Tartagal represents history in motion, experiences.
It is, on the one hand, the tear that falls down Enriqueta's cheek.
She is the mother of Aldana Quico, a young Wichí who lost her life in the same public hospital where she expected to give birth.
Aldana Quico, woman, native, poor.
Aldana Quico, the daughter of the tear.
It is also the effort of the
Wichí leader
Nicasia Laurentina to accompany the women and children of her community.
She suffered marks on her body from living far from health centers.
She now raises awareness, she fights and paints suns.
Tartagal is also the determination of the doctors of the
Juan Domingo Perón Hospital
, who travel for hours to provide care to the places.
She is
Miranda Ruiz
, a doctor criminalized and later dismissed for guaranteeing a Legal Interruption of Pregnancy (ILE), contemplated in the Penal Code since 1921.
The municipality remains one of the poorest in Argentina.
Photo Sebastian Roberto Avila
"I couldn't define Tartagal with a single word," says
Mariana Ortega
, a professor at the regional headquarters of the National University of Salta and an activist on the community radio station
La Voz Indígena
and in the Aretede space.
Instead, he speaks of a complex territory, traversed by struggles, syncretism, the confluence of cultures and the
link with the border.
The researcher highlights the persistence of
traditional customs and forms of organization
, due to the late incorporation of the city into the Argentine Nation State.
Wichís, Chiriguanos, Chanés, Quechuas, Chorotes, Chulupíes, Aymaras and Tobas do not make up
former owners of the arrows
.
They contemplate, instead, a live demography.
The doctor.
Miranda Ruiz.
Photo: AP/Javier Corbalán.
The municipality remains one of the poorest in Argentina.
There, former President Carlos Menem announced
"space flights to the stratosphere"
;
and, in 2009, an implacable avalanche tried to destroy everything.
Vulnerability affects, above all, women.
There is no area in Salta with a higher rate of
"girl mothers"
, from 10 to 14 years old, as shown by the latest report "Selected Indicators of Comprehensive Health in Salta Adolescents", published by the provincial government.
There were 57 in 2019. Despite the progress,
sexual and reproductive rights
are running into long-standing structural problems.
Aldana's dreams
"Tripartite zone"
, announces the entrance sign to Santa Victoria Este.
More than 500 kilometers separate this town from the capital Salta;
163 kilometers from the city of Tartagal;
and, a few minutes, from Bolivia and Paraguay.
To get there, the Clarín
team
asks permission from two caciques who block the route to claim tanker trucks.
Thirst does not let up.
How many stories inhabit the
extreme northeast of the Argentine northwest
?
How many resist, like the vegetation that appears through the cracks of so much stone and path?
45 kilometers away, on a road that is difficult to navigate, is
La Puntana.
And there, forever incomplete, the Quico family.
House of some bricks, a lot of cardboard, sheet metal, branches and canvas.
Blood of the Wichí people-nation.
Surrounded by their large family,
Alejandro and Enriqueta
remember their daughter Aldana, who died at the beginning of 2022. It was in the Tartagal hospital, in circumstances colored by the marginalization of the health system and Justice.
Aldana Quico
>>
Aldana Quico was an 18-year-old teenager from a Wichí community
located in La Puntana, in the northeast of Salta, near the border with Bolivia and Paraguay.
In 2021, she had left the mountains to settle with her father 3 kilometers from Tartagal, Salta.
“I am going to study and I am going to help them so that they have a nice house, that they live well”
, she told him.
Photo: Sebastian Roberto Avila
>>
On January 12, while she was
8 months pregnant
, Aldana began to have losses and symptoms such as swelling of the face, hands and feet.
At her home, an obstetrician and a nurse took her vital signs and confirmed that something was wrong.
Her father claims that
he was told that her daughter had a "nauseous smell"
.
Photo: Sebastian Roberto Avila
>>
Later, Aldana was admitted to the Juan Domingo Perón Hospital in Tartagal, where they told her that
she was carrying a dead fetus
.
Neither she nor her family could believe it.
