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Mexico’s Seguro Popular—A model of inefficiency–Dr. J.

dr j

So January 27 arrived and we got to the Regional at 6:30.  My husband had to stay outside again. I asked in the waiting area who had been the last to arrive and took note, so that when we lined up, I would know who I was after.  While I waited, I listened to the other people waiting tell stories of having to arrive at 4 a.m. at the clinic to get in line or buying a ficha (number) from someone who had arrived earlier.  I distinctly remembered seeing a sign at the front door that said that fichas (numbers) were not for sale…but hey, who am I to begrudge someone 20 pesos for their time?

When the appropriate personnel arrived, we were instructed to line up according to our order of arrival.  This was a surprise to some of the people waiting and there was a bit of shoving to get the line straightened up.  I was 5th or 6th in line, however, those who were waiting with children were giving the first few spaces.  When it was my turn, I handed the attendant the sheet Dr. Viejita (Old Lady) had given me and in return she gave me a paper with the date I should return for results and 4 stickers with my name on them.  It didn’t take too long for them to call my name and take 2 vials of blood and I was out by 7:15 a.m.  I must have looked like a pro because no less than 3 women asked me what the procedure was for the lab while I waited and I explained.

My results were supposed to be ready the next day, so I sent my husband to pick them up.  He had time at 1 p.m. and drove out to the hospital; however the lab only gives results from 9-10 a.m. and 3-4 p.m. and no other time, so he had to make 2 trips.  I looked over the results and didn’t see the TSH results, but I thought maybe it had a different abbreviation in Spanish.  Silly me.

Although my appointment for January 30 was at 9 a.m., my husband insisted we needed to go early.  So we did.  This time, we entered separately, with each of us carrying some paperwork in order to slip past the security guard.  Archivos (archives) didn’t open until 7:20 and I ended up being about 20th in line.  When I arrived at the glass partition, I handed the clerk the copy of our seguro (insurance) policy, a copy of my curp (Mexican social security number), a copy of my new residency card (See Residency at last), a copy of a proof residency which usually is a water or electric bill but in our case came in the form of a letter from Super Prez asserting that we lived in La Yacata, and the pink appointment book.  She returned the pink card to me and gave me a blue laminated ficha (number).

I went to check in at the nurse’s station but was told I needed to check in at the second nurse’s station, which really was just a folding table, 2 chairs and a scale.  So I marched down there and had my height, weight and blood pressure checked.  I understand that my weight and blood pressure might vary, but just not sure why my height might change drastically since the last appointment, but it didn’t cost me anything to stand and be measured again.  The nurse took my ficha (number) and wrote my name down, but couldn’t tell me what consultoria (consulting room) I would be in.  I sat down to wait.

As the crowd thickened, the nurses were questioned repeatedly about when the doctor would arrive to begin consultations.  The harried nurses responded with the startling truth that the doctors did not have set schedules.  When a doctor was finished with his or her rounds in the hospital, then and only then, would he or she report to the consultation area.  This might be around 9 a.m. or might not.  Not encouraging news.

With the press of people in the waiting area and the rising sun, the waiting room became stuffy and hot.  My husband began to get cranky.  I think I have mentioned before that he is not a patient man.  He was ready to leave and make the appointment for another day.  As I had already lost the morning’s work, I didn’t want to reschedule and pleaded with him to be patient just a little longer.  Finally, at 10 a.m. my name was called along with 3 or 4 other women’s and we were told to go over to the consulting room next to x-rays which was in another wing of the hospital.  We did.  It was closer to the front door and therefore, much cooler and we sat down to wait.  Dr. J arrived but we had to wait while he went to hunt down a typewriter for his office.

A woman much like my now deceased mother-in-law tried to bully her way into the consulting room, but Dr. J was having none of that and frowned her into her chair again. I was ficha #2, so I was in before you could say Jack Robinson, comparatively, and seated before the doctor.

