Neighborhood Doctors and Private Practices: Mexico’s Forgotten Heroes of the Pandemic

WHO ranks Mexico as the deadliest country in the Americas for healthcare workers, while the federal vaccination plan excludes most private practice doctors. These are four stories of doctors who were and still are on the front line of the battle.

MEXICO CITY (El País) – Blanca Guadalupe Velázquez, 57, still uses an oxygen tank to sleep at least twice a week. Her sats have not risen above 91 since she was infected almost a year ago with coronavirus. And he has fibrosis in both lungs. She doesn’t sleep well either: “I keep thinking that if I fall asleep, I might not wake up.” A thought crosses her at night since she was admitted to the hospital for nine days, expecting the worst. This morning she is consulting in one of the two jobs she has to make a living, a modest office next to a pharmacy in the Narvarte neighborhood in Mexico City. Fifty pesos per patient, about two and a half dollars, two euros. The cost of a Coca-Cola on a terrace in Madrid.

According to figures from the National Institute of Statistics, Dr. Velázquez is one of the 71,286 doctors in private practices- which the federal vaccination plan has not covered. The Government of Andrés Manuel López Obrador began immunizing the country in February with healthcare personnel, the sector hardest hit by the pandemic. This week, the Pan American Health Organization (under the WHO) ranked the country as the deadliest in the Americas for them. But many of those who do not work in public facilities have been left out. And they must wait for their turn to come according to age, like any other citizen.

From January 2020 through April 13 of this year, 3,534 healthcare workers have died from coronavirus, more than seven healthcare workers a day. This is almost three times the number of deaths in the United States, the country with the highest number of coronavirus deaths globally. And five times more than Brazil, the country with the second-highest number of deaths and 84 million more inhabitants. In total, more than 214,000 people have died in Mexico so far, the third country in the world with the highest number of victims.

The Government’s justification has been ambiguous. It has not considered them to be “front-line” doctors in the battle against the pandemic. Also, the lack of an official census of private doctors in the country has resulted in a deficient vaccination strategy. Like the doctors in the offices of large pharmacy chains, such as Farmacias del Ahorro, some have been vaccinated, and many others have not. Meanwhile, the president celebrated the beginning of the vaccination of public and private school teachers this week.

At the doors of the office of Dr. Aide Salinas, 35, more than 20 patients accumulated around 11:30 a.m. this Wednesday. She is one of three general practitioners in the Santa María Chiconautla neighborhood in Ecatepec (State of Mexico). 

She has seen more than 15 patients with a positive covid test on her hand per day. Entire families have died, the most painful one: a 14-year-old diabetic boy and his two parents. He cries when he remembers his mother’s admission: “My greatest fear was to infect her. I knew it wasn’t me because she infected me. And somehow that comforted me”. He equipped the practice on his own with special suits, disinfectant liquids, gloves, and N95 masks when at that time (a year ago), the price of these materials was sky-high. He runs a small office in one of the municipalities in the country that had the highest number of cases. His salary is around 20,000 pesos a month, about 1,000 dollars.

The reality is that in a country where almost 60% of the population works in the informal economy and therefore does not have social security, this type of clinic has relieved the emergency and waiting rooms of the public sector, which was opened for all severe cases in the worst moments of the pandemic. The 2018 and 2019 National Health and Nutrition Survey (Ensanut) estimated that at least 43% of medical consultations were provided in private practices. Of those, pharmacy doctors had seen 17% of patients.

Not considering them as the first line of battle has outraged a sector that is by definition the first choice of much of the Mexican population. That is how they were designed, even for patients who have public and even private health insurance. The price of consultations (from 40 pesos, about two dollars), the strategic location in the neighborhoods, and the quick access to a check-up and diagnosis has turned them into a fundamental agent in the country’s complex health network. During the pandemic, the fear of being infected in a hospital made many of them indispensable.

General practitioner Alba Isabel Cáceres, 32, has seen entire families die in just one block this year. She is the private doctor in a neighborhood in the Moctezuma neighborhood, in the Venustiano Carranza district of the capital, one of the areas hardest hit by the pandemic. With her right hand, she points to the corner: “Four patients have died here alone. From a tiny consulting room with a stretcher without sheets, a scale, a table, and two chairs, he recounts one of the most painful moments of his work this year. The death of a patient who was already a friend of his, hypertensive and diabetic, his symptoms presented as hiccups and chest pain. “We thought it was heart disease. We were wrong… At the hospital, they also treated it as a heart attack. His family was given a sealed coffin. It was covid,” she says. Cáceres charges about 6,000 pesos a month, 300 dollars. 40 pesos a consultation.

Most of them are the trusted doctors of the families in the neighborhood. They have known and treated them since before the pandemic. In general, they treat the poorest and have contained from their trenches the death that lurked in the emergency rooms of the public hospitals specialized in fighting the pandemic. They checked their symptoms, monitored their oxygen, and referred them to a nearby hospital in the most severe cases at the worst moments of the crisis. A triage that has saved the state a great deal of consultations and hospital beds, they say.

 “If we had a public health system like Denmark’s, I would understand that going to a private doctor would be a luxury. But that is not the reality in our country. We are helping not to saturate the government hospitals even more,” says Armando Magaña, 44, a pediatrician and specialist in cynical immunology and allergies, from Torreón (Coahuila, in the north of the country). The doctor says indignantly from the other end of the phone that when the immunization of doctors assigned to the covid areas began, he understood it, “but we thought we would be next.”

Magaña has had to rent an office outside the private hospital Ángeles in Torreón because his patients did not want to go near the shadow of the center in case they were infected. Most of them suffer from allergies, rhinitis, and respiratory infections that caused coughing and secretions in his office. A high risk that he still faces with the fear of infecting his family. Magaña charges 800 pesos per consultation (40 dollars) and is annoyed by the “hate messages” he has heard from the president: “They talk about us as if we were the fifis as if we were rich and we attended to a minority, that is not so.” It irritates him to know that if he lived not so far from there, in the United States, he would be vaccinated.

Dr. Velázquez laughs when she is called “Fifi” for being a private doctor, the adjective used by López Obrador to discredit those who, according to him, do not agree with the doctrine of the Fourth Transformation. She lives in a 50-square-meter apartment with her parents and son. “It makes me very angry. Imagine isolating yourself in those conditions,” he says. He was on sick leave for four months but without getting paid a penny. Some lifelong patients came to his house with food and made deposits to buy medicine. He knows that he was infected in May in the same office where he works today. His only weapon was his stethoscope and a cloth mask. In the humble waiting room with four plastic chairs, a lady in her 60s waits with a slight cough for her turn. Before receiving it, she remarks: “We have to go on. I just hope we get our turn soon. 

Read the article by “El País” in Spanish



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