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Page last updated at 11:23 GMT, Wednesday, 6 May 2009 12:23 UK

Swine flu: Doctors' diary

People wearing surgical masks stand in line in Mexico City
The doctors say more and more people are wearing masks

Guadalupe and Arturo are doctors working in the Mexico City area. Guadalupe works in cardiology and her husband works in the emergency services.

They are writing a diary for the BBC News website about their experiences with swine flu and how it affects the health community.

TUESDAY, MAY 5

Over the weekend there were no reports of deaths from influenza related pneumonia.

This gives out the impression that the outbreak is diminishing. Out in the streets, less people are using face masks.

Out in the streets, less people are using face masks

I think this is a mistake, because there is still risk of contagion and of a reactivation of the outbreak. We don't want this to happen.

Maybe people are feeling a bit of relief because the media is reporting a reduction in the number of new influenza cases.

But where I work, some doctors are still refusing to treat patients. And there's a region that is forbidding buses coming from Mexico City for fear of contagion.

This weekend, we stayed at home, with all the family. And we continued with all the preventative measures.

FRIDAY, 1 MAY

People are still taking extreme precautions and are following the advice of the health sector and the media.

You don't see many people out on the streets. Yesterday, not many people came for consultation with respiratory symptoms.

Only one patient was admitted during my shift. I think this gives the feeling of a fall in the number of cases and indicates that there is now better control over the propagation of the virus.

We hope this is true, for the good of our population and the rest of the world.

We use masks, we wash our hands frequently, we clean the door knobs and the water taps

Even so, we still believe that the alert level issued by the WHO is still high, so we are still facing uncertainty.

We doctors are dealing with this outbreak by treating the seriously ill patients directly in the emergency room using personal protective equipment like N95 face masks, white coats, goggles and gloves.

We wash our hands every time we check a patient and clean the stethoscope every time. We use anti-virals in a prophylactic [preventative] way.

We also take preventative measures at home. We use masks, we wash our hands frequently, we clean the door knobs and the water taps.

We avoid going out in the streets as much as possible.

We have alerted our relatives in other regions over the phone and told them to follow all the necessary preventative measures.

They think that because there have been no cases where they live the outbreak is not true, or they minimise its importance.

WEDNESDAY, 29 APRIL

Today another five cases of influenza related pneumonia were admitted during my work shift, despite the fact that fewer people went to hospital with symptoms of influenza.

In the hospital where I work there is little support from other services such as internal medicine and the intensive care unit.

There is an emergency going on in our country and we need to work as one

It is my opinion that this is wrong, because there is an emergency going on in our country and we need to work as one.

The workload lies mostly on the shoulders of the resident medical staff of the emergency room and the infectology service, with intermittent support from other services such as general surgery and the ear and throat department.

But there is support by the paramedic team, which I consider very valuable.

There are differences between the media and the health secretary about the number of deaths reported.

I think it is the media that is right, the number of deaths reported should be higher.

The government decided to close schools throughout the country and a friend of mine who is in Cancun told me that there are no tourists and the beaches are empty.

TUESDAY, 28 APRIL

People are taking the preventative measures seriously. They are being informed about them by various media outlets. More and more people are using masks.

Patients continue to pour in with flu symptoms. Some have very serious pneumonia

During consultations we try to calm patients by informing them that this illness has a cure but that early detection and treatment is important to avoid complications. We are advising patients to continue with preventative measures.

In some hospitals there are problems because certain services do not want to see these patients due to risk of infection. In some places undergraduate interns are acting as duty doctors while other hospitals are hit by absenteeism.

There is an overwhelming feeling of uncertainty. Having to use protective equipment, especially face masks, and above all heavy duty versions, makes our daily duties much harder, because they make it difficult to communicate with patients, and cause other problems such as skin irritation; we desperately want to remove our masks but cannot do so due to the risks involved.

Patients continue to pour in with flu symptoms. Some have very serious pneumonia and need to be put on ventilators. I think the total number of deaths is far beyond the seven who have tested positive for the infection.

Even though the measures being taken are adequate, there is a lot of disorganisation.

MONDAY, 27 APRIL

We are scared of carrying it into our homes and infecting our loved ones. One of my colleagues who was exposed chose to stay in a hotel rather than run the risk of infecting her daughters

The number of cases increases significantly every day. The number of fatalities is also increasing. I know of at least three doctors who are said to have died from swine flu. There is great fear among the medical community. We know that the situation is very serious and that we are at high risk of infection.

But we are more scared of carrying it into our homes and infecting our loved ones. One of my colleagues who was exposed chose to stay in a hotel rather than run the risk of infecting her daughters.

These fears are getting worse as we realise that it is not possible to get anti-viral drugs from pharmacies and that in the health sector they are being delivered little by little.

The government says that it has antiviral drugs available to treat a million cases but we do not have easy access to these, even though we are part of the health sector.

In one hospital doctors were given the anti-viral rimantadine, even though there is resistance to this drug. Also, fewer samples are being taken from severe cases, as there is a lack of means for transporting and cultivating the samples.

SUNDAY, 26 APRIL

There have been some cases of young people dying from respiratory infections but this happened before the alert and they were not reported because the necessary tests weren't done.

We doctors knew this was happening a week before the alert was issued and were told to get vaccinated. I went to buy some anti-virals for my husband, who is also a doctor, because he had contact with a young patient who showed influenza symptoms and died. I don't think pharmacies stock enough anti-virals.

I understand the government doesn't want to generate panic, but my personal opinion is that they issued the alert too late.

Even now, people are not getting the information they need. We have been out in the street and some people are not wearing masks or taking any preventative measures.



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