Economic Ills Infect Health of Mexicans

MEXICO CITY —  When 61 newborn babies died in 4 1/2 months at the government hospital in Durango earlier this year, dark rumors surfaced of massive medical malpractice. Or worse.

“Punish the killers!” screamed grieving mothers who gathered outside the local health department office in the northwestern state capital. Furious parents even began to speculate about the unspeakable--that doctors were deliberately killing the infants to sell their organs for profit.

But no, an in-depth federal investigation concluded in August, there was no foul play at Durango General Hospital. It was simply this: The hospital was poorly equipped and understaffed; the babies were premature and malnourished; their parents were too poor to buy even basic medicines that the hospital itself could ill afford.

The team of medical experts from Mexico City concluded that Durango’s infant mortality rate was not unusual. These and other recent findings indicate that this nation’s deep economic crisis has created a parallel disaster in health care. The combination of inflation, unemployment and devaluation has left most of Mexico’s 90 million people with less to spend on medicine, doctors and, for many, the minimum nutrition necessary to fend off disease.

Although experts disagree about the potential long-term harm of the current situation, it is especially distressing to Mexicans because they had begun to see public health here markedly improve from Third World conditions. But now, just 10 months into one of the worst recessions in modern Mexican history, the official statistics are chilling:

* Malnutrition in the capital has increased sixfold since the crisis began last December.

* In the countryside, where the effect of roaring inflation and frozen wages is even more painful, as much as one-fifth of the population is considered “severely undernourished.” Researchers are uncertain of exact numbers; the government has no money for detailed studies this year.

* The incidence of Third World diseases, such as cholera and dengue fever, among a weakened population is almost 10 times higher than a year ago, when the government reported that it had them under control.

* Prices of basic medicines and personal care items needed to combat or prevent disease have skyrocketed an average of 45% since January.

* Business at the nation’s private hospitals--the best source of medical care in Mexico--is down an average of 40%, as newly impoverished middle-class families are forced to return to subsidized care at now overcrowded and underfunded government hospitals and clinics.

“We’re moving backward,” said Roberto Robles Garnica, the opposition chairman of Mexico’s Congressional Health Commission in the federal Chamber of Deputies. “The government would have you believe that the crisis is manageable, that it isn’t that grave. But a great mass--about 40 million people--are living in conditions of poverty. . . .

“We are now living a tragedy where the minimum wage can only buy one-third of basic necessities--what is absolutely indispensable in calories and protein. The conditions are truly dramatic.”

Infections, for example, have been spreading faster and with more lethal effect than the health care system can handle. The starkest proof of Mexico’s slide back toward the Third World, Garnica and independent medical experts said, is government documentation of an alarming outbreak of cholera--particularly among the poor.

In the first half of 1994--relative boom times for Mexico’s poor and its emerging middle class--doctors recorded 1,928 cases of cholera nationwide; 21 of the afflicted died. But this year, the number of victims has more than quadrupled, while the number of fatalities has increased even more sharply. In the first half of 1995, 9,105 people contracted the disease; 102 died.

The government has responded to the outbreak of the disease--commonly associated with poor sanitation and polluted water supplies--with public awareness campaigns and accelerated distribution of kits to ensure that infected patients don’t die of a key cholera effect: dehydration.

But the disease is spreading unabated--especially in poor urban neighborhoods and impoverished states such as conflict-torn Chiapas, where the government’s National Nutrition Institute estimates that as much as 40% of the population is severely undernourished. “And nobody knows when we’re going to be able to get rid of this disease now,” Garnica said.

Access to quality medical care also has worsened as a direct result of the economic crisis, in which annual inflation officially is running at 40%.

Deputy Health Secretary Jose Narro Robles recently conceded that 10 million people remain uncovered, even by government care. Cash-strapped Mexican families--whose purchasing power was cut by more than half within weeks of the government’s harsh peso devaluation in December--also can no longer afford private doctors and hospitals.

“Before the economic crisis, people went to private clinics because they didn’t have to wait in line, because they could choose their doctor or surgeon and because it was just more comfortable,” Garnica said, describing the emerging prosperity that immediately preceded this year’s crisis at Mexico’s grass roots. “Today, no.”

Dr. Francisco Tenorio confirmed the trend. He is one of Mexico’s leading oncologists and president of the Mexican Surgical Academy. He said that consultations at his privately owned Hospital de Mexico, for example, are down 40%; surgeries are down more than a third. Both statistics, he said, are typical of a nationwide trend.

The results, Tenorio said, are long waits and reduced care at overtaxed government hospitals, which increasingly are facing a financial crisis. The institutions are funded by the nation’s social security system, which--as in the United States--is financed by deductions from worker wages. But, with more than 1 million Mexicans thrown out of jobs since the crisis began, social security contributions have plummeted. The public health system can barely maintain itself.

“The biggest problem now is the demand in the public hospitals,” Tenorio said.

Narro Robles, deputy secretary in charge of government health services, conceded in an August interview that inflation is taking a heavy toll on the public health system. The health secretariat’s initial 1995 budget, just over $1 billion, “clearly has been affected, as has the rest of the government, by inflation and the fact that some of our goods are imported,” he said. “We have to buy them [supplies] in foreign currency, and that’s where we feel the impact.”

So great was the harm that President Ernesto Zedillo agreed in August to increase the health department budget by nearly a third, to almost $1.3 billion. Some of the new aid has made its way to the countryside--especially to Durango’s General Hospital. There, after a torrent of negative publicity following the infant deaths last spring, administrators say the government has sent new equipment, medicines and staff.

But with public hospitals elsewhere in the nation--including the poor neighborhoods of Mexico City--complaining of continuing shortages of almost everything, opposition leaders and medical experts say the health budget still isn’t high enough.

“The budgets are increasingly insufficient,” Garnica said. “In real terms, the health department’s budget is down this year. There has always been a deficit. But now, some medications and basic items are scarce--especially at public health department clinics. Patients are often told by medical workers to go buy their own needles and serum--or even to buy towels and soap--before going to a public hospital for treatment.”

Garnica said he could not estimate the long-term effect of what Zedillo insists will be a short-lived crisis--a “structural adjustment” in the nation’s economy in which, the president recently asserted, “the worst has passed.”

“We can conclude that the depressing economic situation is severely affecting health--even though we cannot measure the full impact yet,” the congressman said.

Tenorio agreed, saying: “It is too early to assess the overall impact of the crisis on health. In the last decade, there has been a major transformation in Mexican health care.” The improvement “has taken place largely in the cities. In the countryside, it’s a different picture.

“These are long-term trends which are not easily reversed,” he added. “But if this crisis goes on for an extended period, of course, there could well be serious long-term repercussions.”