Methodology

This report is based on research conducted between September 2011 and February 2014, including field visits to México in September and October 2011, February and April 2012, and February and October 2013. Field research was conducted primarily in the states of Jalisco and Chiapas as well as in México City. We chose these locations for research because of their geographic diversity, with Jalisco situated in Western México, Chiapas in the south, and México City in Central México. Additional research was conducted in the city of Monterrey, Nuevo León, a state in Northern México. We also performed additional research in México State because of its government’s proactive efforts to develop palliative care. We also conducted extensive desk research regarding palliative care availability in various other parts of the country.

Over a cumulative total of eight weeks in México, a Human Rights Watch researcher conducted 115 interviews with a wide variety of stakeholders, including 74 people with cancer, HIV/AIDS, and other life-limiting health conditions, or their relatives; 24 healthcare workers, including oncologists, anesthesiologists, palliative care doctors; 12 pharmacists or pharmacy personnel; and representatives of two pharmaceutical companies.

Interviews with patients and their relatives were conducted at their homes or in palliative care units at hospitals. Interviews were conducted in private whenever possible. Interviews were semi-structured and covered a range of topics related to palliative care and pain treatment. Before each interview we informed interviewees of its purpose, informed them of the kinds of issues that would be covered, and sought their consent before proceeding with the interviews.

Interviewees were informed that they could discontinue the interview at any time or decline to answer any specific questions, without consequence. No incentives were offered or provided to persons interviewed. We have disguised the identities of all patients, relatives and healthcare workers we interviewed in this report to protect their privacy, except when they specifically agreed that their real name could be used.

The Human Rights Watch researcher who led the research conducted almost all the interviews in Spanish, and was assisted by a Mexican psychologist with palliative care experience. A few interviews were conducted in English because the interviewee spoke English fluently.

Human Rights Watch also submitted 24 requests for information under México’s freedom of information act, including one to Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS), one to the customs agency, and 22 to México’s states. We were unable to submit requests to the remaining nine states because their websites were either not functional or did not allow us to submit the requests. We received responses from COFEPRIS and 15 states. COFEPRIS’ response also covered México City and Nuevo León.

In June 2012, Human Rights Watch presented preliminary findings to the then minister of health, officials at the Federal Commission for the Protection against Sanitary Risks (COFEPRIS), and the National Commission for Social Protection in Health (NCSPH), which runs Seguro Popular. Between April 2013 and June 2014, Human Rights Watch presented preliminary findings to various officials of the new administration, including two deputy health ministers, the head of COFEPRIS, and officials at NCSPH, IMSS, and ISSSTE.

While the report focuses primarily on the availability of palliative care, various sections of this report examine the situation with pain treatment and pain clinics. Palliative care services and pain clinics are not the same. The former focuses not just on management of pain but also on other physical, psychosocial, and spiritual problems whereas the latter focuses not just on patients with life-limiting illnesses but also on those with acute or chronic pain problems.

All documents cited in the report are either publicly available or on file with Human Rights Watch.