She had done all the checkups
.
Photo: Rocío Magnani
>>
The doctor in charge administered medication and assured that it was best for her to undergo a normal delivery.
Both Aldana and her family requested a C-section, but were denied.
The family asked for intercultural facilitators.
They were told that everything would be fine and that they could go home.
After twelve hours of agony,
at midnight, Aldana died
.
Photo: Sebastian Roberto Avila
>>
“They didn't want to give her a C-section.
We wait and wait.
I begged them to do a C-section.
But they did not give.
And so until my daughter passed away.
How could she be so confident that we gave them?
We have taken my daughter to the Tartagal Hospital so that nothing happens to her and that is how my daughter died ”.
Enriqueta Díaz, mother of Aldana Quico
Photo: Sebastian Roberto Avila
>>
With the support of the APDH,
the family filed a criminal complaint against the gynecologist
Patricio Parra Marin.
They accused him of "malpractice, abandonment of person and/or torture, obstetric violence and cultural discrimination."
Photo: Sebastian Roberto Avila
>>
The provincial Ministry of Health
initiated an administrative process for the death of the Wichí teenager.
The undersecretary for Health Management of the Province, Silvia Cardozo, in charge of the investigation,
acknowledged that there was "absolute negligence
. "
Photo: Sebastian Roberto Avila
>>
A year later,
the doctor continues with an administrative summary
, as recognized from the Hospital.
He did not stop working
, but he does it in a peripheral center.
Photo: Sebastian Roberto Avila
>>
The Public Prosecutor's Office acknowledged that
there were no charges
.
They allege that from the medical history it is clear that Aldana arrived at the hospital with a "torn bag of more than 48 hours" and an "infection in its last phase."
According to the MPF,
"the parents were summoned on several occasions, but they never showed up
. "
Photo: Sebastian Roberto Avila
>>
Alejandro, Aldana's father, left the city
and returned to the mountains, more than 4 hours by car from Tartagal.
He lives in La Puntana, with the young woman's mother, on a ranch and without a vehicle.
It is a rural area, without water, gas or sewers.
They say they don't return to the city anymore.
Photo: Sebastian Roberto Avila
>>
The Quico family retains the complaint filed with the APDH.
The paper suffered the inclemencies of rain and mud.
They did not continue with the process due to the distance
, the mistreatment suffered and the latent pain due to the death of Aldana.
Photo: Sebastian Roberto Avila
>>
“It remains as a void that cannot be recovered anymore.
I know that she has gone well and that she is with the Lord.
I left Tartagal, because I no longer want to see all that part where she was
, where we lived.
We retired to La Puntana.
I don't want to go back anymore."
Alejandro Quico, Aldana's father
Photo: Sebastian Roberto Avila
Alejandro sustains the
complaint attributed to rain, mud and time.
"See? I have nothing. In bad weather, my children run out of the house, for
fear of the wind
."
Enriqueta has Aldana pierced in the throat.
"She was a little girl, her baby, she loved him," she blurts out.
And she cries again.
The chiaroscuro of a border hospital
Tartagal is considered a
border city.
It is 57 kilometers from Bolivia, a trip six times shorter than the capital Salta.
Even the
Republic of Paraguay
—103 kilometers away— is closer than the center of the province.
The Juan Domingo Perón Hospital receives referrals from five municipalities —with Creole and native populations— and patients from neighboring States.
Irma Quinteros assures that there is a lack of residents.
Photo Sebastian Roberto Avila
Irma Quinteros is an instructor at the
Family Medicine
residency , an important specialty where there is a lack of professionals.
"They give us four places, but we don't cover them. There was even a year without entrants," she elaborates.
This affects sexual and reproductive education.
"She had a resident trained in Pap, IUD and contraception in general. She had an excellent acceptance among the original community, but, due to the needs of the Province, she was assigned to another department", laments Irma.
Walk the corridors of the hospital, full of patients.
They don't reach the chairs and the little ones get restless.
On Mondays the Voluntary Interruption of Pregnancy (IVE) office opens.
