Mexican healthcare


Too much going on to write about today, but here’s a prose piece I wrote last year that tells the whole story . . .

Liftoff

There is dog shit in the gravel yard. I am surprised that I even have a dog to leave me these small gifts, a spunky, throw-away pawned off on my husband by an old friend.

Tomorrow, Miguel will tear off pieces of plastic bag and collect the digestive offerings with hospital care. They go into a small, lidded trash bin, also plastic-lined, which will later be neatly tied and, to prevent punctures, placed gingerly into the 32 gallon garbage can we brought from The North.

When the boy walks down the street ringing a bell, Miguel will roll the can out and pay 10 pesos to the brown man walking behind the unmarked, open box waste truck who will hand it up and in to the king of that unthinkable hill, then return it to my husband, empty as a plundered vault.

But for now I watch the flies settling, probing, taking a short walking tour, practicing liftoff and landing on this canine wasteland.

Across the street our neighbor precisely fills a folding metal table with chicken, flayed, filleted, and whole, proud of the convenience and variety he provides the neighborhood cooks. He moves in ritual, white alb, bloody vestment, swipes the knife, wipes his fingers, pulls the next yellow corpse from the boxes stacked precisely on the sidewalk.

The amateur butcher’s wife calls him inside. He untucks the greasy towel from his apron front, smoothes it across the processed parts, centers the knife just so on the chopping block, turns to answer matrimony’s call. The pilots in my yard liftoff.

The question we’re struggling with right now is how safe do we feel in Mexico.

A neighbor of Miguel’s best friend was in a car accident in late June and the wife asked Miguel’s friend, Adrian, to take her to the hospital. Adrian was so upset by the news he couldn’t drive. So Miguel drove Adrian and the neighbor’s wife to the hospital.

The neighbor and his adult son and another fellow were coming back from work; driving on what passes for highway here. It was just about sundown, 7:30 p.m. or so, and the roads were wet from heavy rains. My guess is everyone was driving at their usual crazy speed. The father was driving in the right hand lane, the son was in the backseat, the passenger in the front seat just happened to be looking backwards and saw another car approaching even faster. As the driver of the second car pulled out to pass the father’s car, she clipped the left rear corner. Yes, it was close enough that the passenger saw it was a woman driving. The neighbor’s car went into a spin, jumped the center divide, and slid into the opposite lanes of traffic – facing in the correct direction for their new lanes, but directly in front of an oncoming vehicle. The impact collapsed the rear of the car, crushing the son inside.

The son was trapped for 30 minutes before the rescue workers could get him out. At the hospital, he was in grave condition – internal injuries, a broken thigh and a foot severed at the arch. The first surgery, after waiting for the mother to arrive with proof of medical insurance, was to put his intestines back together.

Yet, those issues, alone, are not the main reasons for us to rethink living in Mexico. Here are the details as they have been explained to me by Miguel; each an individual assault to my sense of justice and, taken together, one big question mark about what my expectations are for living here.

While in the hospital, the father was arrested for attempted suicide. Apparently there is a law that any driver must be arrested for attempted suicide for intentionally driving fast enough to be potentially life threatening. I think it’s an interesting law and would almost be inclined to support it, except that the arrest was made before the investigation was even begun and the father has to stay in jail until the investigation is completed (weeks/months) or until he pays $150,000 pesos in bail. There is no system of posting bonds for bail. Imagine being stuck in jail, with a family to support, unable to work, and obligated to pay in cash the equivalent of about six years wages. And, even if he is ultimately found innocent, the $150,000 pesos will stay with the police.

I asked, “What about the driver that clipped them?” The father’s attorney says that even if the police located the other driver at the time of the accident (because they won’t likely go looking for her later), the police would simply say, “Pay us $100,000 pesos and we’ll pretend we’ve never seen you.” The obvious question to me was, “Who has that kind of cash on hand?” Apparently, corruption is so institutionalized in Mexico that the police officer will accept whatever cash you have on hand and give you a loan for the rest – secured by your car or your house. If you default on the loan, they take your car or house. If you raise any questions about the propriety of the bribe, it’s just a promissory note between you and a cop – nothing out of the ordinary in the court’s opinion.

Now let me step back to the question of medical care in Mexico…think about this detail and the young man with intestinal surgery. According to Miguel’s mother and sisters, all surgery done on Mexico is done under a local anesthetic. No one is put to sleep for any reason. Ever. Miriam’s appendix ruptured last year, she had to wait a number of hours before they operated, she was awake for the entire operation, the resulting infection required three more surgeries to clean up the poisons that spilled into her body with the rupture – all done with eyes wide open, she was off work more than four months, and was left with a wide and winding ten-inch scar down the middle of her abdomen.

