21st Century

Mexico City´s Moments of Epidemic Emergency, April 23-29

May 1, 2009 ⋅ Post a comment

Claudia Agostoni

Noted historian of Mexican public health, Claudia Agostoni, reflects from within the current influenza epidemic, on forced hygiene education and general uncertainty.

One week after the declaration of a sanitary emergency in the country, the daily life of the inhabitants of one of the most populated cities in the world has been deeply shaken. On April 23 the Health Minister, Dr. José Ángel Córdova Villalobos declared, “we are experiencing a prolongation of the influenza season that normally ends in February. We’re seeing cases in March, in April, that very probably are related to an epidemic in the US that also resulted in a few deaths. Let’s say it’s the tail end of the epidemic that is affecting us (Reforma, 23 April, emphasis mine).

The “tail end of the epidemic” – that the World Health Organization changed from a phase 4 to a phase 5 pandemic alert on the 29th of April – has changed everyday life for millions of people and introduced a climate of uncertainty, suspicion and contradiction at a speed unheard of in the recent sanitary history of the country. The uncertainty has been nourished not only by the fear raised historically by the word “epidemic,” but rather also by the contradictory declarations of the authorities in reference to numbers of affected, suspected and dead that are reported in the media day after day. We know that it is not the “tail end of the epidemic” but rather a serious international health emergency.

On the 26th of April the Diario Oficial de la Federación, the official government paper, reported a series of exceptional measures that entered into effect from that moment on, and that take in, among other things, “the isolation of people who might suffer from the disease and of those who are carriers of it for the time that is strictly necessary,” as well as the power of the health authorities to “enter any type of place or home in order to effect activities aimed at controlling and combatting the epidemic.” Still, who exactly has in their hands the authority to declare such extraordinary powers in effect and under what conditions has not been specified with any clarity or transparency.

It is worth noting that the extraordinary measures enacted evoke the programs to control epidemics that were put into place at the end of the 19th century during the authoritarian regime of Porfirio Díaz, as well as the arguments that the physician and general, José María Rodríguez presented before the Constitutional Congress in January 1917, when he determined that imposing a “sanitary dictatorship” was a practice seen in all civilized countries, and that, therefore, only by putting into place obligatory preventive measures would it be possible to contain the spread of epidemics.

Also on the 26th, a Sunday, the “Señor de la Salud” (Christ the Protector of Health) emerged from the Metropolitan Cathedral to be passed in solemn procession through the streest of the city centre to calm the souls of the residents of the capital. “Señor de la Salud” had not been seen outside the cathedral walls since 1691 when he appeared to give succour and hope to the population in the face of a smallpox epidemic. Nevertheless, this brief moment of succour and hope faded the next day, when a strong tremor shook Mexico City, alarming even more the people of a city where the doors of schools, courts, cinemas, theatres, museums, archaeoloical sites, football stadiums, restaurants, bars and churches are closed.

Every day workplace absences grow, and caution and suspicion are the inescapable barriers that condition social relations and public and private demonstrations of affection and friendship. We are literally confined to domestic space, obliged to stay in a “refuge” where, nevertheless, every hour we are subjected to a kind of “forcible hygiene education campaign.” Newspapers, magazines, quick hits, newscasts and television programs; ads in newspapers, on radio shows, posters, Internet sites; and publicity of every type of domestic product and service provider sing in unison the virtues and benefits of public and private hygiene for emerging victorious from the epidemic crisis. So, wash hands frequently, eat foods rich in vitamins, use facemasks, don’t greet by kissing or shaking hands, don’t go to crowded places, don’t share food, plates or cutlery, and consult a doctor or a health center as soon as any symptom or sign of the infection present themselves.

All are put forward as the actions that individuals must adopt in a permanent fashion to contain the propagation of the disease. This forced hygiene education campaign also includes instructions for the citizens to make their own facemasks at home (due to the scarcity in pharmacies), counsels for the adequate cleaning of the home, guides on “how to live during a sanitary emergency”, and pictorial and written explanations on how to attack and identify the symptoms of influenza, as well as accounts from affected people who survived the disease and who share with a cautious public their experiences as survivors. According to the newspaper, El Universal, starting on April 29th, 110 “Health Caravans” will begin to go around the different neighbourhoods and districts of Mexico City to detect outbreaks of the virus and intensify the work of hygiene education.

Yet this hygiene education campaign that invades every space of public and private life and that has no precedent in the country’s history is blurred by the vertiginous increase in the number of cases of people hospitalized and dead, and by the awareness of the enormous failings and limitations that for decades have prevailed in the health care system and in state public health. And even though it is urgent that the population collectively makes the dictates of hygiene their own, the recommendations, suggestions, and prescriptions come up against the blunting effect of medical negligence, as in the case of a little girl who, after being examined at the “Dr. Luis Mazotti Galindo” Health Centre for symptoms of influenza, was sent home only to die a few hours later (El Universal, 29 April).

