Gustavo Salazar cannot forget the panic he felt on June 30 when a friend called him to tell him that he had run out of pills and at the hospital pharmacy where they treat him told him that they did not have them.
Immediately, he began to count the pills he had left, and when he realized that there were only three, he burst into tears.
“If we stop taking the medicine we can burn a scheme, that means that the medicine no longer works.
Our viral load reaches such low levels that we could fall into the AIDS stage
and opportunistic diseases kill us, ”he says with a broken voice, while explaining that he and his friend were long ago diagnosed with the human immunodeficiency virus (HIV) .
Complaints about the shortage of medicines in Mexico, and its consequences for the public health system and patients, have become recurrent.
In many cases, the shortage forces people with chronic diseases to turn to support networks, social organizations and private pharmacies.
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Salazar, 34, took to social networks to tell about the situation he suffers every time he does not get his medicine.
“When people give you one of their pills, you know that they give you one more day of protection,
one more day of better life,
but you pay your fees at the ISSTE (the Institute of Social Security and Services for State Workers) now Sometimes you don't get anything, ”he says desperately in an
interview with Noticias Telemundo
.
Since its creation in 2019, the Cero shortage collective, an organization that monitors the shortage of medicines in the country, has registered 4,504 reports on its platform;
In
the first four months of 2021 alone, they received 773 reports from patients
and health professionals detailing the lack of access to medicines.
“People don't understand that medicine is a matter of life and death for us.
Many think that they can be easily bought in pharmacies but it is not available, I am not lying to them.
And when I get it, it
costs 12,000 Mexican pesos (about $ 600)
.
Most of the boys and girls living with HIV cannot pay these amounts, ”says Salazar, 34, in frustration.
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According to the most recent report of Zero shortage, the situation of medicines not only affects people with serious diseases but has also become a general problem, to the point that the shortage of
drugs to control diabetes occupies the first position of its reports with 19% of the cases reported
in the first months of the year.
“President Andrés Manuel López Obrador eliminated a regulatory body for the prices of medicines and health supplies and transferred all functions to the Ministry of Finance, but they do not have the knowledge to carry out these processes, so now everything takes much longer ”Explains Nicole Finkelstein Mizrahi, director of the AIDS Healthcare Foundation in Mexico, a non-profit organization that supports people with HIV.
For several years, the shortage and shortage of medicines have become a cyclical problem for Mexicans and it is a situation that impacts the lives of the most disadvantaged social groups. But it has worsened since mid-2019, when changes were made in government purchases of drugs such as methotrexate, after suspicions of contamination in some doses, and in the face of complaints from President López Obrador that few companies concentrated the sale and production to allegedly overcharging or committing alleged acts of corruption.
“In no way are we against improving the processes.
The problem is when this is done at the expense of the patients because these changes have consequences, I do not know if they were not measured or if it did not matter (...) but
we already have almost three years with a frank shortage and with despair and lives that it costs,
”says Andrés Castañeda, doctor and member of Cero desabasto.
Relatives of children with cancer during a demonstration against drug shortages at the Benito Juárez International Airport in Mexico City, June 30, 2021. Reuters
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Experts, activists and patients from various medical centers contacted by Noticias Telemundo agree that the changes in purchases were implemented quickly, without taking into account the complexities of the drug purchase process, which has caused great delays. They have also denounced the failures of the Institute of Health for Well-being (Insabi), whose creation took place in this Government and has not managed to solve the supply of treatments for highly specialized patients, such as people with cancer or HIV.
To Finkelstein, for example, no one has to explain the characteristics of the drug shortage in the country.
As a doctor and activist, she often listens to the testimonies of dozens of people who, in the height of despair, endlessly visit pharmacies and medical centers in various states in search of remedies for their ills.
In addition, it is an anguish that lives in its own flesh.
“I have a chronic condition which is ankylosing spondylitis and neuromyelitis optica, a rheumatological autoimmune disease.
My treatment is with methotrexate and there is nowhere, neither in public nor private institutions,
because there was a deregulation in its production and import, ”explains Finkelstein, who searched for his drug throughout the territory, from Tijuana to Quintana Roo without being able to to get it.
Sometimes knowledge can be a burden.
As a healthcare professional, Finkelstein knows exactly what will happen to her if she stops her treatment, and that increases her distress.
