Open Journal Systems

HISTORY AND PHYLOSOPHY OF MEDICINE

Received: 12/08^th 2014

Accepted: April 7^th 2015

Four stages in the history of the Centro Médico Nacional Siglo XXI of the IMSS

^aGuillermo Fajardo-Ortiz

^aSubdivisión de EDUCACIÓN Continua, División de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Distrito Federal, México

Communication with: Guillermo Fajardo-Ortiz

Telephone: (55) 5623 7254

Email: gfortiz@unam.mx

This document presents four stages in the history of the Centro Médico Nacional Siglo XXI (National Medical Center XXI Century) of the Instituto Mexicano del Seguro Social. The first stage started at the end of the third decade of the twentieth century and ended in 1961, it corresponded to the conception, planning and construction of what was to be the Centro Médico del Distrito Federal (Medical Center of the Federal District) belonging to the Secretaría de Salubridad y Asistencia (Ministry of Health and Assistance). The second stage began when the Center was acquired by the Institute, then was known like Centro Médico Nacional (National Medical Center), being put into full operation in 1963, more than twenty-two years later, in 1985, an earthquake virtually ended it, immediately began its reconstruction, finishing the second stage. In 1989 began the third stage, different and new buildings complemented or replaced the structures damaged or destroyed by the earthquake which formed the now Centro Médico Nacional Siglo XXI (National Medical Center XXI Century). In 2004 the fourth stage opened when the four hospitals of the Center were categorized like Unidades Médicas de Alta Especialidad (High Specialized Medical Units).

Keywords: History of Medicine, Health systems, Health services,Mexico

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This is the history of the current day Centro Médico Nacional Siglo XXI of the Instituto Mexicano del Seguro Social (IMSS), which began in the late thirties of the twentieth century. This is one of the greatest exponents of contemporary specialized medical care in Mexico, besides being an important place of teaching, research, and work.

Its history is presented in four chronological stages that reflect membership, architectural changes, economic conditions, epidemiological dynamics and administrative changes.

First stage. A challenge: creating the Centro Médico of the Distrito Federal

The first phase began when the then Secretaría de Asistencia Pública had the idea of ​​having a Centro Médico  in the Distrito Federal like those that already existed in other parts of the world, this was in the final years of the thirties of the last century . Shortly thereafter, the project began to materialize through the Secretaría de Salubridad y Asistencia (SSA), which during the 1940-1946 presidential administration of General Manuel Avila Camacho, intended to replace the Hospital General with this center. In 1945 this Secretaría acquired a neighboring piece of land south of that hospital plus wooded areas and green spaces immediately adjacent, in Colonia Buenos Aires, on the calzada de la Piedad, today avenue Cuauhtémoc.¹ In these expropriated spaces they began construction of some works, the Instituto Nacional de Cardiología and the Hospital Infantil already having been built, and belonging to the SSA, both facilities would be part of the Centro Médico of D.F.; also on the property was the Hospital de la Secretaría de Comunicaciones y Obras Públicas (SCOP).

To prevent flooding during the rainy season the Piedad river was intubated, which was close to what was intended to be Centro Médico of D.F. Just over five years passed, during which the works were virtually abandoned, before the project was resumed in 1952, during the administration of President Adolfo Ruiz Cortines, who took control of it and noted the neglect that the constructions were in.² Hospital SCOP was demolished, as it was already insufficient and functionally inadequate to provide services to the workers of that agency and their families.

By the end of 1960 the Centro Médico of D.F. was already part of the urban environment, housing a total of 15 geometrical-style buildings, bounded by avenues, wide open spaces, along with gardens, terraces and esplanades. The properties that then formed this center were: Admission, Laundry, Education and Housing, Hospital de Especialidades Médico-Quirúrgicas, Hospital de Enfermedades Nerviosas, Hospital de Neumología, Hospital de Emergencias, Hospital de Oncología, Hospital de Gineco-Obstetricia, Hospital de Enfermedades de la Nutrición, Conference and Convention Building, General Office, Machine House, Drug Laboratory, and Nursery. The seven hospitals had just over 2000 beds. The floor area was 207,283 m² and the land surface of 156,000 m².²

Second stage. Centro Médico Nacional inaugurated with presidential address

In 1961 the Centro Médico del Distrito Federal was acquired by the IMSS and began the second stage; that year SSA had financial problems to maintain the Centro and the IMSS had to to strengthen its network of medical facilities, so it was decided to carry out the sale to the Institute, and since then it has been named Centro Médico Nacional. The cost of the Centro for IMSS was 602 million pesos, they paid SSA the amount of 407 million pesos in cash and goods, and the remaining 195 million were used to adapt the property and provide them with the equipment required to cover the needs and characteristics of the population covered by the Institute.

