2020, Number 3
Memoirs of a General Surgical Service and its surgeons. Part 2
Full text
10.35366/99966
Language: English/Spanish [Versi?n en espa?ol]
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CHRONOLOGY OF THE GENERAL SURGERY SERVICE AND OF THE GENERAL SURGEONS OF THE HOSPITAL GENERAL HOSPITAL OF THE NATIONAL MEDICAL CENTER OF THE MEXICAN INSTITUTE OF SOCIAL SECURITY (
DR.
Doctor Gustavo Baz was born in Tlalnepantla, State of Mexico, on May 1, 1894. To remember a man, revolutionary, politician, teacher, a great Mexican and above all a remarkable surgeon is an honor, so that present and future medical-surgical generations know his origins and do not forget that the present was made by thinking and modifying people of his time. It is also our duty to do the same.
I met him in the twilight of his life. Many Sundays we talked at noon, and I was always impressed by his intelligence and creativity, he always had something new he wanted to undertake. As a surgeon, I had the opportunity to assist him in an appendectomy –the last one he performed– on the young daughter of a friend of his, and despite his age –over 80 years old– I was surprised by his speed and technique. He seemed like a fish in the water. I can say that I saw him operate and the assistance was not necessary. We will now recall some passages of his life, along his political, academic and professional heritage.
Youth was always one of his preoccupations, for example he wrote:
Time and the wind go away and do not return...
History is written on the leaf of time...
Youth, like time, goes away and does not return...
Youth: write your story on the leaf of time...
And let the wind carry away triumph and glory!
His surgeon's thesis dissertation on "vascular surgery" marked the beginning of a non-conformist surgeon, who sought and acquired experience abroad, applying it in the Mexico of his time in its hospital systems, in university life and in politics. He performed the first experimental kidney transplant (Figure 2) and the first aortic graft, implemented asepsis and antisepsis techniques, dressed physicians in white, and his personal surgical techniques were recognized, copied, and praised.1
His professional achievements and his dedication to teaching led him to become the Director of the National School of Medicine and at the same time of the Military Medical School, to unify and improve the curricula already with the military rank of General (Figure 3 A and B). It is important to highlight this fact, since I have no information that the same individual has achieved this rank twice. In 1936 he implemented the Social Medical Service for medical students, with the objective of contributing to the improve the health of the neediest groups and to give medical students the opportunity to put their knowledge into practice before graduation;1 and on July 7, 1937, the University Military Sports Pentathlon was created to contribute to the development of university students, with sports, social activities and military discipline. Among the founding students were Jorge Jiménez-Cantú, Armando León-Bejarano and Luis Sáenz-Arroyo1 (Figure 4).
In June 1938 he was elected rector of the Universidad Nacional Autónoma de México, a position from which he contributed to raising academic standards and university prestige (Figure 5). He remained in such a high academic position only for two years. His resignation was never accepted, so he never left the university. In that same year, in December, the University Council awarded him the title of "Doctor Honoris Causa".2
As rector, he regularized and reorganized the school cycles and the teaching staff; in short, he improved the university, while it was already ranked among the five worst in the world. During his tenure, he had another success for the youth, he founded the University Military Sports Pentathlon.
It is necessary to make a pause to go back to the past, to restart his biography chronologically, and enter the novel, the legend, and the history.
Dr. Gustavo Baz-Prada was born in the Municipality of Tlalnepantla, in the State of Mexico, on May 1, 1894. And for his eminent services rendered to the Mexican people and to his state, on December 23, 1978, the State Legislature decreed that the Municipality of Tlalnepantla would be named Tlalnepantla de Baz.3
Since he was a child, he distinguished himself for his seriousness and dedication, and demonstrated great intelligence that allowed him to excel in all the positions he held. As an example, we can read the following phrase: "work and courage, together and sustained for a long time, overcome obstacles" that he wrote in French, at the age of nine years old.
