‘It’s Not the Virus’: Mexico’s Broken Hospitals Become Killers, Too

By Natalie Kitroeff and Paulina Villegas

Years of neglect have hobbled many Mexican hospitals. Now, as the pandemic strikes, some patients are dying from neglect or from mistakes that are easily prevented, doctors and nurses say.

A billboard in Mexico City featuring the image of a healthcare worker with a message urging people to stay in their homes.
A billboard in Mexico City featuring the image of a healthcare worker with a message urging people to stay in their homes.Credit...Meghan Dhaliwal for The New York Times

By Natalie Kitroeff and

The senseless deaths torment doctors and nurses the most: The man who died because an inexperienced nurse unplugged his ventilator. The patient who died from septic shock because no one monitored his vital signs. The people whose breathing tubes clogged after being abandoned in their hospital beds for hours on end.

In Mexico, it’s not just the coronavirus that is claiming lives. The country’s broken health system is killing people as well.

Years of neglect had already hobbled Mexico’s health care system, leaving it dangerously short of doctors, nurses and equipment to fight a virus that has overwhelmed far richer nations.

Now, the pandemic is making matters much worse, sickening more than 11,000 Mexican health workers — one of the highest rates in the world — and depleting the already thin ranks in hospitals. Some hospitals have lost half their staff to illness and absenteeism. Others are running low on basic equipment, like heart monitors.

The shortages have had devastating consequences for patients, according to interviews with health workers across the country. Several doctors and nurses recounted dozens of preventable deaths in hospitals — the result of neglect or mistakes that never should have happened.

“We have had many of what we call ‘dumb deaths,’” said Pablo Villaseñor, a doctor at the General Hospital in Tijuana, the center of an outbreak. “It’s not the virus that is killing them. It’s the lack of proper care.”

ImageEduardo Rojano Mercado, a surgeon at Hospital General Balbuena, which is not a dedicated Covid-19 hospital, but is treating patients for the virus.
Eduardo Rojano Mercado, a surgeon at Hospital General Balbuena, which is not a dedicated Covid-19 hospital, but is treating patients for the virus.Credit...Meghan Dhaliwal for The New York Times

Patients die because they’re given the wrong medications, or the wrong dose, health workers say. The protective gloves at some hospitals are so old that they crack the moment they’re slipped on, nurses say. People are often not sedated properly, then wake up and yank out their own breathing tubes, hospital employees say.

Adriana de la Cruz, a nurse at Dr. Belisario Domínguez hospital in the southeast corner of Mexico City, said the overstretched and often undertrained work force has made glaring errors — at great cost.

“People have died because of a lack of medical attention and because of negligence,” said Ms. de la Cruz. “These patients would have a better chance of surviving if we could offer better care.”

The Mexican government spends less on health care as a percent of its economy than most countries in the Western Hemisphere, according to the World Bank, and President Andrés Manuel López Obrador presided over spending cuts even after acknowledging his country had 200,000 fewer health care workers than it needed.

When the epidemic hit Mexico in March, many hospitals sent front-line workers to confront the deluge of cases without any protective equipment or training. Some nurses say they were told not to wear masks to avoid causing panic. Many say they were forced to buy face shields and goggles themselves.

The fallout has been severe. About one in five confirmed cases in Mexico are health workers — a greater share than in the United States, Italy or China.

Mexico’s outbreak is growing quickly and shows no signs of slowing. Reported cases and deaths have risen every week for the last couple of months, hitting Mexico City and Baja California, which includes Tijuana, particularly hard.

After a Times analysis found evidence that federal authorities were underreporting fatalities, a top federal health official publicly conceded that the government does not have an accurate count of deaths caused by the virus.

At Dr. Villaseñor’s hospital, there are so few doctors left that during some shifts, critically ill patients are going eight hours without anyone checking on them, he said.

“You hear of one patient dying because he didn’t get the proper care — and then another one and another one — and you try not to become paralyzed,” added Dr. Villaseñor, a rheumatologist who said he had to learn how to suit up to treat coronavirus patients by watching a video on YouTube.