And, from Monday to Friday, you can go without turn to ask for contraceptive methods or advice.
Sexually transmitted diseases abound.
But the
early onset of sexual activity
and pregnancies forms the central problem.
On the
side of Route 86
is a large part of the
original population
.
Nurses, gynecologists, obstetricians and doctors from the hospital travel at least three times a week to provide care.
There are two health centers, at Kilometer 6 and Kilometer 3, where
Clarín
accompanied Irma.
The temperature is very high.
Young women wait, with babies and children:
skinny or with swollen bellies
, due to diets marked by carbohydrates and fats.
The professionals have been working hard and constantly for years, impossible without the active collaboration of community leaders.
On the side of Route 86 is a large part of the original population. Photo Sebastián Roberto Avila
"We see
15-year-old mothers, 30-year-old grandmothers, and 45-year-old great-grandmothers
."
The wear and tear of the bones, malnutrition, the greater predisposition to cervical cancer, high blood pressure and eclampsia mean that women age and even lose their lives.
Many have premature births, low birth weight babies, and poor growth.
Positive changes
occurred
.
Women ask more and information is slowly democratized.
A lot is missing.
In the middle of the interview, in an office that she overlooks an open road,
Irma takes off her stethoscope and her cheeks get wet
: "I think of the boys outside."
What about migrant women?
The Juan Domingo Perón Hospital was the subject of several
complaints before the Inadi
.
More than anything, by original people and migrants.
Like Marta Cardozo, who in 2020 alleged that
they wanted to charge her for the delivery and birth certificate
of her baby, for having Bolivian nationality.
"The legal advisers of the team spoke with the legal advisers of the hospital and the conflict was unblocked," Gustavo Farqhuarson, representative of the organization in Salta,
tells
Clarín .
He alludes to various discriminatory abuses against which the Inadi intervened: cancer cases deprived of attention, rejection of hormonal treatments, to name a few.
"About birth certificates, I really don't know. There are self-management hospital systems: in this case, you have to ask each management. Yes, I can affirm that ILE, IVE, medication and contraceptive methods are available to all people" answers Javier Yapura, supervisor of the area of Sexual Health and Responsible Procreation of the Maternal and Child Directorate of the province.
Pedro Urueña, the new manager of the Tartagal hospital, comments that many patients from other countries also have Argentine documentation.
In that case, all services are covered.
The professional accepts that there are
paid procedures
, although "a solution is always sought through the social service of the hospital."
"This applies throughout the entire network. We have often had to refer foreign patients to more complex hospitals in the Capital and there are also
paid internships
there ," he argues.
flower spurge
Yapura assures that there are still
no official numbers on
sexual health in Tartagal: "We made a database of the entire province. We still have partial numbers, it is not possible to break down by department."
Only in the middle or end of March could they give an overview of 2022.
Yapura points out that the predisposition of the communities and their
caciques
influences the ability of women to approach the health system.
And she mentions that there is an interculturality project, in which the Health portfolio is involved —with the Maternal and Child Directorate taking a leading role—, together with
UNICEF and Furrows.
It seeks to guarantee sexual and reproductive rights, mainly among indigenous adolescents from Oran and Tartagal.
From his office, Urueña adds: "We are setting up a pediatric critical care service, but the ideal would be to have a greater number of intensivists, to be able to set up a therapy."
His hospital receives
boys and girls from the Salta Chaco
in serious condition, due to diarrhea, malnutrition and dehydration.
His objective is to solve the pathologies within the hospital, to "avoid the
uprooting of the original family
".
The doctor repeats a sentence that is already a motto in the city:
"Salta does not end at the Bermejo River."
There is an intercultural project, in which the Health portfolio is involved.
Photo Sebastian Roberto Avila
Where was the wealth of oil, present in the local shield?
Far from the tourist eye, health personnel weave with their own skin the patches that cover the lack of resources.
The hospital, a flower without petals like that of the spurge, is planted.
