Humane Medicine: A Single Comparison Between Care in the Medicaid System in Mexico Versus the U.S
Medicine, or healthcare, is a tedious topic everywhere, but it is more tedious and broken in some places than others, and I saw this first hand last week in Mexico. This past week I was on the other side of medicine, the patient side. My uncle became ill in the beginning of July and was admitted into the hospital on July 11th. After 20 days of CT scans, biopsies, MRIs, exam after exam, I sat silently with my aunt and the oncologist as we waited for the prognosis. Pancreatic cancer, that had traveled to the liver and was secreting fluid into the abdominal cavity. Treatment wise there was nothing else left to do, just wait. I recall very clearly sitting in that room with the oncologist and general surgeon for 20 minutes as they explained it all, the diagnosis, prognosis, the emotional toll on the family, my uncles’ living will, coping mechanisms, and advice on how to get through this. 2 days later my uncle took his last breath and his heart stopped. Time of death, 6:20 pm.
I have been on the patient side various times, only this time there were a big difference, I had never been on the patient side in another country. As someone who has a career in medicine, this difference made me be not only on the patient side, but also the doctor side, observing and learning how medicine works in another country. During my week there I noticed 3 big differences, hierarchy, humanity and quality of medicine.
The hospital I was in belonged to the public sector of healthcare in Mexico known as Isssteson, this in the U.S would be Medicaid, like AHCCCS, or the Arizona Health care Cost Containment System in Arizona. The hospital, it was small, only one story and had only 1 hallway, the ED entrance was next to the entrance for patients who were admitted, it resembled a primary care clinic. As I entered I saw white coats everywhere, both short and long. The nurses all wore the same scrubs, white and burgundy, and nurse hats. The Hierarchy in Mexico was clear, respected and non-invasive for both the medical team and patients. It was easy distinguishing who was who, and what each did, something that now in the U.S has become an issue with the growth of new careers in medicine, like PAs and NPs. Also, titles have become mixed in the U.S as medical doctors are no longer the only ones called doctors, you hear nurses, PAs, NPs and many other medical professionals being referred to as “doctor.” This has caused a lot of confusion regarding who is who in the U.S. This can be frustrating both for families and medical doctors themselves, as an NP or PA does not replace a medical doctor.
When I entered the patient rooms, every patient was in a room with 2 other high risk patient and only a curtain dividing them. There was only one chair for family members, and only one family member allowed at a time, maybe 2 if the security guard liked you. None of the patients had a monitor to check their vitals, they only had an IV that was never flushed or changed. I asked the nurse when they were going to put a monitor on my uncle as his BP was low in the 90s, I recall her answer clearly, “what’s that?” They did not have monitor, thus many of the nurses didn’t even know monitors existed. As I arrived into my uncle’s room I asked the nurse to change his IV as it hadn’t been changed in more than 3 days. The nurse came, and he started feeling my uncles arm without gloves on, and proceeded to insert the needle, fail. I asked him if he had anything to put pressure on the upper arm to see the visible veins, he laughed and told me “ You are in Mexico, not the U.S.” They did they didn’t have equipment to find a vein, this include gloves or something to wrap his arm to make the veins visible, instead they poked and prodded till they found a viable vein. During my days there, there was no protocol on when to check in on patients, it was on a need basis, this included pain, cardiac arrest, and difficulty breathing. My uncle started to develop a fever later in the day, I went to tell the nurse who sent the doctor to us for the doctor to tell us that they had no medication left, but that we could go to the pharmacy and buy a certain medication, he gave us the name and I went to buy it. Medication was unavailable most of the time, despite the need for medication for fever or pain. Some families, like mine, had to go buy the medication because the hospital didn’t have any, and it was full cost on the family. Later, on my uncle’s last day his BP was in the 60s and he was tachycardia, I frustrated, went to the nursing station and demanded they get a monitor on him or at least check his vital every other hour, and I asked where the crash car was. Crash carts didn’t exist there, equipment for intubation was scarce. A few minutes after this incident the director of the hospital kicked me out after asking how I knew so much about medicine.
In the midst of IVs, imaging and blood work, came the doctors to tell us the results. I was ready for the 5-minute consult with only 1 questions per 5 minutes. 10 minutes passed, and the doctor continued to explain the results and what we could do and why, alongside that he provided support and comfort as the results were always grim. They were not just doctors, they were humane. I wasn’t used to this 15-minute consult with comfort and guidance, not as a patient and not as a student in medicine. The general surgeon not only explained the diagnosis, prognosis, he explained after life care, for not only the patient but family, the mental health care needed to endure what we were going through with my uncle and examples of his life, and how he manages things like this for 20 minutes. This gave my family and I closure, and mental sanity despite knowing that my uncle was going to pass away sooner than later.
My uncle received great medical care from both the private and public health care sector in Mexico with what was available, and we all tried everything we could to remove the tumor and do treatment, but the cancer was too advanced. Could we have given him better care with more equipment and resources? Most definitely, but would it have changed the prognosis, most likely not. In our case we needed humanity more than heart monitors and crash carts, but that will not be the case for all patients, many will need these monitors, more sanitary environments, more equipment, more medicine, protocols and checklists, like in the U.S. But many in the U.S need more humanity like in Mexico. We don’t need just medicine, we need humane medicine to be able to give our patient’s the best care possible and faith in medicine because one bad experience can cause someone to never trust medicine again, and that isn’t going to save lives either.