So, whether it is true that surgery is never done under a general anesthesia in Mexico, or whether it is only the local hospitals that are not equipped for procedures that require general anesthesia, medical care is on our list of concerns next to traffic safety and corruption. (And I have a new understanding of and appreciation for the road-bump-cursed surface streets.)

On the other hand, apart from being charged an occasional premium for green eyes, we have not experienced racism in Mexico like we did in the US. Just as in Mexico I am concerned each day about corruption, when we lived in Seattle I was concerned every day about Miguel’s well being in the context of racism.

I can hear you saying, “Racism? In Seattle?” But, yes, Racism. In Seattle. And across the US. And even worse today with immigration conflicts. The subtle and not so subtle racist activities I encountered in the Pacific Northwest included things like

  • The popular “Save the Whale, Kill an Indian” bumper sticker during the 1999 Makah whale hunt (what other cultural group could be so blatantly menaced and no cry of outrage heard in the national press?)
  • The day before our wedding in 2000 my brown-skinned husband was refused a key to the Pike Place Starbuck’s bathroom while I was ordering coffee for our party of four – “You have to buy something” the barista snapped at him, while at the same moment I watched a white man walk in off the street, ask for and was given the key, and then left without ordering a thing (and, even worse, when I complained to the company’s corporate offices they didn’t even bother to respond)
  • After a day spent fishing the far side of a Montana lake in the summer of 1992, my “Red Power” bumper sticker had been pounded into the steel of my bumper with a ball peen hammer
  • The unlikely coincidence that all of my husband’s Mexican coworkers who drive down the same small-town street past the police station to cash their paychecks have been stopped for speeding when they were obeying the speed limit, and the fact that the former city attorney for that same small-town admitted to me that racial profiling for false traffic violations was a city policy because it almost always resulted in large fines from citations to drivers without a license or insurance.

And, yes, I agree that everyone should obey the law and always carry a valid driver’s license and appropriate insurance, but racial profiling is not the way to enforce the law. Miguel’s co-worker who actually produced a valid license and insurance was then charged with drunk driving, even though he wasn’t, and even though many other details of the arrest were questionable, and he had to pay a lot of money to get his record cleared up so as not to jeopardize his legal immigration status. And the terror I saw on their faces when I went to translate for him and his wife with their attorney was, I am certain, what I would have felt had it been me and Miguel.

So, our predicament is this: Which is more difficult to endure? Racism? Or corruption? Both happen every moment of every day. We have experienced both in the past. Either could happen at any moment in the future. Which is more traumatic? Which is easier to put out of my mind as I go through my daily activities?

I got sick just after Christmas. My first encounter with healthcare in Mexico. Everybody here has a favorite cure, recommended without hesitation. For my violent stomach flu while traveling, I was sent to the pharmacy to buy various prescription drugs over the counter – without a prescription. Medications that say things on the side like “don’t use this for more than five days because it can cause liver damage.” In Spanish, of course.

The pharmacist just handed over whatever I asked for without question. Depending on the product, the prices ranged from $3 pesos to $45 pesos for anywhere from 1 day of treatment to 5 days of treatment. Even considering the economics of the peso, these prices are comparable to what I’d pay in the US for prescription medication – that doesn’t mean I think they’re reasonable prices (don’t get me started on US drug pricing), just that they’re proportionate prices.

Returning home, the intestinal malady had run its course but I came down with a respiratory bug. Worse, for me, because of my history of pneumonia. Again, more remedies than I could possibly use were offered – my favorite was the recipe for some kind of poison from my mother-in-law:  Nescafe, lime and honey. I told her I’d drink it if she did, too. She just laughed, so I still don’t know if it tastes as vile as it sounds.

After six days of various pills (again, the potential-liver-damage-warning kind), the older couple that runs our favorite taco stand heard me coughing and insisted that I go to the pharmacy right that minute and get an injection. Injection is the most favored treatment in Mexico for “la grippa” and, in fact, is usually recommended even before any proffered home-remedy. (Yes, my mother-in-law offered to give me an injection before she offered to poison me. Of course I declined. Would you want your mother-in-law anywhere near your butt with a needle?)

