The current number of those eligible to receive health services from IMSS (the Mexican Institute of Social Security) is 79,722 Social Security recipients who are cared for in five medical offices with14 physicians working in shifts. Each doctor has to serve 8,000 eligible patients. The best clinic among these does not have a surgical ward.
“The workers use gloves, mask, robes, depending on the area. Some don’t need them, but they do require them, or they want to use them.”—Anonymous IMSS doctor
Fear of the Unknown
By Jesús Aguado
Unidad Médica Familiar (Family Medical Unit), known as UMF 11, forms part of the Mexican Institute of Social Security (IMSS), and is located on Calzada de la Aurora in San Miguel de Allende. The doctors, nurses, and administrative staff of this local IMSS are in charge of the healthcare of 80,000 people.
We spoke to one of the doctors (who requested anonymity and will be referred to as “Francisco Ocaña”) to find out how the personnel is dealing with the exploding pandemic since this is the only federal government clinic in the city. The other healthcare facilities are private hospitals; those that depend on state funding, the regional hospital, and CAISES Health Centers.
Chaos has erupted at the national level because many IMSS doctors have publicly stated that they lack supplies and material to treat patients with COVID-19. In Guanajuato, the IMSS T1 Regional Hospital of Leon is designated for COVID-19 patients. Currently they have cancelled all non-essential health services, elective surgeries, and regular office visits to focus on the crisis.
In San Miguel, UMF is the only first level hospital that works in collaboration with IMSS of Celaya with a second level facility, and the IMSS of Leon where there is first, second, and third levels of care are available. When someone is ill and needs treatment the patient covered by IMSS is routed to a particular clinic. Ocaña explained that they have been preparing for the contingency. They’ve requested the necessary supplies such as robes, gloves, and masks that are to be used only in specific areas.
The doctor commented, “We are all naturally afraid for our entire personnel, and it’s not easy for anyone. There is international news that disseminates misinformation, fear, and uncertainty. However, here we work as usual. At first we struggled with acceptance of this health crisis, and we have now accepted its reality. We are conscious about what is to come, but we don’t know what it is. Until it arrives we will not know.”
He went on to say, “No one has gone into panic mode. Yes, we fear the unknown. But no one has expressed terror. Personally, every worker has to overcome his or her fears. That is why we have daily briefings including training, information, and education. We are kept up to date regarding the evolution of the virus.”
He also said the healthcare workers carry on with their jobs as usual and nobody has been attacked or threatened—which has occurred in other health care facilities in Mexico. “The personnel is advised not to go out in uniform—from home to work and vice-versa—and we change into our work clothes in the clinic.” These measures are taken to avoid attacks, according to the doctor.
However, in spite of the briefings, the fear of attack is present. “We are all afraid of contagion. There have been courses and briefings to help us to avoid risks. We do have a ventilator, but we don’t have tests. We have an agreement with CAISES that in a case the need arises, they will do the testing. We also have an agreement with the general hospital to help with the treatment of serious cases,” said Ocaña.
When asked if they are prepared to take in such cases, he said, “Nobody is prepared. We are learning and getting closer to being prepared. In practice we do not know what capacity of patients we are facing. Fear can work in your favor or against us. All I can say is that the personnel has the protective materials we need and we are working.”
We continue caring for patients through social distancing
The doctor said that they are taking precautions when attending patients and are applying social distancing measures indoors. For example, there are benches that cannot be occupied by patients while they wait for their turn because of space requirements.
A tent has been set up outside for those who accompany the patients—but do not need to be with them—as a waiting room. In the meantime, they are informed about how to prevent contagion from COVID-19.
The IMSS clinic is also giving out phone instructions about health. There are few patients who have arrived with COVID-19 symptoms. One patient was sent to CAISES and later was reported to be positive for the virus.
“I leave my work clothes in the office. When I arrive at home I clean my shoes. I have hardly seen my family. Each family member is in his or her own space. I sanitize myself as much as possible. Other colleagues with adults at home arrive and take a bath and change. I have nearly zero contact with my family. I arrive late, tired, the only thing I want is to have dinner and rest,” concluded the doctor.