‘If I don’t take care of myself, who will?’ Self-caring subjects in Oaxaca’s mutual-aid groups

Abstract

Based on seven months of ethnographic fieldwork in two urban health centres in Oaxaca City, Mexico, this paper analyses the ways in which underprivileged middle-aged and older female patients experience and transform grupos de ayuda mutua (GAMs), or mutual-aid groups, a public health programme aimed at improving chronic patients’ adherence to their biomedical treatments. GAMs work as ‘technologies of the self’ within the context of the Mexican neoliberal regime and patients are urged to be self-responsible. GAM members regard such urging favourably and act according to their broader understandings of life, which they see as a lucha (struggle) that requires cuidarse (a polysemic verb alluding to self-care for self-preservation) and hard work in a structurally unequal place characterised by precarity and social unrest. This seemingly rugged individualism is converted into microlevel collaboration through culturally distinctive Oaxacan practices of mutual help. By exploring the playful ways these women participate in GAMs, this paper shows how biomedical settings can be repurposed as spaces of socialisation and wellbeing for older women living in vulnerable conditions.

Keywords:

• Chronic patients
• self-care
• mutual-aid groups
• Mexico

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 Names of places (except for the city) and people have been changed to protect anonymity.

2 Médicos pasantes are medical students going through their year of social service, a requirement for graduation. They are sent to work both in urban and rural clinics but most often to remote areas where health services and medical staff are scarce.

3 Analysing global health interventions predicated upon multidisciplinary collaboration, Yates-Doerr (2019) proposes “careful equivocation” as a technique that enables working together without homogenising “health”. Here I refer to an unplanned and yet bridging act of equivocation.

4 Although relatively recent, GAMs are the heirs of self-help experiences which have been in Latin America since the 1970s (Menéndez 2009, 110), often without the intermediation of health professionals, as in the case of Alcoholics Anonymous. The direct precursors of GAMs for chronic patients are the so-called Club de diabéticos, implemented by the MoH in the 1990s (Acero Vidal 2012, 44).

5 Requirements for participation in the accreditation process are: registration of the GAM programme in the Health Information System and the National Catalogue of GAMs chronic diseases; possession of the constitutive act of the GAM and of the Monthly Register of the Treatment Goals (Secretaría de Salud (Ssa) 2011, 31–3).

Additional information

Funding

This work was supported by Consejo Nacional de Ciencia y Tecnología (CONACyT) under a Postdoctoral scholarship.