Dr. J was much younger than Dr. Viejita.  I would estimate he was in his early 30s, with wispy light brown hair and an failing attempt at a moustache. He was recently married as evidence by the shiny new golden wedding band on his finger. He was wearing a surgical mask, which made it difficult for me to hear him since he was so soft spoken, but I did my best.  He asked why I was there and I again explained I needed a permanent prescription for hypothyroidism.  He asked about surgeries, if I had ever received a blood transfusion, if I had diabetes or high blood pressure, all which seemed to be relevant questions to my health issue at hand. He examined my throat for possible goiter, had me raise my arms to check for trembling, which is a sign for too much thyroid hormone and then sat down again to look at my lab results.  And surprise, surprise, there were no TSH results to be found.  So he gave me a new blood work order and sent me back to the lab to schedule the test.  He told me after I got the results, I should come back and see him directly and not to go through Archivos.  He was there Monday thru Friday.  Okie Dokie.

So I went back out to my waiting husband and told him I needed to schedule a new lab.  He was annoyed, but since we had come this far, we might as well keep going.  I queued up and made an appointment.  Since the following Monday was Constitution Day, the labs wouldn’t open until 8 a.m.  That was fine since there would be no school that day and I wouldn’t miss any work.

When I retold this adventure to my sister-in-law, she remarked that at least it was a free service.  However, I pointed out that the gas and time and money lost from canceled classes hardly made this free and she had to agree.

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Mexico’s Seguro Popular—A model of inefficiency–Dr. Viejita

 

dr viejitaSo we went to the Regional in Uriangato, which is the hospital where my mother-in-law died.  My husband had gone the day before to inquire about the procedure and was told by the pharmacy that I needed to make an appointment with archivos (archives) first to open a file.  Archivos (archives) opens at 7 and it’s on a first come, first serve basis. Therefore we were up at the crack of dawn so that we could take animals out to pasture and drive to Uriangato.  It is about a 30 minute trip by moto, but seems much, much longer in the frigid early morning.  We arrived at 6 a.m.

The security guard on duty would not let my husband in, so I took the paperwork and queued up.  The clerk arrived at 7:15 and started processing appointments.  I was about the 10th in line, so it was about 7:40 when I reached the desk.  I explained my situation and showed her my papers.  She looked them over and told me that it was the responsibility of the clinic that gave me the prescription to continue giving me the medication and that if they wanted to send me here, they needed to give me a referral.  Well, they hadn’t and she knew that, so she went ahead and gave me an appointment with a general practitioner anyway.

I checked in at the nurse’s station and had my height, weight and blood pressure checked and returned to my seat.

I was #3, but as the doctor doesn’t begin seeing patients until 9 a.m., I had to wait.  Meanwhile, my long-suffering husband was shivering in the cold.  After 9, he suddenly appeared in the waiting room.  He had waited until the guards had changed, then asked permission to use the bathroom, which was on the other end of the hall where the consulting offices were.  He did use the bathroom, but instead of returning outside, he headed down the hall to see where I was.  By this time, there were so many people, one more wasn’t noticed.

So 9:30 came and it was finally my turn.  I was shown into a small consulting office and sat down in a chair next to a tiny space heater.  The female doctor was at least 80 years old and was extremely disconcerted that I was not Mexican.  She asked me several times if I could understand her questions and each time I assured her I did.  I explained what it was that I wanted.  She then said I would have to be referred to a specialist.  She pulled up her Olympia typewriter and started in on the referral.  She asked where I lived, but didn’t understand me, so I handed her the policy which had our address on it.  Then she asked about my age, place of birth, religion, age that I began menstruating, age that I married, if I had my son vaginally or by c-section (she even mimed this one for me in case I didn’t understand her meaning), and if I lived permanently in México or was just here for a visit.  I answered her questions, but tried to explain again that I had hypothyroidism and told her that I had had preeclampsia and pregnancy-induced hypertension, but she made no note of those issues.  I told her about surgeries I had as well, but again, nothing written down.  She apparently made a mistake on the form, so she pulled the sheet out of the typewriter and started again.

