| | |  Health & Beauty | May 2009 
A Critical Patient, an Overwhelmed Hospital and a Tenacious Newspaper
 Tracy Wilkinson - Los Angeles Times
go to original
| | Doctors at Dr. Aurelio Valdivieso General Hospital in Oaxaca, where the first swine flu fatality occurred. A newspaper sent in undercover reporters after a tip from an insider at the under-equipped facility. (Alexandre Meneghini/Associated Press) | |
Oaxaca City - It was Easter weekend when people here noticed strange happenings at the state-run Dr. Aurelio Valdivieso General Hospital. Sections suddenly were off-limits. Security guards were added.
The police reporter at the local newspaper, El Diario Despertar, got a tip from a source at the hospital. The paper sent two people to investigate. They quickly realized that the hospital was seized by alarm.
Queries from Despertar forced Oaxaca health officials to go public on April 16 - a full week before a national emergency was declared over swine flu - with news of a deadly "atypical pneumonia."
How Oaxaca, one of the nation's poorest and most ethnically diverse regions, with a crusading newspaper and a strapped health system, faced the first strikes of what would become a global health crisis underscores the public-health dilemma facing Mexico.
Adela Gutiarrez, who became the first flu fatality, sought hospital care late, after she was repeatedly misdiagnosed. The hospital stumbled, lacking the equipment for proper analysis; officials were perplexed and the public kept in the dark.
Once the truth became known, Oaxaca also illustrated the important role of a grassroots health care network in rugged, remote terrain with scattered populations.
In Valdivieso General's busy emergency room, Dr. Serafín López Concha was hours into his shift on the Thursday before Easter when Gutiarrez staggered in. She was gasping for breath, and her oxygen-starved fingers were turning blue.
Gutiarrez, 39, had been sick for a week. She had continued to work as a door-to-door census-taker for the tax bureau until the Easter week break. She had seen three or four doctors, López recalled. They had told her she had a throat infection and given her medicine, but she only got worse.
"She was in very serious condition," said López, a Oaxaca native who took charge of Gutiarrez's case.
Believing she was suffering from pneumonia, López and his team gave her antibiotics and serums to hydrate her. But Gutiarrez couldn't catch her breath and they had to intubate her; she was no longer breathing on her own.
Two days later, the hospital sent a bronchial sample from GutiAcrrez to an outside laboratory that often does testing for Valdivieso General, because despite being Oaxaca's largest medical facility, it doesn't have the equipment.
Molecular chemist Adrián Juárez Avendaño tested the sample and on Easter Sunday had the results: positive for coronavirus, a highly contagious and unusual viral strain. This result would prove incorrect. Testing in Canada would show Gutiarrez had contracted the unique strain of H1N1, or swine flu.
Still, the misdiagnosis set in motion a chain reaction - probably the right things to do, if for the wrong reason.
Hospital authorities as early as the day before Easter isolated Gutiarrez and began fumigating and sterilizing the building, even throwing away mattresses and pillows to calm hospital workers.
They were preparing to transfer Gutiarrez to a specialized hospital, but she died at 4:45 p.m. on April 13, four days after being admitted.
That same day, Dr. RubAcn Coronado García was springing into action. As head of the Intelligence Unit for Epidemiological Emergencies in the Oaxaca Health Secretariat, he was in charge of finding everyone with whom GutiAcrrez had come into contact.
Coronado mobilized seven brigades of three inspectors each to begin fanning through Oaxaca. They concentrated on three areas: the hospital, Gutiarrez's home and family, and her place of work.
At the hospital, Coronado and his inspectors made sure that everyone who came near Gutiarrez was wearing protective gear, and they began testing the staff for infection. A total of 105 people were tested, "from the people pushing the gurneys to the X-ray technicians and the doctors," he said.
At GutiAcrrez's house, her husband, three daughters and mother-in-law were tested. No one has shown any symptoms.
Coronado's teams checked 106 of Gutiarrez's co-workers through April 22. Most were fellow field agents and office workers with whom she met at the beginning and end of each workday.
Among those checked at the hospital and GutiAcrrez's workplace, 26 developed flu symptoms. But none tested positive for the more serious strain, and all have recovered.
Coronado said his teams did not try to retrace Gutiarrez's door-to-door route because they decided that her contact with people in her survey-taking was transitory compared with that with family and co-workers. And since none of the people she spent the most time with were infected, he calculated that the chances of infection among people she visited briefly were minimal.
"For a week or so, while sick, she was sleeping in the same bed with her husband every night, and living in close quarters with her children, like every Oaxacan family does, and not a single one of them shows any symptoms," Coronado said.
His unit maintains 28 mobile centers throughout Oaxaca that are on the lookout for flu symptoms. This is built on a rural network set up two years ago to care for scattered communities in a poor region with a large indigenous population. Oaxaca stretches over 36,000 square miles in southernmost Mexico, furrowed by mountain ridges. It's home to more than a dozen ethnic groups and 50 dialects.
Gutiarrez loved to visit those rural towns, her family says, and continued to do so until shortly before she died. She had been in reasonably good health until the flu hit her. Her family remains bitter, sad and confused.
"She was very sociable, and very responsible," said Luis Ramírez, her husband. They had been married 22 years.
And Alfredo Martínez de Aguilar, publisher of the Despertar newspaper, is feeling vindicated, wondering whether local health authorities would have informed the public of the emergency if his reporters had not dug up the truth.
"We made them come to us," he said. |
|
| |
Vallarta Weddings
Tell a Friend
Site Map
Print this Page
Email Us