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PALLIATIVE CARE IN MEXICO

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    Donia Remedios, 73, who has pancreatic cancer, poses for a photo with her daughter, Orlanda Hernandez Ramirez Remedios, 44, at their family compound in the colony of Dendho in Atitalaque, Mexico on Aug. 31, 2014.
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    Donia Remedios, and her daughter check in at the National Cancer Institute to receive palliative care and pain medicine in Mexico City, Mexico.
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    Doctors and nurses tend to patients in the Palliative Care Unit at the National Institute for Cancer.
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    The daughter of a Palliative Care patient cries and clings to her ailing father as he withers away from melanoma.
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    A patient, 70, spends his final hours in the Palliative Care Unit at the National Institute for Cancer.
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    Donia Remedios, 73, attends a service at the Church of San Miguel Arch Angel in Atitalaque, Mexico.
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    Dish-ware hangs on the wall at the Remedios family compound in the colony of Dendho in Atitalaque, Mexico.
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    Adriana Lucia Preciado Perez, 40, is photographed at home in Guadalajara, Mexico. Her father passed away last year from cancer.
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    Adriana Lucia Preciado Perez, 40, looks at her parents' wedding album with her younger sister, Martha Elizabeth Preciado Perez, 30 and their mother, Guadalupe Teresa Perez Lopez, 69.
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    Dr. Gloria Dominquez Castillejos, pain clinic director, speaks with a patient in Hospital Doctor Angel Leano in Guadalajara.
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    Juana Hernandez Bautista, 49, suffering from breast cancer, waits with her husband in the Palliative Care Unit at the National Institute for Cancer in Mexico City.
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    A nurse checks the vitals for a patient at the Palliative Care Unit.
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    Dr. Sylvia Allende, Director of the Palliative Care Unit, takes care of of a patient, along with her colleagues.
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    A man watches as his daughter, 34, is treated for leukemia.
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    Donia Remedios sits pensively at home.
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    Donia Remedios spends time at home with her daughter, Orlanda Hernandez Ramirez Remedios, 44, at their family compound.
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    Donia Remedios prepares to begin her early morning trek to the National Cancer Institute in Mexico City. They start at 4am at their home in Colony Dendho in Atitalaquia and then have to walk for 30 minutes to catch a series of 4 buses for a total journey of 4-5 hours.
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    Donia Remedios travels with her daughter, Orlanda Hernandez Ramirez Remedios to the National Cancer Institute.
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    Donia Remedios waits for an early morning bus to Mexico City with her daughter in order to receive palliative care treatment for her pancreatic cancer.
Palliative Care in Mexico

Remedios Ramirez Facio (73) lives with her husband on a small plot of land in Atitalaquia, a village in the state of Hidalgo in Central Mexico. When a Human Rights Watch team visited their modest home on a warm Sunday in late August 2014, Ramirez’s energy level was remarkable for a woman whose pancreatic cancer has metastasized to her lungs and liver. A few weeks earlier, suffering from severe abdominal pain and nausea, she had no energy and had lost her will to live. Ramirez attributes her remarkable turnaround to the fact that she is now receiving palliative care at Mexico’s National Cancer Institute in Mexico City. As Ramirez puts it, [with palliative care services, including seeing a physician, psychologist and nutritionist] I have come back to life.

 

But there is a complication. In all of Hidalgo, home to more than 2.5 million people, there is not a single public hospital that offers palliative care; many of the local doctors have no idea what palliative care even is. Thus, Ramirez has to travel every few weeks to go to the National Cancer Institute, a trip that takes almost the entire day. Luckily, the local community clinic tries to make an ambulance available to people who need to make the long trip to hospitals in Mexico City for medical care. The ambulance picks up Ramirez at around 4:30am and usually does not get her back home until around 4:30pm. The round-trip cost of 200 pesos (about US$15) is more than Ramirez and her husband normally spend in weeks.

 

On September 1, Ramirez had an appointment at the hospital, but the ambulance was not available. So she and her daughter, Orlanda, had to travel by public transport on 4 separate buses. Even with help from the Human Rights Watch team, which was filming their journey and took them part of the way by car, the trip was arduous. As her illness progresses, Ramirez’s condition is likely to deteriorate, making the trip increasingly hard. No matter how difficult it is to face her own mortality, Ramirez says she feels grateful that the doctors have spoken with her openly and with empathy: “It gives me more desire to live.”

Watch the film here.

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