The taqueros, Mari and Poli, are truly dear people, celebrating their 35th wedding anniversary next week, so I figured if they’re that nice and have managed to be married to the same person that long, they must also be wise beyond my years. So we went over and asked the pharmacist for the name of the drug they recommended. I expected another controlled substance freely passed to me over the counter but, not this time. The package contained a syringe and two vials, one of which contained eucalyptus oil. Hmm, a commercially packaged home remedy.

The next problem was to find someone to actually do the injecting. My husband is as freaked out by needles as I am, so that was one candidate down. The only other person I know in the neighborhood is the thirty-something woman that lives across the street and sells us sopes and pambasos in the mornings out of her carport – really delicious sopes and pambasos. She is also going to school to be a hair stylist. Neither of those career choices particularly qualify her to stick a needle in my butt. Nevertheless, she is one of the nicest people I’ve ever met, so I trusted that she wouldn’t hurt me intentionally or send someone to rob our house later.

It was embarrassing to ask, but Faviola acted like it was no big deal. It turns out that she actually has several neighbors to whom she gives injections on a regular basis, including a fellow in his 50’s that has cancer from working in a paper mill without breathing protection. When her children were babies Faviola took nursing classes because she couldn’t afford to take them to the doctor every time they needed injections. Fortunately, the injecting classes came before the wound dressing classes because she passed out at the sight of blood and never went back.

Faviola came to our house with her teenage daughter. She explained that the injection would probably hurt a lot because of the eucalyptus oil and because the needle was not the best brand. She prophetically recommended that in the future we ask for the needles with the yellow top because they are thinner and less inclined to form bubbles. She also recommended that I go see the doctora in the green building on the corner at the end of the short cut we take to the taco stand. She insisted that I go the next morning.

Faviola took her time preparing the injection, mixing a little bit of the clear liquid, then a little bit of the eucalyptus oil, then shaking. Back and forth, slowly filling the syringe and mixing the potion. After leaning me over the kitchen table, she refused to take any money for stabbing me in the hip – and I would have been pleased to pay her because it didn’t hurt at all. So I gave her a grapefruit-sized juicy orange that we’d bought at the street market that day and she accepted it with a warm smile and a hug.

I did not awake feeling better, but my hip didn’t hurt so I was thankful. Miguel and I walked to the doctor’s office and waited to be seen. There were only three people ahead of us, so the wait wasn’t long, just time enough for me to read each and every maxim handwritten on florescent posterboard and taped to the whitewashed cement wall. Floor to ceiling. Before I entered the doctor’s office, I felt well-reminded that God loves me and hasn’t forgotten me even if I may have forgotten Him, and knew that if God didn’t love me enough to cure me immediately a house call would only cost the equivalent of $23 US dollars. My spirits were lifted.

The doctor was efficient and kind and asked the right questions. I felt reassured. She said I would need antibiotics – would I prefer an injection or pills? By now my cough had moved from my throat to my chest and I was all for avoiding bronchitis – which would be the quicker treatment? An injection, of course. She wrote out the prescription for the injection and some capsules for my congestion.

I stepped through the door back into the reception area where her assistant (and mother) sold me the recommended treatments. The consultation and medication cost a total of $100 pesos. Yep, $9 dollars to see my new doctor plus a five day supply of prescription drugs.

Miguel and I went in search of the good quality needles. Only when the first pharmacist opened the package of medicine did I realize that I had just agreed to FIVE days of injections. Oh, yes, I was going to need those thin needles.

Unfortunately, none of the neighborhood pharmacies had the treasured prize. Faviola and her husband were standing in their restaurant carport when we stepped onto our street from the shortcut. We asked her where to go to find the yellow-topped syringes. She said, “Oh, don’t worry, my husband is going on errands and I’ll have him pick them up. How many do you need?” And then wouldn’t take any money for them. Did I say that she is gracious as well as kind?

Faviola showed up that evening after she got back from hairdressing classes, syringes in hand. This prescription was for real antibiotics and she reassured me that it wouldn’t hurt like the other mixture because it had no oil. She lied. It burned like a small fire – even after she removed the needle.

Over the next four evenings, we got into a nice routine of tea and talk before the inevitable poke. An odd way to get to know one’s neighbor, but it worked out just fine, and we’ve even had a few visits since the nursing services ended. She’s quite a lovely young woman with a strong spirit. In fact, I like Faviola so much I’ve even forgiven her deception (my rump still hurts even after three weeks) because I know it had nothing to do with her fine skill or kindly intentions.