Beating ancestry with a woman's heart
Behind the cry for
noble equality
, the founding inequities of the Argentine State continue their course.
Laurentina Nicacio
, a Wichí reference, pursues
the laurels that are yet to be achieved
.
She is 27 years old, she lives in General Ballivián —47 kilometers from Tartagal— and presides over the Juala Foundation.
She teaches to read, intervenes if there is a lack of medicine or if someone falls ill, she acts as a liaison with the health agents and the local health center.
Cumbersome geography
,
bureaucracy, political decisions, and segregation affect people.
Especially to those who inhabit the places of the mountain, which are isolated in periods of rain.
"Close to giving birth, women try to stay with someone they know, in towns that have hospitals," argues Laurentina.
She suffered a hemorrhage herself before having her baby.
The ambulance took a long time to arrive.
"I bled out all the way
," she says.
Uterine cancer
is
a widespread disease.
Just last year a gynecologist arrived in Ballivián.
She is not enough.
Many women in labor cannot attend check-ups and give birth at home, in poor hygiene conditions.
Laurentina identifies the persistence of
"myths"
: for example, "that it is wrong for a person who is not your partner to touch you", in relation to tests such as pap smears or colposcopy.
The social stigma and economic gaps are reflected in the drama of
sexual abuse
, which often ends up being silenced.
The families of the victims are usually low-income and do not dare to denounce members of their own clans, Creoles, "relatives of such" or "people of money from the town."
In October 2022, there were seven attacks on children concentrated in one week.
The Women's Soccer Commission of General Ballivián, a
feminist organization in the area
, called for a large mobilization.
Roadblocks due to the health emergency
Simultaneously with the mobilization in Ballivián, a health claim began in the nearby town of General Mosconi.
With a long piquetero tradition, the residents of this town stopped Route 34. They demanded the appointment of more specialists for the local hospital
—the
Hospital of that town— of complexity 2 or intermediate.
The city is located just 40 kilometers from Ballivián, where those who require complex care remain prisoners of a
bureaucratic circle
, says Laurentina: first they are referred to Mosconi, then to the Hospital de Tartagal —of complexity 4— and, from there, they must get a Transfer to Salta Capital.
The entire area, included within the department of San Martín, has been in a "socio-sanitary emergency" since 2020, when the death of boys and girls from preventable causes was known.
The news escalated, and not only nationally.
Robert Valent, the UN's highest authority
in Argentina
, compared the situation of the Wichís in Salta with the humanitarian crisis in South Sudan.
Provincial Route 54 cutoff in the Santa Victoria Este Salta area Photo Sebastián Roberto Avila
At the end of 2022, the Ministry of Health changed the managers in the hospitals in the area and appointed thirteen new medical specialists for Tartagal.
In January, after the change in management, the ministry implemented a new service operation through the Extramural Assistance program.
As reported, from General Ballivián, twelve pregnant women were referred for fetal cardiological control.
Macarena Aucapiña, a reference for
Infancia en Deuda
, a civil society coalition in defense of the rights of children and adolescents, says that while the health system "is very precarious," it is even more so for women and girls "because of what patriarchy represents within their own cultures, as well as in the province".
Salta has one of the highest native population rates in the country
: 6.5% of its inhabitants self-identify as indigenous, according to data from INDEC.
Of these, 42.6% live in rural areas, a proportion that increases among the most numerous peoples, such as the Wichí (60.7%) and the Kolla (60.9%).
Wichí reference Laurentina Nicacio highlights the number of cases of advanced uterine cancer.
Photo: Sebastian Roberto Avila
The activist assures that the operations carried out this year by the Ministry "are necessary in the context of crisis, but they do not solve structural problems", such as access to water or inaccessibility of roads.
En ese sentido, destacó que es urgente que se tomen medidas para el acceso al agua en la zona y también para la reglamentación de la Ley provincial de Salud Intercultural, sancionada en 2014 para evitar las barreras idiomáticas y mejorar la integración de las comunidades indígenas.
