Because palliative care has not been recognized as a medical discipline within the Mexican health care organization, most physicians are paid for their other medical specialisations. For instance, most physicians working in palliative care in Mexico are anaesthesiologists that allocate part of their working time to palliative care.

Dr Argelia Lara outlines how the palliative care team at the National Institute of Nutrition is comprised:

“Currently, we are three physicians working full time at the [Pain and Palliative Medicine] unit. The three of us have a specialization in pain clinic and I did a fellowship in palliative care in Spain. And we are organized to complement each other’s work. [In everyday clinic, we have got patients with chronic pain, cancer and non-cancer pain; in this way, the pathologies we see are very diverse. From the point of view of our staffs, some of us are more interested in the area of interventions based on analgesic invasive techniques. On the other hand, myself, for instance, I preferred looking after palliative care patients]. In general, we function as a pain unit and the palliative care programme has been inserted within it. In consequence, palliative care is not an independent service; it is a service integrated into the chronic pain unit. We have [the collaboration of several consultants and we have the advantage of working with a highly specialized multidisciplinary team (third level) that allows asking for any specialized advise whenever is needed. We also have support from a part-time psychiatrist and a part-time psychologist; two Psychology students undertaking a Master degree on Behavioural Psychology; a social worker exclusively assigned to us; and two nurses; one, permanent and the other, in her last year of her nursing studies]”.²³
NB: interview transcription edited by Dr. Argelia Lara (29-09-04).

Although scarcely provided, demand for palliative home care appears to be significant. Ms. Beatriz Montes de Oca describes her experience in Guadalajara:

“In one afternoon, we can see eleven [patients] when we divided ourselves into two groups This means that we can do twenty-two home visits in one day This is an enormous amount of work; it is very, very hard. Right now, we are in great need of experienced people ”²⁴

Dr. Gloria Dominguez Castillejos, palliative care specialist at the University Centre for the Study and Treatment of Pain and Palliative Care at the Universidad Autónoma de Guadalajara in Jalisco, describes her experience working in a poor area looking after patients with serious financial constraints and with no governmental support:

“Our institution depends upon the University. But, obviously, the University also has scarce resources and our unit is poor There are many things that we buy with our own savings to make it a bit better. But, we are short of everything much of the time. The important issue to me is the availability of medicines. Sometimes there are patients who tell us after having to pay for the consultation, that here is something symbolic like thirty pesos (that is about two euros) and they pay that and they get back to us and tell us “doctor, I cannot buy the medicine because either I pay for the consultation or I buy the medicine”. The University provides us with space, beds, desks, but nothing else. That means that we have no medicines; the patient has to buy them. And in a situation like this, students are of much help [through voluntary donations]”.²⁵

Dr Mayer outlines the role of the nurse in a hospital palliative care team:

“ we have got [nursing] personnel rotating in the service. Although they do not attend a formal [training] course, [nurses of our team] trained them in the nursing role in palliative medicine. They [palliative care nurses] usually train the families to be able to care for the patient at home, plus all other conventional nursing activities within the unit as well as within the inpatient area. They also deal with the instruments when we perform interventional procedures in the clinic and they are responsible for looking after the patient from admission to discharge. And they keep record of all daily clinical activities and of home visit activities”. ²⁶