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APHA Scientific Session and Event Listing

Recorded presentation

Linnea Capps, MD, MPH, Doctors for Global Health, 155 Underhill Ave, Brooklyn, NY 11238, 212-939-1423, lc9@columbia.edu and Frederique Jacquerioz, MD, MPH, Tulane School of Public Health and Tropical Medicine, Doctors of the World-Switzerland, 1440 Canal Street, Ste 1820, New Orleans, LA 70112.

Indigenous Mayans comprise thirty percent of the population of Chiapas, Mexico. In 1994 an armed uprising against the mestizo-led government occurred, calling for greater autonomy and improved human rights. Although an early cease-fire was brokered, no long term resolution to the conflict has been achieved. The militarized climate since the uprising has had a profound impact on the health of the indigenous communities. A hospital in eastern Chiapas, which primarily serves this indigenous population, has continued to report new cases of tuberculosis, despite the government's assertion that tuberculosis no longer poses a major problem in Mexico. The number during the year 1997 was 125 and ranged from 47 to 127 in the subsequent years from 1998 to 2005. This represents only the patients who are able to come to the hospital. The expense of transportation from their isolated communities and fears related to the military occupation prevent people from seeking medical care and returning to the hospital for follow-up visits. During the late 1990's, approximately 40% of patients did not complete treatment. Directly observed therapy has not been possible because of lack of resources and the ongoing conflict preventing long term community based projects. In addition, many patients come from very small, isolated rural communities. In 2000 Doctors of the World-Switzerland began a project to help patients pay the cost of diagnostic tests and transportation to return for follow-up visits. In addition, much more investigation of contacts was done and the number of new cases diagnosed in 2005 was higher. Over the past year the rate of patients' not completing treatment has fallen to 6.5%. A very simple intervention has reduced the rate of abandonment of treatment in this population where DOT is very difficult. In addition to the direct provision of medical care, health improvement in Chiapas will depend on examination and resolution of the underlying political conflict.

Learning Objectives: The learner will be able to

• Describe the continued importance of tuberculosis in Chiapas, Mexico
• Recognize the effect of the conflict and militarization on the treatment and control of tuberculosis
• Recognize the human rights consequences of the militarization

Keywords: Tuberculosis, Human Rights

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation