The Mexican Healthcare System in the Age of COVID-19
By: Gb Rogut
Tags: Culture, Health, Current, This Happened To Me, Life

My husband was diagnosed with prostate cancer a little over a year ago. It has spread slowly…but steadily.

It has gradually eroded his health. He’s in constant pain and moves slower now. On the few occasions he goes outside, he tends to use a cane for extra support. He can’t eat as much as before and has trouble sleeping. I should add, though, that the last sentence is kind of a lie.

I mean, to say that someone has sleeping problems, isn’t it a requirement for that person to actually catch any sleep?

Treatment.

You have probably heard that cancer treatment is very expensive. I can tell you it’s all true.

Luckily, living in Mexico as a salaried worker, my family and I have access to basic healthcare. In our case, we receive medical attention from an institution called Instituto Mexicano del Seguro Social (IMSS), although most people in my country refer to it as El Seguro.

Mexican people have a complicated relationship with El Seguro. We all complain about the delays and lengthy bureaucratic approaches. No matter what kind of procedure you are talking about, everything is long: the lines, the waiting times, the list of people you need to speak with to get things done…

Those who can afford it pay to get treated at private hospitals. This way, they no longer have to deal with El Seguro.

There are just so many people who need medical attention and not enough employees or resources to get adequate health support. Nurses, doctors, and administrative personnel have developed a reputation of being mean. I’m sure there are a few cases of people who are kind of nasty, but mostly I think they all have grown a thick skin to protect themselves. They have to witness so much pain and death every day. Plus, they’re often verbally assaulted by patients and their relatives, people who are understandably sad and scared.

In fact, all around the facilities you can find posters warning of the possible consequences for verbally or physically abusing one of the employees.

In other words, El Seguro was already in a very difficult situation pre-pandemic.

Despite all of these faults, I have to say my family has been spared a substantial financial burden, all for the monthly quote that is deducted from my salary — no copays, no extra charges. I have looked up the prices of some of the drugs my husband takes, and there’s no way in hell we would have been able to afford them.

What are you doing here?

As part of his treatment, my husband has to show up once a month to his assigned clinic. There, they check his overall health and give him his prescriptions. Around March, he went to his usual appointment.

His doctor was furious.

“What are you doing here?” she asked. “You are over 60, and you have cancer. You are in the high-risk group for COVID-19!”

“Doc, but I need my medicine,” he argued.

The doctor thought about it for a moment. “You are going to have to send your wife,” she concluded.

You see, after so many appointments, she has come to know us. She is aware that I’m 22 years younger than him and that I am quite healthy. She decided I was going to be the surrogate patient.

Basically, I have to show up to the appointments, face mask and everything, give a report on my husband’s health and pick up his medications. He is not to set foot in the clinic unless something serious happens.

At the moment, a hospital is one of the most dangerous places on Earth for a cancer patient.

Injection Day.

Besides taking certain drugs daily, my husband also receives a dose of Leuprorelin every six months to reduce his body’s testosterone production, thus inhibiting tumor progression. It’s a subcutaneous injection a nurse applies on his belly.

It hurts a lot.

Also, it comes with some debilitating side effects such as bone pain, tiredness, hot flushes, and loss of appetite. The list includes erection problems, but my husband insists everyone knows he doesn’t have that issue, a fact I’m happy to corroborate.

Men…

For obvious reasons, this is the one procedure I cannot do for him; he has to show up to the clinic, pick up the medication and then go to a nurse so she can administer it.

However, to get this shot, he has to go to what we call a Specialty Clinic and visit his urologist and, sometimes, also his oncologist. This is a huge hospital, located in one of the oldest parts of town. Usually, hundreds of people come and go every day, but now…

Yeah, my city is always this sunny (Photo by the author)

On a typical day, this is one of the busiest streets in my Mexican border town, with hundreds of people coming and going, street vendors on the sides, a rush of activity.

Nowadays, the street has been closed down. There’s even a police car 24/7 to help maintain order. People can enter only on a need-to basis.

My husband showed up on time for his appointment. However, at the entrance of the building, there were a couple of administrative aides to provide “guidance” to the patients. Once he was there, these aides told him all appointments had been canceled, and there was medical attention only in case of extreme emergency, aka for people about to die.

Oh! And no, he was not going to receive his shot — you know, the one that is helping keep him alive.

He argued, debated, pleaded, nearly cried, but the answer was still no. There was nothing they could do to help him.

In the end, they gave him a tiny piece of paper with a phone number on it. “You can call here,” they told him, “if you want.” Frustrated, he left.

Hope?

The next day, I took that piece of paper and dialed the number on it. No one answered.

I tried again. This time, a woman picked up the phone.

I explained to her how, since all appointments and treatments had been canceled, I wanted to know what we were to do next. Were we supposed to reschedule? What was going to be done about my husband’s injection now?

She was startled.

“What do you mean appointments have been canceled? The doctors have been showing up to work. We are sending some people away, but we are still seeing patients,” she said.

I almost stopped breathing.

“Wait a minute,” I said, “the doctor was there?!”

“Yes,” she said. “Your husband should have explained the situation to the people at the entrance, that he was there to get his treatment.”