At a very young age he joined the Zapatista army. He was only 19 years old when he woke up in the Sierra del Ajusco along the Zapatistas. His work and the tasks entrusted to him were always carried out efficiently by the young Baz, which is why he was soon promoted to Lieutenant Colonel of Cavalry of the Liberating Army and later to Colonel, appointments that were signed by Emiliano Zapata himeself.4
Shortly after, in the following month, to be exact on December 14, a meeting of revolutionary leaders gathered in Toluca, decided to name him provisional Governor of the State.4 He had only lived 20 years and for 11 months he governed his state, surprising everyone with his organizational capacity, and his economic and political vision (Figure 6).
The experience of having known General Zapata, of having been his trusted courier, left a deep and permanent impression on him. After the triumph of Carranza, he resumed his path in student life, but not before having renounced his rank of revolutionary general. "The revolution had lost a general, but the country had gained a great surgeon", wrote one of his biographers.5 He was a friend, doctor, surgeon, advisor, and collaborator of many presidents. In 1942, with General Manuel Avila Camacho as President of Mexico, he created the Secretariat of Health and Assistance by merging the Secretariat of Assistance with the Department of Health6 (Figure 7). Under his direction, this Secretariat laid the foundations of the largest hospital system ever known in our country.
Among his works were the National Medical Center (CMN) of de Mexican Institute of Social Security (IMSS), badly devastated in the 1985 earthquake, the cardiology and nutrition institutes, the children's hospital, and most of the hospitals in many municipalities throughout the country. He promoted in an intense and planned way the sending of young doctors abroad, around 480 as it is recognized. It was thanks to this that the institutes were able to grow and bear fruit. He was also responsible for the prenuptial certificates and the use of white coats in the operating rooms.
He had reached prominence in his profession in an undisputed and indisputable way, and once again he rides the steed, noble animal, where man becomes a knight, and where his word is worth as much as his life. Citizen Baz-Prada faced his circumstances and always kept his word. He was a man of his time, but his actions also put him ahead of his time. Gustavo Baz, "Protean Man" as one of his biographers -the master Don Andrés Serra Rojas- called him, re-emerged into politics at the age of sixty years.7
Forty-three years later, Gustavo Baz Prada became again governor of his state. But on this occasion, he arrived by political means (Figure 8). During his administration, he stimulated and promoted the growth of the labor army, built the University City in Toluca, held the first national agrarian congress, and developed the automotive industry. He always fought for the disappearance of the shortages of life, because he learned them from a very young age, living with the homeless. At the age of 82, he became a senator for his state in the LI Legislature of the Congress of the Union, for the 1976-1982 period.
He received many awards and recognitions. The last one was the "Belisario Domínguez" medal awarded by the Senate of the Republic to Mexicans who have outstandingly excelled in the defense of popular causes and in the service to the country or humanity.
His golden rules were:
Do not speak ill of anyone
Live within reality
Do not confuse what is supposed with what has been ascertained
Be timely
DR.
I met Dr. Bernardo Sepúlveda during my residency and my first years as a surgeon in the Gastroenterology Service. I never had direct contact with him, but I was always struck by his intelligence, neatness, punctuality, professional, and academic performance. I was fortunate to meet one of the masters of Mexican gastroenterology.
He was born in Monterrey, Nuevo León state, where he completed his pre-professional studies. He studied medicine at the School of Medicine of the Mexico Autonomous National University (UNAM). In the early 40's he was granted a scholarship by the Mayo Foundation for Medical Research and dedicated himself to the gastroenterology and experimental medicine sections. He specialized at the General Hospital where he began his professional work, and from where he was called to collaborate in the recently founded National Institute of Nutrition. When he was head of the Gastroenterology Service, he was surprised by the invitation to collaborate in the IMSS.
In 1958 he joined the IMSS, where his brilliant work, as always, left its mark. He oversaw reorganizing and improving the medical services Through his initiative the Department of Technical Planning of the Medical Services was created. He implemented the first Basic List of Medicines, which gave him experience to later preside the Interinstitutional Commission of the Basic List of Inputs of the Health Sector, which was complemented with the Basic List of Curing Material and Prosthesis in agreement with Dr. Norberto Treviño García-Manzo, last Director of the General Hospital (HG) of the IMSS CMN. He participated in teaching the Specialty in Gastroenterology. Along with Dr. Luis Landa-Verdugo, he continued his teaching work, impregnating it with wisdom, research, and perfecting modern clinical procedures, with scientific methodology to achieve a modern avant-garde specialty. Dr. Norberto Treviño, during his tenure as HG Director, managed to name the IMSS CMN General Hospital "Dr. Bernardo Sepulveda".
