation.Instead, Carr, under pressure fromhis superiors to begin the unit, entered uncharted waters.With the DSP reluc-tant to enter into a contractual arrangement for the unit, Carr temporarilybypassed it, in spite of RF principles requiring federal participation.The unitwas guided by only a vague outline of financial obligations made on a basis offriendship and voluntary desire, unlike the RF s customary binding anddetailed contract.To resolve the issue of accountability for the unit s well-being,Carr convinced Veracruz Governor Heriberto Jara, a strong backer of the proj-ect, and state health officer Dr.Agust�n Hern�ndez Mej�a to take responsibilityfor securing payment from the municipalities, warning them that the unit wascertain to fail unless closely monitored.60g'130 goi ng localg'Table 3.1.Funding sources for Minatitl�n Puerto M�xico, 1928*Pesos 2004 Dollars(Approximate)Veracruz State Health Department 4,890 25,750Municipality of Minatitl�n 3,600 18,500Municipality of Puerto M�xico 3,600 18,500Rockefeller Foundation 4,890 25,750Total 16,980 88,500*The DSP did not contribute until 1930.Source : Carr, Annual Report of Unidad Sanitaria Cooperativa Minatitl�n Puerto M�xico forthe Year 1928, RG 5, Series 3, Box 146, RFA.Carr was more preoccupied by the political implications of the DSP s absencethan by the question of adequate financing, since both towns have unusuallyadequate incomes because refineries and oil fields of the Mexican PetroleumCompany are located in the area.The situation is that the money is there, thequestion is to divert a part of it. 61 Senior IHD administrator Wilbur Sawyer con-gratulated Carr on the founding of the first unit, confident that the DSP wouldparticipate as soon as it proved stable and useful.In the meantime, Sawyerrecommended that Carr lobby the state and both municipalities to assure theirmonthly contributions.62The joint unit which would later become two full-fledged units openedoffices in both towns, each staffed by a sanitary inspector and a nurse.To keepcosts down, the two towns, separated by fifteen miles of rough terrain, shared aphysician-director.63 Operating under an annual budget of 16,980 silver pesos(the equivalent of $7300 in U.S.gold in 1927) or.70 pesos per capita ($3.00 in2004 dollars), the unit was slated to receive 50 percent of its budget from thetwo municipalities, an important contribution, for Neither Federal or StateGovernments would find it feasible to fund a health unit in every municipality.64The first year, Puerto M�xico and Minatitl�n together financed almost 40 per-cent of the budget, with the balance split by the State of Veracruz and the RF(see table 3.1).For two full years the DSP remained notably absent from the listof funders.Carr promised that the Minatitl�n Puerto M�xico unit would adapt modern,scientific public health methods to local conditions, dealing with problems encountered in proportion to the relative importance of the disease.in thelocality. 65 Based on his own observations, Carr ranked the towns principalpublic health priorities as malaria, hookworm, soil sanitation, smallpox, maternaland infant hygiene, child health, and regulation and instruction of midwives.These were All the problems, in a rather exaggerated form, which would begoi ng local 131encountered in some of the southern [U.S.] states. 66 The DSP was not satisfiedwith Carr s impressions, however, and commissioned its own survey of the coastalVeracruz population.The study also showed a preponderance of malaria andhookworm, the latter in part reflecting attention to hookworm in the RF-DSPcampaign.Finding the crude mortality rate to be 31.5/1000, over 50 percenthigher than the accepted rate, 67 the survey emphasized the need to combatexcessive death rates rather than sickness rates (such as rates of infestation fromhookworm disease), but this recommendation was ignored in the early years.Instead, the unit s early focus was on sound administration and achievable goals.Continuity of policy, financial responsibilities shared by various levels of govern-ment, a full-time staff, and the selection of honorable and intelligent and ener-getic employees were elements that the RF deemed essential in this endeavor.Even without DSP participation, Carr claimed that the new unit met them all.Elated, he declared that the new unit will awaken interest not only among nationalhealth authorities but also in civil leaders and the inhabitants themselves, who willcooperate with an organization directly interested in their welfare. 68In the first annual report of the Unidad Sanitaria Cooperativa Minatitl�n-Puerto M�xico for 1928, Carr proudly recounted that the IHD had successfullypioneered a new type of health organization in Mexico.Criticizing itinerantcampaigns for failing to complete their disease control objectives, monitorrecurrence of diseases, battle local health problems, and carry out effective pre-ventive health education, Carr lauded the efforts of the joint health unit.Sizedfor efficient management, according to Carr, the unit had also overcome theduplication of efforts by local, state, and national entities: the unit representscomplete and effective economic and administrative cooperation, with thedirector receiving his instructions from a unified panel of the DSP chief, thestate health officer, and the municipal president.69The annual report in Spanish and English versions became an importanttool of public relations, reflecting the unit s need to address different audiences.Carr s report to the IHD was vague about the financial contribution made byeach entity because of the lingering uncertainty of regular payments, yet it out-lined the annual budget in detail, proudly displaying a table of staff salaries andexpenses (table 3.2).The Spanish version of the report omitted these figures,perhaps unwilling to arouse the ire of local inhabitants, most of whom earnedless than one third of the lowest-paid sanitary unit employee.70 Instead, it show-ered praise on the unit s state and local financiers, advertising it as a cooperativefinancing success, while failing to mention that the DSP s only contribution wasa few pieces of equipment.Notwithstanding Carr s vow to combat all prevalent diseases, in its first year theMinatitl�n-Puerto M�xico sanitary unit featured hookworm diagnosis and treat-ment, the testing of antihelminthic drugs, latrine construction, and hookwormprevention lectures.Dental hygiene, prenatal care, and routine vaccinations werelater incorporated, but quarterly reports repeatedly highlighted hookworm.Ing'132 goi ng localg'Table 3.2 [ Pobierz całość w formacie PDF ]

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