For 84 years in Mexico, October 23 has been celebrated as Doctors’ Day. The convention of confederate medical unions meeting in Cuernavaca in 1937 chose that day in honor of Dr. Valentín Gómez Farías, who during his tenure as President of the Republic, approved the educational reform that gave rise to the Establishment of Medical Sciences on October 23, 1833. In the world there is a tradition of celebrating these professionals annually, but not all countries do it on the same day. For example, seven countries in the region (Argentina, Bolivia, Colombia, Cuba, Guatemala, Paraguay, and Uruguay) are following the initiative launched by the Pan American Health Organization (PAHO) in 1953 to celebrate Pan-American doctors on December 3. in homage to Dr. Carlos Finlay (1833-1915); Cuban doctor who discovered the role of the mosquito that transmits yellow fever. Curiously, six other countries: Brazil, Costa Rica, Honduras, Nicaragua, Peru and Mexico, coincide in honoring these health professionals in the month of October, but the reasons are very different.
While the idea of celebrating doctors in Mexico comes from a civil society union organization nine decades ago; The COVID-19 pandemic caused the president of Mexico to issue a decree in the Official Gazette of the Federation which declares “Doctor’s Day” on October 23 of each year. This decree, says the text, offers the legal instrument to render the deserved recognition of the hard work of delivery to those who exercise this profession.
What to celebrate in 2021?
First, remember Valentín Gómez Farías (1781-1858). Original physician and lifelong politician. He practiced the profession for ten years in Aguascalientes and transformed the profession through the reform of 1833 which began the career of medical surgeon, professional training that was previously carried out separately. Dr. Gómez Farías is an essential character in the history of Mexico. In 1868 his name was inscribed in golden letters in the session hall of the Congress of the Union and in 1933 his remains were moved to the Rotunda of Illustrious Characters. His political career can be summarized as: deputy five times, senator of the Republic, vice president and interim president of Antonio López de Santa Ana five times. His time as president of the nation was ephemeral, he did not accumulate a year in the five times, but forceful in the actions and reforms he carried out, for the same reason the deserved recognition as the “Father of the Reform.” Of liberal ideas, he fought against the power of the church, lived for years in exile and was imprisoned for a few months for sticking to his federalist principles. His legacy is having been the first to sign the 1857 constitution and the only Mexican who participated in the drafting of two Mexican constitutions (in 1824 and 1857).
Second, the study of medicine in Mexico is dominated by women and although statistics are lacking, it is very possible that they are also the majority in the labor market. It is noted that they are making steady progress in occupying managerial and decision-making positions in the institutions. According to the National Association of Universities and Institutions of Higher Education (ANUIES) http: // www. anuies.mx/informacion-y-servicios/informacion-estadistica-de-educacion-superior/anuario-estadistico-de-educacion-superior medicine enrollment in 2020-21 was 146 thousand students (59% women); that year 25 thousand young people entered the career, of which 62% were women and that year 7,568 doctors and 6,899 doctors graduated.
What should we not celebrate in 2021?
The labor market collects biased statistics on doctors in Mexico. The Ministry of Health reports people who are on the payroll of any of the public institutions without an interest in carrying out a demographic analysis (age and sex) and less a precision exercise to avoid duplication in the account. For its part, INEGI collects data from the private sector and adding the results from the two sources, it can be said that in 2020 there were around 323 thousand doctors in Mexico, which represents a ratio of 2.6 per thousand inhabitants. This figure offers three aspects to analyze: a) insufficient density, b) uneven geographic concentration, and c) imbalance between general practitioners and specialists. In addition, there are hidden poor working conditions, low salaries in the public sector, no economic incentives and medical underemployment or unemployment that we cannot easily document.
a) The density of medical personnel in Mexico is insufficient as international standards call for more doctors per inhabitant. It is known that more doctors does not equal better health, but it is also known that the lack of trained personnel directly affects the good performance of the institutions and consequently the health care of the population. Rather, the question that must be answered is what is the figure that must be reached to achieve the universal health coverage that is sought?
b) The distribution of medical personnel in the country is uneven. In four states (CDMX, Estado de México, Jalisco and Nuevo León) they concentrate 39% of the personnel, in contrast to 22 states that add up a similar number. The difference is that 32% of the population live in the first four and 42% in the second block. In other words, for every medical professional in CDMX there are 200 people and in Chiapas there are 667. The opportunity to find a doctor is 3.3 times easier for someone who lives in CDMX than for someone who lives in Chiapas, although it is possible that This inequality is repeated within the state, if we compare Tuxtla Gutiérrez with other municipalities.
c) In Mexico, out of every four doctors, three are specialists and one is not. However, in Chiapas, Guerrero, Oaxaca and Tabasco the ratio is 1: 1. On the other hand, in Aguascalientes, Jalisco, San Luis Potosí and CDMX for every general practitioner there are five or six specialists. The extreme is Nuevo León, which concentrates 20% of the private sector medical specialists in the country and for the same reason there are 15 specialists in the state for each general practitioner.
The Covid-19 has been in general the most difficult test for human resources in health, but particularly for medical personnel. According to the statistics of the General Directorate of Epidemiology, lacking denominator and asymptomatic positives, they tell us that in a period of 21 months, 71,880 positive symptomatic cases have accumulated among doctors, of which 2,018 have died. The risk of dying if it is a positive case is 3.6 times higher in medical personnel, in relation to nursing personnel. Some may think that this happens to physicians because they accumulate metabolic risk factors, but how to wear and the availability of personal protective equipment (PPE) should be seriously considered.
Some studies have suggested that healthcare workers are ten times more likely to be infected with Covid-19 compared to the public, and that serious, and life-threatening infections are seven times more likely among healthcare workers. Aside from the moral imperative to protect those who risk their lives to care for us, there is a compelling practical argument. If health workers are infected, health facilities become places of super-spread. For that reason, while far from being glamorous, masks, gloves, and aprons are vital tools in responding to Covid-19, saving lives, and making us safer from future infectious disease threats. So when we invest and act in vaccines, treatments and tests, we must also invest and act in PPE.
It is highly recommended for health personnel and for the authorities in charge to review the initiative “Rethinking the EPP”. This proposal establishes that the transformation of the PPE ecosystem will require five types of activities:
- Catalyze PPE innovation;
- Improve the quality standards of PPE;
- Expand and diversify regional manufacturing capacity;
- Strengthen procurement practices and
- Optimize use and safe disposal.
If you start with reviewing these actions and implementing them, it would make a big difference in our ability to protect health workers in Mexico.
I take this text to sincerely congratulate my colleagues by profession and to offer my condolences to all the families who lost a relative due to the COVID19 pandemic between 2020 and 2021.
* The author is a graduate of the Faculty of Medicine of the UNAM, generation 1973-1978.
@DrRafaelLozano
Reference-www.eleconomista.com.mx