An Oncologist in Mexico City Reflects on Earthquake Destruction, Preparation

An Oncologist in Mexico City Reflects on Earthquake Destruction, Preparation

Dr. Enrique Soto
Enrique Soto, MD, of the Salvador Zubiran National Institute of Medical Science and Nutrition, in Mexico City, grew up to the sound of seismic alarms. Mexico City is located on a fault line, and Dr. Soto was no stranger to feeling the earth shake beneath his feet. He felt equipped to respond in the event of an earthquake.

But from the first rumblings of the magnitude 7.1 earthquake that hit Mexico City on September 19, 2017, Dr. Soto knew something was different from past experiences. “When a minute or so had passed and the buildings continued to shake violently, we were all prepared for the worst,” he said.

Dr. Soto is a medical oncologist specializing in geriatric oncology. When the September 19 earthquake hit, he was in his office on the 7th floor of Salvador Zubiran’s outpatient clinic. “The first part of the earthquake felt like we had all just hit a bump in the road; everything just jumped,” he said. “Then the building started shaking.”

Dr. Soto and his colleagues quickly headed for the building’s safety zone alongside its elevators and waited for the shaking to stop. Although the quake only lasted seconds, “it felt like an eternity,” Dr. Soto said.

Assessing the Damage

Dr. Soto was fortunate to avoid devastating structural damage firsthand. The newer buildings in his medical center—including the outpatient clinic in which he works along with the chemotherapy and radiotherapy buildings—were constructed with an antiseismic design allowing them to withstand earthquakes of significant magnitude. Hundreds of older buildings in the city, however, saw severe damage or total destruction. The results were catastrophic. Thousands of people were injured, and fatalities totaled 320. In the aftermath of the disaster, the Mexican public sector lost 3% to 5% of its hospital beds. “This was quite considerable,” Dr. Soto said, especially during a time when emergency care was in its highest demand.

Although Salvador Zubiran did have a detailed protocol in place for earthquake response, which consisted of evacuating personnel, discharging patients with non–life-threatening conditions, and transferring others to safe zones in newer buildings, the earthquake caused unprecedented consequences for the center nonetheless. The state of emergency was such that acute earthquake-related injuries took center stage.

“The emergency room immediately filled with inpatients, meaning that some of our patients with cancer experiencing chemotherapy side effects had to be referred to other centers, and several nonemergency oncologic surgeries had to be rescheduled,” Dr. Soto said. “Many patients with chronic diseases were left unattended during the natural disaster, and in my own practice, I had several patients who were sent home from the emergency department.”

A building collapsed on two vehicles and onlookers inspect the damage as others seek assistance. Buildings continued to fall throughout the next day.
Fortunately, none of Dr. Soto’s patients with cancer died as a result of their treatment delays, but Dr. Soto emphasized that this lapse in treatment was a learning point.

“Resilient health care systems need to be able to provide care not only to those suffering from acute injuries, but also to chronically ill patients who are in need of treatment, particularly those who depend on certain medications for pain control and those who require dialysis,” he said.

In the case of Salvador Zubiran, accounting for treatment delays consisted of swiftly adopting a new plan to partner with the Mexico National Cancer Institute to send patients with chemotherapy complications to their nearby emergency room.

Telemedicine During Disaster Events

In a blog post Dr. Soto wrote for ASCO Connection shortly after the earthquake, he told the story of one of his patients with prostate cancer who had recently received his third dose of chemotherapy. When his patient reported abdominal pain and a fever on the morning of September 19, Dr. Soto suggested he visit the emergency room for testing and told him he would come by to see him shortly. But then the earthquake hit, and when Dr. Soto was finally able to get to the emergency room, he found his patient standing outside; the CT scan he was supposed to have didn’t happen. “In order to make room for potential victims of the earthquake, all patients without an emergency were discharged,” Dr. Soto said.

That’s when Dr. Soto made a small gesture that meant a great deal to his patient; he gave him his personal cellphone number. “In the following days, as my colleagues and I scrambled around the city trying our best to help [victims of the earthquake], I kept in touch with this patient and his family through messages and calls. I felt worried, but I knew that it was impossible for him to go to a hospital, because all the existing resources were focused on the earthquake,” Dr. Soto wrote in his ASCO Connection blog.

Dr. Soto’s patient and his family members later expressed how grateful they were for Dr. Soto’s consistent communication. This experience led Dr. Soto to acknowledge just how imperative it is to check in with patients when immediate medical care is not readily available.

“As doctors, we sometimes underestimate the effect we can have on patients and their families by being available and by caring. Remember that your patients are as scared as you are, and that they may have many questions regarding the continuity of their care,” Dr. Soto said. “In the face of natural disasters, checking in on patients and providing them with your contact information so they can reach out if they need it can mean the world.”

On an institutional level, Dr. Soto’s advice for earthquake preparedness involves establishing a local disaster plan and evacuation procedure along with providing all patients with information sheets specifying their diagnosis and current treatment regimen. This will enable patients to efficiently seek care at other institutions if needed. Printouts and information about what to do in the case of a disaster should also be readily available to patients, Dr. Soto said.

For additional advice, Dr. Soto will be speaking during an Education Session on June 4, “Cancer Care for Displaced Populations: Conflict and Natural Disasters.”

 –Caroline Hopkins