OAXACA, MEXICO — 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."
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.