I waited.  When she had finished I showed her the prescription that I had been given at the clinic and told her I needed a refill.  She looked it over and said that she would write a prescription and that I would need some blood work too.  That seemed reasonable, since in the States, I would periodically go for TSH level blood tests.  I thought perhaps she had understood my problem after all. Silly me.

I was there about an hour while she filled out these forms.  She made no attempt to examine me and when we were finished she asked if I felt I had been treated fairly.  I suppose I had.

So then, I went back to archivos (archives) to schedule an appointment with a specialist.  There the clerk gave me pink appointment booklet and scheduled the appointment with Dr. J for January 30 at 9 a.m.  Then I went to the lab desk to schedule an appointment for the blood draw.  That was set up for January 27 at 7 a.m.  Finally, I went to the pharmacy to fill the prescription, but they didn’t have the medicine there.  Since I was already late for work, I didn’t have time to hunt down some other pharmacy.  I sent my husband later in the day to find the referral pharmacy and get the prescription filled.

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Mexico’s Seguro Popular—A model of inefficiency–Getting Started

CAISES in Moroleón

CAISES in Moroleón

I have hypothyroidism which was diagnosed shortly after the birth of my son.  It’s a chronic condition that requires a pill each and every day.  A box of these pills costs $400 pesos and lasts about 2 months.  Sometimes we don’t have the $400 pesos and I do without.  A long period of doing without means that I become over-emotional, weepy and exhausted.

My husband decided that we needed to find a way for me to get my pills and applied for Seguro Popular, the Mexican version of Medicare.  We qualified, despite the fact that I am only a Mexican resident, because my husband has been out of work for the last 3 or 4 years and the fact that we live in La Yacata without electricity, water or sewage.  However, in order to get the all-important policy paper, we had to provide a comprobante de domicilio (proof of residency) in the form of a water or electric bill.  On other occasions, we have borrowed a bill and claimed we were renting at the address on the bill.   We were tired of doing this and therefore solicited a letter bajo protesta decir la verdad (under oath to tell the truth) from SuperPrez saying that we were living in La Yacata without utilities.  Thankfully, the office accepted it as adequate proof and we went for our initial family consult at the hospitalito (clinic).

The reason there isn't a line at 9 a.m. is because everyone knows they must arrive at 4 a.m. to get a number!

The reason there isn’t a line at 9 a.m. is because everyone knows they must arrive at 4 a.m. to get a number!

We arrived well before 8 a.m. which was good since it took 40 minutes for the staff to determine which module La Yacata belonged to.  Finally they decided that we should be assigned to module 5, which was only open in the afternoon.   Since we were already there, and a little peeved, the nurse on duty said that she would do our consults that morning, so we waited.  Our examination consisted of each of us being weighed and measured, a blood pressure and diabetes check and a health questionnaire about vaccinations, illnesses and surgeries.  I explained that I needed to take levotiroxina, but that I had run out of pills.  The nurse had a doctor write a prescription for me, but the pharmacy at the clinic didn’t carry that medicine.  My husband went to another clinic, but they wouldn’t give him the medicine because the doctor had written a prescription for 2 boxes and they said they never give 2 boxes.  So my husband returned to the first clinic for another prescription for a single box and then back to the second clinic for the medicine.  It took all day but I got a box with 100 pills.

The nurse told me that when I ran out, I would need to come in again for a full examination to get a prescription refill.  So that’s what I tried to do.  We arrived before 8 a.m. for a ficha (number) for module #5 but were told that all the fichas (numbers) had already been given.  The nurse said we could come back at 2 p.m. to see if the doctor had time to see us after all the people with fichas (numbers) had been attended to.  So we did.  And we waited.  Then another nurse told us that we would need to go to the Regional (regional hospital) in Uriangato to get a receta permenente (permanent prescription) since my condition was chronic.  It would have been nice to know that before we wasted the entire day.

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