His participation first in the School of Medicine and later in the UNAM was always remarkable. He began as an assistant at the Propedeutic Clinic, and his fruitful work as a teacher over the years led him to receive in 1979 the designation of Professor Emeritus of the UNAM.
His professional merits allowed him to enter the Colegio Nacional, where he also had an exemplary performance. The presentation of almost two hundred scientific papers in national and foreign meetings allowed him to have a great image. Of all the digestive pathologies, two stood out in his research, liver diseases and invasive amebiasis. In 1968, he founded "The Center for Studies on Amebiasis". The first seminar was held with the participation of gastroenterologists, surgeons, pathologists, and radiologists from the CMN HG. Its success opened the doors to national researchers from other institutions, as well as foreign physicians, interested in this subject. The amebiasis disease, known and studied previously by several Mexican physicians, had unfinished answers, and lacked research, so it was possible to discover clinical behaviors that improved the clinical evolution of this disease. On the other hand, being a disease of public health importance, it forced the participation of the Ministry of Health and Assistance.
In 1975, on the centenary of the discovery of Entamoeba histolytica by Fedor Aleksandrovich Lesh in St. Petersburg, the seventh seminar on amebiasis was held with the participation of experts from USA, Canada, South Africa, India, France, England, Italy, the Netherlands, Gambia, Tunisia, Iraq, Poland, Sweden, Germany, Japan, Colombia, Peru, and Costa Rica.
I remember an important and transcendental proposal made by Dr. Sepúlveda: to give two tablets of metronidazole to every patient presenting at the emergency departments of all hospitals. I do not know if this suggestion was carried out, but I can mention that my activities in Extramural Surgery during eight years led me to travel most of the republic and in each and every one of the hospitals where we carried out these activities, we used to ask about the presence of patients hospitalized for complications of amebiasis. In all of them the answers were negative. In view of this evidence, I consider that Mexico has taken a great step forward in public health by practically eradicating this pathology.
Drs. Hugh R Butt and Louis S Diamond, great researchers in gastroenterology, confirmed the international importance of their participation in world congresses and meetings, particularly on hepatology and amebiasis. Further proof of his interest in hepatic pathology is revealed in the 56 published papers, 45 of which refer to the hepatic gland.
For many years Dr. Sepúlveda was a professor at the School of Medicine of the UNAM. He was an intern at the General Hospital (1935-1946), Head of the Department of Gastroenterology of the Hospital of Nutrition Diseases (1946-1962) and Head of the Division of Higher Studies of the Faculty of Medicine of the UNAM (1958-1967). He was a member of the Board of Governors of the UNAM (1964-1966), and one of the founders of the National Institute of Nutrition, as well as of the National Medical Center of the Social Security. He was coordinator of the Center for Amebiasis Studies and Secretary of the Consejo de Salubridad General from 1977 until his death.
Throughout his life he received numerous honors and recognitions: he was president of the National Academy of Medicine (1957-1958), of the French Mexican Medical Association (1959-1961) and of the Mexican Association of Gastroenterology (1960-1961). Mastership of the American of Physicians (1971), professor emeritus of the UNAM School of Medicine (1979), Doctor Honoris Causa by the Universidad Autónoma de Nuevo León (1982), ordinary president of the World Organization of Gastroenterology (1982), National Science Award (1982), and member of the Board of Directors of the National System of Researchers (1984). Dr. Sepúlveda joined El Colegio Nacional on October 24, 1975. His inaugural speech, "Conquests and problems of contemporary medicine", was answered by famous cardiologist Dr. Ignacio Chávez.