Tartagal vuelve a ser noticia: una médica presa por garantizar un aborto
"Doctora, Dios la va a ayudar". La médica Miranda Ruiz acababa de salir de la cárcel y su celular estaba estallado. Uno tras otro caían los mensajes, las oraciones de pacientes y los apoyos de colegas del hospital, la mayoría de ellos objetores de conciencia.
En la provincia más conservadora del país —por ejemplo, pasó más de cien años sin aplicar el aborto legal por causales— , mujeres religiosas, que en general se oponen al aborto, pedían por la liberación de esa médica que con 33 años había llegado de Buenos Aires al Chaco salteño, con vocación por la Medicina Familiar.
Miranda vive en Tartagal desde junio de 2019. La pandemia la sorprendió a poco de llegar y, como era la única especialista en Medicina Interna, hizo los protocolos de internación del hospital. A la vez, se encargaba del consultorio de aborto, que funcionaba —y funciona— una vez por semana.
En agosto de 2021, una joven de 21 años llegó al hospital solicitando interrumpir el embarazo. Había viajado 70 kilómetros, desde Salvador Mazza, la última ciudad argentina antes de cruzar la frontera con Bolivia. La joven estaba con su nena de dos años en brazos. Tras una consulta en la que intervinieron una trabajadora social y una psicóloga, se convino que lo mejor era que la joven quedara internada mientras se autoadministraba las pastillas para interrumpir el embarazo.
Protesta frente a la Casa de Salta contra la detención de Miranda Ruiz en Tartagal, Foto Juano Tesone
Ese día, Miranda era la única médica capacitada y no objetora de conciencia que trabajaba en el hospital. Pero, al ser residente, el procedimiento fue firmado también por otro médico responsable. Además, dio su aval el entonces director del hospital. Se acordó que el caso se encuadrara en el protocolo surgido a raíz del fallo FAL (un fallo de la Corte Suprema) de 2012, en base al Código Penal argentino:, que establece que el aborto es legal en cualquier momento de la gestación, cuando existe riesgo para la salud o la vida de la persona gestante o si el embarazo fuera producto de una violación.
Los problemas comenzaron cuando una tía de la paciente se enteró de la situación. "Empezaron a hostigarla de todas partes", narra Miranda. Y recuerda que mientras la paciente empezaba a ingerir las pastillas, Claudia Subleza, una concejala de Salvador Mazza, lanzó una campaña procurando frenar el procedimiento. "Llamó a un sacerdote para que mandara gente, ella misma lo dijo", agrega la médica.
La ley de Interrupción Voluntaria del Embarazo (IVE), que admite los abortos sin causales hasta la semana 14 de gestación, no tenía todavía un año. Los esfuerzos de los sectores opuestos al aborto se orientaban a judicializar la norma: en 2021 hubo al menos 37 demandas de grupos conservadores contra leyes, programas y otras normas vinculadas, según detalla un informe del Ministerio de Salud.
Miranda Ruiz es médica generalista en el Hospital Juan Domingo Perón de Tartagal, a más de 300 kilómetros de la capital salteña. Foto Sebastián Roberto Avila
La mayoría de estos intentos quedaron en el olvido, por la negativa de jueces a continuar con una discusión legal por demás saldada, tras extensos debates en el Congreso de la Nación.
En ese marco, la noticia de que una médica había sido encarcelada por el "delito de aborto" impactó con fuerza en los medios nacionales y en "la marea verde". El activismo feminista salió a repudiar el hecho y, a las horas, la médica fue liberada. Sin embargo, quedaría procesada por casi trece meses por el supuesto de que había actuado "sin consentimiento de la gestante".
Fue la única profesional criminalizada por el hecho, a pesar de que habían intervenido cinco personas. Fue sobreseída en septiembre de 2022.
La criminalización como estrategia
Cristina Rosero, asesora legal del Centro de Derechos Reproductivos para América Latina y el Caribe, asegura que América Latina es a la vez "una de las regiones con legislaciones más restrictivas en término de aborto", pero, también, una "esperanza para el mundo". En los últimos 25 años, resalta que existe una clara tendencia hacia la despenalización.
