On Christmas Eve, just as Mexico became the first country in Latin America to roll out a COVID-19 vaccine, Jorge Angel Lopez, a 29-year-old medical intern in Mexico State, was fighting for his life. Lopez had contracted COVID-19 at work, just a few weeks before the first vaccine shot given to a nurse. He was rotating through the emergency room as part of his training, even though the hospital was not supposed to assign interns to high-risk areas like the ER and intensive care units due to COVID-19. Even worse, the hospital was deploying Lopez and other health workers into these areas with nothing more than a face mask.
Almost a year into the pandemic that has cost more than 140,000 lives in Mexico (the fourth-highest COVID-19 death toll in the world), health care workers still lack personal protective equipment to respond to the crisis. Health workers represent 1 in every 7 positive cases (the same ratio as in the U.S., according to the Pan American Health Organization’s numbers from September) and account for 2,580 COVID-19 deaths as of Jan. 11. And with COVID-19 infections on the rise in Mexico, health care workers are demanding not only a fair chance to get the shot that could save their lives, but something far more basic: protection.
Mexico has no monopoly on concerns surrounding inadequate protection for exposed health care workers during this pandemic. But the situation in Mexico is exacerbated by having a highly segmented and resource-starved public health system. Worse, the country promises free access to medical care for all but often can’t provide it for those working within the health system.
Medical interns don’t get to choose where to do their internship, and Jorge Angel Lopez was assigned to the Hospital General de Ecatepec in July. The Valley of Mexico, where Ecatepec sits, is home to more than 21 million people and simply not enough hospitals. Ecatepec alone has a population of more than 2.5 million people. On Dec. 12, Lopez informed his supervisors that he was presenting possible COVID-19 symptoms but was told to keep working. When days passed and Lopez got progressively worse, the hospital tested him for COVID-19 and X-rayed his lungs. Again, his supervisors told him to continue his shift since he didn’t look ill. The hospital never granted Lopez an excused leave; he wouldn’t even receive the results of a test he took on Dec. 15 until weeks later. So, Lopez kept showing up to work until Dec. 18. Finally, after long weeks of fretting about possibly losing his unpaid internship or, worse, his life, Lopez, who was no longer able to breathe, was taken to the hospital on Jan. 4. His colleagues scrambled to find gloves before they could attempt to resuscitate him. Later, they would write they lacked alcohol, needles, and protective equipment to treat Lopez, who died 40 minutes after arriving at the hospital where he once saved lives. (In response to Lopez’s case, which was widely covered by Mexican media, Mexico’s Health Ministry called out hospital administrators for neglecting COVID-19 health protocols for medical interns.)
The deplorable state of Mexico’s public health care system precedes COVID-19, but the pandemic has heightened the effects of entrenched corruption and little government funding. Mexico has 1.4 hospital beds per 1,000 inhabitants, a rate far below the 4.7 bed average among nations belonging to the Organisation for Economic Co-operation and Development. According to its own Health Ministry, Mexico also has a deficit of about 500,000 doctors and nurses, on top of low wages that drive many health care workers in the public sector to juggle between two, and sometimes three, jobs. At least 87,000 health workers have temporary contracts that strip them from social security and benefits like health insurance, a pension, and severance pay, to name a few. And for Mexicans seeking care, an ailing public health sector means subpar treatment. Parents of children with cancer, for example, have been waging a high-profile campaign to secure treatment for their little ones for months.
Mexicans have watched with horror as public hospitals become ground zero of COVID-19 outbreaks. In recent months, hospitals in Mexico City and its surrounding area have edged dangerously close to reaching full capacity, prompting medical professionals to beg people to stay at home. The federal government has taken some steps to alleviate the overburdened health system by hiring thousands of new doctors and nurses, converting old hospitals and spaces to increase bed capacity, and offering stipends for those working in COVID-19 areas. But precarious working conditions remain.
Mexico’s national vaccination plan began in cities where hospitals edged closed to saturation, with priority given to medical staff and workers in direct contact with COVID-19 patients. Once the entire workforce is covered, the rest of the population will follow by age groups, from oldest to youngest. The goal is to vaccinate 750,000 health care workers by the end of January so the campaign can move on to the elderly population.
Soon after the first vaccination was televised on Christmas Eve, things started going awry. A hospital director in the state of Mexico allegedly ignored instructions to vaccinate front-line workers first by getting his shot before them and signing up his family members. Then came the photo of a muscular ophthalmologist getting the shot that went viral. Social media was quick to call out that he is not a front-line worker. And on Dec. 31, a pediatrician made her resignation public on social media, having witnessed hospital administrators skip the line. Just a few days into the rollout, health workers were staging protests.
COVID-19 vaccines are not the top priority for one of Lopez’s colleagues, a medical intern at the Hospital General de Ecatepec who asked not to be identified for fear of reprisals. “Personal protective equipment is still essential. Otherwise medical personal will keep dying,” she said over the phone. The 23-year-old has had to bring her own surgical gowns, masks, needles, gloves, and sanitizer to every shift for nearly the six months of her unpaid internship. After watching her close friend die, she is no longer sure she wants to continue her medical studies in Mexico.
“It’s painful to see the hospital deny its own staff the care and services they desperately need,” she said, referring to Lopez. “It hurts to see they don’t care about you and that you are just a number.” After Lopez’s death garnered media attention, his medical school pulled its interns out of the Hospital General de Ecatepec until it could guarantee safe working conditions and ordered evaluations of other medical facilities.
Health care workers are often kept silent by fear of retaliation and threats from administrators; very few speak out and hold protests. Francisco Julian Martinez, 46, a nurse in Mexico City, belongs to the Unión Nacional de Trabajadores por la Salud de México, a group of health care workers decrying foul play in the nation’s public health care system. Martinez has been a nurse for 24 years, and while he has already received the vaccine, he didn’t hesitate to join protesters on Jan. 2 who came out to demand fair access to the shot. “Hospitals are our second home, we are a family,” he said in between shifts, “and when no one has our backs, we have to take care of each other.”
The group has staged various protests this last year and is keeping a close eye on the vaccine rollout. Carolina Morales, 36, a hospital administrator at the Hospital La Raza in Mexico City and a member of the group, says they are only asking for more supervision and transparency from the government. Morales has witnessed the rollout inside her hospital firsthand and says the strategy as it stands today is subject to nepotism. “I don’t understand why the lists have to be a state secret,” she said of how vaccines are assigned to workers.
Sharon Lopez, Jorge’s sister, doesn’t believe her brother would have ever gotten the vaccine on time, but it doesn’t matter anymore. Her family hasn’t had much time to process Jorge’s death, because her father was hospitalized after developing a serious case of pneumonia caused by COVID-19. “Jorge was a hero with a white coat,” she said. “We only want justice for him and a better treatment for all medical interns.”