In two CDMX health centers, a patient diagnosed with monkeypox was left without medical care

In two CDMX health centers, a patient diagnosed with monkeypox was left without medical care

José had a fever, fatigue, swollen glands and strange blisters. He was sure he had contracted monkeypox. He went to a clinic in Mexico City, but they didn’t treat him. It was July 12 this year, 19 days after the Ministry of Health issued an epidemiological alert for this disease.

The young man, whom we will call José to protect his identity, arrived very early at the T-II health center on July 25, in the neighborhood of San Felipe, in the town hall of Gustavo A. Madero.

When he arrived, he was prepared for an operation like a film to be played at the clinic, in which he would find himself hospitalized and isolated to be able to observe his progress and prevent him from infecting anyone else. This does not happen.

In the July 25 T-II from the Mexico City Health Secretariat (Sedesa), where José arrived at 7 a.m., a nurse came out to tell those in line that there would be no consultation. They had only received five people.

They had another line of COVID suspects, they were a priority and there was no staff to deal with anyone else.

José told the nurse that he was leaving for a delicate case. In front of everyone, she asked him to explain what it was about. José clarified that it was a confidential matter.

“Well, there are no consultations anyway, if it’s urgent, go to the health center in La Villa (also in Sedesa),” replied the nurse.

He obeyed and went there, to the T-III Doctor Manuel Cárdenas de la Vega, a center of greater capacity than on July 25. What he found there was a lack of control and discrimination.

“As soon as I told them about the blisters, I felt rejected. The nurse hasn’t even finished taking my vital signs. It happened to me with a doctor who didn’t ask me for any information or anything, she just told me that they were going to treat me in epidemiology. They left me waiting for over an hour in the common room. I felt terrible, had fever, body aches, fatigue, swollen glands and blisters. I became desperate and better to leave so as not to infect anyone else. Nobody stopped me at the exit”, says José.

In Mexico, the Guide for the medical approach to monkeypox It was presented until July 25. At that time, 60 cases had already been detected in the country. The first was on May 28, 2022. Yet, since the 24th of this month, health authorities had already issued a epidemiological alert where health centers and clinics are informed of what to do.

Despite this, José left a T-III in Mexico City without leaving his phone, no one from there stopped him and, of course, they didn’t look for him afterwards. They let go undiagnosed and untreated of a case of monkeypox, a disease the World Health Organization has declared public health emergency of international concern.

“I thought that in the health centers they were going to have a specific protocol to treat me, that’s why, in fact, I went to the public sector and not with a private doctor. I thought they would be more organized, ready to test me and all that. But I just saw that they didn’t know what to do, a lot of disinterest and rejection,” says José.

political animal asked the Secretary of Health in Mexico City, through his communications office, for an explanation of why this was happening in health centers, where it seemed, in José’s experience, that they did not know what to do, to which the unit replied that in specialized centers like T-III there was a protocol, that samples had to be taken there from patients and sent to the National Institute for Epidemiological Diagnosis and reference (InDRE), which determines whether the case is positive or not (as indicated in the guide and the epidemiological notice).

When told that none of this had happened with José, the press office replied that they should re-examine the matter.

Monkeypox: what to do?

The clinical management guide for monkeypox cases, published on July 25, recalls that, like human smallpox, it was considered that person-to-person transmission could occur through respiratory droplets during close and prolonged face-to-face contact. , by direct contact with the bodily fluids of a sick person or by contact with contaminated objects, such as bedding or personal clothing, kitchen utensils, etc. Sexual transmission is not excluded.

A probable case is defined as a person of any age and gender with one or more rashes on the skin or mucous membranes and one or more of the following signs or symptoms:

  • Fever.
  • Headaches and muscle aches.
  • Swollen lymph nodes.
  • Fatigue.

The guide recalls that to date, only one case of this emerging disease must be considered an epidemic and during its study, the investigation must include: the search for possible scenarios or exposure events within 21 days preceding the onset of symptoms; active search for suspected cases or case network; Complete clinical examination, with adequate management of infection control and prevention measures.

Within first-level healthcare facilities and first-contact public or private medical practices, the clinical and paraclinical evaluation of a suspected case must be carried out in a complete manner, in the event of not having the means necessary for the care and follow-up , You must immediately refer to the nearest unit that has the infrastructure to provide care.

During the consultation, the doctor carrying out the assessment must give clear, simple and well-founded indications on the possible diagnosis, treatment, monitoring and/or referral of the patient, appropriately promoting the taking of decision and responsibility in its management. cut.

All clinical care should focus on respecting people’s rights, free of stigma and discrimination.

So far, there is no treatment for this disease. What is recommended for physicians is to treat symptoms, advise the patient on adequate hydration and control fever, as well as avoid handling injuries and isolation.

When José left the second health center where he did not find good care, he returned home, but he did not know what to do.

A friend recommended that she contact an activist for sexual diversity and the rights of people living with HIV. It was this person who recommended that he go to the Condesa clinic (also in Sedesa), where they finally treated him and gave him the appropriate follow-up.

“They treated me very well there, I have no complaints, they tested me and I tested positive for monkeypox. They gave me treatment and asked me to isolate at home. The direction was ambulatory, but I was under surveillance by them, through what is messages, ”says José.

The decision to isolate and monitor a patient at home, says the clinical management guide, should be assessed on a case-by-case basis and based on clinical severity, presence of complications, care needs, factors risk of serious illness and access to referral for hospitalization if the state of health deteriorates.

Jose did well. He says he now only has the scabs from the welts and some that took a while to heal in certain areas of his body. But he also has the bad experience in the two health centers.

What is monkey pox?

Monkeypox (SV) is a disease caused by a virus that belongs to the family that causes smallpox. This infection is endemic in the rainforest regions of Central and West Africa and was recognized as a human disease in 1970.

The first reported outbreak of VS outside of Africa, in 2003, was linked to the importation of infected mammals into the United States. From 2018 to 2021, 12 cases have been reported in Europe associated with travel outside of Africa. It was not until 2022 that outbreaks, with no epidemiological link, were reported for the first time in various countries.

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