The problem of violence against health personnel is not new; in 2003, the World Health Organization (WHO) published guidelines to treat it in response to the strategies applied in the United Kingdom, the United States, Sweden and Australia.
The pandemic did not start the violence, it made it cruder. This aroused the interest of the population. It is not a local phenomenon, the Medscape news portal published in April 2020 a column entitled “Crisis exposes resident abuse” in which they narrate the abuses to which residents in the United States are exposed during the pandemic. Also, the International Forum of Internal Medicine published an article —in which I had the privilege of participating—, in which it is described that attacks on health personnel during the pandemic increased throughout Latin America.
On March 11, 2020, the WHO declared a pandemic in relation to the SARS-CoV-2 virus and pulled back the curtain on the great abuses that were tolerated within our health system, including violence against workers. From before, the health system was authoritarian, violent and did not show much interest in its staff; During the pandemic, this was made clear and society and the media turned to see a problem that we have been struggling with for years.
In Mexico, before the pandemic, Dr. Roberto Castro from UNAM warned us for years about violence within the medical field and most preferred to ignore or minimize the problem. To understand a little more about violence in the medical field, I recommend looking for his publications.
A classification of violence in the medical field divides it into two major subtypes: internal violence (that which occurs between actors within the health system) and external violence (that which comes from people outside the system). In times of COVID, both types of violence flourished. Health personnel were attacked by outsiders: relatives, patients, health authorities, the media and, of course, there was a lot of violence between members of the medical union and the rest of the health personnel.
The pandemic began with an act of violence against a doctor. In December 2019, Dr. Li Wenliang alerted others to an outbreak of probable SARS cases in China; in February 2020 he passed away from complications of COVID-19; During those months he was harassed by local authorities for allegedly spreading false rumours. Dr. Li Wenliang was one of the first heroes of the pandemic and one of the first health workers to be victims of violence due to the pandemic.
On March 18, 2020, the Ministry of Health reports the first death from COVID-19 in Mexico and Mexican society, full of curiosity and fear, turned to see our health system, which was looted and in ruins. On March 30, by agreement of the General Health Council, a health emergency is declared.
By March 31, 2020, we have reported in the media the first serious cases of external violence; Some people threatened to burn down the Ángel Ventura Neri hospital in Morelos if it admitted COVID patients. On April 6, some residents burned part of a hospital in Nuevo León for treating COVID patients. Attacks against hospitals and health centers will be a constant during the pandemic; Later, the president will have to ask the National Guard and the state security forces to protect the medical units to avoid this type of situation.
On those same dates the attacks against health personnel began in the streets. Attacks that were gestated in fear, but also in prejudice and discrimination. On March 31, 2020, the note was reported that in Jalisco they had attacked a nurse on public transport and, in Mérida, another nurse was lowered by passengers of a public transport unit shouting “Put her down! Things were just beginning and the attacks were not only not going to stop, but they were gradually getting worse. In those days, speaking with a doctor, she told me that she had to send her children to live in another state, because they put a note on the door of her house that said that if someone died of COVID out there, the following in to die would be his children.
In April, the murder of three doctors from the IMSS of Morelos was reported and attacks with chlorine continued in various parts of the country.
All these events can be classified as events of external violence, since health personnel were attacked by people outside the health system and, in many cases, we see clear data of discrimination because the attacks were not against the person in question. particular, but because of his condition as a health worker. These acts are very difficult to stop, because they can occur anywhere; the best strategy to avoid them is to avoid wearing uniforms or badges that identify people as health personnel during their transfers.
But the attacks did not only come from the general population. A media outlet (April 2020) presented a story in which it described as traitors 12 doctors who had promoted protections against the pandemic so as not to work without protective equipment suffering from risk factors. The media outlet even featured their photos and names. It is incredible that some people are not clear that the amparo trial is a tool to guarantee human rights, no one can be classified as a “traitor” for processing an amparo. It is a right!
The violence continued to increase and from chlorine we moved on to beatings. On April 9, it was reported that a health worker had been beaten by relatives of a patient who died of COVID. Sadly, it wouldn’t be the last time that would happen.
In relation to internal violence, this was also repeatedly reported in the national media. From an article that talked about some nurses in Monclova asking them not to wear face masks, to the dismissal of a manager at a Mexicali hospital who was infected with COVID and did not officially notify him.
