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Health centers leave a patient with monkeypox unattended

José had a fever, fatigue, swollen glands and strange blisters. He was sure that he had contracted monkeypox. He went to a clinic in Mexico City, but they did not attend him. It was July 12 of this year, 19 days after the Ministry of Health issued an epidemiological alert for this disease.

The young man, whom we will call José to protect his identity, arrived very early at the T-II Health Center on July 25, in the San Felipe neighborhood, in the Gustavo A. Madero mayor’s office.

Upon arrival, he was prepared for an operation like a movie to unfold in the clinic, in which he would end up hospitalized and in isolation to be able to observe his evolution and prevent him from infecting someone else. It didn’t happen.

In the T-II July 25, of the Secretariat of Health of Mexico City (Sedesa), where José arrived at 7 in the morning, a nurse came out to tell those who were waiting in line that there would be no consultation. They had only received five people.

They had another line of COVID suspects, they were a priority and there was no staff to attend to anyone else.

José told the nurse that he was going for a delicate case. In front of all the people she asked him to explain what it was about. José clarified that it was a confidential matter.

“Well, there are no consultations anyway, if it’s urgent, go to the La Villa health center (also from Sedesa),” the nurse replied.

He obeyed and went there, to the T-III Doctor Manuel Cárdenas de la Vega, a center with greater capacity than on July 25. What he found in that place was lack of control and discrimination.

“As soon as I told them about the ampoules, I felt rejected. The nurse didn’t even finish taking my vital signs. She put me through to a doctor who didn’t ask me for any information or anything, she just told me that they were going to treat me in epidemiology. They left me waiting for over an hour in the common room. I felt very bad, I had a fever, body aches, fatigue, swollen glands and blisters. I got desperate and better left so as not to infect anyone else. No one stopped me at the exit,” says José.

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In Mexico, the Guide for the Medical Approach to Monkeypox It was presented until July 25. By then, 60 cases had already been detected in the country. The first was on May 28, 2022. However, since the 24th of that month, the health authorities had already issued a epidemiological alert where health centers and clinics are told what to do.

Despite this, José left a T-III in Mexico City without leaving his phone, no one from there stopped him and, of course, they did not look for him afterwards. They let go without diagnosis and without treatment a case of monkeypox, a disease that the World Health Organization declared a public health emergency of international concern.

“I thought that in the health centers they were going to have a specific protocol to treat me, that is why, in fact, I went to the public sector and not with a private doctor. I thought they would be more organized, ready to test me and stuff. But I only found that they did not know what to do, a lot of disinterest and rejection”, says José.

Political Animal asked the Secretary of Health of Mexico City, through its communication office, for an explanation as to why this was happening in the health centers, where it seemed, according to José’s experience, that they did not know what to do , to which the unit responded that in specialized centers such as T-III there was a protocol, that samples from patients should be taken there and sent to the National Institute of Epidemiological Diagnosis and Reference (InDRE), which determines if the case it is positive or not (as indicated in the guide and the epidemiological notice).

When they were told that none of this happened with José, the press office replied that they would have to review the case.

Monkeypox: What should be done?

The guide for the clinical management of monkeypox cases, issued on July 25, points out that like human smallpox, it has been considered that person-to-person transmission can occur through respiratory droplets during face-to-face contact. close and prolonged face, by direct contact with the body fluids of a sick person or contact with contaminated objects, such as bedding or personal clothing, eating utensils, etc. Sexual transmission is not ruled out.

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A probable case is defined as a person of any age and gender presenting with one or multiple skin or mucosal rashes and one or more of the following signs or symptoms:

  • Fever.
  • Headache and muscle pain.
  • Swelling of the lymph nodes.
  • Fatigue.

The guide points out that to date, a single case of this emerging disease should be considered an outbreak and during its study, the investigation should include: search for possible scenarios or exposure events in the 21 days prior to the onset of symptoms; active search for suspected cases or case network; Complete clinical examination, with adequate management of infection control and prevention measures.

Within the health units of the first level of care and public or private medical offices of first contact, the clinical and paraclinical evaluation of a suspected case must be carried out completely, in the case of not having the necessary resources for care and follow-up, You must immediately refer to the nearest unit that has the infrastructure to provide care.

During the consultation, the doctor who makes the evaluation must provide clear, simple and well-founded guidance on the possible diagnosis, treatment, surveillance and/or referral of the patient, favoring decision-making and responsibility in their care in an appropriate way. joint.

All clinical care should focus on respect for the rights of people, free from stigma and discrimination.

So far there is no treatment for this disease. What is recommended for doctors is to treat the symptoms, advise adequate hydration to the patient and control fever, as well as avoid handling injuries and isolation.

When José left the second health center where he did not find good care, he headed home, but he did not know what to do.

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A friend recommended that she contact an activist for sexual diversity and the rights of people living with HIV. It was that person who recommended him to go to the Condesa Clinic (also from Sedesa), where they finally treated him and gave him the proper follow-up.

“They treated me very well there, I have no complaints, they tested me and I tested positive for monkeypox. They gave me care and asked me to isolate myself at home. The management was outpatient, but I was under surveillance by them, through whats messages, “says José.

The decision to isolate and monitor a patient at home, says the clinical management guide, should be evaluated on a case-by-case basis and based on clinical severity, presence of complications, care needs, risk factors for severe illness, and access to referral for hospitalization if the health condition deteriorates.

José did well. He says that all he has left are the scabs from the welts and some that have been slow to heal in certain areas of his body. But he also has the bad experience in the two health centers.

What is monkeypox?

Monkeypox (SV) is a disease caused by a virus that belongs to the family that causes smallpox. This infection is endemic in the rainforest regions of Central and West Africa and was recognized as a human disease in 1970.

The first reported outbreak of VS outside of Africa, in 2003, was related to the importation of infected mammals into the United States. From 2018 to 2021, 12 cases were reported in Europe associated with travel outside of Africa. It was not until 2022 when outbreaks, which had no epidemiological link, were reported for the first time in various countries.

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