Facemasks have introduced a new feature into the urban landscape of the “City of Palaces.” Millions of men, women and children go out on the street with small strips of fabric – blue, white and pink – that not only impede the passing of the virus into the organism but also disable the expressions and gestures that often say more than a thousand words. Kisses are proscribed, as are handshakes. The prohibition on kisses, whether fraternal or not, has modified relations between people, turning everyone into a possible carrier of the disease. And if this were not enough, the kissing ban will apparently make its way into the soap operas that we are obliged to indulge in due to the quarantine imposed by the authorities. The media reported that the telenovela, “Gancho al corazón” (Hook in the Heart) is considering limiting kisses so that the viewers don’t get the wrong message.

The almost anonymous incursions into public space by thousands and thousands of residents of the capital, the constant suspicion and the immense fear at any sneeze, mean that many individuals go out on the street with doubts about whether they will return safe and sound after a long workday, or after plunging into the depths of Mexico City’s public transport system.

The rapid spread of the influenza virus in Mexico, that has now crossed the majority of international borders, will have enormous repurcussions on politics, the economy, society, culture, and credibility at the international level. In Mexico, these repurcussions are already being felt. Economic losses are high, and the sanitary emergency is revealing the great inequities that mark the provision of health services, the absence of clear and precise criteria in terms of epidemiological control, as well as the insufficient and unequal provision of economic resources to the health sector. It is difficult to know what the course of the epidemic will be, or whether or not the actions taken up to now will be effective. It is also unclear how the health authorities and the government of Felipe Calderón will recover the confidence of the people, or how the population might regain the reassurance and certainty of everyday life’s goings on.

Discussion

2 comments for “Mexico City´s Moments of Epidemic Emergency, April 23-29”

  1. The author of this article assumes, as de facto, that the spread of the influenza virus in Mexico was originated in Mexican soil. Although at the beginning of her article, the author referred to the link that health authorities in Mexico established between a possible epidemic in the USA and its spread into Mexico, up to now, Mexican authorities have not been able to confirm, neither to deny, that the source has been located yet. Media and print press in Mexico reported that an eight years old boy from a town in the Mexican state of Veracruz was the first person, also called patient zero, who contracted the virus. However, in the USA, media sources such as Msnbc (see “Amid swine flu outbreak, racism goes viral”, http://www.msnbc.msn.com/id/30467300) had suggested that it was highly likely that the outbreak could erupt from the American pig farms close to the Mexican border, in particular, in the state of Texas.
    The source of this large-scale outbreak is an important issue to consider, precisely for the same reasons that the author points out as to be of “enormous repercussions on politics, the economy, society, culture, and credibility at the international level.” It is unlikely that the political, social and economic costs that Mexico should have to endure from now on, and who knows for how long, were the solely outcome of insufficient or inefficient Mexican sanitary measures.
    Lack of regulation to enforce hygienic practises in the American agro-business sector has been a long standing issue in the political agenda between Republicans and Democrats, to the point that deregulation of this sector has become an issue of major concern even before the celebration of NAFTA. It is wide known, as well in the USA and Canada, that farms are the main source for polluting water beds, rivers, and soil, causing epidemics such as the 2003 avian flue that, at the time, also had a vague epicentre as, it is today with the swine flue.
    The point is that the author, although she is convincing in describing the Porfirian sanitary practises style that the administration of President Calderon put forward, she did not consider the historical context of Mexico-USA relationship, in general, and in particular, the context of industrial and agricultural diseases between the two countries. Many of the most severe outbreaks of influenza had come from the USA, since 1918, when the so called Spanish influenza killed more than 40,000 people at both sides of the Mexico-USA border.
    As the economic crisis under which we are living today was caused in the USA, and their repercussions are felt globally, this outbreak of swine flue has American origins too. So far, the Obama administration has conveniently silenced this issue and focused on, as the author of this article describes that Mexican authorities are doing in Mexico, to teach the American people how to protect themselves from the virus. Americans are saying to each other, “wash your hands”, in what can be interpreted as an ironical twist of meaning.
    The financial and health interconnectedness between Mexico and the USA is an issue that we are jut beginning to acknowledge. Viruses and global economies have apparently no borders but, their negative side effects, are national and regionally focused instead. There will be no economic compensation from the Mexican government to all those Mexican families and businesses that may not survive the economic side effects of the swine flue. There will not be any economic bail out or restoration from the American government to Mexico either. As the USA economy today desperately tries to overcome from its own loses, the burden of this reactivation would be at the expense of Mexico. The historical lessons that viruses and globalized economies are teaching us now, as Mexicans, are hard medicine and, unfortunately, as history has shown to us too, never is enough money to buy it.

    Posted by Miguel A. Aviles | 2009-05-01, 10.43 pm

  2. Este articulo me da a conocer otro punto de vista de la actual situacion en tu pais

    Posted by monica serratos | 2009-05-03, 8.11 pm

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