I consider that, of all of his brilliant academic career, the most transcendental thing for Mexican medicine was his university participation. Dr. Raoul Fournier, as Director of the National School of Medicine of the UNAM, appointed him Head of the Department of Graduates. This position gave rise to the current Division of Graduate Studies. Later, with the approval of the University Council in 1960, the National School of Medicine became the School of Medicine. The Hospital de Especialidades del Centro Médico Siglo XXI was named after him.
Doctors who knew him and collaborated with him in the various fields in which he participated agree that he belongs to a medical generation that transformed Mexican medicine.
Dr. Bernardo Sepúlveda Gutiérrez died on March 17, 1985, in Mexico City.
DR.
A native of San Luis Potosi, Dr. Manuel Quijano was a cultured man, an excellent surgeon, and a great university student. He frequently used the phrase of José de Letamendi, a great Spanish physician who said: "the doctor who always talks about medicine, does not even know medicine". Together with the professors of the General Surgery course of the General Hospital of the CMN of the IMSS, they put a lot of effort during the selection of the surgical aspirants, investigating their hobbies and knowledge of culture in general, especially music and art. I remember that in one of the few breakfasts I had the opportunity to personally meet him, years after leaving the IMSS, he told me that one of his passions was traveling, and that he preferred to have an old-fashioned car, so he could invest that money in enjoying trips abroad. He told me, with some sadness, that his next trip to France would be the last he would make because of his age, and because of the socioeconomic changes we were experiencing at that time in our country.
As a remarkable surgeon, he has a very long history, so I will only relate the highlights of his professional activities, without keeping a chronological order of his time at the IMSS, UNAM, SSA, international organizations and as a surgeon.
During the funeral tribute to Dr. Gustavo Baz in the auditorium of the School of Medicine of the UNAM, I had the opportunity to sit next to my teacher, Dr. Manuel Quijano, who told me that he had also been one of the first Mexican doctors favored by the scholarship program for foreigners, instituted by Dr. Baz as Secretary of Health and Assistance in the forties. Dr. Quijano began his surgical residency at the General Hospital of Mexico in 1944 and went to the United States of America in 1945, to continue his surgical training at St. Lucke's Hospital, then at the Lahey Clinic and at the Massachusetts General Hospital, perfecting his knowledge at the Saint-Louis Hospital in Paris. These preparation trips were not easy to make, only with his effort, sacrifice, tenacity, economy savings, and desire to succeed allowed him to realize his dream of life. At the same time, he managed to broaden his culture, which he used with simplicity. Upon his return, his surgical skills allowed him to excel in the National Institute of Nutrition, which transcended as the best surgeon of the moment, so that Gustavo Diaz Ordaz, President-elect of Mexico, requested his professional services to operate his wife for a vesicular lithiasis.
Dr. Ignacio Chávez, as Rector of the UNAM (1961-1966), called Dr. Manuel Quijano to take charge of School Services, a commitment that forced him to leave surgery and his work at the National Institute of Nutrition. From this position he was able to bring order to the school procedures at the Rector's Office. He consolidated six student federations into one. The procedures for studies, internship letters, or setting dates for professional exams were more efficient. Established satellite offices, decentralizing the main school services office. He designed a sheet for possible procedures and operated the undergraduate admission exam, which to date continues to be an important element for the academic improvement of UNAM. Going back in time, in 1958, as professor of Introduction to Surgery at the School of Medicine of the UNAM, he was allowed to perform operations on dogs, creating the Department that later became known as "Experimental Surgery".
After two years, in 1963, he resigned at the invitation of Mr. Benito Coquet to direct the recently inaugurated General Hospital of the IMSS National Medical Center.
His transit through our main University did not end there. From 1968 to 1977 he was a member of the Board of Governors of the UNAM, so he was closely involved in the student movement. For two years (1978-1979) he was head of the office of the Graduate Division of the School of Medicine. In short, he started the admission exam for the medical degree at UNAM, was a member of the Board of Governors and finally he created the Revista de la Facultad de Medicina as its editor.
