It was a full week here in Mexico. Highlights:
* A tour of the Clínica Amistad on the Santa Fe campus of Hospital ABC, a clinic totally devoted to preventative services.
* An overview of how some private hospitals have incorporated the Toyota Production System and the philosophy of Just Culture into their operations.
* An in-depth discussion about Seguro Popular with Mexico's National Commissioner of Social Protection in Health, Dr. Gabriel O'Shea.
* A presentation on the complexity of the myriad issues surrounding immigrants and health with Haydeé Pérez and José Knippen of Fundar.
* A visit to the Office of Intercultural Development to better understand the roles that traditional and alternative medicines play in the modern Mexican healthcare system.
* The education and training of doctors at the University of Anáhuac.
* A deep dive into data about socioeconomics and international migration at CONAPO.
* Impact measurement and data evaluation at the Office of Evaluation and Performance.
And these are just the highlights, not even mentioning other interesting parts of the week (like Teletón, Mexico's equivalent of the Jerry Lewis Telethon).
It is very difficult to distill all I saw, heard and learned over the course of the past week into this post, so I will constrain myself to some impressions.
My initial sense that Mexico puts an immense amount of effort into prevention was reinforced. It was amazing to visit a clinic the size of Casa de Salud that was 100% about promoting and enabling the prevention of disease; to see multiple programs aimed at reducing teenage pregnancy (including movie-quality PSAs aimed squarely at pre-adolescents and teens with explicit messaging - "it's not about preventing sex, it's about preventing pregnancy and disease"); and the government-sponsored bike riding classes to get young children active as soon as possible.
Although Seguro Popular has theoretically led to universal access, to a certain extent this is true only on paper. As I mentioned previously, coverage does not necessarily equal access, and that is certainly true here. As just one example, Seguro Popular may cover your costs for treatment, but if you live in the state of Chihuahua, which, despite being the largest of Mexico's 31 states, has only two hospitals, then you're going to have a difficult time having your healthcare needs met despite no out-of-pocket costs.
Medical students in Mexico must serve one year in a Level One clinic (basic non-urgent care, similar to community clinics in the U.S.) before being granted their official MD. Not only does this enhance Mexico’s prevention efforts, which locally are often centered at these clinics, it also inculcates a sense of service into the providers. How I would love to have Casa de Salud and the more than 1,000 other community clinics in the U.S. benefit from this type of mandate.
By the admission of many of the people I've spoken with, Mexico lags in metrics and measurements and their evaluation. Still, they are not ignorant of the importance of these issues and people like Dr. Rubén López, who I met at Office of Evaluation and Performance, are working diligently to bring the country up to speed (I am grateful that he took the time to review my information about Casa de Salud's operations and make some excellent suggestions about how my clinic can do better in its own impact evaluation).
So what am I left with? I am in a country with constrained resources (spending just above 6% of GDP on healthcare when the average in Latin America is 8%) and large swaths of territory that are rural and remote, yet has a Constitution that declares healthcare a human right guaranteed to every Mexican and is trying (especially through Seguro Popular) to live up to that ideal. Its system is complex, fragmented, and siloed, leading to different levels of access and outcomes. Given this set of facts, it is making an enormous effort to push and prod the population to adopt healthier lifestyles that will unburden the system and free up resources to deal with existing chronic illnesses and an aging population.
In short, though the particular circumstances are unique to Mexico, the country shares the challenges of most other nations of scale: how to best use finite resources that are always inadequate to the overall need; how to improve outcomes without untenable cost increases; and how to engage the entire citizenry in being responsible for its collective health. And where there are similar challenges, there is an opportunity to find solutions from cooperation.
This is what I find particularly satisfying about the Eisenhower Fellowships experience. One of the main ideas behind the program is that there is mutual prosperity to be had when nations learn from each other. This premise has been affirmed by my visits to Mexico and Germany, combined with my native understanding of the United States. Each country does certain things very well, while other aspects are lacking. Each has a different philosophy, but all are trying to achieve the same general result: a healthy population. To the extent that we are willing to examine what other peoples are doing and have the humility to, when it makes sense, adopt or adapt their strategies that are working, it can only help us. And given the ever-growing global nature of health (can you say Ebola?) it is in all our best interests to do so.
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