This article pretends to give a general idea about the Anesthesiology in Mexico, taking advantage of the excellent coverage that Joseph Eldor's website (CSEN) has on the practice of this speciality.
Even before Mexico was conquered by the spaniards in 1521 the ancient cultures of America already had a great tradition in healing medicine. This was characterized, among other things, by the great number of resources they used to cure and treat illnesses with herbs, animals, minerals, baths, etc. All these practices are illustrated in the famous aztec (nahuatl) codices such as the De La Cruz-Badiano's Codex. In this book there are 272 different curative plant varieties. In another book the Florentino Codex there are 142 healing herbs described and in the Matritense Codex there are 73 more.
In Mexico, Dr. Ramon Pardo Galindez, physician from the state of Oaxaca was the first doctor that practiced raquianalgesia in Latin America. He realized that procedure at the Hospital de la Caridad in the state of Oaxaca in 1900; this took place 2 years after August Bier, German physician, at the University Hospital in Kiel performed the same procedure for the first time.
The Mexican Society of Anesthetists was founded in 1934 with the collaboration of the very first specialists on this field. They were Dr. Juan White Morquecho, Dr. Benjamin Bandera, Dr. Antonio Colina Barranco, and Dr. Vicente Garcia Olivera. It was this last one who in 1946, organized the first Mexican National Anesthesiology Congress. He also fought for using the more proper name of anesthesiologist instead of anesthetist. He was also responsible for publishing the first Journal of Mexican Anesthesiology (Revista Mexicana de Anestesiologia), in 1951. This Journal remains the official publication of the Mexican Society of Anesthesiology. Dr. Garcia Olivera also founded the first Pain Clinic at the Hospital General de Mexico (General Hospital of Mexico) in 1976.
From 1940 to 1946 there were differences between general anesthesia and raquianalgesia. The later was considered to be better than the first one. However, the number of neurological complications associated with the raquia (spinal blockade) lead to its discredit in such a way that patients were afraid of it. Dr. Dario Fernandez Fierro used raquianalgesia intensively in almost any kind of surgery. He even used it for operations of thyroid, ear and throat, and called it "general analgesia". The same technique was used independently by Dr. Koster in New York, but it was in fact Dr. Dario Fernandez who used it in Mexico for the very first time ever. Fortunatelly, this method due to its high risks was not popular anymore.
Today, thanks to the great advances in anesthesiology (techniques, pharmacology, etc.) regional anesthesia is one of the most popular types of anesthesia practiced here in Mexico, with any of its three modalities: epidural, spinal, or combined. At the hospital I work for, 40 to 50 % of the surgical procedures are performed with regional anesthesia. Among these, the 90 % are lumbar epidural blockade, 7 % are spinal blockade, and 3 % are combined technique.
In order to obtain the specialty of Anesthesiology in Mexico, a person must first complete 4 years of medical studies, then continue with one year of internship and then one more year of Social Service. After all this, he or she must complete four more years of anesthesiology specialty studies. It is also possible to continue studying after this specialty to obtain a subspecialty on Neuroanesthesiology, anesthesia for cardiovascular surgery, pediatrics anesthesia, gynecobstetric anesthesia, and pain clinic. In contrast to other countries, it is not necessary to have the specialty of Critical Care Medicine and/or Internal Medicine, to become an anesthesiologist.
Mexico has organizations that regulate the practice of anesthesiolgy in the country. They are: the University of Mexico (Universidad Nacional Autonoma de Mexico), the Federation of Anesthesiology Societies of the Mexican Republic, the Mexican Society of Anesthesiology, the Anesthesiologists College, and the Mexican Council of Anesthesiology. There are also other minor organizations that regulate in part the practice of anesthesiology in this country, but the ones mentioned above are the most important.
Actually, (September 1997), the minimum number of legal documents required for the practicing of Anesthesiology in any Mexican hospital is: Medical doctor diploma, given by a major University, Professional License, Department of Health Licence, Diploma of the specialty (in this case anesthesiology), and to be registered at the Mexican Counsil of Anesthesiology.
Fees an anesthesiologist receives in Mexico for his work vary a lot, depending if the person works at a private or public institution, or both. However, in general they are low. An anesthesiologist working full time for a public institution makes an average wage of US$7,500.00 to US$15,000.00 a year. In average, at a public hospital, an anesthesiologist performs two to six anesthetic procedures per day. This means about 40 to 120 procedures per month. So, for a single anesthetic procedure, he or she makes US$10.40.
Anesthesiologists' wages from banks and insurance companies are also low. For example, the amount of money he or she receives for anesthesia for a cesarean section is something between US$35.00 and US$100.00, cholecystectomy between US$100.00 to US$187.00. Wages for an anesthesiologist at a private institution are a little higher, but unfortunatelly, for most of our Mexican colleagues this type of job is "an impossible dream". This is mainly because the majority of the Mexican people are unable to pay for private medical services. Insurance companies to cover for these expenses are not an option because premiums are just too high for the average person to pay. In private practice a cesarian section runs about US$187.50 to US$375.00, and a cholecystectomy for about US$250.00 to US$500.00.
To finish I just would like to make known the fact that in Mexico the big deficiencies due to the lack of resources we experience, is efficiently overcome thanks to the excellent work and dedication of the Mexican anesthesiologists.
Luis Federico Higgins Guerra, MD
Anesthesiologist
Mexico City
e-mail: higgins@data.net.mx