During an interview he commented that in those years (decade of the 60's) the work on organ transplants was outstanding. None had been performed in Mexico and to gain experience he worked on corpses and dogs. Let's remember that kidney transplantation as a treatment started in Russia in the 30's, obviously with bad results. On May 5, 1963, the first successful liver transplant was reported by Dr. Thomas Starzl.8
On December 4th of that same year, the first kidney transplant was performed at the General Hospital of the CMN of the IMSS by Dr. Manuel Quijano, Dr. Federico Ortiz-Quezada, and Dr. Gilberto Flores-Izquierdo.
In 1964, when he was director of the General Hospital of the IMSS Medical Center, in an undoubtedly visionary act, he authorized the creation of a Psychiatry Service. A good idea, which was echoed in the SSA, and which I was able to verify when I became director of the General Hospital of Tlalnepantla, in the State of Mexico. Unfortunately, sometime later this specialty disappeared from the hospital organization chart.
The program of university recognition of residencies began in 1965 and he was appointed head of the residency in General Surgery, establishing a rotation plan for various specialties, to train the resident to operate abdomen, neck, gynecology procedures, and perform cesarean sections, and rotating through a service of orthopedics and peripheral vascular, as well as in the emergency departments. This program was accepted and implemented in all General Surgery courses.
As a thoughtful and visionary professor, he gathered all the professors of general surgery services to create the Mexican Council of General Surgery. On November 11, 1978, it was registered before the Ministry of Foreign Affairs and the National Academy of Medicine, gathering 1,769 surgeons who accepted a transitory article. Of course, the position of first president was his responsibility.
As professor of the specialty in general surgery on behalf of the UNAM, he stayed until the end of 1972. Dr. Luis Ize was the penultimate chief resident, and due to his promotion to the newly created parenteral nutrition service, he left the position vacant which I assumed during the last four months of that generation. For that same reason, I was the last chief resident of the general surgery course of Dr. Manuel Quijano-Narezo.
After leaving the Direction of the General Hospital of the CMN of the IMSS, his intellectual capacity and preparation granted him a place to participate as Scientific Attaché in the Mexican Mission to UNESCO in Paris, France (1980 to 1983). During that time, he had the opportunity to work with Dr. Guillermo Soberón. When he returned to Mexico, Dr. Soberón, by then Secretary of Health, invited him to collaborate in the SSA in the General Directorate of International Affairs (1983-1989). He was Scientific Advisor of the World Health Organization (1987-1989) and President of the World Health Organization in 1989.
He was an active member of national and international medical and surgical Academies and Associations, among which he was a Member of the Academy of Surgery, Paris, and Officer of the Ordre National du Mérite, of the French Republic.
One of his natural attributes, which allowed him to describe his ideas and experiences, was writing. He wrote more than 60 scientific articles, countless editorials and two books: "Fundamental Principles of Surgery" in two volumes in 1981, which became a surgical literary work that was indispensable tool for residents and surgeons of that time, and dissertations and repetitions edited by Siglo XXI and co-published with the UNAM in 2003. His participation in book chapters on health and politics that deserve to be noted such as in "International Cooperation for Health. Mexico International Politics in the 80's (La cooperación internacional en materia de salud. La política internacional de México en el decenio de los ochenta)". Fondo de Cultura Económica, 1994. "Mexican medicine in globalization (La medicina mexicana en la globalización)". "A century of health sciences in Mexico (Un siglo de ciencias de la salud en México)", edition coordinated by Hugo Aréchiga and Luis Benítez Bribiesca published by the Fondo de Cultura Económica, First edition, Mexico 2000. As editor of the journal of the School of Medicine, his most important achievement was to publish it for general practitioners, in addition to indexing it and increasing its circulation to 20,000 copies.
DR.
Undoubtedly, Dr. Luis Landa was an exceptional and excellent Chief of Service, with an iron character, disciplined and with a tough personality. I met him during my residency, when I rotated through his service, and later he was my chief when I was selected in 1973 to fill the vacancy left by Dr. Gustavo Baz Díaz-Lombardo.
Like all humans, he had natural and acquired attributes, good and bad. I should not judge him, so I can only comment on what I experienced during the time I worked under him. His service, its distribution, the pairs of gastroenterologists and surgeons he created, the bibliographic and radiological sessions, etc., have already been described above. In all of them there was a commitment to improve, to increase knowledge and experience, with the sole purpose of serving and making the best Gastroenterology Service of the IMSS.