“He did!” I nearly shouted.

She paused and took a deep breath. I knew she was considering what she was going to say next.

“Had I been there, I would have let him in,” she said. A long silence followed.

“Look,” she spoke again, “tell your husband to come tomorrow at 8:30 sharp. If I’m not there, then he’s gonna have to ask for me.”

She gave me her name — let’s call her M, shall we? — and we said goodbye.

Yes! But, also, no!

Oh, my husband was there on time. Heck, he got there with 20 minutes to spare. Upon arrival, there they were again, the same two aides. They repeated the information from the day before and, when my husband asked for M, they said they had no idea where she was.

Since they did not let him in, my husband had to take a seat on the steps of the stairs outside the clinic.

I will never know the reasons behind these people’s behavior. Clearly, some internal issues are going on at El Seguro.

At 8:30 a.m., M showed up.

My husband said he heard a woman’s voice. “There must be a man here, looking for me. Where is he?” she asked. The aides pointed toward my husband on the stairs.

“Hello, come with me, sir,” she told him. In just a few minutes, he was inside and sitting on a chair. “The doctor will see you in a moment,” she said.

He looked around and was stunned. This Specialty Clinic is usually at max capacity, with lots of people waiting for their turn to see their doctor. On that day, it was nearly empty and eerily quiet.

He paid close attention to what M was doing. She was some sort of receptionist/assistant/prestidigitator. She moved in a blur of activity, her phone ringing non-stop with desperate calls from people who needed her guidance. At the same time, she was typing in her computer and monitoring the doctors’ and patients’ comings and goings.

Then, the doctor called my husband.

This was not my husband’s usual urologist. However, a quick look at the file gave him all of the information he needed.

“It’s time for your shot,” the doctor said. “There’s just one problem.”

The medication was available. The issue? The doctor could write the prescription, and my husband was free to pick it up, but they had no personnel available to administer the shot.

Bummer…

So, my husband walked out of there with a piece of paper that allowed him to receive the medication he needed, but that was it.

He came back home and explained the situation to me. And then a grand search began. We needed to find a doctor, nurse, clinic, anyone that would administer the shot to my husband. Also, we needed to make sure it wasn’t going to be too expensive.

I made a ton of phone calls.

I discovered this was an unusual situation for most private practitioners. They are used to selling you the drugs they administer to you, but they weren’t sure how much to charge us to administer the shot. I was put on hold, sent from person to person; some people even hung up on me.

Frustrated, I made up my mind.

I was going to have to make a little excursion into the Medical District.

The what?

I live in a border town, next to the state of California. If I grabbed my car right now and drove for about 15 minutes, I would find myself face to face with The Fence (it’s not a wall. Not yet.)

Here’s the thing: In the USA, healthcare is super expensive. Like, it will ruin your finances kind of expensive. As I mentioned before, in Mexico, private healthcare is not cheap, but things are not as bad as in the USA.

According to this NPR article, “The U.S. government estimates that close to 1 million people in California alone cross to Mexico annually for healthcare, including to buy prescription drugs.” The same piece explains how a 3-month supply of insulin that in the USA would cost $3,700, in Mexico will only put you out $600.

Yep.

This is what we call Medical Tourism, meaning people who come here for the sole purpose of taking care of their health. As a result, cities like mine have developed Medical Districts. These are areas with lots of doctor’s offices from all kinds of specialties, laboratories, and lots of pharmacies.

I knew that if I drove around for a little while, I was sure to find someone who could help me. I stopped by a couple of private hospitals, and, after some waiting, I was able to come to an agreement. They were going to charge us 200 pesos — that’s around $9 at the current rate.

Once I had secured a location, I drove back home, picked up my husband, went to the pharmacy so they could give us the medication, and then drove back to the private hospital where they were going to administer the shot.

I had to wait outside; only people with severe mobility limitations can have a friend or family member accompany them. I looked at the people around, all of them wearing masks, and used that time to check some of my students’ emails, which I hadn’t been able to do the entire day.

About 20 minutes later, my husband was ready to go. However, we soon realized we had forgotten his cane back home. He held onto me as we walked back to our car. We had to move very slowly.

We Are Back.

We were finally home. I looked at the time: 3 p.m.

How was this possible? Our entire day gone between phone calls, driving around, the hospital…We hadn’t even been able to eat, and we both were exhausted.

I fixed a quick meal, and then my husband went straight to bed, holding his belly.

In about a week, I have to go to our assigned clinic to pick up some pills. I will have to keep doing that every month. And, in 6 months, my husband will have to go again to get his shot.

What will things be like then? Will there be some sort of normalcy?

And, most important of all, will M still be there to help us?

I don’t know. Like everybody else, we will have to wait. There might be a pandemic out there, but the world keeps on spinning, and cancer cells keep on duplicating.

I get a headache every time I think about the whole affair.

NOTE #1: if you are an American citizen thinking about coming to Mexico to buy certain medications, I strongly suggest you first read these guidelines by the U.S. Customs and Border Protection Agency, and these from the Food and Drug Administration.

NOTE #2: M, you rule!