The Effects of Violence on Health Professionals in Mexico: A Qualitative Inquiry into Working in Adverse Environments

Background and Purpose: Mexico has lived through prolonged endemic violence caused by organized crime and the war on drugs. This qualitative study explores the effects of violence on health care professionals. Little is known about how health professionals working in contexts of high violence are affected. This paper fills a gap by examining the accounts of health service providers that have had direct or indirect exposure to violence in their work environments and communities.

Methods: Eighty semi-structured ethnographic interviews were conducted with physicians (72%) and other health professionals (28%) including mental health professionals and social workers located in five states of Mexico selected for their high incidence of violence. The sample is predominantly male (66%). This study used snowball sampling through local public health agencies and recruitment was in person as well as through telephone or email.

Interviews focused on participant’s perceptions of how violence affects them directly and their ability to provide services to the community, focusing on perceptions of direct or indirect effects that have professional, physical, mental or emotional consequences for these individuals. Field notes and recordings were transcribed, and coded thematically using ATLAS.ti qualitative software, framework analysis was used to interpret key themes and findings.

Findings: Results reveal a shortage of specialists in various fields ranging from surgery to traumatology in all five states. Violence has targeted medical professionals for kidnapping or extortion because they are thought to earn more money. Doctors have had to temporarily or permanently close their private practices. In some border regions with the U.S., medical tourism decreased. Violence affects service provision in primary care centers through reductions in the hours of operation; other services such as scheduled surgery, vaccination campaigns, and home-care visits were limited or cancelled. Medical students and doctors avoided wearing white robes outside of medical facilities as self-protection measures. Violence has negative effects for the local economy, reducing the amount of money spent on healthcare, as well as the income and professional opportunities for medical professionals.

Conclusions and Implications: Findings reveal that specialty physicians will gravitate away from regions that are violent, despite efforts of public health agencies to offer higher compensation as an incentive to attract specialists. Service providers also give accounts of adapting service delivery, for example through the use of skype enabled TeleMedicine that connects primary care physicians and patients outside of large urban areas with specialists. This study underscores the importance of understanding how violence affects health professionals. It highlights the importance of preventive efforts to protect service providers that may be applicable in other contexts or geographic regions.