Perhaps we will understand better his haughty and sometimes arrogant personality, but mainly that of a leader, if we remember an anecdote told by the wife of a surgeon who accompanied them to a congress somewhere in the Mexican province, by land, with several hours in the public transport of that time: "While most complained about the heat and dust, at an obligatory stop of the bus, Dr. Landa got off and in the public restrooms of the bus terminal washed, shaved, combed his hair and changed his shirt and tie, and returned to the bus as fresh as if he were just starting the trip, an attitude that surprised the rest of travelers".
He never missed an opportunity to participate and improve the image of his service. When a congress or meeting was approaching, the usual sessions were suspended to dedicate ourselves to presenting our papers and correcting them down to the smallest detail, either orally or written. On the other side of the coin, when he or one of his assigned physicians attended international or world congresses, they would reproduce the new developments in the sessions and later we would put them into clinical practice. I still have a copy of the document of a symposium on pancreas held abroad that he attended, and that upon his return was reproduced in several sessions, so that our knowledge of this pathology was immediately and significantly updated. As a researcher, his fields of interest were on hepatitis and amebiasis, and with Professor Sepulveda, they created the protocol for the management of portal hypertension, as well on the use of the first oral H2 blockers. I remember the first session on hormones of the digestive tract, which today is still being researched and producing important discoveries in type 2 diabetes, obesity, and other topics.
His door was always open to innovation, to creative work. The example is the support he gave to Dr. Rafael Alvarez-Cordero, to create the Intensive Care ward on the sixth floor (the surgical patients' floor) of the HG of the CMN of the IMSS.
In his service he started a routine, but I do not know who initiated it. On the surgical note sheet there must be a drawing demonstrating the surgery performed. It is important to mention this, because many residents preferred to carry their box of colored paint pencils, instead of a scalpel. With time these drawings became mandatory, which Dr. Landa rewarded with verbal congratulations to the sketcher rather than to the surgeon.
The Gastroenterology Service was considered one of the best, if not the best in the country, so that important patients from politics, science, arts, and cinematography would come to recover their health.
Dr. Landa was Director of the HG of CMN for a brief period -fourth director- and migrated to the Subdirección Médica del ISSSTE and later to the Direction of the Hospital de Xoco belonging to the Department of DF. He continued until the end of his life practicing private medicine, until he suffered with Parkinson's disease, and finally a complicated gastrointestinal bleeding led to his death.
DR.
Son of Dr. Gustavo Baz-Prada, Dr. Gustavo Baz Díaz-Lombardo was born in Mexico City. He was the first surgeon to arrive at the HG of the CMN of the IMSS at a young age, with a background of surgical residency at the University of Minnesota (1958-1961) whose professor was renowned Dr. Wangesteen, and at the National Institute of Nutrition, where he became chief resident (1961-1963).
As a surgeon and professor of surgery for the university course, he always had excellent relations with the residents because of his youth and character. He liked music, it was always pleasant to operate with him because whenever possible, in his operating room you could listen fine sounds that relieved stress. As a friend I was fortunate to know him and learnt about his taste for good sound equipment and classical as well as popular music. We would affectionately call him a puppy of the "Mexican Revolution", to which he would respond with a smile.
The surgical topics in which he participated in an outstanding way were the surgical treatment of obesity -non-absorptive surgery-, single plane anastomosis, treatment of portal hypertension, surgical treatment of complications of amebiasis. Regarding this pathology, he designed and had special needles made for the puncture of amebic liver abscesses, which at that time were very frequent. I still use those needles in laparoscopic surgery when it is necessary to puncture an acute gallbladder. In gallbladder and biliary tract surgery, he moved like a fish in water. To remember is his manual technique without vision for the removal of pio-cholecysts, hydro-cholecysts or acutely inflamed gallbladders, technique that is not described in textbooks. One of his greatest surgical successes was the operation performed on a patient (MNS) during an on-call shift, who presented a state of shock due to acute mesenteric ischemia, which included jejunum, ileum, and right colon. It was necessary to remove all the intestinal segments mentioned and reconstructing the intestinal transit with a duodenum-colic anastomosis, which allowed the patient to survive for more than 30 years. This was an exceptional and unique case.
