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Uncovering the swine flu crisis

It was Easter weekend when people in Oaxaca noticed strange happenings at the state-run Dr. Aurelio Valdivieso General Hospital. Sections were suddenly off-limits. Security guards were added.

The cop reporter at the local newspaper, El Diario Despertar, got a tip from a source at the hospital. Not above dressing its journalists up as paramedics, the paper sent two people to investigate. They quickly realized that the hospital was seized by alarm.

Queries from Despertar forced Oaxaca health officials to go public on April 16 -- a full week before a national emergency was declared over swine flu -- with news of a deadly “atypical pneumonia.”

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One of the Oaxaca patients was the first person confirmed to have died from swine flu in an outbreak now circling the world.

How Oaxaca, one of Mexico’s poorest and most ethnically diverse regions, with a crusading newspaper and a strapped health system, faced the first strikes of what would become a global health crisis underscores the public health dilemma facing Mexico.

Adela Gutierrez, who became the first fatality, sought hospital care late, after she was repeatedly misdiagnosed; the hospital stumbled, lacking the equipment for proper analysis; officials were perplexed and the public kept in the dark.

Once the truth became known, Oaxaca also illustrated the important role of a grass-roots healthcare network in rugged, remote terrain with scattered migrant populations.

In Valdivieso General’s busy emergency room, Dr. Serafin Lopez Concha was hours into his shift on the Thursday before Easter when Gutierrez staggered in. She was gasping for breath, her oxygen-starved fingers turning blue.

Gutierrez, 39, had been sick for a week. She had continued to work as a far-roaming door-to-door census-taker for the tax bureau until the Easter week break. She had seen three or four doctors, Lopez recalled. They’d told her she had a throat infection and given her medicine, but she only got worse.

“She was in very serious condition,” said Lopez, a Oaxaca native who took charge of Gutierrez’s case.

Believing she was suffering from pneumonia, Lopez and his team gave her antibiotics and serums to hydrate her. But Gutierrez couldn’t catch her breath and they had to intubate her; she was no longer breathing on her own.

Two days later, the hospital sent a bronchial sample from Gutierrez to an outside lab that often does testing for Valdivieso General, because despite being Oaxaca’s largest medical facility, it doesn’t have the equipment.

Molecular chemist Adrian Juarez Avendano tested the sample and on Easter Sunday had the results: positive for coronavirus, a highly contagious and unusual viral strain. This result would prove incorrect, and testing in Canada would show Gutierrez had contracted the unique strain of swine flu. Still, the misdiagnosis set in motion a chain of reactions -- probably the right things to do, if for the wrong reason.

Hospital authorities as early as the day before Easter isolated Gutierrez and began fumigating and sterilizing the building, even throwing away mattresses and pillows to calm hospital workers.

They were preparing to transfer Gutierrez to a specialized hospital but she died at 4:45 p.m. on April 13, four days after being admitted.

That same day, Dr. Ruben Coronado Garcia was springing into action. As head of the Intelligence Unit for Epidemiological Emergencies in the Oaxaca health department, he was in charge of finding everyone with whom Gutierrez had come into contact.

Coronado mobilized seven brigades of three inspectors each to begin fanning through Oaxaca. They concentrated on three areas: the hospital, Gutierrez’s home and family, and her place of work.

At the hospital, Coronado and his inspectors made sure that everyone who came near Gutierrez was wearing protective gear, and they began testing the staff for infection. A total of 105 people were tested, “from the people pushing the gurneys to the X-ray technicians and the doctors,” he said.

At Gutierrez’s house, her husband, three daughters and mother-in-law were tested. No one has shown any symptoms.

Coronado’s teams checked 106 of Gutierrez’s co-workers through April 22. Most were fellow field agents and office workers with whom she met at the beginning and end of each workday.

Among those checked at the hospital and Gutierrez’s workplace, 26 developed flu symptoms. But none tested positive for the more serious strain and all have recovered.

Coronado said his teams did not try to retrace Gutierrez’s door-to-door route because they decided that her contact with people in her survey-taking was transitory compared with that with family and co-workers. And since none of the people she spent the most time with were infected, he said, he calculated that the chances of infection among people she visited briefly were minimal.

“For a week or so, while sick, she was sleeping in the same bed with her husband every night, and living in close quarters with her children, like every Oaxacan family does, and not a single one of them shows any symptoms,” Coronado said.

His unit maintains 28 mobile centers throughout Oaxaca state that are on the lookout for flu symptoms. This is built on a rural network set up two years ago to care for scattered communities in a poor region with a large indigenous population. Oaxaca stretches over 36,000 square miles in southernmost Mexico, furrowed by mountain ridges. It’s home to more than a dozen ethnic groups and 50 dialects.

Gutierrez loved to visit those rural towns, her family says, and continued to do so until shortly before she died.

She had been in reasonably good health until the flu hit her. Her family remains bitter, sad and confused.

“She was very sociable, and very responsible,” husband Luis Ramirez, a welder, said. They had been married 22 years.

And Alfredo Martinez de Aguilar, publisher of the Despertar newspaper, is feeling vindicated. The paper (its name means “to wake up”) was founded just a year ago, with $3 million from a group of investors, 100 employees and a commitment to a different kind of journalism. It has taken on inept officials, money launderers and corrupt cops.

Martinez prides himself on his “intelligence unit,” the less-than-orthodox team of staffers who might pose as something other than journalists if that’s what it takes.

And in this case, Martinez says, that is what it took. He wonders whether local health authorities would have informed the public of the emergency if his reporters had not gone into the hospital and dug up the truth.

“We made them come to us,” he said.

--

wilkinson@latimes.com


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