Interpersonal Challenges in Surgical Care Provision in Rural Mexico: A Qualitative Study

Background: Chiapas is among the states with lowest access to health care, like surgical services, in Mexico. A better understanding of the role of interpersonal relationships in referral systems could improve access to care in the region. The purpose of this study was to analyze the underlying barriers and facilitators to accessing surgical care at public hospitals run by the Ministry of Health in Chiapas.   Methods: In this qualitative study based in grounded theory, we performed semi-structured interviews with 19 surgical patients and 18 health care workers at three public hospitals in the Fraylesca Region of Chiapas to explore barriers and facilitators to successfully accessing surgical treatment. Transcripts were coded and analyzed using an inductive, thematic approach to data analysis.   Findings: The five major themes identified as barriers to surgical care were dehumanization of patients, the toll of rehumanizing patients, animosity in the system, the refraction of violence onto patients, and poor resource coordination. Three themes identified as facilitators to receiving care were teamwork, social capital, and accompaniment.   Interpretation: Health care workers described a culture of demoralization and mistrust within the health system that is worsened by a scarcity of resources. As a result, patient care is hampered by conflict, miscommunication, and feelings of dehumanization. Efforts to improve access to surgical care in the region should consider strategies to improve teamwork and expand patient accompaniment.  Funding Information: The Harvard Mexico Foundation, the David Rockefeller Center for Latin American Studies, the Abundance Foundation, and the National Council of Science and Technology of Mexico provided funding for this project Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics Approval Statement: Researchers read and obtained verbal consent from patient participants. This study was approved by Harvard IRB, the Instituto Tecnologico y Estudios Superiores de Monterrey (ITESM) ethics committee, and the Chiapas MOH ethics review board.