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Poverty, Tendency to Self-Medicate Help Drive Up Flu Deaths in Mexico

The free public hospital down the street, Iztapalapa General Hospital, often requires patients to wait for hours with no guarantee that medicines will be in stock. A course of antiviral medication used to treat swine flu costs more than $100, pharmacists said, a price out of reach for many patients.

"People prefer to come here because it is cheaper," said Emelia Segura Vázquez, a homemaker who sought a consult with the on-site doctor at the Christ Medical Pharmacy in Iztapalapa for her 6-year-old son, Omar Israel, who had diarrhea. "This is the closest thing we have. And more than anything, I don't want to take him to a clinic because of all the contagion there from the flu."

Mexico has three parallel health-care systems. Workers who are employed by the government or private companies are part of the national social security system, as are their families. When they go to a hospital or doctor, the care is mostly free. The uninsured, about 50 percent of the population, include the unemployed and those who work in the informal economy. They also have access to health care, at public clinics and hospitals run by the Health Ministry. They are required to pay for services, but the amount is based on their income. It is often just a few dollars for a doctor's visit. A small fraction of people, about 3 percent, visit private hospitals using insurance or, if they are wealthy enough, by paying in cash.

"Mexico is a country with a lot of self-medication," said Homero Martinez, a researcher at the Rand Corporation in Los Angeles who specializes in the study of the Mexican health-care system. "You can go to the pharmacies, they are open 24 hours a day, they deliver, and you can buy all the medicine you want for yourself -- and your neighbors."

Outside the Christ Medical Pharmacy waiting room, in a graffiti-scarred block of concrete buildings, 6-year-old Miguel Pérez threw up into the grass along the sidewalk. His mother, María, said her husband lost his job, along with his insurance, three months ago. Her government-assigned clinic, according to her address, is about 45 minutes away by bus. "They attend you well here, it's not a problem," she said.

During the outbreak, when masses of people became concerned about the possibility of infection, patients waited hours to see doctors. Some family members slept overnight on the sidewalks. The government deployed more than 100 ad hoc clinics -- trucks and tents staffed with doctors and nurses -- to quickly screen for prospective flu cases. At one mobile clinic in Iztapalapa, frustrated residents last week said they had waited for up to four hours to see the doctor. At one point, care was delayed even further because a crying boy had a high fever and the doctor wanted him rushed to a hospital, but there was no ambulance available.

Health care has become more accessible during the outbreak. Calderón decreed last week that all public and private hospitals provide care for people with flu symptoms.

"Now everyone is very aware of the risk," Martinez said. "Nobody in his or her right mind would wait to rush to the hospital if they had a high fever."

But it is still not a simple process. When Araceli Durán took one of her four children, Noe Guillermo Ramos, 26, to Iztapalapa General Hospital last week, the doctor said he had laryngitis and sent them home with medicine, she said.

By Sunday, her son had a ragged cough, a fever and aching bones, so she went to a neighborhood public clinic, where a doctor said he had a common cold. She took him to another government clinic, but because of a shift change, she was told she would need to wait more than four hours for attention. She then went back to Iztapalapa General Hospital.

"He is worse now," she said. "It's obviously a serious infection that needs to get under control."

But Durán, like many people waiting at the hospital, did not even trust that swine flu was real. Some said it was an elaborate government lie. Others said they would be convinced only if they knew someone who had the virus.

"I don't believe any of this," Durán said. "This is all just psychological."

Staff photographer Melina Mara contributed to this report.

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