En ese sentido, distingue que los problemas judiciales en la región se dividen en dos grupos. El primero comprende sobre todo a los países, como El Salvador, donde "la criminalización está normalizada". Esto genera que las mujeres teman ser perseguidas y caigan en prácticas inseguras con riesgo para su salud y también que los médicos desconozcan su obligación al secreto profesional y denuncien a mujeres ante abortos o abortos involuntarios".
Hay un segundo grupo de países, en los que los juicios aumentan "como reacción a los avances a las normativas locales", sigue Rosero. Por ejemplo, en Colombia, justo después de la despenalización de 2006 hubo un incremento del 1.000 por ciento de las cifras de criminalización del aborto.
Mujeres festejan en la Plaza Güemes de Salta la sanción de la ley de Interrupción Voluntaria del Embarazo. Foto: Javier Corbalán
¿Por qué? Porque cuando el tema se discute públicamente deja de estar escondido, "igual también hay una reacción de ciertos sectores que hacen que las denuncias se acrecienten". Esto podría corresponder a la situación de la Argentina, sugirió Rosero.
Estados Unidos podría ser un caso aparte en términos de criminalización. Antes del caso por el que la Corte Suprema de Estados Unidos anuló, en junio de 2022, la histórica sentencia Roe vs. Wade —que desde 1973 garantizaba el derecho al aborto en el país—, "la mayoría de los casos que se han llevado a la Justicia fueron más bien contra los proveedores o las clínicas que proveían los servicios".
La especialista en derechos reproductivos asegura que, para el resto de la región, la anulación de esta sentencia de casi 50 años de historia en Estados Unidos tendrá principalmente un “impacto simbólico”. Opina que "los avances que se han dado en Latinoamérica, como en la Argentina, México y Colombia, muestran desarrollos diferentes".
El fracaso de los extremismos
"Haberme judicializado fue un gran logro del grupo extremista. Si consiguieron perseguir una práctica médica que fue impecable, fue gracias al apoyo de esta concejala y funcionaria local, y gracias al escrache mediático de medios provinciales", afirma Miranda.
Lejos de amedrentarse, Miranda continuó su labor en el consultorio de ILE e IVE. Dice que la "persecución judicial" en su contra fue "un tiro que les salió por la culata" a los opositores al aborto, porque la difusión de su caso "permitió que se hable del tema en una sociedad como Salta, en donde lo que nunca le conviene a los extremos es que se tenga información".
Miranda reflexiona: "Con todo esto que me pasó, me di cuenta que los extremismos generan muchísimo daño en una sociedad. Porque hay que diferenciar. Los extremismos no representaban para nada a todos 'los celestes' (en referencia a quienes se oponían). Las personas católicas podían estar en contra del aborto, pero siempre me expresaron su apoyo".
En enero de este año, el Ministerio de Salud destacó a un médico por provincia por su labor durante la pandemia por Covid 19. Miranda fue la elegida por la provincia de Salta. "Para mí, es un resarcimiento espiritual importante asegura-. Esto evidencia la mediocridad, la corrupción y falta de compromiso social que hay detrás de quienes me han querido anular por garantizar derechos en zona de frontera”.
El efecto del sobreseímiento fue multiplicador. Este año, la residencia en Medicina Familiar y Comunitaria, por la que Miranda dejó Buenos Aires, volvió a tener cupo completo de postulantes y más mujeres y niñas asistieron al hospital para pedir interrupciones del embarazo en lo que llaman "Consultorio Miranda".
Dr. Miranda Ruiz. (AP Photo/Javier Corbalan)
Faltan muchos médicos especialistas y recursos del Estado para solucionar los problemas estructurales dentro y fuera del hospital, pero las historias de estas mujeres médicas, indígenas y activistas son una esperanza para esta región largamente postergada.
Este reportaje fue apoyado por la iniciativa de Salud Reproductiva, Derechos y Justicia en las Américas de la International Women's Media Foundation (IWMF).
MI