Most of the medical students who had withdrawn from health institutions have already returned to their jobs as Undergraduate Internal Physicians (MIP) and social service interns, but have not done so at their own free will, as authorities have suggested. educational and health of the country, they have done so as not to compromise their professional career.
“I rejoined this Monday to an IMSS hospital, but I did not return because I wanted to return at this time when we are in phase 3, no hospital is exempt from receiving patients with COVID and even the base doctors are getting it, I returned because otherwise I would not have my letter of release from boarding school and could not do a specialty, ”says Aurora, whom we will call so to reserve his identity.
Read more: Medical students denounce that they will be forced to return to hospitals in the middle of phase 3 of COVID-19
The implications on the academic and professional careers of medical students who decide not to return to health institutions these days seem to be seen in the medium term.
This is pointed out to Political Animal representatives of IPM associations, a category in which are those who are studying the last year of a medical degree, when more than in the classrooms the training is already in a health institution, rotating in the services and making guards. Once this stage of internship is over comes the period of social service and until later the degree as general practitioners.
In the case of these students, it has been said that the decision to return to the institutions is voluntary, after the UNAM and the IPN removed them from those places in the first days of April, on the grounds that they needed to train them and make sure that they would not be at risk of contagion, in the middle of phase 2 of the epidemic of COVID in Mexico.
But from the third week of April, the health authorities of the various institutions issued official letters and communiqués requesting the return of the inmates, starting on May 1, in the middle of phase 3 of the pandemic.
On April 30, ISSSTE issued a statement in which it assured that the Undergraduate Internal Doctors, without risk factors, could voluntarily rejoin their medical units.
That same day, the director of the Faculty of Medicine (FM) of UNAM, Germán Enrique Fajardo Dolci, declared, in the morning conference of President Andrés Manuel López Obrador, that the return of the students of that university to health institutions it would be on a voluntary basis.
“Medical students who want to return to internship practices can do so, that is what is being discussed, reiterating that the priority is to protect them,” he said.
On Tuesday, May 5, the Ministry of Health released a statement reiterating that the MIPs and social service interns from all health careers without risk factors for serious illness due to COVID-19 must rejoin, as of May 1, 2020, to health institutions.
The ISSSTE communication office confirmed to Political Animal That institution adhered to what was issued by Health and the same in the case of the IMSS.
The Health communiqué specifies that in the event that the units where the students were interned have been designated for the care of COVID-19 patients, they will be relocated to areas of lower risk, determined by the State Health Services (SESA) in agreement with the educational institutions of origin.
At the end of the cycle, the SESA and DGCES will extend the term letter to the MIPs without risk factors that have been reinstated within the established term. Those who voluntarily decide not to rejoin –said the document– will be able to request a certificate for the effective service time in the health unit. They will also stop receiving their scholarship payment, which will be reactivated until they rejoin.
For students, these two guidelines are a clear way to compel them to return, even if it is said that they may voluntarily not return.
This letter of completion of the internship period is necessary to continue with the academic career: the social service and the qualification exam.
“With the UNAM it has already been agreed that those who do not return to the institutions and do not obtain this letter will not have academic implications, they will still be able to do their service and graduate,” says a representative of the MIP Assembly of this university.
But there are two problems in this, not all schools have committed to the same thing, students denounce that the IPN has not done so, for example, the other is that the UNAM itself cannot stop the implications of not having that letter. beyond the academic field.
“To make a residency at the IMSS, presenting that document is a requirement, that means that whoever does not have it will not be able to do a specialty in Social Security, which represents a huge implication for many,” explains a representative of the Assembly. Mexican of Internal Medicine of Undergraduate, AMMIP, (this of national scope and of several schools, like the IPN, the UNAM, the Veracruzana University, the Autonomous University of Aguascalientes, among others).
The student assures that to clarify this crucial aspect they have requested for days a meeting with Javier Mancilla, director of the DGCES, but it has not materialized.
He says that they have met with representatives of the Mexican Association of Schools and Faculties of Medicine (AMFEM), who told them that they will issue a position these days.
Political Animal Several times he sought an interview with this association but until the closing of the edition there was no response, nor was there any by UNAM, IPN and Health.
The ISSSTE only sent a brief explanation through its social communication area in which it states that “the doctors are not asked for this letter because when they present the title, they have already released the boarding school.”
In the case of the IMSS, Beatriz Escobar, head of the Head of the Institute’s Undergraduate Area, pointed out that “within the requirements to do a specialty is that they have completed an undergraduate medical internship.”