On May 15, 1961 nine buildings were put into operation, some kept their name, others changed them, the buildings that began to provide services were: Auditorium, Education and Housing Building, Laundry, Pharmacy, Hospital de Oncología, Hospital de Gineco-Obstetricia, Hospital de Neumología-Cirugía de Tórax, Conference and Meeting Building, and the General Offices Building.

Two years later, on March 15, 1963, the entire Centro Médico Nacional was officially opened, on that date they opened the hospitals General, de Pediatría, de Traumatología y Rehabilitación, and Convalecencia. For its inauguration there was a grand ceremony with many invited guests. Secretaries of state, politicians, doctors, nurses, teachers, members of the diplomatic corps and students were present, and that day the then president of Mexico, Mr. Adolfo Lopez Mateos said:

"Today, March 15, 1963, the year which celebrates the twentieth anniversary of the enactment of the Ley del Seguro Social, I solemnly declare inaugurated the services of the Centro Médico of the Instituto Mexicano del Seguro Social."

"This is a memorable day in the struggle of the Mexican Revolution to bring health and welfare to workers in the country. The Centro Médico Nacional is one of the great social works whose importance is not for a government, but the continuous, constant and relentless effort of Mexico for social justice, we must forever keep the commitment to make common work a force of solidarity to benefit all Mexicans."³

With their buildings, facilities and human capital, the Centro Médico Nacional would be the largest and most important clinical organization of our country and probably in all Latin America; thanks to the Centro Médico national health care was revitalized. 

22 years passed in which various functional and architectural improvements and reconfigurations were made. Then on September 19, 1985 the majority of the Centro Médico Nacional facilities were hit by a terrible earthquake, which stopped it from providing almost all of its services. This prompted a quick institutional reaction to circumstances, as just over 1880 patients who were at the Centro Médico were transferred to other IMSS hospitals.⁴

Before the disaster, the Centro consisted of the following buildings: Hospital de Gineco-Obstetricia Número 2, Hospital General, Hospital de Oftalmología, Hospital General para la Comisión Federal de Electricidad, Hospital de Pediatría, Hospital de Traumatología y Ortopedia, Hospital de Cardiología y Neumología, Hospital de Oncología, Hospital de Convalecencia, Central Blood Bank, Pharmacy, Central Pathology Unit, Conference Unit, Medical Research Unit, Housing Unit -School of Nursing, Ambulance Central, Maintenance, Laundry and General Offices. The existence of various hospitals meant that there was no important branch of medicine that was not present at the Centro Médico Nacional. Below is a brief overview of some of those buildings.

The Hospital de Gineco-Obstetricia Número 2 had 270 beds, 300 cribs and 70 incubators. The first director of the hospital was Dr. Benjamin Eguiluz Lopez, who dedicated 20 years of his life to the IMSS, thanks to his efforts in the building various aspects of gynecology and obstetrics were integrated. In the seventies of the last century they reduced the length of hospital stay for patients in normal labor to 3 days, which was not without its critics, and in the following decade they put into operation the Programa de Salud Reproductiva of IMSS. The quake disabled the property almost entirely, so it had to be demolished, at the time of the incident its director was Dr. Alberto Alvarado Duran, who through his dedication and vision made significant developments in neonatal, maternal and child medicine, epidural block in obstetrics, in vitro fertilization and embryo transfer.

The Hospital General was a great 10-story building that had 400 beds. Dr. Manuel Quijano Narezo was the first director of the institution, and during his tenure he favored the professional and academic growth of staff and development of research. Until 1970 it had a psychiatry service, when it was considered that this specialty did not correspond to a general hospital; they had an excellent department for medical and surgical emergency care, organized by Dr. Fernando Gonzalez Montesinos and Dr. Adalia Lee. The hospital had eight auditoriums that still remain; on the outside of these there are stone reliefs in different colors, which recall the history of world medicine. In October 1980 a two-story building dedicated to surgical services was added. Much of the construction of this hospital withstood the quake.

