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Trying to Save Lives Amid Relentless Drug Violence, Mexican Medical Workers Put Their Own On the Line
email this pageprint this pageemail usAnne-Marie O'Connor & William Booth - Washington Post
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November 22, 2010

Zapopan, Mexico - Physician Jose Luis Guerrero was at the bedside of a patient when the terrified young man splattered with blood burst into the hospital, screaming that hit men were chasing him.

Minutes later, automatic weapons fire strafed the walls. Two receptionists fainted. A grenade exploded through the window of the intensive care unit, raining glass beside a 14-year-old girl who had been injured in a car accident. Police shot wildly in the streets as patients in hospital gowns ran in search of closets to hide in.

It is the kind of medical emergency Mexico's doctors and nurses have come to dread, as mounting drug violence tears at the country's social safety net, shuttering clinics, creating no-go zones for ambulances and forcing medical workers to flee north of the border.

"We pray not to have these kinds of patients," said Guerrero, a 32-year-old trauma specialist who is director of the clean, modern Arboledas Hospital in the suburbs of Guadalajara, still visibly upset by the memory of the July melee. The bloodied young man was targeted by two truckloads of assassins, police later said, because he was dating the girlfriend of a drug trafficker. He survived.

With alarming frequency, narcotics violence is spilling into hospitals and clinics across Mexico. Drug traffickers have shot doctors who treated them. They've burst into emergency rooms and executed their enemies on operating tables. They've hijacked ambulances, demanding that paramedics save the lives of wounded gunmen.

"These attacks have not been reported by the press, who fear reprisals," said Ricardo Monreal, a federal senator and former governor of Zacatecas state. "Like teachers who are afraid to teach, the doctors do not want to work. This is more collateral damage generated by the fight against organized crime."

Physician Ramon Murrieta Gonzalez, the president-elect of the Medical College of Mexico, a national umbrella organization, said professional groups like his try to keep word out of the media when a doctor is shot to death to avoid stigmatizing the children and other survivors, as readers often wrongly assume that the doctor was mixed up with drug traffickers.

Health Minister Jose Angel Cordova Villalobos has warned that drug violence is undermining Mexico's ability to provide quality medical care for its citizens - one of the proudest achievements of the modern Mexican state - as specialists refuse jobs in violence-plagued regions.

'In the middle of a war'

Murrieta said that in the past two years, 15 doctors have been shot to death in Ciudad Juarez - in drug rehabilitation centers, at their practices, in public places.

More than 250 Ciudad Juarez doctors now commute across the border from El Paso, where they have moved with their families for safety, Murrieta said. Seventy-five more have fled the area, and 30 percent of the city's private practices have closed, he said.

"We are in the middle of a war without choosing to be," Murrieta said. "Commandos assassinate wounded men in the hospital - once in the surgical suite while they were operating on the patient. This is a grave danger to the entire country."

Six doctors have been killed in Tamaulipas in the past two years, and two others in Tijuana, he said. The bullet-riddled body of a respected doctor was dumped on the highway in San Luis Potosi the other day, he said. Kidnappings are commonplace.

"Organized crime is taking a toll on us," he said.

In Tijuana, doctors have marched to demand more protection from organized crime after being targeted in kidnappings and endangered by gunmen who left three dead and three wounded in a 2007 attack at the main hospital.

Physician Jesus Cornejo Rincon, the president of the Medical College of Tijuana, said 50 doctors have left that city in the past two years because of the insecurity. And he said there has been a 50 percent decline in medical tourism - Americans coming to Mexico for cheaper treatment - because of fear and the delays at border crossings that have resulted from intensified security checks.

"There has been a very significant exodus of doctors because of the insecurity," he said. "Many have gone to the United States to work as paramedics."

"In the last four years, 40 doctors I know have moved to San Diego, and every night they drive across the border to go home," said physician Luis Calderon, the former vice president of the National Federation of Medical Colleges of Mexico and past president of the Medical College of Baja California. "The exodus on the border is much greater than it appears because many Tijuana doctors and their families live in the United States."

Impact across the border

U.S. cross-border medical delivery is also being hurt. The Salt Lake City branch of the Shriners Hospitals for Children recently suspended an outpatient clinic program it had run for 30 years in Ciudad Juarez, at which U.S. doctors would identify Mexican children in need of surgery for spinal injuries or treatment for scoliosis and spina bifida.

The Shriners moved the clinic to El Paso, but visas to bring the children over cost $166 each for a child and parent. The Ciudad Juarez clinic saw an average of 200 children each time the program was run, but only 35 showed up when it moved to El Paso.

"It has almost killed it," said Craig Patchin, the hospital administrator. "We struggled to keep it going as the violence escalated. But it became so apparent that targets over there weren't just drug traffickers, but innocent people at birthday parties and other gatherings."

The violence doesn't affect only doctors on the embattled border. Last month, gunmen shot a wounded man dead in his hospital bed in the Pacific Coast beach town of Mazatlan, then strolled to another room and dragged off a convalescing patient who was in police detention. The patient's whereabouts are not known.

"As citizens, we must overcome our fear and speak openly about this, for the good of our society," said physician Leticia Chavarria, the president of the Citizens Medical Committee in Ciudad Juarez. "Last year an armed commando barged into an emergency room and threatened everyone until they found the wounded man, and killed him right then and there, in the middle of the day."

Chavarria's group is calling for authorities to make it a federal crime to harm a doctor or endanger a medical facility. There has been no response by the government yet.

First responders at risk

The assaults in Mexico's hospitals and clinics have become so common that doctors and journalists have invented a new verb - "rematar," meaning "to re-kill."

"This is having a significant impact on public health," said human rights activist and university professor Victor Quintana, a former legislator from the border state of Chihuahua. "Organized crime is engaged in kidnappings, constant intimidation and extortion. Many doctors have been forced to emigrate because they had to close their clinics. This is reducing medical services."

Neither the government nor medical associations track how many doctors or nurses have left the country or stopped practicing. Government and media databases keep track of police and soldiers killed in drug violence - nearly 700 in the last four years - but not the number of medical workers.

In Mexico, hospitals have traditionally been seen as sanctuaries of healing, almost like churches, and so their violation is especially unnerving to Mexicans. "Before, hospitals were respected," said Martin Barron Cruz, a researcher at the National Institute of Criminal Science in Mexico City. "This adds to the psychological war by organized crime, as a show of force that is part of an alarming social deterioration."

Earlier this year in the Gulf Coast city of Tampico, south of the Texas border, Red Cross leader Miguel Angel Valdez told his staff not to begin treating anyone with bullet wounds until authorities arrive and secure the scene. Valdez acknowledges that help for victims may be delayed but says the new measures are needed to protect his paramedics.

"Otherwise, people are too much at risk," Valdez said. "Who would want to be in a situation like this? It is difficult to find people who want to go to a conflict zone."

In Ciudad Juarez, when a car bomb was set off in July, respected veteran physician Guillermo Ortiz Collazo rushed to where two policemen lay. As Ortiz examined the victims, there was a second explosion. Ortiz was killed, along with a paramedic.

oconnoram(at), boothb(at)

Researcher Gabriela Martinez in Mexico City contributed to this report.

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