Power, Suffering, and the Struggle for Dignity. Alicia Ely Yamin

body was found, having been beaten badly. Josefina was missing. Although we were told that there was physical as well as circumstantial evidence that pointed to him, Gabriela’s husband was never charged, an omission that seemed directly related to his being friends with the police in the district. Josefina was never located.

      We stayed in touch, albeit sporadically, with Patricia and her daughter. I knew Patricia would never recover from the murder of the sister with whom she shared everything or from the disappearance of her niece. The years passed and Patricia dedicated herself entirely to her daughter, and she was as proud as any mother could be. But in some important way, the impunity in Gabriela’s murder and Josefina’s disappearance, and Patricia’s sense of powerlessness, had taken her life from her too; there was a background of grief that made her into someone she would otherwise not have become.

      When I lived in Mexico, the impunity of the police and military for torture and other abuses, including homicides, was shocking. The security forces not only were not serving the protective functions they were supposed to fulfill in a democratic state but also had become predatory; it was largely the poor like Gabriela and others in the working-class neighborhoods such as Mixcoac, who suffered the toll of their abuses. Nevertheless, there is even greater impunity and, too often, public acceptance of poor people being mistreated in health facilities, and deprived of essential care. And despite tremendous advances, far too many women and children are subjected to abuse and neglect of all forms within homes—across not only Mexico but the world.

      Applying a meaningful human rights framework to health requires transforming our narratives of people’s suffering, as well as transforming the ways in which power is exercised to deprive people of power and dignity, whether through acts or omissions and whether in public or private. In turn, as I discuss at length in later chapters, it requires identifying the contours of the state and societal responsibilities needed to transform those conditions, and the social, political and legal opportunity structures for different actors to do so.

       Chapter 2

      The Powerlessness of Extreme Poverty: Human Rights and Social Justice

      Like slavery and apartheid, poverty is not natural. It is man-made, and it can be overcome and eradicated by the actions of human beings. And overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life.

      —Nelson Mandela, BBC News, February 3, 2005

      People used to say that it is awful, regrettable, or troubling that so many children go to bed hungry…. Today … we can now picture the poor not as shrunken wretches begging for our help, but as persons with dignity who are claiming what is theirs by right.

      —Thomas Pogge, Freedom from Poverty as a Human Right

      Around the world, it is the poor who suffer the vast majority of civil and political rights violations, including torture, in both public and private spheres. In the years I lived in Mexico, far more of the clients I worked with were like Gabriela, with limited choices and struggling to make ends meet—and not like Rosa, who was decidedly middle class. There was the teenager who was playing soccer with friends, who must have irritated the wrong police officer on the wrong day because he ended up tortured to death in a local jail for simply urinating in public. Or the campesino (peasant farmer) who was mercilessly harassed and finally murdered with impunity by drug traffickers when he wouldn’t relinquish the land his family had received from “The Great One”—Lázaro Cárdenas—after the Mexican Revolution.¹ Or the young woman who got caught up in helping a drug dealer for money, was subjected to a Kafkaesque trial, and was then sexually assaulted by a guard in prison. Or a dozen other people for whom severe poverty itself was a prison of despair.

      Profound poverty makes people hostages to their fates, and entire futures dissolve because of petty bureaucratic decisions or arbitrary abuses of power. In Behind the Beautiful Forevers, Katherine Boo writes of Annawadi, a slum in Mumbai, India, saying that for the very poor, good fortune “derived not just from what people did, or how well they did it, but from the accidents and catastrophes they dodged. A decent life was the train that hadn’t hit you, the slumlord you hadn’t offended, the malaria you hadn’t caught.”² People who are not just of modest means but who live in extreme poverty are constantly faced with “Sophie’s choices” about which child goes to school, which will get health care, who will get to eat that day.³ When poverty takes away such basic power over one’s life, it makes self-governance and therefore dignity impossible, and it represents violations of a series of human rights, including health and other economic and social rights, under international law.

      I was still doing conventional civil and political rights work in Mexico when I participated in a fact-finding delegation to Baborigame, a small village in the southern part of the Sierra Tarahumara in the state of Chihuahua. Baborigame would be a short flight to Tucson, Arizona, where some of the most sophisticated medical care in the world is available. But the Sierra Tarahumara is a mountainous area, and in the early 1990s it had extremely poor infrastructure. The terrain and difficulty of access made the Sierra Tarahumara ideal for cultivating opium poppies, and drug lords forced many of the indigenous campesinos who owned small tracts of land in the area to do just that. As I have described elsewhere, in 1992, the Mexican military burned down much of the village of Baborigame, took away men to torture them, stole and killed livestock, and displaced the entire population.⁴ Allegedly the military was eradicating opium poppies, but it is entirely possible that the eradication merely reflected a transfer of control between the cartels, on whose payrolls were many of the Mexican officials engaged in the so-called “drug war.”

      Along with a small group that included both Mexican and international human rights activists, I went to investigate the events that had occurred in Baborigame.⁵ One morning, the helicopter going to survey the eradicated crops from the air was full and I stayed behind with the missionary nuns, who did what they could to attend to the impoverished Tepehuac community in this isolated area of northern Mexico. The Tepehuac community, like the vast majority of indigenous groups in Mexico, was disproportionately represented among the most severely impoverished in the country. At the time, the government was providing almost no water, sanitation, or health services to this remote area. The small group of nuns provided basic primary care and did whatever they could for patients who required more complicated attention, such as a man with leprosy who had lost some of his limb function.

      I had no idea that I was going to watch a child die that day. By the time his mother, Pilar, brought him in, the infant was so dehydrated and weak that he was incapable of crying. Given the nuns’ meager supplies, there was nothing to do but pray and watch as life faded from his tiny body. Pilar held his body and cried softly. We all cried. The commonly accepted narrative that the destitute or those in certain “other” cultures experience less grief over the loss of a child because it is so common is simply not true. But it may allow the privileged to distance themselves from the implications of having to address the immense suffering of fellow human beings, whether in the slum across the street or across the world.

      Apart from the images of the last minutes of the child’s life, what I recall most vividly from that day more than twenty years ago was that his mother did not express the rage, in addition to sadness, which I felt so acutely—rage that her community lived without adequate water, sanitation, and food; rage that there was no accessible health care when her son did fall ill as a result; rage that her son had died an entirely preventable death because of these deprivations and the systematic discrimination against indigenous populations in Mexico. Pilar understood the military’s arbitrary detentions, tortures, theft of livestock, and wanton destruction of property as human rights violations. Indeed, denouncing those abuses to my delegation is what had brought her and her neighbors down the mountain. Nevertheless, her anger did not appear to extend to her living conditions, which were the underlying cause of her son’s death. What was striking on that cold morning in 1992 was the absence of the mother’s sense of the terrible injustice implicit in her son’s suffering and death. To her, as with so many mothers and families I have met before and after her, the death of her son was simply “the will of God.”⁶