Armando Ahue
Ministry of Health
View from the Top

House Calls for the Pregnant and Sick

Wed, 09/07/2016 - 09:39

Q: Last year we talked about maternal mortality rates and “Médico en tu Casa”. How are things coming along?

A: The “Médico en tu Casa” program is almost 2 years old and emerged as a response to maternal and infant mortality. Many had never received antenatal care. Today, we have more than 8,500 pregnant women who had not been to a single session of antenatal care and 40 percent of those had high-risk pregnancies, that is to say their lives were at risk. Most of those were children 11-14 years old. I can now say 93 percent of those women have given birth with no deaths. This is due to us going to their houses and administering prenatal and antenatal care and taking them to hospital when needed. If we keep waiting until emergency obstetric care is needed, many women will surely continue to die.

Why do you think many women have never received antenatal care when the free clinics are open from 8am to 8pm and hospitals are open 24 hours? The services are free and accessible. It is because there is no health education and women are not conscious that they have to take care of themselves and go to antenatal care. We have not educated and made people responsible for looking after their health and we have not taught people about sexual and reproductive health. When we ask children 11-13 years old in their seventh month of pregnancy why they did not go to antenatal care, they say it is because they did not think about going.

We need to create this consciousness, avoid child and teenage pregnancies and work extensively on health and sexual health education. Through the “Médico en tu Casa” program we have visited over 2.5 million homes, we have found over 200,000 people in vulnerable conditions, almost 175,000 elderly adults who cannot leave their homes and almost 1,900 bedridden people in terrible conditions.

Q: What level of investment is needed for a program such as this?

A: This year it was priced at MX$170 million (US$9 million), which may seem high but in reality is not when compared to the huge impact it is having. This year we have been buying vehicles and other necessary equipment. The remainder of the money will be used to employ more doctors and nurses so we can reach more people. It will survive the budget cuts because it is part of the law in Mexico City, which means it is not subject to the whims of incoming ministers. It is an obligation of the government and the local institutions.

There also are many doctors that work full time in this program, which gives it sustainability. There are 10,000 medical students participating in the “Médico en tu Casa” program and there are nurses, psychologists, odontologists and social workers working as trainees and practitioners. It is a great force with qualified personnel and is also helping train professionals with a greater sense of solidarity and humanitarian and vocational understanding. These students come from 17 universities. Three are public, IPN, UNAM and UAM, and 14 are private, such as La Salle, Anáhuac, ITESM, the Panamericana, Westhill and Iberoamericana colleges. These students learn lessons that cannot be taught in the classroom, in the health center or the hospital. They learn in patients’ homes, interacting with patients. Seeing how they live becomes decisive for health. It reminds them that people’s health and sickness depends on the conditions in which they live, whether they have running water, plumbing, a refrigerator and safe water to drink in their houses.

Q: What are the main challenges in terms of implementing this in other cities in Mexico or internationally?

A: It is implemented in almost nine states, it has been signed in eight states: Michoacan, Sinaloa, Chihuahua, Durango, Tlaxcala, Tabasco, Chiapas and Nuevo Leon. Jalisco has done something similar. They call it “El Médico en tu Barrio” but it is almost the same model. Internationally, it has been adopted by Kuwait, Dubai and will soon be adopted by Paris, Madrid, Ukraine, China and Cuba, which already has a similar model but they really liked the work we were doing, Bogota and Medellin, Guatemala, Panama, Buenos Aires, Santiago de Chile, Peru, Ecuador, Dominican Republic and Costa Rica.

We have agreements in place with five US universities: University of Philadelphia, University of Washington, Harvard University, University of San Francisco and soon the University of Miami.

Q: What has been the key to your success?

A: The key has been daring to change the paradigm of medical attention, having gone to knock on doors instead of building more hospitals because people were not reaching those hospitals either due to their condition or because they did not want to. We dared to instigate this program and give it medical resources.

Many doctors and nurses asked me why we needed to go looking for patients in their homes. They thought it was patronizing but they understood once they went to houses and saw patients sprawled on beds 24/7 with no vehicle, no money to pay for a taxi and no ability to take public transport. They saw almost 19,000 people with physical disabilities unable to leave the house. These people live and exist and were not present in the health system. There are diabetics and people with hypertension we are now monitoring. If we had not identified these patients they would have become an extra burden for the health system as they would have arrived at a hospital with a heart attack, a cardiovascular condition, advanced cancer or with diabetes that requires amputation or dialysis, or blind already. Caring for these people in their homes is the most cost-effective solution. We use generic medicine and when the doctors go to houses, they take their medicine bags directly to the patient.

Q: How did this program obtain an international reach?

A: Ten doctoral Harvard students came and spent 10 days working here. Seeing our work, they uploaded it to their social media saying, ́look at what Mexico City is doing ́. We then began to receive calls from health ministries from Guatemala, Panama and other countries that were interested in what we were doing. It is because they came from such a high level of education that people paid attention and asked how we were managing, what strategies we were using to make it work. The Parisian mayor was saying she wanted to implement the program for refugees, so did Madrid and a province in China for its 70 million inhabitants. This week I will be welcoming the Indian and Israeli ambassadors.

Q: How is the situation of chronic degenerative diseases evolving in Mexico?

A: We have the most overweight children in the world and the second most overweight adults. This leads to many problems such as hypertension and diabetes and we need to take action, starting with education. We have many campaigns in place, for example “muévete y métete en cintura” (move and get yourself in shape). We are giving zumba and physical activity classes in many places, we implemented squats in the Metro, the Ecobici program, free gyms in public spaces so that people can exercise outside, we are increasing the number of indoor gyms, taking salt shakers out of restaurants, we are in the midst of reducing the sugar in sweet bread by 10 percent and the theme of soda in schools is highly debated but we need parents and grandparents to participate. They need to make children do physical activities and move. Nowadays they only move two fingers to play videogames and they do not play ballgames anymore. The city presents many opportunities, even for those with less means, but parents need to seek them out and encourage children. We are telling people how to eat a balanced diet and why physical activity is important. We have brigades for education and medical teaching in over 90 schools, giving recommendations to parents.

I am convinced that there should be an obligatory health class in schools. It should be the most important subject at school not because I work in health, but because there is nothing more important for a human than knowing how the body works, how to maintain it in a healthy state and what the main risks are for your health. If we do not set a good example, how do we expect children to take care of themselves?

Q: What have been the results from the campaigns?

A: I think they have made progress, although no policies yield immediate results. We need to continue our efforts distributing information to the population. We have already taken away salt shakers, made glasses of water free and put a tax on soft drinks, which has resulted in a rapid drop in the consumption of soft drinks. But no single action alone leads to long-lasting results. Many policies need to be implemented. The government needs to have a wide range of offers but people need to be proactive.