As Mexico’s population grew during the last decade, the government kept hospital funding low, devoting less than 3 percent of its national output to health care. World Bank data shows that by 2017, well before Mr. López Obrador took office, only two countries in Central and South America spent less on health than Mexico as a share of their economies: Guatemala and Venezuela.

Dr. Carlos Mac Gregor hospital is one of Mexico City’s designated Covid-19 hospitals.Credit...Meghan Dhaliwal for The New York Times

“Administration after administration gave lip service to the issue of health, but it never showed up as a priority in the budget,” Judith Méndez, an analyst at the Economic and Budgetary Research Center, said of Mexico’s successive governments.

The Mexican government did not respond to repeated requests for comment. Local health ministers in Baja California and Mexico City also declined to comment.

Patients have filed thousands of complaints with the country’s human rights commission about negligence in hospitals in recent years. And the quality of care only diminished further after hospital workers in Mexico endured some of the nation’s first coronavirus outbreaks.

Many countries have struggled with doctors and nurses falling ill, but in Mexico the problem is particularly bad. The government’s data suggests around one in five confirmed coronavirus cases in the country are health workers.

“If health workers are getting sick at this rate, bottom line is you risk not having a health work force to look after people,” said Howard Catton, the chief executive of the International Council of Nurses.

Ms. de la Cruz, the nurse in Mexico City, said that her hospital initially instructed employees not to wear masks around a patient until the person tested positive for coronavirus.

  • Updated May 28, 2020

    • Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

“You waited three or four days to see if the patient tested positive, and in the meantime you got infected,” said Ms. de la Cruz, who noted that 80 of her colleagues have gotten sick.

Some hospitals did prepare early for the virus, which swept the United States and Europe before outbreaks flared in Mexico. In Monterrey, doctors said protocols to shield workers were put in place months ago. Rodolfo Ruiz, an infectious disease specialist, says he feels protected at his public hospital in Mexicali, even as hospital beds fill up.

But the missteps in some of the hardest hit cities have brought overrun hospitals to a breaking point, workers say. Doctors and nurses have staged protests outside their hospitals in at least a dozen states, according to local news reports. Some doctors and nurses have refused to treat coronavirus patients.

Rosario Luna, a nurse at the José María Morelos and Pavón hospital in Mexico City, described treating Covid-19 patients with broken heart monitors and faulty suction machines.

Rosario Luna, a nurse.Credit...Meghan Dhaliwal for The New York Times

Doctors and nurses say that many errors inside hospitals are never investigated, in part because overtaxed health workers are unlikely to lodge complaints against their own colleagues.

At Dr. Carlos Mac Gregor hospital in Mexico City, Berenice Andrade, a doctor, said that one internist quit because of the lack of personnel and that only one doctor watched over 54 patients during the weekends.

“It makes the care we offer very deficient,” said Dr. Andrade. “The patient’s health is of course affected.”

Berenice Andrade, a doctor at Dr. Carlos Mac Gregor hospital.Credit...Meghan Dhaliwal for The New York Times

Five health workers have died at La Raza Medical Center, a public hospital complex in Mexico City, according to a spokesman for the federal health system. This month, one of the hospitals started offering psychological support to workers.

“It’s not easy knowing that one day you were working with someone and the next, they aren’t there anymore,” said Ivette Díaz, an intensive care nurse, who is 37 and lives with her elderly parents. “I’m scared every day. My alarm goes off and I don’t want to go to work.”

The hospital has never had enough supplies, she said. Bandages don’t stick to patients because they’ve lost their adhesive. But after her colleagues blocked roads leading into the hospital last month, executives began providing more protective equipment. Still, the masks that they gave out were perforated, because of a manufacturing flaw, Ms. Díaz said.

“If here in Mexico they invested in the health sector, if we had adequate materials, things would look very different,” she said.

She spent her day off recently scouring the streets of her neighborhood until she found a local vendor to sell her a batch of masks. She paid $7 for each, a small price for a mask free of holes, she decided.

Ivette Díaz, center, an intensive care nurse at La Raza hospital, buying safety goggles and latex gloves from a street vendor.Credit...Meghan Dhaliwal for The New York Times