The Hospital de Oftalmología and the Hospital para la Comisión Federal de Electricidad were the result of the transformation of properties that had belonged to the Instituto Nacional de Cardiología, all of which were acquired by the IMSS. These buildings withstood the quake, but medical needs made it become, after their renovations, part of the Hospital de Especialidades del Centro Médico Nacional n 1986.

The Hospital de Pediatría served children from birth to 16 years old, its original physical structure was overhauled as this hospital had been planned originally by the SSA for Hospital de Enfermedades de la Nutrición. The Hospital de Pediatría consisted of 12 floors and had a bed capacity for 465 children and 15 outpatient offices. Its first directors were Dr. Federico Gomez Santos, Oscar Creoles and Silvestre Frenk. In the decade from 1961-1970 the hospital began a campaign against nosocomial infections, one of the pioneering institutions in the country to control these problems. By 1975 a service was structured to serve poisoned children, one of the fruits of this was the creation of similar services in other medical organizations. In 1981 it began a program of oral hydration in the emergency room which had great success, prompting its implementation in other medical units of the Institute, thus decreasing the number of hospital discharges for dehydration. The earthquake severely damaged the building, so it had to be demolished.

The Hospital de Traumatología y Ortopedia had 198 beds, providing medical and surgical services to people with traumas, and responsible for caring for patients in case of sequelae; they had rehabilitation services for people over 16 years and a department to serve enrollee burn victims of all ages. Dr. J.A. Ugalde was its first director. The building was badly damaged by the quake.

The Hospital de Cardiología y Neumología was initially led by Dr. Charles Noble, in 1970 it was called Hospital de Neumología y Cirugía de Tórax, and was later known by the name of Hospital de Enfermedades del Tórax, shortly after which physical modifications were made and it was renamed the Hospital de Cardiología y Neumología.

The designations expressed changes in medical guidance for the establishment and were related to predominant epidemiology, as well as existing human and physical resources. The center had 176 beds, had room for individual isolation, intensive care and a coronary unit. Outpatient facilities could serve about 200 patients per day. For some time the hospital had two special programs: one for the detection of rheumatic fever and another for thoracic examination; the purpose of the first was to eradicate streptococcal infection, while the second was intended to discover thoracic pathologies. Most real estate resources of the hospital were affected by the earthquake, only some areas of diagnosis and surgery were saved.

The Hospital de Oncología had 186 beds; Dr. Rafael Martinez Gonzalez participated in its initial organization and became its first director. In the outpatient clinic they could serve more than 200 patients per day, and the intensive care services were an area for the toughest staff, as valves, pipes, tubes and wires seemed to invade the sick from every angle. In the seventies of the last century, the technical and administration audit office was placed in the clinical analysis laboratory, which would later apply to other hospitals.⁵ The quake did not damage the areas of radiotherapy. Dr. Anselmo Vasquez y Curiel, who would be one of its directors, took advantage of the difficult time to promote the improvement in quality of all hospital services.

The Hospital de Convalecencia hosted sick patients discharged from other hospitals of Centro Médico Nacional who needed minimal care, their focus was dietary measures, physical exercise and recreation. The operation of Hospital de Convalecencia facilitated the recovery of patients and allowed better use of beds in the other hospitals of Centro Médico Nacional.⁶ Unfortunately, the building was severely affected by the quake.

The Central Blood Bank operated nationally. The staff who worked there took care to obtain, classify and preserve human blood whole or in fractions; they selected donors and studied recipients to prevent undesirable reactions. From the angle of teaching, they disseminated technical and scientific knowledge on the proper implementation and optimal use of blood. Some areas of the building were not damaged by the quake.

The Centro Médico Nacional pharmacy was, at the time, the IMSS's largest, having all the medicines for the basic chart. It was located in an area easily accessible to the public, on avenue Cuauhtemoc; in addition to serving Centro Médico Nacional hospitals, they served beneficiaries of any IMSS hospital or clinic. The pharmacy was open every day, 24 hours a day. The movement, dispensing, and consumption of drugs was registered by electronic machines, which helped them maintain proper operations and develop statistics for control purposes. Engineering studies predicted its destruction.

In the Central Unit of Pathology studies were done with organs, parts and tissues coming from Centro Médico Nacional hospitals; it contained laboratories, autopsy rooms, equipment and sterilization rooms, refrigerators, laboratories and classrooms for academic and teaching sessions. The quake wiped out almost all the facilities of the Unit.