Another interesting anecdote that allows us to remember the personality of Dr. Baz as a surgical professor was frequently told by Dr. Antonio Escobedo, from Tampico, Tamaulipas (now deceased). He recalled that when he was his resident, when his wife was in an operating room as a patient, Dr. Baz ordered him to operate in the neighbor operating room. Baz ordered him to operate on a patient in the next operating room, so that he would temper his surgeon's courage, because it was necessary for him to have that experience, since the surgeon does not know when he will be called to operate, regardless of the surgeon's moods, and he should always be ready to render his professional services. When he finished operating the important part, he replaced him and allowed him to appear in the operating room where his wife was being operated on.
With his genetic inheritance, together with his intelligence and preparation, he thrived both in the surgical field and in the public health field. After a short life as a surgeon (10 years), he decided to enter the field of Public Health. One morning in 1973, at the end of our surgical activities, he invited me to visit a new hospital, located in Ciudad Netzahualcoyotl, in the neighborhood La Perla, Municipality of the State of Mexico, which was part of a new generation of SSA hospitals. After visiting it, he asked me a question, he asked my opinion about the proposal that Dr. Jorge Jiménez-Cantú, at that time Secretary of Health, had invited him to be the director of that new hospital, in addition to developing a regional health system. My response was immediate. Considering that he was a surgeon in an enviable place, with an even more promising future, and considering the distance and the radical change that his administration required, my answer was negative. Months later I found out that he had requested permission from the CMN to start his administrative activities in health, without any hesitation. His political and public health genes had won the initiative. Therefore, the winner of the position in the Gastro Surgery Service was me. Mexico's surgery had lost a great surgeon but had found an excellent public health physician who would make many substantial changes at the first-level health care. Sometime later he told me that Dr. Jorge Jiménez-Cantú did not accept his refusal, commenting that being a pioneer in installing a new health system would allow him to increase his image politically, opening so a promising future for him, besides bringing health to the population most in need of new hope.
As his acting resident, I had the opportunity to share important times in his professional life. Undoubtedly, a friendship developed that lasted until the last day of his life. First as his resident, then as a practice partner and collaborator in the State of Mexico, and finally a friendship that survived for almost 40 years.
After the direction of the Hospital de La Perla, he was promoted to Secretary of Health of the State of Mexico, a position he held with four governors, during which he created a new health system, an example for the Mexican Republic and taken to Latin America and Africa. His leadership led him to change the name and function of the Secretary of Health of the State of Mexico to the Institute of Health of the State of Mexico. He surrounded himself with health physicians that he trained at the School of Public Health that he founded together with the Autonomous University of the State of Mexico, who helped him to solve and implement the health programs that transformed the State of Mexico during his leadership. Under his tutoring, mental health, ophthalmology, and emergency care programs were created.
On October 11, 1976, Dr. Jorge Jimenez-Cantu, Constitutional Governor of the State of Mexico, instructed the head of the Coordinated Public Health Services (ISEM) Dr. Gustavo Baz Diaz-Lombardo to initiate operations of the Emergency Services of the State of Mexico (SUEM), as a result of a flood in Santo Domingo de Guzman, Municipality of Ixtlahuaca, since at that time there were no specialized emergency services in the state. If it was not the first Emergency Service at the state level, it was one of the first where young people were physically prepared, with updated and humanized techniques, focused on pre-hospital care and rescue of victims.
He founded the School of Public Health of the State of Mexico to train sanitary doctors who were indispensable for the unexpected demand due to the programs implemented by the State Health Services. Of course, it produced rejection, adverse comments, especially from the traditional health professionals in Mexico, because it took away the hegemony of the federal School of Public Health, dependent on the SSA, the only one that produced this type of specialists. By 1991, 630 professionals had completed the course and 134 were in process.