So he decided to change the presentation of the drug and go from pills to use the subcutaneous modality.
“Now I have to inject myself, but
that's the only thing left and it has an expiration date of two months.
Also, methotrexate is used in cancer treatment, and it is not available.
I don't want to imagine what the parents of children with cancer feel, "he says bluntly.
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Blockages to children with cancer
Faced with complaints about this problem, spokespersons for the Mexican government often deny the shortage or announce purchases and guarantee the supply of drugs that, however, take a long time to reach patients. Parents of children with cancer, for example, have made multiple demonstrations,
blocking access to the Mexico City international airport four times
in the last two years.
At the end of last month, Hugo López-Gatell, undersecretary of Prevention and Health Promotion, even said in an interview that these demonstrations were connected with “coup narratives” as part of a political strategy. "This idea of children with cancer who do not have drugs, we increasingly see it positioned as
part of a campaign beyond the country of international right-wing groups,
" said the official.
According to the parents of children with cancer, the shortage of medicines began to appear in September 2018, but it became a chronic phenomenon - like the illness of their children - with this Government.
The absence of drugs is a nightmare marked by names like
methotrexate, filgrastim, and vincristine
.
When they get any of those medicines, then months later they lack others like cyclophosphamide, daunorubicin or temozolomide.
“I had to battle with medicines like methotrexate, vincristine and with L-asparaginase.
To me
it exhausted me because desabasto was always
"explained Yamileth of the river, mother of Alexis, a boy with cancer who died after suffering complications due to drug shortages.
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After the controversy over López-Gatell's statements, President López Obrador once again assured that his government works to buy drugs abroad and end the monopoly that existed in the country.
"My respect to the mothers and fathers of children with cancer, to tell them that
we are doing everything so that they do not lack medicines
, facing all obstacles, and we are going to comply," he declared in his usual morning conference on June 29.
Shortly after, the country's authorities announced that some
30,000 units of cancer drugs
had been distributed
, ensuring that the supply is guaranteed.
However, many parents like Luis Fernando Reyes Guzmán do not believe in the ongoing promises of the current administration.
“The reality is that the authorities are not looking for long-term solutions.
They think that it is enough to buy the medicine for the hospital that requires it at that moment, but that only lasts 15 days.
In this way, cancer is not cured because later it fails again and the children suffer serious sequelae or die, ”says Reyes Guzmán, in a desperate tone.
Her son, Fernando Gael, is a cheerful five-year-old boy who likes to sing. At home, his chants are often heard everywhere as he plays awkwardly. According to his father, Fernando Gael suffered a very severe shortage of an important drug for his cancer treatment during 2019. As a consequence of that, last year they
had to remove his left eye
, leaving it in the shadows because in the right it has a detachment of retina that destroyed his vision.
“It's hard to explain, but sometimes cancer doesn't wait a day.
On that occasion we had to interrupt the chemotherapies because the hospital did not have the medicine, and
in the pharmacies it cost 16,000 pesos (about $ 800) but they had to put ten doses
.
It was impossible for us to get that money, and Fer never recovered, ”Reyes explains with a broken voice.
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The relatives of minors who receive cancer treatment have been grouped in the National Movement for Health Parents of Children with Cancer, an organization that ensures that currently
20 federal hospitals and 15 state health centers register between 70 and a 90% shortage
of chemotherapy drugs.
Reyes is part of the movement and ensures that they have received complaints about the shortage of "39 drug codes."
"We have reports of
1,600 children who have died due to the shortage
and this has harmed the 19,000 child patients in public hospitals in the country," explains Reyes.
In a recent report, Cero shortage found that at least in the Mexican Institute of Social Security, from 2019 to 2020, the percentage of filled prescriptions fell from
98 to 92%, which means that 16 million prescriptions “could not be
filled completely. to provide adequate treatment ”.
However, the shortage of drugs is not limited to public entities.
The private sector, which includes a network of more than 40,000 pharmacies, is also beginning to be affected by the absence of the medicines that the population needs.
“We have detected that there is a shortage of 15%, we could say that it has tripled in recent weeks.
Two out of every ten patients are referred to their doctors so that another medicine is prescribed
, ”says Marcos Pascual, commercial director of the National Association of Pharmacies of Mexico (Anafarmex).