The Conference Unit consisted of two buildings, A and B, in which meetings of scientific, cultural and social importance were held. Building A was composed of a large auditorium that accommodated up to 900 people, and also five smaller rooms, this area of ​​the unit was practically undamaged by the quake. Building B had three auditoriums, a library, offices, and meeting rooms; it also housed the Academia Nacional de Medicina and the Academia Mexicana de Cirugía. Unlike Building A, this unit was affected by the quake.

The Unidad de Investigaciones Médicas was in a three-story building in which there were laboratories. Many of the panels were movable to have areas adequate to meet specific needs. There were sections to house animals for experimentation. The building was badly damaged by the seismic event.

The Housing Unit-School of Nursing had the capacity to accommodate 250 doctors in training, interns, residents, and visitors, some of the latter, of foreign origin; there was also the School of Nursing, the educational entity charged with preparing and training nursing staff of various levels throughout the IMSS medical system. The unit suffered extensive damage and finally disappeared. 

The laundry had a capacity to process up to 10,000 kilos of clothing per day, a task that could be performed in eight hours, the clothes came from various medical units of the IMSS and not just the Centro Médico Nacional. The equipment was saved.

The General Offices were the seat of the Subdirección General de Medicina of IMSS and its various agencies; it represented the administrative, technical and educational capital of institutional health services. The quake disabled the building.

In the decade of 1971-1980 Centro Médico Nacional hospitals hosted resources that at the time were considered the most advanced technology relating to: nuclear medicine, ultrasound, dialysis, computed axial tomography and more.

The Centro Médico Nacional worked 22 years, attended hundreds of thousands of patients, the earthquake caused the pride of Mexican medicine to be shaken. The Centro Médico Nacional represented a site of medical possibilities, not just for health, but also to develop human resources, research, offer and share services and to provide and create jobs. In its corridors, the figures of students, medical interns and residents, young nurses and orderlies were indispensable, present all hours of the day and night.

In December 1985, the buildings of the Hospital de Gineco-Obstetricia, Hospital de Oncología, Hospital General, Hospital de Pediatría, Hospital de Cardiología y Neumología, Hospital de Traumatología y Ortopedia, and General Offices, crumbled as if under the action of hundreds of kilograms of plastic explosives.

It took only seconds to destroy the buildings, even some that seemed that they would not yield, remembering their past, but which eventually crumbled, followed by other properties disappearing. And they fell, just over two decades of brave struggle and efforts to seek the health of Mexicans.

Third stage. From adversity to strategic response: Centro Médico Nacional Siglo XXI

Despite the earthquake, a few areas continued to operate. At the end of 1989 some buildings had been reconstructed and new facilities resumed their activities, those were still days of physical decline, despite the labor and intellectual wealth they held. It was then that Siglo XXI was added to the name of the Centro Médico Nacional, beginning the third stage; three years later the president of Mexico, Carlos Salinas de Gortari, inaugurated it on 27 April 1992 in front of representatives of medical and scientific societies, government officials, union leaders, and beneficiaries.⁷ The number of hospitals was reduced from nine to four, following demographic and epidemiological studies. The hospitals of Centro Médico Nacional XXI Siglo would be the following: Pediatría, Cardiología, Oncología and Especialidades Médicas, with 846 beds in total plus the Central Blood Bank, the floor area was over 222 thousand square meters, in buildings that joined tradition and modernity.

An outline is presented of the hospitals at their inauguration in 1992.

The Hospital de Cardiología had 186 beds and served more than three thousand visits per month. An example of their progress was the two-level cardiac catheterization room for hemodynamic and angiographic diagnosis.

The Hospital de Oncología had 250 beds available, 41 offices, cobalt pumps, linear accelerators, operating rooms and an area for ​​bone marrow transplants.

The Hospital de Pediatría covering 40 medical and surgical specialties, had 200 beds.

The Hospital de Especialidades had 210 beds and 49 clinics, and covered 52 medical specialties.

The Central Blood Bank received more than 5,500 donors every month, attended the requirements of the healthcare units throughout the southern region of the Valley of Mexico, plus the states of Guerrero, Queretaro, Chiapas and Morelos.

