Culture of Avoiding the Doctor Intensifies Health Concerns in Mexico

“Many patients take drugs by themselves. They don’t ask the doctor. So they were coming very late to the hospital” in the early days of the outbreak, said Dr. Francisco Moreno, a Mexico City physician who treated some H1N1 swine flu patients.

That changed when the media started broadcasting the seriousness of the new strain of flu, but many health experts say it indicates a larger problem in Mexico.

Dr. Rafael Lozano, general director of health information for Mexico’s Ministry of Health from 2001 to 2007, said people only go to the doctor if they feel very ill and believe they have a serious condition.

National health surveys in 2000 and 2005 showed that nearly a third of those questioned said they would not go to the doctor if they had a respiratory infection, such as influenza, he said.

Jose Emilio Serrano Roa, a drafter for an architecture firm in Mexico City, said he always tries to avoid going to the doctor and only goes as a last resort.

“I will just let my body do what it needs to do,” said Serrano Roa. The wait for public health services is often very long, so “most people go to their mother-in-law or the woman … in the family for advice, or they will go buy medicine at the pharmacy,” he said.

Christian Amezcua, a musician and student in Mexico City, said many people don’t want to pay for prescription medicines or even the more expensive over-the-counter drugs. If they are feeling sick, they would rather get herbal remedies that may be cheaper, he said.

Nieto-Rodriguez, dean of the Faculty of Pharmacy at the Universidad Autonoma del Estado de Morelos, said this mentality is a big problem in Mexico, especially when a sick person consults someone who doesn’t have any pharmaceutical experience.

He attributes people’s reluctance to visiting the doctor to potential costs and the fact that many medicines that commonly require a prescription in countries like the United States can be bought over the counter in Mexico.

The Mexican Ministry of Health switched more than 200 prescription drugs to over-the-counter status in the late 1990s, making a total of more than 500 over-the-counter products, according to researchers at the University of Pennsylvania.

Antibiotics, antidepressants, birth-control pills and heart medications are among the available drugs.

Lozano, now a professor of public health at the University of Washington, said the availability of more over-the-counter medication takes away some of the incentive to visit doctors, and that having antibiotics available over the counter creates other concerns, such as the development of drug-resistant strains of disease.

Regulating pharmacies in Mexico is difficult as well, he said, because some stores that are not designated as pharmacies still sell medications.

Lozano said to make people want to go to the doctor, there needs to be a boost of confidence in the quality of available health care and better communication about free services.

In 2004, the government began offering subsidized, publicly provided health insurance to 50 million Mexicans who were previously not covered by private insurance or social security. At the end of 2006, 42.9 percent of the previously uninsured were enrolled in the program.

Despite the reform, people still worry that they will end up being charged in some way or that complications will arise, said Lozano.

“It seems to me a little lack of communication regarding this point,” he said. “It should be clear people aren’t going to pay.”

Filemon Almanza, a carpenter from the state of Guanajuato, located northwest of Mexico City, said there have been times when he has been sick and couldn’t go to the doctor because he didn’t have any money. He said he thinks time and money are the biggest reasons Mexicans don’t get medical attention.

Serrano Roa believes the outbreak of H1N1 may start to change how people approach doctor’s visits, at least in the short-term.

“Right now we are all so afraid,” he said. “I would definitely run to the doctor right away.”

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