Tuesday, May 05, 2009

tussin....,

WaPo | Toward the start of Mexico's swine flu outbreak on April 24, Ángel Flores Maldonado had so many patients at his office that when he finally escaped at 10:15 that night, the line still stretched into the street.

The doctor does not work at a hospital, or a clinic, or the government respiratory center, but on the evening shift at a pharmacy in the poor, crowded neighborhood of Iztapalapa, in eastern Mexico City. "The same but cheaper," reads the sign at this popular pharmacy chain, Similares, and that is the calculation many Mexicans seem to have made while the virus spread through the capital.

"In Mexico, we are very unaccustomed to going to the hospital. Here, if someone has a cold or anything else, they buy something in the pharmacy, or they leave it be," Flores said. "This is why Mexicans are dying. Because we are very indecisive about going to a hospital until it's too late."

Several theories have emerged as to why all but one of the confirmed deaths from swine flu have occurred in Mexico. Much of it is speculation -- that Mexico City's 7,300-foot elevation exacerbates respiratory illnesses, that there may be a slight variation between the viral strain prevalent in Mexico and swine flu elsewhere, that Mexico is further along in disease transmission and other countries will eventually see severe cases.

But a critical factor, according to specialists here, is that flu victims have delayed checking into hospitals until their condition has deteriorated so much they cannot be saved. While medicines are plentiful and cheap at Mexican pharmacies, swine flu antiviral medication was often not available or prohibitively expensive.

"Some patients arrive late at the hospitals, and to a certain degree this is a problem of education," José Sifuentes-Osorio, an infectious-disease specialist at the National Institute of Medical Sciences and Nutrition, said in a radio interview Monday. "Many of our people, independent of their socioeconomic situation, self-medicate for three or four days, and they lose precious time."