June 30, 2012

Patience, Public Health Care, and No More Mr. Nice People—VOTA MAÑANA PAISANOS

I'm not usually a proponent of time flying, but we are well ready for June to be OVER. Life ain't often a bowl of cherries here, but June seemed to be particularly rough for this family. Heck, it's been a rough spring. After the fire from the lightning strike, then it was Margo's finger. Then a round of Giardia for us all. Then I got food poisoning. Baby fell down and split her lip. I finally went to a naturopath and my tummy is feeling much better, but then Margo got stung by a scorpion. I'm looking forward to turning the page on the calendar.

As if all this wasn't enough, Thursday, Margo's 75-year old father got into a serious accident in his truck when he was headed out to his cornfields. I asked Margo, "what the hell, do we have a hex on us or something?" Margo, who doesn't have a superstitious bone in his body, replied deadpan "maybe it's time for you to get out your brujeria," referring to my incense. The idea of a shamanic limpia doesn't sound half bad right now. Too bad it's too late for the elections tomorrow.

Amidst all this chaos, I've been working busily on my last chapter in Amor and Exile, an emotional task in and of itself. Part of me is desperate to finish and get it over with, part of me is breathlessly excited to figure out how we're going to publish, and a little bit of me is sad that such an absorbing and satisfying project will soon come to an end.

In the book, one of the biggest changes I've noted in myself in the nearly six years since I had to relocate to Mexico is that I've (forcibly) become a more patient person. I say forcibly because I haven't always accepted that change in myself, especially when running up against bureacratic red tape that I've encountered in Mexican institutions. But since there's a different pace of life here than the one I was raised in in New York, I've had no choice but to be patient with my in-laws, with friends, coworkers, land titles, myself even. And I do think I'm a slightly better person as a result.

But I'd be lying if I said I've become uniformly patient with everything across the board. I might be more patient with individuals, for example tonight when we went to get a haircut with Margo's cousin. We called at 5:30 to see if she was free, and she replied come at 6:30. But when we got there at that time, she was coloring one woman's hair and cutting another's, while another was waiting in front of us. I did get a little huffy, but I also did calm down and wait—until a little after 7 pm. After all, you can't beat a haircut for $2 bucks. And it's not like we had anything better to do.

You see, I can be patient when I'm just killing time waiting for something else. I'm talking about waiting for news about Margo's father, mi suegro. And I'm finding that I'm not quite so patient when it comes to health matters. Ever since his accident Thursday morning, we've been waiting for something concrete to happen in his treatment, a sign that he'll definitely be OK. But now, almost 60 hours later, there's still no green light on his surgery to fix two crushed vertebrae in his neck (C4 & C5), no assurance he won't be coming home on a respirator.

Unfortunately, it's not a matter I have much power to affect—not from an logistical nor from an economic standpoint. Maybe that's what upsets me so much about it. The whole situation reminds me of what happened when Margo's mother had a stroke—the entire family just waited patiently while she was channeled back and forth between the clinic and home and to various practitioners who failed to consider her need for rehabilitation urgent. No one was happy that she was ill, but neither did anyone seem as upset as me that it was taking so long for her to get sent to physical therapy. Eventually, almost two months after her stroke, she did get sent to therapy, and recovered a good deal of the use of her left side, but she's still too weak to cook or clean for herself, and her quality of life has significantly diminished. Of course it's impossible to know if this is because of the delay in therapy.

In the case of my suegro, he was taken directly from the site of the accident to the state hospital. There, they decided they'd transfer him to the hospital where he's insured as a pensioner (IMSS, stands for Instituto Medico de Seguro Social). It took TWELVE hours and more than 6 visits back and forth between clinics and copy shops for Margo to get the necessary paperwork to get his father moved. By the time he was transferred, it was almost 11 pm. More than half a day had passed since his accident.

All the while, they had full knowledge that he had broken or dislocated vertebrae. It was the opinion of the treating ER doctor who received him that he'd need to be sent to Mexico City for treatment, they didn't have the right equipment in Queretaro. Even so, it took another EIGHTEEN HOURS, to Friday 6 pm, for the attending neurologist to evaluate his scans and confirm that he'd need to be sent to the specialist hospital 3 hours away in Mexico City. He wasn't sent until 11 pm that night, by ambulance.

Meanwhile, what's incredible is that my suegro was totally conscious, aside from catnaps, and could move all parts of his body. But just a tiny lesson in vertebral anatomy belies the heavy risk of his situation—whether spinal cord damage is sustained above or below the C6 vertebra (his fractures are at C4 & 5) determines whether you'll become a paraplegic or a quadriplegic. Even so, despite now being at the trauma center in Mexico City since 2 am this morning, he STILL hasn't received a green light for the surgery. We were under the impression that with the determination sent from Queretaro, he'd be seen immediately upon arrival. Not so.

