MEXICO CITY (NYTIMES) - The senseless deaths torment doctors and nurses the most: The man who died because an inexperienced nurse unplugged his ventilator. The patient who died from septic shock because no one monitored his vital signs. The people whose breathing tubes clogged after being abandoned in their hospital beds for hours on end.
In Mexico, it's not just the coronavirus that is claiming lives. The country's broken health system is killing people as well.
Years of neglect had already hobbled Mexico's health care system, leaving it dangerously short of doctors, nurses and equipment to fight a virus that has overwhelmed far richer nations.
Now, the pandemic is making matters much worse, sickening more than 11,000 Mexican health workers - one of the highest rates in the world - and depleting the already thin ranks in hospitals. Some hospitals have lost half their staff to illness and absenteeism. Others are running low on basic equipment, like heart monitors.
The shortages have had devastating consequences for patients, according to interviews with health workers across the country. Several doctors and nurses recounted dozens of preventable deaths in hospitals - the result of neglect or mistakes that never should have happened.
"We have had many of what we call 'dumb deaths'," said Pablo Villaseñor, a doctor at the General Hospital in Tijuana, the centre of an outbreak. "It's not the virus that is killing them. It's the lack of proper care."
Patients die because they're given the wrong medications, or the wrong dose, health workers say. The protective gloves at some hospitals are so old that they crack the moment they're slipped on, nurses say. People are often not sedated properly, then wake up and yank out their own breathing tubes, hospital employees say.
Adriana de la Cruz, a nurse at Dr Belisario Domínguez hospital in the southeast corner of Mexico City, said the overstretched and often undertrained workforce has made glaring errors - at great cost.
"People have died because of a lack of medical attention and because of negligence," de la Cruz said. "These patients would have a better chance of surviving if we could offer better care."
The Mexican government spends less on health care as a percent of its economy than most countries in the Western Hemisphere, according to the World Bank, and President Andrés Manuel López Obrador presided over spending cuts even after acknowledging his country had 200,000 fewer health care workers than it needed.
When the epidemic hit Mexico in March, many hospitals sent front-line workers to confront the deluge of cases without any protective equipment or training. Some nurses say they were told not to wear masks to avoid causing panic. Many say they were forced to buy face shields and goggles themselves.
TOLL ON HEALTH WORKERS
The fallout has been severe. About 1 in 5 confirmed cases in Mexico are health workers - a greater share than in the United States, Italy or China.
Mexico's outbreak is growing quickly and shows no signs of slowing. Reported cases and deaths have risen every week for the last couple of months, hitting Mexico City and Baja California, which includes Tijuana, particularly hard.
After a Times analysis found evidence that federal authorities were underreporting fatalities, a top federal health official publicly conceded that the government does not have an accurate count of deaths caused by the virus.
At Villaseñor's hospital, there are so few doctors left that during some shifts, critically ill patients are going eight hours without anyone checking on them, he said.
"You hear of one patient dying because he didn't get the proper care - and then another one and another one - and you try not to become paralysed," added Villaseñor, a rheumatologist who said he had to learn how to suit up to treat coronavirus patients by watching a video on YouTube.
As Mexico's population grew during the last decade, the government kept hospital funding low, devoting less than 3 per cent of its national output to health care. World Bank data shows that by 2017, well before López Obrador took office, only two countries in Central and South America spent less on health than Mexico as a share of their economies: Guatemala and Venezuela.
"Administration after administration gave lip service to the issue of health, but it never showed up as a priority in the budget," Judith Méndez, an analyst at the Economic and Budgetary Research Center, said of Mexico's successive governments.
The Mexican government did not respond to repeated requests for comment. Local health ministers in Baja California and Mexico City also declined to comment.
Patients have filed thousands of complaints with the country's human rights commission about negligence in hospitals in recent years. And the quality of care only diminished further after hospital workers in Mexico endured some of the nation's first coronavirus outbreaks.
Many countries have struggled with doctors and nurses falling ill, but in Mexico the problem is particularly bad.
"If health workers are getting sick at this rate, bottom line is you risk not having a health workforce to look after people," said Howard Catton, the chief executive of the International Council of Nurses.
De la Cruz, the nurse in Mexico City, said that her hospital initially instructed employees not to wear masks around a patient until the person tested positive for coronavirus.
"You waited three or four days to see if the patient tested positive, and in the meantime you got infected," said de la Cruz, who noted that 80 of her colleagues have gotten sick.
Some hospitals did prepare early for the virus, which swept the United States and Europe before outbreaks flared in Mexico. In Monterrey, doctors said protocols to shield workers were put in place months ago. Rodolfo Ruiz, an infectious disease specialist, says he feels protected at his public hospital in Mexicali, even as hospital beds fill up.
But the missteps in some of the hardest hit cities have brought overrun hospitals to a breaking point, workers say. Doctors and nurses have staged protests outside their hospitals in at least a dozen states, according to local news reports. Some doctors and nurses have refused to treat coronavirus patients.
Rosario Luna, a nurse at the José María Morelos and Pavón hospital in Mexico City, described treating Covid-19 patients with broken heart monitors and faulty suction machines.
Doctors and nurses say that many errors inside hospitals are never investigated, in part because overtaxed health workers are unlikely to lodge complaints against their own colleagues.
At Dr Carlos Mac Gregor hospital in Mexico City, Berenice Andrade, a doctor, said that one internist quit because of the lack of personnel and that only one doctor watched over 54 patients during the weekends.
"It makes the care we offer very deficient," said Andrade. "The patient's health is of course affected."