Many expats are unaware of the public healthcare blood donor issue in Mexico, which is the subject of today’s blog. If you are enrolled in a government healthcare program, it should be of particular interest. But first, a little cultural context.
If you’ve been in Mexico any length of time you have discovered that one of the nearly universal quirks of Mexican culture is related to the ability (or rather the inability) to say “no.” I mean “no” in the sense of declining a request.
For example, if you ask storekeepers if they have a product, and they don’t have it in stock, rather than being told that they don’t have it, you are likely to be told that they will have the item in question in “dos semanas.” As a hapless foreigner, you are likely to return to the store in the stated two weeks in eager anticipation only to be told that your heart’s desire isn’t there yet but try again in another two weeks.
The problem is that you misunderstood the meaning of “we’ll have it in two weeks” as literally “come back then, we’ll have it in two weeks.” But in the cultural code of Mexico, it is far more likely that this is simply a way of telling you that they don’t have it and most likely never will.
This is not viewed as a negative in Mexico. While in another culture this might even be seen as lying, it is not among Mexicans where saving face and good manners trump the truth. Those little white lies are simply understood as being exceedingly polite, Mexican style.
In Mexico, it is considered rude to decline a request or an invitation because to do so is taken as a personal rejection. One is expected to offer a vaguely positive response that is universally understood as a decline. An enthusiastic “We’ll be there” may indeed actually mean “we can’t make it.” As an expat host or hostess, you are likely to get your signals mixed and feel slighted when the guest in question doesn’t show, the business meeting doesn’t materialize, etc.
So, in Mexico you can’t decide how much food to prepare based on the number of people who said they were coming to your party. You just plan for more than enough and trust that it will all be put to good use.
But there are far more serious matters than who is going to show up for your party. In Mexico a “polite decline” might even involve a matter of life and death. Let me see if I can explain.
If you have public health coverage in Mexico, either IMSS or Seguro Popular, and you need surgery, it is typically expected that you will bring your own blood donors before the surgery in anticipation of need. Unless it is an emergency, it is likely that you will be told how many donors you need and given instructions on when and where the donors should report.
While this may be an annoyance for Mexicans, for most surgeries this is not a major hurdle. There are typically many family members to contribute on one’s behalf and in a cultural system of mutual favors as a survival strategy, it is understood that the favors you do for another are banked and when you are in need you can draw on your account. When called on to donate for a family member, you show up.
But when it comes to blood donation, sometimes the bar is set so high that it is impossible to meet. It is not unusual to see or receive solicitations seeking blood donors that frankly are more like medical “declines” in very polite sheep’s clothing. For example, I received a message pleading for donors on Facebook recently when a woman in need of life-saving surgery was seeking 40 donors. I assert that this may be, at least in part, a way that medical professionals can decline service without doing so directly. Of course, it is also possible that a large amount of blood was indeed legitimately required because of the nature of the medical treatment. We may never know.
In fact, I have had some personal experience with blood donor issues with a family member who needed surgery to repair a hernia. The hernia had not quite reached the emergency stage, so he was released from an IMSS hospital with instructions to produce six perfectly healthy male blood donors under the age of 50 and weighing more than 60 kilos. All six needed to arrive at the hospital on the same day at 6 a.m. having fasted since the night before and without drinking alcohol or eating spicy food or red meat for the previous 24 hours. Payment for blood or a transfer of blood from a local blood bank was not accepted by the hospital in question.
Regretfully, the patient in question was new in town and had no family members locally. And so, the search for blood donors began through social media, networking, the Red Cross, churches and even a plea for donors at a local army facility. Despite offers of pick-up and drop-off, a big breakfast following the sacrifice and other inducements, the goal could not be achieved. So, despite being “covered” by IMSS, surgery was never arranged and after a year of pain and frustration, a far more serious surgery was required on an emergency basis at a private hospital.
As an expat living in Mexico, you may never face this situation. There are hundreds of surgeries each year that simply go swimmingly for expats. But blood donors may be a problem in some instances — especially if you belong to a public healthcare program and the hospital is reluctant to actually perform the surgery.
Whatever your healthcare situation is, I highly recommend that you form your own mutual blood donor agreement with others in advance of need if at all possible. Remember, age is sometimes a limitation for donors so you may need to cast the net beyond retirees.