As of 8 pm this evening, now almost 60 hours since his accident, the word is that he is still in observation and they are evaluating his tomography to see if his vertebral fractures are due to an old injury or the car crash. WTF? Prior to the crash, he is one of the most physically fit members of this family who never complains of aches or pains, and after the crash he had bruises all over his body, a 3-inch laceration on the back of his head and bleeding on the brain (not to mention the previous hospital had already determined the necessity of surgical vertebral replacement). Does this require a rocket scientist?

Why they are taking their time on this is beyond my capability of understanding. When I say this to Margo, or his brother who accompanied him to the DF, they respond that there are a lot of other people with worse injuries in line in front of them. Now, I understand the need for triage, and I don't know exactly what their system is here at the IMSS trauma centers, but if you continually put someone in line behind every more traumatic patient that arrives, you'll be waiting all year because car accidents are one of the top causes of death here. And sadly, exceedingly long waits appear to be the norm, as I found on one forum with comments about IMSS service at that particular hospital.

As soon as I heard about the crash, I immediately recommended a private hospital. I raised the same issue with my suegra's stroke 2 years ago, and I received the same response this week: "where else would we take him?" And I say, to Hospital Angeles? Medica Tec 100? (The first rate hospitals in this city). I then get the same response: "but they're too expensive." And then I try to give up the suggestion, respect their decision (although I really can't get it out of my head). The reason I'm frustrated is because I see a family, a matrix of people, who could get access to the necessary resources but don't consider them an option for a case like this, where their health hangs in the balance. Margo's father has several landholdings, a herd of cows, and several vehicles and pieces of valuable heavy machinery that could easily be cashed in for better treatment. To Margo's credit, he's tried to recommend long-term planning for emergencies/retirement age before, but his ideas probably seem foreign to a family who's always lived from hand to mouth (or maybe they sound too much like his wife's). But the brothers who drive those vehicles and operate that heavy machinery that their father bought haven't volunteered to sell a single one—just a few hours ago I saw one getting drunk and the other has only called once in the last 48 hours.

I try to respect the family's acceptance of the need to just wait, emulate their patience, but it's so hard, especially when I suspect it's completely unnecessary, and just an artifact of a several-decades long habit of complacency. When I think about my father-in-law laying there in a hospital bed, a millimeter away from becoming quadriplegic, I just can't accept that patiently waiting is the only option. But why is it that I'm the only one who seems so intent that there's several ways that this situation could be made better? I try to breathe deeply, ask my husband how he feels. He replies simply, "frustrated." I empathize, deeply. Even though my father-in-law and I are not close, he does not deserve to suffer. I want to see him come home walking—still be able to eat my baked goods he can sniff from a football field away, play with his granddaughter. Or realize what he's been missing by spending so much time on the farm and not with his enormous family.

I'll take some lessons away from this experience, toward my own family's health. For the last couple years, we've been enrolled in the even more basic Seguro Popular universal health care system here in Mexico. I've considered it backup catastrophic insurance, and the truth is it's come in handy a couple times, like when Margo got stung by a scorpion—we didn't pay a dime. We usually pay out of pocket for private doctors' visits. When I had my appendix out last year, it caught me by surprise, and I had to borrow money from my parents to have the surgery in a private clinic. Afterwards, I started thinking, maybe I should have sucked it up and gone to the public hospital. But now, after seeing firsthand what happens in the case of a true emergency, how proper care is delayed again and again, I don't feel quite the same conviction. My only other option is private health insurance—the kind that Americans are now forced to carry, for their own benefit. I'm not obligated to have it, and I'm not even sure I could afford it, but it's something I want to look into.

When I told this to Margo, he cynically replied, "it'd be just the same service, you'll see." Somehow I doubt that. The difference between the service I've received at the IMSS clinics (I did enroll when Margo had a company job a few years ago, just to "check it out") and the private clinics is like night and day.

I've been told this it how it works in the public health system. That's it's good service but that it takes a long time. I'm afraid that in some cases, taking a long time is not good enough. Sometimes it's just not better late than never—it's got to be NOW.

p.s. I would have thought that on the eve of the 2012 Mexican presidential elections, I'd be blogging about that topic instead. But almost everyday of this month, with the exception of a few Facebook posts here and there, the personal has forced its way into precedence over the political in my life. I feel a bit badly about that. But it's also my first presidential election as a newly naturalized Mexican citizen and part of me thinks it's important to not just vote, but absorb the whole panorama before I start shooting my mouth off. On the other hand, I see a lot of parallels between this "exceedingly patient" syndrome I've encountered, and the citizenry's de facto acceptance of continual abuses of corruption and mismanagement of public funds at the hands of a government and media endowed with a significantly lopsided amount of power. Let's not be patient, paisanos—let's get change where it's needed, NOW.

No comments:

Post a Comment

Your comments are welcome!