Doctors are being forced to abandon patients and even flee Mexico's most deadly city of Ciudad Juarez on the US border, in a worrying trend in response to extortion, kidnappings and murder. Pediatrician Elsa Maldonado has only been working for one year but is almost alone in her practice, where old flowers dry out in a vase near a bullet-riddled window.
Most of Maldonado's colleagues have fled leaving their diplomas and medical equipment behind. She is the last who still regularly attends to patients and describes the exodus of her colleagues with a tense expression. "The gynaecologist received death threats three years ago and disappeared without giving any news. The ear, nose and throat specialist had his car stolen at gunpoint and never returned. The general practitioner now only works a few hours per day."
The city across the Rio Grande river from El Paso, Texas, has seen the deadliest violence in recent years as drug gangs clash with each other and security forces in the fight over lucrative trafficking routes to the United States. Rising drug-related violence has left almost 35,000 people dead in Mexico since the government of President Felipe Calderon launched a military crackdown on the cartels in 2006, according to official figures.
Last year, 3,100 people died in violent attacks in Ciudad Juarez alone while petty crime, such as robbery and extortion, exploded. And criminals are increasingly targeting doctors in the city of 1.2 million, due to their good salaries and vulnerability. At least nine doctors have been killed and 21 others kidnapped in the past two years, according to the Citizen's Medical Committee of Ciudad Juarez.
"Almost 70 percent of private practices in the city have closed down since 2008," according to committee member Leticia Chavarria. She had to give up her job as a general practitioner at a "maquiladora" - a Mexican factory working cheaply for US customers - due to rising violence. "After an armed attack, the company which employed me decided to close my practice down. Since then I've been seeing patients in secret, in an anonymous office that isn't set up for medical consultations," she said.
Many doctors have been forced to close shop, as patients have also fled the city, and work in discount pharmacies instead, taking a large cut in their fees, Chavarria said. "The cost of a consultation then changes from 200 pesos (around 17 dollars) to 30 pesos (around 2.6 dollars) It's impossible to live on that little." Miguel Garcia, the head of a private clinic, showed no apparent worry, although he admitted calmly that security had become a major concern. "We've reduced our opening hours. We refuse to see new patients we don't know. We have security guards who are armed with stun guns and radios. We change our routes to work every day," he said.
Garcia complained he had suffered six armed assaults in three years, each time to steal the day's takings. Doctors were powerless in those situations, he said. "A patient in the surgery can simply sit down in front of the doctor and take out a gun." Business had reduced 60 percent since 2007, Garcia said, adding that he planned to leave the city.
"I give myself a one year limit. If the situation doesn't improve by then, we'll go somewhere else." Pediatrician Maldonado had to temporarily leave last year. "My sister received information that I was on a list of potential targets for a kidnapping gang. I had to leave for six months and join my family in the south of Chihuahua state," she said.
Without other work or the chance to change her profession, Maldonado decided to return after the criminal gang which had threatened her was arrested. "I took back the same practice, with the same hours. I have the same car. I didn't change anything because they can't reduce us to our knees. If something happens to me, may God help me," she said.
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