ED KASHI


A film by Ed Kashi and Human Rights Watch created to raise awareness about the need for and lack of access to palliative care in Mexico. This film was funded by HRW’s Kickstarter campaign that was funded in May 2014.

Remedios Ramirez Facio (73) lives with her husband on a small plot of land in Atitalaquia, a village in the state of Hidalgo in Central Mexico. When a Human Rights Watch team visited their modest home on a warm Sunday in late August 2014, Ramirez’s energy level was remarkable for a woman whose pancreatic cancer has metastasized to her lungs and liver. A few weeks earlier, suffering from severe abdominal pain and nausea, she had no energy and had lost her will to live. Ramirez attributes her remarkable turnaround to the fact that she is now receiving palliative care at Mexico’s National Cancer Institute in Mexico City. As Ramirez puts it, [with palliative care services, including seeing a physician, psychologist and nutritionist] I have come back to life.

In all of Hidalgo, home to more than 2.5 million people, there is not a single public hospital that offers palliative care; many of the local doctors have no idea what palliative care even is. Thus, Ramirez has to travel every few weeks to go to the National Cancer Institute, a trip that takes almost the entire day. Luckily, the local community clinic tries to make an ambulance available to people who need to make the long trip to hospitals in Mexico City for medical care. The ambulance picks up Ramirez at around 4:30am and usually does not get her back home until around 4:30pm. The round-trip cost of 200 pesos (about US$15) is more than Ramirez and her husband normally spend in weeks.

On September 1, Ramirez had an appointment at the hospital, but the ambulance was not available. So she and her daughter, Orlanda, had to travel by public transport on 4 separate buses. Even with help from the Human Rights Watch team, which was filming their journey and took them part of the way by car, the trip was arduous. As her illness progresses, Ramirez’s condition is likely to deteriorate, making the trip increasingly hard. No matter how difficult it is to face her own mortality, Ramirez says she feels grateful that the doctors have spoken with her openly and with empathy: “It gives me more desire to live.”