Friday, October 26, 2012

Navigating one part of Mexico's "universal" healthcare system.

I had written that I'd signed up with Seguro Popular in September. This week I took a stab at seeing a doctor.

I live in the historic center of Zacatecas, 4 blocks up the hill behind the cathedral. The Health Center (Centro de Salud) is about 2 miles from the nearest bus stop which is about a half mile walk from my house. The bus

costs 3 pesos for Seniors with an INAPAM card. It's probably walk able by a slightly different route which I haven't investigated yet. I mention this because walking is imperative for managing my diabetes and high blood pressure.

I took my first shot Tuesday morning, arriving at 8:30AM. It looked like a mad house, with people milling about or lining up in what looked like endless files. A young lady in a lab coat was passing by so I got her attention and asked what I needed to do to see a doctor. She said she was a student and didn’t know but led me to one and then another window where I found out that you had to go to the window with the "Fichas" sign and they'd give you a chit with an office number and a turn number. But, it was Doctor's Day and they wouldn't be giving them out till 11AM because all the docs were at a breakfast. I thanked the young lady and said I probably come back the next day. I hadn't had breakfast because I expected they'd want me fasting and decided I'd rather eat than wait.

Yesterday, Wednesday, I arrived around 8:00AM and it looked like bedlam again but I already knew where to go. I got my chit for "consultorio 6," turn #3. I presented my chit to the nurse at the desk out front. She said that were 3 people ahead of me, I should have a seat and she’d holler when it was my turn. My turn came and she took a history, blood pressure, blood sugar, height, weight, and waistline and filled the personal data page of a booklet that lists the basic services Seguro Popular provides and contains pages to record visits, tests and treatments. Now it was time to wait for the doctor whose shift was about to start. When my turn came, the doctor spent plenty of time getting to know me and going over my needs and concerns. As we were finishing up, he hollered over to the person in charge of the lab and asked if there was still time for me to get blood drawn. No, they’d already started processing the morning’s collections. The doctor gave me a lab order and a cup to pee in, telling me to see his nurse at 8:30AM next morning for laboratory chit and to bring the full cup with me. I left, got the bus to downtown and decided to have breakfast at McDonalds. The time on the cash register receipt was 11:29AM. The waits did seem long, longer than the actual time. I’m not really sure how much time was just waiting and how much was time I was actually being attended to. Three hours doesn’t seem that long compared to driving times and wait times I faced in the US over the years.

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The next day, Thursday, I was there at 8:00AM and went directly to the nurse’s desk where she gave me a laboratory pass and told me to go to the Seguro Popular office and get a receipt for the lab work.  She also told me to come back after I finished at the lab, the doctor wanted to see me.  It turns out the Health Center is a State of Zacatecas operation and they do have paying customers, something I’ll look into in the future to salve my curiosity.  I headed down the hall to the Seguro Popular office where there was a line about 20 people long.  I passed the time just chatting with people about nothing in particular.  My turn came and it was a simple matter to show the doctor’s lab request and my “policy” proving I had Seguro Popular. 

The next step was to check in with the laboratory, another line, this one with 30 people.  While standing in line, a phlebotomist verified demographic information and took a couple of additional pieces of information and handed me the form saying results would be ready at 4PM the next day Friday.  When I got up to the window, the clerk took my lab order, the form the phlebotomist gave me and the laboratory pass and stamped them with a code number.  She then hand wrote 4 labels each with the code number and a procedure code.  One was for the urine sample which I put on a tray next to the window, the other 3 for the vacutainers which the phlebotomist on the next line handed to me after applying the labels.  This one was only 15 people long.  That phlebotomist also reminded me results would be ready at 4PM the next day Friday.  This line ended at a little room where two phlebotomists we drawing blood.  With that taken care of I went back to the waiting area by the nurse’s desk.  The doctor hadn’t come in yet, he should be in “ya merito,” almost immediately and that there were two patients ahead of me.  The wait didn’t seem too interminable, the doctor arrived and took care of the two patients plus 3 or 4 interruptions.  My turn and about the time I was walking into his office/examination room, two other doctors came by looking to go to lunch.  My doc said he wouldn’t be long and they should sit in if they wanted.  Well, it took a good bit longer than I would have suspected.  I was asked about my background and why I came to Zacatecas and we detoured into philosophy and politics a bit and then my doctor explained his diagnosis of my problems and the next few steps in his plan including meds from those available through Seguro Popular plus certain ultrasounds at the General Hospital.  He gave me an order for the Hospital and told me go the next day and look for Dr. Navarro in the X-ray Dept., referring to him, Dr. Molina.  The four of us chatted a bit more and then it occurred Dr. Molina to call Dr. Navarro and set up an appointment for Friday at 5:30PM.  I didn’t have to wait long for a bus back to downtown.  I stopped in at my favorite gordita place and got some for breakfast and lunch before treating myself to a cab up the hill to the house.  I had to call the lady who cleans up for me on Fridays to see if she could come early so I’d be sure to be able to pick up the lab results around 4PM.  No problem.

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I was out there at 4PM today, Friday, and sure enough the results were ready.  Instead of going back home, the General Hospital is only about a half-mile from the Health Center.  I took a little walk to kill time before 5:30 and stopped at restaurant for a soft drink right across the street from the Health Center.  It’s a fairly upscale place with nice d├ęcor and attentive staff.  I guess I’ll go back and see what the food is like.

I got to the General Hospital around 5:20 and asked for Dr. Navarro.  They didn’t seem to recognize the name and the best they could offer was wait a half-hour or so and see if he shows up.  I wandered around built.  The place looks modern, opened in 2010, and kept well maintained.  I don’t know how many beds, but it has all the departments you expect in a major facility.

About the time the half-hour was up, a “doctor-looking” gentleman walked out of a door marked Ultrasound.  I asked him if he knew Dr. Navarro.  Of course, he’s a colleague and a friend.  Do you know if he’ll be in today?  No, they should know at the reception window.  I already asked.  He took me over to the window and talked to one particular person who hadn’t been there when I arrived.  Dr. Navarro left a message that he wouldn’t be able to make it today.  After a little bit of back and forth I settled for an appointment next Wednesday at 5PM.  Nobody thought to give him my phone number so he could contact me and maybe the people I talked to first didn’t recognize the name because of my accent.  If we connect on Weds. All will be forgiven.

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