A front row seat to community mobilization

There have been major things happening at work that I have not had the opportunity to write about due to the need to act first and think later. The clinic that I work at has found themselves in the middle of a political battle not of their making that threatened both my supervisor’s job as head of the clinic and the continued existence of the clinic for people living with HIV.

How An Internal Personnel Conflict Became a Municipal Problem

Most workplaces have at least one person that seems to cause more problems than most; the clinic that I work at is no exception. Both the staff and the patients do not like Dr. Ruiz. She has managed to be manipulative, verbally abusive, incompetent and otherwise a horrible person as she lies, cheats and steals her way to getting what she wants.

She precipitated this situation with a denunciation against my supervisor saying that he mistreated the staff and patients and that she was the only doctor who worked. This denunciation arrived on the desk of the municipal Secretary of Health Dr. Jaime Henen who in turn involved the Director of Management of the centros de salud Dr. Martin Silberman. The denunciation supposedly included the signatures of 15 of the clinic’s patients. To date, the only people who have read the denunciation are Ruiz, Silberman, and Henen.

Two weeks ago, the entire staff met with Silberman and Henen to discuss the allegations. Dr. Ruiz took that opportunity to continue lying about her work at the clinic. The rest of the staff shared a number of stories about her propensity verbally castigate the staff and her unethical dealings with patients. Henen and Silberman left the meeting saying that they would think about the next steps to take and would return the following Monday to inform everyone of their decision. The staff was confident that the authorities would remove Dr. Ruiz from her position. Dr. Ruiz took the one week delay to mean that she could yell at patients in the waiting room and continue to spread rumors about the staff.

How That Municipal Problem Became A Political Cover

Henen and Silberman returned to the clinic last week on Monday to deliver their decision. Dr. Ruiz would keep her job at the clinic. They announced plans to create a new position to coordinate the municipal program for HIV/AIDS and they intended my supervisor to take the raise. In reality, there is no municipal program for HIV/AIDS as most programming is run through conventions and medical protocol. To replace my supervisor as the head of the clinic, they wanted to bring in a new head of the clinic from outside rather than hiring one of the doctors on staff. Furthermore, the authorities announced plans to bring in other specialties such as pediatrics and vaccination into the center.

The decision that the authorities made was shocking on several levels. Doctors had presented evidence that her actions were at least unethical, at most illegal. Henen and Silberman feared exposure in the media by Dr. Ruiz. The raise offered to my supervisor was a back-handed way to fire him from a position that he has had for 22 years. The raise also presented an opportunity to sideline my supervisor for the now apparent purpose of the authorities’ involvement. The clinic is located in the middle of the city and they want to take advantage of the central location for “normal” patients. Offering yet another location for vaccination in a neighborhood that has two locations within walking distance permits the appearance of action against the rise in infant mortality observed since this administration took office.

How Patients Fought the Political Decision

After the shock of the blatant political decision wore off, the staff began to formulate a plan to use the media to pressure Henen and Silberman to rethink their decision. The patients, now involved in the conflict and their own health at stake with the recent decision, also started asked for ways that they could fight. By the end of Tuesday, patients had begun collecting phone numbers and sending text messages. A small core group cam together to draft a statement of support addressed to Henen and collected signatures from other patients.

On Thursday, patients gave interviews with the three major newspapers of La Plata and the stories came out last Friday. One of the local television stations came to the clinic to speak with them and the report was broadcast on Thursday night.  One of the patients did a radio interview with Henen. They also organized the meeting with Henen today at the municipal office for the Secretary of Health. They also gave interviews with Radio Provincia and other news media today. Their efforts resulted in over 100 signatures in support for the center continuing in its present state without the intervention of the authorities.

Their impassioned discussion during this morning’s meeting did not seem to emotionally affect Henen and the two other directors who briefly attended the meeting. Although in many ways Argentina’s approach to HIV/AIDS is more advanced than other countries such as Mozambique, the perception still exists that people living with HIV passively accept challenges to their quality of life. However, I do think that the organized effort and strong, emotional defense caught them by surprise. Previously, Henen and Silberman showed no inclination for negotiation, but today Silberman came and promised one concession. My supervisor will continue as chief of the center, but they still want to bring in the other specialties.

Next Steps

Tomorrow, patients and their families, staff and I are going to the Consejo Deliberante, which is the municipal legislative body. Involving the legislature is an important step for several reasons. The most important is that Argentina’s Constitution protects the right to health in general, and there are laws from the national level to municipal ordinances that legally obligate legislators and politicians to provide services for people living with HIV. This attempt to marginalize the services offered by the clinic violates a number of these legal protections. Allowing additional opportunities for patients to advocate for the center provides invaluable skills; Silberman agreed to the creation of an advisory body of patients for future decisions and programs. Presenting the case before the Consejo will also help to solidify the new arrangements.

This intersection of health, politics, and human rights has been interesting to explore through experience rather than through studies.  It has shown me that I am more than unwilling to sit on the sidelines. I have actively taken part in meetings, helped to write declarations and wished that I could do more to protect this clinic which has been a large part of the lives of so many for years. It is hard not to take the words and actions of these politicians personally as they have shown no desire to learn about the work or the patients who frequent the clinics. I find that the anger combined with the desire and ability to act does have concrete and substantive results which might be most valuable lesson to learn from this situation.

1 comment so far

  1. Martin on

    I think that is a part of the story I don`t know how long `ve you been livinng here.
    You should tell more things about the doctors and the treatments with patients with no money. And de most patients who don´t have access to the tretments.
    Martin Silberman


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