Wednesday, December 22, 2010

A Pátzcuaro Physician: One Year to Go

Luís Manuel Jxxx Bxxx was born in 1986 in Uruapan. When he was quite young, his family moved to Pátzcuaro, where his father practiced as a traumatology physician. His mother dedicated her professional life to Pátzcuaro’s public library where she is now the Directora. In 1999 Luis Manuel’s father was killed in a car accident, leaving his mother to provide for and to educate two children on a modest salary.

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Luís Manuel and his mother, Gloria Bxxx Lxxx

Today Yanira de la Salud Jxxx Bxxx, Luis Manuel’s older sister is a licensed physician, working on a specialization in emergency medicine in Guadalajara. Luís Manuel has completed five years of medical studies at UMSNH (Universidad Michoacana San Nicolás Hidalgo) in Morelia. He also has finished his year of residency at a Morelia hospital where he delivered a number of babies when working in obstetrics.

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Unlike IMSS clinics, IMSS Oportunidades clinics
are free; they are for people at the bottom of a
”low income” class.

Before he can take his final comprehensive exams, Luís Manuel must give a year of service in a Michoacán pueblo. He was assigned to Tunguitiro, a town founded in 1530, located near Coeneo. After this service and passing his examinations he will be licensed and may practice as a doctor of medicine. For his year’s service in Tunguitiro, the government provides him a modest stipend to help cover living expenses and, attached to the clinic, a bedroom with a kitchenette and bathroom. He normally spends week-ends at home in Pátzcuaro and the work week in Tunguitiro, about an hour away by car.

tunguitiro Oct2010 (22)The Tunguitiro clinic.
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Luís Manuel’s basic accommodations
at the Tunguitiro clinic.

On a typical Monday, Luis Manuel’s mother drives him back to work in Tunguitiro, and on a particular Monday we accompanied them. He works at an IMSS Oportunidades clinic which, he explains, is different from an IMSS clinic. IMSS Oportunidades is for people who have no means to pay anything for health services. If it were not for the IMSS Oportunidades in their pueblo, the nearest clinic for residents of Tunguitiro would be one that is private and unaffordable in Coeneo.

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Nurse prepares to vaccinate a little boy.

Ouch. But it was over quickly.

The Tunguitiro clinic is staffed by Luis Manuel and a nurse assistant. The head clinic of IMSS Oportunidades rural clinics is located at Santa Fe de la Laguna; it oversees the free clinics located on Lake Pátzcuaro plus five others. This main clinic is staffed by two licensed physicians, one for administration and the other for consultation. Luís Manuel has constant contact with the consulting physician by radio for any questions or guidance he may need. It is interesting to note that Don Vasco de Quiroga’s most important pueblo-hospital, as part of his vision of Utopia, was located in Santa Fe de la Laguna.

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Luís Manuel dispenses free medications
on site

The IMSS Oportunidades clinic at Tunguitiro provides health care for the residents of four communities: Tunguitiro, Cotiro, Pretoria and Transval. The people of the communities (I believe that all four are ejidos) are involved with the clinic. In return for their free medical attention they take turns working there, doing chores such as cleaning, painting, maintenance and yard work. In addition, the government pays families to meet certain requirements. To earn the allocation, a family’s children have to attend school and go to the clinic for medical exams; parents must attend lectures on health and nutrition; adolescents must attend sex education classes.

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A Tungitiro street.

Luís Manuel practices primarily preventive medicine. He oversees vaccinations; he tests and treats for diabetes and hypertension which which are common; he provides prenatal care (his stint in obstetrics in Morelia serves him well in this community); and he refers patients to other venues for emergencies, surgeries and needs beyond the basic care that the Tunguitiro clinic can provide. The nearest IMSS emergency care available is in Paracho or Ario de Rosales, which are hours away. Local people cannot afford alternative, emergency care in private clinics in a closer location.

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People queue for health care.

I asked about IMSS in Patzcuaro, which is closer than Paracho or Ario for emergencies. The response: there is no surgeon, the clinic is too busy, and it is understaffed.

Luís Manuel’s father was a physician, his older sister is a physician, and I have no doubt that he will soon be licensed as a physician. He is not only dedicated, but he is also a very personable young man—a felicitous combination for his patients, young and old.

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