When questioned if whoever does not have this letter of release from boarding school will not be able to do a specialty, he replied that the validity of the certificate that would be given to the MIPs who do not return is only being agreed upon by the DGCES.
“I do not want to say that it will have the same validity as that of a boy who has not retired during the contingency, but I cannot comment on the implications because that has to be agreed with the DGCES.”
Aurora says that it is because of this uncertainty that she rejoined MIP at the IMSS. “I didn’t want to go back. I did it because of course the decision is not voluntary. If I did not return, they were only going to give me a record for the effective time I have spent as a boarding school but not the release letter, so I could not think about doing a specialty afterwards. ”
Of course, it says that in fact they reassigned it to a place with less risk of contagion. When UNAM, where she studies, decided to withdraw her students from institutions, on April 7, she was in a COVID hospital and there was already, she says, at least one case of an infected IPM.
“This Monday when I rejoined my internship activities, I was assigned to a Family Medicine Unit where they are only providing maternal and child service. Nothing for COVID or respiratory infections. I’m calmer, of course, but it is already known that there may be asymptomatic cases everywhere, although they did give me the white overalls, mask and glasses. ”
On the other hand, Lidia, her fictitious name, a student at the University of Sonora, was neither changed from hospital nor given protective equipment. “I returned this Wednesday to the same hospital where I was, and where they are receiving COVID patients, although they put me outside the area where they are and they placed me in the gynecology and pediatrics area, but they have not even given me a mouthguards, I had to buy them. “
Lidia says that she did not return under her free will. “I came back for the same as almost everyone, so as not to lose my letter of release from boarding school, because in addition, we have not even been assured that without it we could continue with the social service and the degree”.
He says he is afraid. “I know that when I return there is risk. We are in phase 3, nobody can assure that a patient with mild symptoms or an asymptomatic does not arrive in any area of the hospital, there are also doctors who work in various institutions and services, they can still be infected and come here, but I cannot risk my career “
The representatives of the student associations stress that this is another great problem, the heterogeneity in the response and the degree of commitment between the universities and the hospitals towards the MIPs. “Everyone does what they want and that generates inequality in responses and prevents us from making a common front,” they say.
For now, the AMMIP has provided a platform and an email to receive complaints and questions from the MIP, so far they have received about 500 emails, a copy of each automatically reaches the director of the DGCES.
“We have at least 30 complaints from inmates who have already returned to hospitals and indicate that they either give them nothing or only give them a face mask and that they are in non-COVID hospitals but that patients with respiratory infections do arrive. The complaints involve the three health institutions, IMSS, ISSSTE in that order, “says the representative of the AMMIP.
Between pressure and blackmail of students
The students also point out that these days a wave of messages has been generated from various fronts that point out as lacking in vocation those who refuse to return to the institutions. But there is also a very latent call to return to help care in hospitals, as a way to fulfill an ethical commitment.
A MIP from the Autonomous University of Aguascalientes denounces that a basic doctor of internal medicine made a comment on Facebook inviting medical students to return to institutions.
“He put there that we do not leave the boat lying down when they need us most, he says that we lack a vocation, but that in the end we are not indispensable”.
The person who uploaded the post, although he later deleted it, is Gabriela Ramírez, a doctor assigned to the Internal Medicine Service at the Centennial Miguel Hidalgo Hospital in Aguascalientes.
In this he had written: “The future doctors left the hospitals when we needed them most, they believe that we do not feel anguish and concern about becoming infected, some of my colleagues or residents have risk factors to really have a bad time if they become infected.”
And it continues: “You, however, were the least risky personnel, you know it !!!, there are doctors who came back even with risk factors, how sad that they could not learn it, because they are not here, that is also teaching for you, it is very unfortunate that instead of joining forces as we are doing in the hospital, they fled in that way … you think and are used as a millennial generation to get everything easy, “said the post.
At the COVID-19 conference this Saturday, Juan Manuel Quijada Gaytán, general director of Psychiatric Care Services, addressed the country’s medical students.
“Medicine is a rewarding career, we need you, it is not always as hard as what you are experiencing right now. Do not be afraid, do not give up, we need dedicated and passionate professionals to get the country out of this and all the slopes that we have in front of us, “he told them.
In response to this, the representative of AMMIP says: “We agree that Mexico needs doctors in training but needs them healthy and well prepared, updated on emerging health issues so that we can be professionals of excellence, we will not serve them if we are sick ”.
“Do not forget the doctor that we also need a lot from Mexico, we need a decent scholarship and security. A month before the start of the pandemic we held a march for the medical students who have been killed and we see no response, “they replied.
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