Tuesday, May 05, 2009

How poverty contributed to the Swine Flu deaths in Mexico

We don't want to join in the media freak-out about swine flu, but we did find this story relevant to poverty.

Medical experts are looking into why there were many more deaths in Mexico than elsewhere. The medical community blames poverty and self medication as some of the causes for the death toll.

From this Washington Post article that we found in The Spokesman Review, writers Joshua Partlow And William Booth also point to the illnesses spread throughout densely populated areas.

Among the largest concentrations of swine flu cases is in Iztapalapa, with nearly 2 million people the densest, most populous of Mexico City’s 16 districts, and also one of the poorest, said Miguel Angel Lezana, the government’s top epidemiologist.

“It’s an area with a huge demographic concentration. Since this is a disease that is transmitted and spread by personal contact, when you have this huge accumulation (of) people in a rather small area, you have a greater opportunity to spread the disease,” Lezana said. “Besides, these are the people with not actual lack of access, but difficulty getting access to medical facilities, so they get there late to the doctor or the ERs in case they need it.”

The reasons behind this delay have little to do with apathy, according to Mexican patients and doctors.

“Delaying medical care is a characteristic of poverty. For people living close to the edge, taking off a day to visit a doctor or staying home sick is literally taking food out of their mouths,” said Paul Gertler, a professor of economics at the School of Public Health at the University of California at Berkeley, who has worked in Mexico.

Mexico has three parallel health care systems. Workers who are employed by the government or private companies are part of the national social security system, as are their families. When they go to a hospital or doctor, the care is mostly free. The uninsured, about 50 percent of the population, include the unemployed and those who work in the informal economy. They also have access to health care, at public clinics and hospitals run by the Health Ministry. They are required to pay for services, but the amount is based on their income. It is often just a few dollars for a doctor’s visit. About 3 percent of people visit private hospitals using insurance or, if they are wealthy enough, by paying in cash.

“Mexico is a country with a lot of self-medication,” said Homero Martinez, a researcher at the Rand Corporation in Los Angeles who specializes in the study of the Mexican health care system. “You can go to the pharmacies, they are open 24 hours a day, they deliver, and you can buy all the medicine you want for yourself – and your neighbors.”

During the outbreak, when masses of people became concerned about the possibility of infection, patients waited hours to see doctors. Some family members slept overnight on the sidewalks. The government deployed more than 100 ad hoc clinics – trucks and tents staffed with doctors and nurses – to quickly screen for prospective flu cases. At one mobile clinic in Iztapalapa, residents last week said they had waited for up to four hours to see the doctor. At one point, care was delayed further because a crying boy had a high fever and the doctor wanted him rushed to a hospital, but no ambulance was available.

Health care has become more accessible during the outbreak. Calderon decreed last week that all public and private hospitals provide care for people with flu symptoms.

1 comment:

Shirley Selman said...

Thank you for a most enlightening piece on swine flu in Mexico. It's edifying to know that you get it by human contact, for example, and not by eating pork. With 1 out of 7 Americans uninsured and many more underinsured, the example of Iztapalapa could easily be replicated if a really dangerous epidemic were to get started in the United States. I hope this flu scare will awaken us to how broken, not to mention how expensive, our health system is. To ensure our own health, we should support access to health care for everyone. That's ultimately the only way to protect ourselves against a pandemic.