At the beginning of the pandemic, protective equipment was lacking. The Excelsior published that doctors spent up to 10,000 pesos on protective equipment and even spent 50% of their salary on equipment. El Universal published a similar note and put the amount at 20 thousand pesos. This is violence, because the bosses must guarantee the work material and, the most honest and decent thing, would have been for the health institutions to reimburse their doctors for their expenses if they obtained their protective equipment from outside. Let’s remember that at the beginning of the pandemic it was very difficult to get face masks and other supplies. Unfortunately, honesty and decency are rare in our health authorities.
All these events must be understood as hegemonic internal violence, since the authority should respect and guarantee the integrity, human and labor rights of the workers.
Some workers began to report retaliation by the authorities of their hospitals for demanding protection measures. Blockades of roads by health personnel have become routine throughout the country. Also threats, illegal dismissals and protections. The problem is that on many occasions the conciliation boards and the courts were closed, so it was very difficult to defend the illegally fired personnel, in addition, that the health workers are terrified of their authorities.
The health secretaries of some entities evidenced their authoritarian character and their ignorance of the law. The Secretary of Health of Sonora asked medical students of clinical cycles “to make sure that it is their vocation” and to attend COVID patients. No one explained to the doctor that the NOM on clinical cycles mentions that students must carry out the activities contained in the academic and operational programs, without replacing institutional personnel in their functions. For his part, the Secretary of Health of Chiapas said that health personnel comply or earn money by selling tacos. An offense for both health personnel and taco vendors; who are a frequent target of prejudiced and classist comments, but sometimes they are more prosperous than the medical profession.
Subsequently, a series of very important events take place.
- 1. May 1, 2020: At the Hospital de las Américas in Ecatepec, a group of relatives force their way in to see their patient and discover him dead. In the media and social networks they talked about the ignorance of the people who had done this, but in reality, if we analyze the international publications on violence in the field of health, we realize that all the red lights were found: it was night, in a highly populated area, with a recent shift change, few staff, little surveillance, hospital saturation and little communication between staff and relatives. What happened in that hospital was something that could have been prevented, but for years the health system was abandoned and the pandemic pushed it to the limit. The amazing thing is not what happened that day, but that it didn’t happen more often.
- 2. May 8, 2020: The president says that doctors only seek to get rich, that during the “neoliberal period” some were “mercantilists.” The medical union responded with indignation and through its different associations and societies they requested a public apology. The damage was already done and to this day, many people quote the president to attack the guild.
- 3. May 19, 2020: 14 health workers kidnapped in CDMX are rescued. This was a shocking and hard to believe case, a group of nurses were kidnapped virtually, that is, while they were in two hotels in CDMX, a criminal group made extortion calls to their relatives with the threat that they had them kidnapped. It turns out that most of the staff came from Nuevo León to help with sanitation work in the city.
- 4. On June 18, El Financiero published an article mentioning that 94% of attacks on doctors go unpunished. In said note, only reference is made to external violence, but in relation to internal violence, the percentage, it seems to me, is higher.
We were barely there in June, the pandemic had been in Mexico for four months and the violence against health personnel was undeniable, constant and came from many places; the workers were attacked by the population who sprayed them with chlorine, beat them and burned the hospitals. Relatives sometimes attacked and came to break the security in Ecatepec. There were cases of rape and homicide against health personnel in the middle of the pandemic. The authorities, from the very head of the executive, showed little empathy with their work and reviled them. They called them mercantilists, some media called them traitors, the state health secretaries demonstrated their authoritarianism, little education and ignorance of the law and publicly attacked their doctors. The cases of doctors threatened, fired or humiliated for asking for protective equipment numbered in the dozens. Meanwhile, the courts are closed and the country is without justice.
The pandemic exposed a dilapidated, poorly managed and authoritarian health system, in which the conditions of patients and workers matter very little.
In the next installment I will continue analyzing violence against health personnel during the pandemic and I will talk about the three most paradigmatic cases to date.
If you were interested in my column, I invite you to read my books: In the medical residence and From victim to tyrant: R2 chronicle, published on Amazon.mx in physical and digital format or tell me your experiences or opinions by email: [email protected]