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  Frontera NorteSur
April 2002


Hospital de la Familia: Health Care for Cd. Juárez
by Greg Bloom, FNS Editor

The Hospital de la Familia, located in Ciudad Juárez, is the city's fourth largest hospital with over 100 beds, according to Dr. Gustavo Martínez, general director of the facility. It sees approximately 30,000 people per month--including U.S. citizens that cannot afford or access health care in their own country. The hospital performs 43,000 services a month and does this with no subsidy to its operating budget from the Mexican government or other outside sources. Money for physical expansion comes from Femap (Federación Mexicana de Asociaciones Privadas de Salud y Desarrollo Comunitario, The Mexican Federation of Private Health and Community Development Associations) and the El Paso-based Femap Foundation, which serves as a channel for US individuals, foundations and companies to more easily give to Mexico-based Femap.

With its narrow street front, just two blocks from the US-Mexico border, a visitor can't see that the hospital has grown massively since its start in 1976. Begun with help from Femap founder Guadalupe Arizpe de la Vega, a Cd. Juárez resident, the facility was born as a family-planning and birth clinic with one doctor and four beds. Since then, the hospital has grown back into the city block it dominates and has added a second story as well. Instead of one doctor there are now 93 with 14 areas of specialization. The hospital also runs a nursing school.

The Hospital de la Familia has an emergency room and offers regular medical, pediatric and gynecological exams. There are specialists in pediatrics, orthopedics, neurology, dermatology, otolaryngology (ear, nose, throat), ophthalmology (eyes), pediatric surgery, and other areas. The hospital takes particular pride in its prenatal program and the fact that since 1976 it has delivered over 64,000 babies (with more than 3,000 in the year 2000). Brain surgeries are regular although few in number and in 2001 the hospital performed its first open-heart surgery, on a two-year old boy, which was a success.

The hospital is seen as an excellent place to work and Martínez states that some of Mexico's top doctors want to be there. Many come from Mexico City and other distant places to work at the facility, he states.

Dr. Rodrigo Nieto, a radiologist, says that he likes working at the Hospital de la Familia, where he has been for eleven years. Like Martínez, Nieto began his days as a doctor in the state health system. Unlike the US, where ultrasounds are performed by a technician, at the Hospital de la Familia, Dr. Nieto and two other radiologists perform all of the exams--more than 2,000 per month.

Finances

In the early 1990s, the Hospital de la Familia was told by international funding organizations that their priorities had changed and the hospital would have to survive on its own within three years. In response to this, the organization developed a strategy of self-sufficiency and income generation that has succeeded marvelously, according to Martínez. Proof of this is that over the past six or seven years the hospital has had only two months when it operated at a loss, he says.

Martínez attributes the financial success of his hospital to the right mixture of high volume, low prices and high quality. However, not all aspects of the hospital's operation are profitable--nor will they be so in the future. Profits made in everything from pharmacy and cafeteria sales to ultrasounds and lab work are used to support the neonatal facility with it costly incubators, oxygen and drugs. Martínez says that neonatal services cost US$300 per day. However, the hospital charges only US$130 per day for the service but receives an average payment of just US$40 per day. The act of sponsoring the neonatal clinic and other money-losing services through the sales of testing, drugs and food is what Martínez refers to as "subsidio cruzado" (cross subsidy).

While the hospital's X-ray services were nonprofitable for twelve years they now make some money for the hospital. Surgeries are a big expense to the hospital but they earn a profit of 2 or 3%.

Studies

The Hospital de la Familia not only provides health care in Cd. Juárez but it also shares in region-wide health studies. With the support of the El Paso-based Center for Border Health Research and other organizations, the hospital hopes to soon begin work on a number of new projects. One of these looks at risk factors for infant mortality while another will seek to identify which cervical cancer viruses are present in the region.

Two other areas of future research will look at childbirth. One program is aimed at keeping teenage mothers on their "proyecto de vida" (life path) so that they can reach their career and personal goals. This project will also look at self-esteem issues and will offer parenting classes. Another program will look at how to improve the nutritional habits of pregnant women that have just immigrated to Cd. Juárez. Their poor diets, which have been identified in previous studies, put them and their babies at a higher risk for complications during pregnancy.

Nursing

Just like in the US, there is also a shortage of nurses in Cd. Juárez and throughout the state. To help remedy this, the Hospital de la Familia began its own nursing program. Currently, the school of nursing has 150 students--for a state that needs 1,000 new nurses per year. For many reasons nursing is unattractive to people in Cd. Juárez, says Martínez, and two years ago all the school's new students came from other states, many from as far away as Chiapas.

Promotoras

The role of the Hospital de la Familia and Femap neither starts nor ends at its doors. The organizations' use of citizen volunteers (called "promotoras") was one of the first in North America and looks especially at reproductive issues, says Martínez. Under the promotora system, one paid hospital social worker works with 8 volunteer coordinators. In turn, these coordinators have many volunteer promotoras working with them that go door to door in their communities talking about issues like family planning and reproductive health.

Martínez said that the program is a strong one because even if the social worker leaves, the coordinators and promotoras hardly ever give up their work. Indeed, some of them have been with the outreach program for so long that the hospital is now beginning to attract a second generation of volunteers.

Expansion

While the hospital intends to keep improving its services in many dimensions, possibilities for growth on the city block where it is located are limited. To remedy this limitation, and to serve people that live on the growing edges of Cd. Juárez and travel as long as two hours on busses to reach the facility, the hospital will open a new location in the southeastern part of the city, near the airport. Funds for construction will come from Femap and the Femap Foundation.

According to Martínez, the hospital nearly has the land it wants in southeast Cd. Juárez. Construction will cost US$6 million. The new facility will begin by offering just outpatient care but will quickly expand to 50 beds. Within two or three years, the hospital will have 100 beds just like its successful counterpart in central Cd. Juárez.