The operational essence of the regionalization of health services was the control section called the Primary Health Care Unit (UAPS). Each municipal coordination was divided into micro-regions where 2,500 to 3,000 inhabitants (450 to 500 families on average) were located. Thus, each municipal coordination controlled 10 micro-regions, with an average of 30 to 60 thousand inhabitants.
I consider that his greatest achievement in his work as a public health doctor was to have devised, created and implemented the PRODIAPS program, which was implemented in 2,350 micro-regions in the State of Mexico, and a technician person called primary care program operator was hired. These technicians were natives of the community in which they worked and with a primary education level in urban areas. In all cases they participated and had to pass the specific course. These workers were in a permanent training process, and the experience they developed allowed them to become true health technicians. Their work was improved by providing them with digital instruments for the collection of census data from the micro-regions in their charge. With this information, the family health diagnosis was developed in the State of Mexico as an advance and innovation due this technique and its fundamental purpose was to cover the objectives of the health diagnosis, but starting with data collection from the family nucleus, which was considered for these purposes as a social epidemiological unit, subject to descriptive and analytical study. This program was disseminated and accepted worldwide. Its dental health (iodized and fluoridated salt) and ophthalmology programs were copied and adopted in European, African, and Latin American countries. In the ophthalmology program, he demonstrated that 35% of the children in Mexico, and not 10% as was mentioned in the literature, had visual problems.
After the 1985 earthquake, the Health Services of the Federal District and the suburban municipalities of the State of Mexico were restructured. Of the hospitals programmed by the Federal Government, the Ministry of Health was able to build them in the municipalities of Naucalpan, Atizapán, Cuautitlán, and Nezahualcóyotl, to stop the influx of patients from those municipalities to the hospitals in Mexico City. In addition to the mentioned hospitals 70 municipal hospitals and 200 clinics or doctor's offices were built during this period. He received the health services of the State of Mexico with 750 workers and handed it over 20 years later with more than 20,000 and an important track record.
His work in the SSA continued when he left the ISEM (Health Institute of the State of Mexico). He was Director of Sectorial and International Affairs of the SSA, and later participated in health care programs for the open population. He was also part of the Directorate of Programs and Development of Public Health Services in Mexico City, and in the Undersecretary of Health of the Mexico City government. He returned later to the SSA where he was an advisor to the Undersecretary of Innovation and Quality, when he was surprised by the disease that led to his death.
He was founder of the Mexican Association of General Surgery, member of the Mexican Association of Gastroenterology, and of the American College of Surgeons. He continued his postgraduate academic preparation with management diplomas dedicated to personal improvement and the best application to regional and municipal health.
His teaching activities were professor in the specialties of general surgery and surgical gastroenterology at the School of Medicine, Master in Public Health in the schools of medicine of the Autonomous University of the State of Mexico and UNAM, professor in the master's degree in Hospital Administration in the School of Accounting and Management of the UNAM and guest professor at various medical schools in the Mexican Republic, as well as in academies and medical associations.
His participation in academies, societies and professional associations was multiple and varied. Just to mention a few were World Chairman at the 23rd World Congress of Medical Informatics in Switzerland. Vice President of the Mexican Association of Schools of Public Health in Latin America and later President. Member of the Mexican Association of Public Health. Founder and President of the Public Health Society of Mexico City.
His international presence reveals that he participated in conferences and in the implementation of various health programs in the following countries: Cuba, Venezuela, Peru, Costa Rica, Holland, Switzerland, Egypt, Canada, France.
He was always a lover of sports, practiced physical exercise, swimming, skiing, archery, and Olympic rifle shooting. His passion was sailboats, so every year he went to the city of Miami, Florida, USA, to attend the Expo boat. His youthful character and simplicity allowed him to be a charismatic man who always had friends in many hospitals and in the immense field of public health. We never saw him upset or angry, so it is considered that he was a kind man. On April 22, 2009 the newspapers of the city of Toluca reported his death, when he did not resist a heart surgery.
REFERENCES
AFFILIATIONS
1 Associate Member of the Mexican Association of General Surgery.
CORRESPONDENCE
David Olvera-Pérez, MD. E-mail: docolvera2@gmail.comReceived: 02/27/2019. Accepted: 08/07/2019