Pascual says that this considerably increases the "out-of-pocket expense" of patients and their families by more than 70%, and recently a chain of pharmacies published in several newspapers a space in which it alerted consumers of
the absence of 54 drugs
among those who were drugs of mass consumption such as Afrin (a nasal decongestant), Caltrate (calcium and vitamin D) and Riopan (an antacid).
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The manager affirms that logistical difficulties are part of the elements that delay supply because, in the past, transport and distribution were in charge of private companies that have more than 250,000 square meters of storage facilities and 1,000 transport units. for cold network management, a necessary condition for many substances.
“Our industry displaced around 2,400 million pieces annually, that is, we have the capacity to guarantee supply.
The states do not have it, in addition,
the pandemic has caused a shortage of raw materials worldwide, and Mexico imports more than 80%
of these materials, ”concludes Pascual.
"The investment was not enough"
Apart from the delay generated by bureaucratic changes, the Mexican case is part of a worrying trend in the region: the pandemic has exposed the scant investment that Latin American governments have made in their health systems.
Mexico is going through its third wave of COVID-19 with more than 2.5 million infections and 234,675 deaths
, although that number could exceed 350,000 deaths if official data on excess mortality associated with the pandemic are added.
“The investment in public health was not enough.
In our countries there are highly fragmented health systems where access to medical care depends on where you work.
All that has to change, ”said Gerry Eijkemans, head of the Health Promotion and Social Determinants Unit of the Pan American Health Organization, in an interview with Noticias Telemundo.
"
Governments could not cope with COVID,
but they could not attend to all chronic diseases, and that will be the next wave," warns Eijkemans.
For experts like Finkelstein, government announcements of drug purchases do not reflect a lasting change in the condition of patients.
“The shortage exists until the medicine is in the hands of those who need it to live.
It is useless for the authorities to say that they bought millions of units or that they have them in warehouses.
There is bad management and that is genocide and corruption.
The shortage is not a rumor
”, explains the doctor.
Various health agencies of the Mexican Government, such as Insabi, Cofepris and the Ministry of Health, were contacted during the investigation of this report but did not respond to requests for interviews.
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Live counting every pill
In the case of chronic conditions, the consequences of shortages are usually serious.
Various organizations that support people with HIV in Mexico have warned about the complications that come with stopping antiretroviral therapy.
"
If you stop taking the drug, the first thing you lose is undetectability,
that is, you can transmit the virus again and the other thing is that your health begins to deteriorate," explains Alaín Pinzón, activist and human rights defender who leads HIVve Libre, an organization that supports people with HIV.
For a decade, Pinzón has lived with the virus and suffered the limits of death in his own body when he fell into the AIDS stage several years ago.
Among other things, HIVve Libre focuses on collecting and distributing medicines for free, which is why Pinzón tends to quickly find out about shortages in Mexico City and the rest of the country.
“I must be emphatic, with this administration we have seen a very large growth of this problem.
From December 1, 2019 until this month, we counted
approximately 94 cases of people in the AIDS phase, unfortunately more than half have died
”, he explains.
In Hermosillo, Sonora, Marta has spent almost two decades struggling with the complications of HIV that her husband, the father of her two children, infected her.
He explains that the disease is magical because it allows him to discover the true faces of people.
“At first I never talk about my condition, but when I tell it I see how they change.
So I have lost jobs, friends and part of my life.
I don't know how it is in other countries, but
in Mexico there is a lot of struggle to get the medicines.
Although that is not new, now it has gotten worse, ”explains Marta, 55, who asked to remain anonymous for fear of reprisals.
Although she defines herself as a survivor because she has overcome cancer and COVID-19, twice, she does not hesitate to hold the Mexican government responsible for her poor quality of life.
“Last year I lasted three months without medicine, that's why I got COVID and it repeated.
They have been years of lawsuits, and lawsuits with everyone because they do not understand that we need medicine on a daily basis.
People tell you 'why do you fight so much if you're going to die anyway'.
But I also have illusions and desire to live ”, he says with dismay.
When Marta is asked to explain what it means not to have her drugs, she smiles sadly and asserts:
"The shortage is lethal for us because it takes days off your life, you live counting pills
.
"
If you have information about shortages in Mexico or Central America, you can write to
albinson.linares@nbcuni.com.
