Drug runner

This is the sort of one sided news story that I generally feel calls for a stiffly worded rebuttal, but having been in and out of hospitals here the last two months (long story short:  a broken leg, followed by an infection, followed by having a titanium plate installed in my leg) has added — much against my will — to some understanding of where “those people” are getting their ideas.

The Indiana couple who felt they, or rather their preemie baby, was being “held hostage” are pandering to prejuice and indulging in stereotyping in their attempt to find someone to blame for their bad luck… of course.   And the local politicians of even more egregious pandering… and the media nreports were lazy — simply parroting  the family’s version of events unquestioningly.  STILL… recent events (which prevented me from posting as much as I should have… or is that a rationalization?) make me wonder if in part the “issue” isn’t just the naivete and blinkered world’view of so many of our visitors, but at least partially the hospital´s own limited world-view.

Comments posted on Indiana sites that reported the story often mentioned that the couple should have purchased travel insurance.  Especially since the mother was 28 weeks pregnant.  Less noted, but still a factor for many, was that while the couple did have insurance, it was a state “workaround” to the new U.S. health insurance system, and the premature birth wouldn’t have been covered if the couple was anywhere outside the state. Still others noted that the amount the couple had to pay before leaving (about 30,000 US$) was less than they might have to pay “out of pocket” even with what passes for decent insurance in the United States… and that the cost of medical care for a premature baby can easily run to a much higher figure:  up to a million dollars.

All true.  Although those defending the couple generally pointed to claims (by the baby’s grandfather) that the child was a “hostage” in attempts to collect that $30,000 and there were threats to just put the baby on the street if the money wasn’t delivered immediately.

I was fortunate in that when I had my accident, one of the bystanders who stood by me (one asks if complete strangers would have dropped whatever they were doing to assist a person in distress back in Indiana like they did here) happened to be a third-year medical student.  I recall her asking me if I wanted to go to the “foreigners’ hospital”. I expect the Indiana couple, being at an “all-inclusive resort” when the ambulance was called, were just automatically routed to a “foreigners’ hospital”… a euphimism for a U.S. style for-profit medical center.  Like any such business, it is going to immediately start charging the patient the moment they come through the door.  We paid 3000 pesos not too long ago for an emergency room visit to our neighborhood private hospital for what turned out to be a relatively minor incident that resolved itself without medical intervention).

I could have gone to an IMSS (Mexican Social Security Institute), but with stories of the overburdened emergency rooms dancing in my head (I read the papers and watch the news here), I specially asked to be sent to the Red Cross Hospital.  And, even though it is a “not-for-profit” institution, there are still expenses to be met.  I knew that.  With my leg shaped like the letter “Z” and in intense pain, I was more interested in immediate care, and the Red Cross ambulance was on the way.  So …

I spent a week at the Red Cross hospital, and — although the mounting bills (and need to pay before services were rendered) was nerve-wracking… especially that first night when, on top of dealing with the shock of the accident, my spouse had to make multiple trips to Polanco to arrange the intial payments… living here it was expected.  I imagine the Indiana couple somehow had it in their heads that a “foreigners hospital” could just bill them for the services provided, despite not having any insurance, or ties to the country (it’s not like a Mexican hospital can send somebody to collect in a foreign country, and what would they do… threaten to break some legs?).

After my release, there were problems with my recovery and my leg became badly infected.  This meant being re-admitted to  the Red Cross Hospital (and another round of payments), and those “uncovered” services that in Latin America the hospitals can’t provide, that the patient’s family members have to perform.  In the “foreigner hospital” these services might be provided, and the bills presented as they came up… which is what, in the news stories about the Indiana couple… accounts for the extra charges they suggested was a form of shakedown.

One of those costs are the drugs administed to the patient.  Strange but true:  in the name of neo-liberal reforms, hospitals do not include medication with their standard services.  Our inadequate social safety net relies on the assumption that Mexicans are a family-oriented culture, and the family can pick up those tasks the hospital can’t.  Like running to the pharmacy to purchase those medications.  At least price-controls on medications somewhat keep the costs down, it can still be difficult.  And even if you live here, it doesn’t always make sense.  But then, what in any health care system does?

To my spouse, photographer John Kirsch, fell the familial duty of buying my drugs (and dealing with the billing office in general).  His story:

A few minutes earlier, she had told me her name was Laura and that she was the head of surgery at Hospital Cruz Roja.

Only an hour or so earlier, Richard, my husband had been readmitted to the hospital after X-rays found that his leg had refractured and was badly infected.

A few weeks earlier, he had been discharged after surgery on his leg, which he had broken in a bicycle accident.

We had traveled half-way across the city for a checkup, expecting that the doctors would tell us that Richard’s leg was healing and that he would walk again soon.

Instead, Richard was now in the emergency room, being readied for more tests and a likely surgery as doctors looked for ways to combat the infection.

At first, I did not believe my ears when Laura told me, in a calm and even voice, that I would need to buy antibiotics for Richard.

What kind of hospital is this? I wondered. Don’t they have drugs for their patients?

But I could see that Laura was perfectly serious. I would have to stifle my disbelief and find the drugs that Richard needed to fight his infection.

A few minutes later, the short, heavy-set doctor and I raced through the rain to the pharmacy at the Superama a few blocks from the hospital. I didn’t exactly feel like I was in a nightmare because I knew that what was happening was real.

But I still felt caught up in a situation that seemed unreal to me. A hospital that does not have drugs for its patients? The question kept going through my mind.

The situation was so far outside my sense of what is normal that I could  hardly grasp it. All I could do was do what Laura told me to do.

Then the doctor and I were at the pharmacy counter. The pharmacist and the doctor – Laura had told me his name but I could not remember it – discussed the medication, the doctor called Laura to make sure the medication was acceptable, then I paid $700 pesos for two boxes of medication and we were back in the rain on our way back to the hospital.

I left the hospital that night thinking that my drug run had been a one-off affair.

The next day, when a young male nurse handed me a prescription for several drugs, I learned that I was wrong.

“You’ve got to be kidding,” I said loudly as the nurse walked quickly away.

It dawned on me that I would be expected to buy drugs every day for Richard. I wasn’t mad about the money. I was mad at the hospital, for forcing me, a family member with no medical training, to buy the drugs that my husband needed to fight his infection and get well.

“If you don’t provide drugs, can you even call this a hospital?” I asked one of the doctors a day later. He looked away momentarily and said he and the other doctors were troubled by the policy but that the administration was adamant about keeping it in place.

Each day, Alison, the social worker assigned to Richard’s ward, handed me a prescription for the drugs he needed and I made the rounds of the pharmacies, some of which were blocks from the hospital.

I was usually able to find all the medications the doctors required but a few times I could not. When that happened I sought assurance from a nurse or doctor that Richard would be okay anyway. They gave it, sometimes, I thought, with a bit of hesitation, and I would leave that night with a small twinge of fear in the pit of my stomach.

I have been told that hospitals in Latin America often require family members or friends of patients to buy medications. So I guess my days as a “drug runner” for Cruz Roja were a learning experience.

But part of me is still dumbfounded by the notion of family and friends having to buy drugs for their loved ones in the hospital.

I hope never to have to do that again.