In the Centro Médico Nacional XXI Siglo since then, in addition to hospitals, there are buildings that house the Dirección Regional Siglo XXI, the Conference Unit, of the Centro Nacional de Investigación Documental en Salud “Ignacio García Téllez”, named in honor of the second director of IMSS, where the Institute’s historical heritage is preserved. In addition to these properties there are: the Coordinación de Enseñanza e Investigación y Políticas de Salud, an exhibition hall, the building for the Academia Mexicana de Cirugía and the Academia Nacional de Medicina, a pharmacy, a subway station, banking facilities and a restaurant. From 1988 to 1993 at the Centro Médico Nacional had a history other than medical; Building A of the Conference Unit served as headquarters of the Cámara de Diputados, and currently one of the areas houses the largest nursery of medicinal plants in America.

Fourth Stage. The important thing is to be more than what one is: Unidades Médicas de Alta Especialidad of the Centro Médico Nacional Siglo XXI

The fourth stage began in 2004, when the four Centro Médico Nacional hospitals were rated as Unidades Médicas de Alta Especialidad (UMAE), upon determining that they would act as decentralized organs with management, technical, administrative, and budgetary autonomy,⁸ considering that they grant specialized medical services, that their educational activities are excellent and health research is at the forefront. Each unit is classified as a "Safe Hospital", its foundations are about 14 meters deep.

The Hospital de Pediatría in January 2013, was named after Dr. Silvestre Felix Frenk Freund, in honor of its former manager, distinguished professor and exemplary teacher.⁹

In the Hospital de Cardiología, in 2001, the first titanium heart implant was performed, six years later, in November 2007, the Unidad de Investigación Biomolecular "Ruben Aguero Sánchez" was inaugurated, named after the former manager of the hospital; since 2012 minimally invasive cardiac surgery is routine.

Hospital de Especialidades was named after "Dr. Bernardo Sepúlveda" remembering the Institution’s famous gastroenterologist. In September 2007 the clinical analysis laboratory was renovated, equipped with an information system for the control of samples and patients, improving their productivity and efficiency, which has reduced staff contact with samples, granting biosafety to chemists, laboratory workers, and support staff. In 2008, doctors at the Hospital de Especialidades began a protocol, placing a brain pacemaker in a woman who walked again after being operated on by a multidisciplinary group, the 52-year-old patient was discharged, they had treated Parkinson’s disease.

The Hospital de Oncología, starting in 2013, features the latest generation of linear accelerators and a cyberKnife, to enhance therapeutic actions.

Centro Médico Nacional Siglo XXI is bounded on the north by the Hospital General "Dr. Eduardo Liceaga" and Hospital Infantil de México “Dr. Federico Gómez”, both of SSA; moreover, to the west it borders avenue Cuauhtemoc, to the south Ignacio Morones Prieto axis, formerly Baja California avenue, and to the east with Doctor Jimenez street.

The image of the Centro Médico Nacional is linked to its permanent art collection, which has great symbolic weight; in addition to the stone reliefs on the auditoriums of Hospital de Especialidades, there are murals, stained glass, carvings, statues and aluminum casts, which were made by renowned artists, and which combine a multiplicity of meanings; many of these works testify to historical aspects of medicine in the world and in Mexico.

Today, the Centro Médico Nacional Siglo XXI is an irreplaceable reference in Mexican medicine. More than 50 years of fruitful activity testify that it has fulfilled and is fulfilling the original purpose for which it was created: to serve hundreds of thousands of beneficiaries.

These schematic lines have been written by one who knows and has known the Centro Médico Nacional Siglo XXI of IMSS, from 1954 to date, who participated in the initial planning, worked on it, was in the earthquake of 1985 and participated in its recreation.

References

1. Asociación Mexicana de Hospitales. Centro Médico del Distrito Federal. Expediente. México, D.F. 1957.
2. Olvera E.F. Antecedentes. Hospital. Hospitales. Centro Médico. En libro Hospital General. Centro Médico Nacional IMSS (1963-1985). Coautores- Alejandro Treviño Becerra, Francisco Olvera Esnaurrizar, Félix Ramírez Espinosa, Margarita Díaz Jiménez. Colegio de Médicos Posgraduados. IMSS. A.C- IMSS. 1996. México p. 16.
3. Instituto Mexicano del Seguro Social. Centro Médico Nacional. IMSS. 1969. p. 32.
4. El Universal, Excélsior, El Nacional. Notas de dichos diarios periodísticos. 21, 22 y 23 de septiembre, 1985. México.
5. Mancera Massieu R. Expansión. Evolución de los Servicios Médicos. IMSS. 1944-1974. IMSS. 1974 p. 233.
6. Instituto Mexicano del Seguro Social. Hospital de Convalecencia, expediente de la Jefatura de Planeación y Supervisión Médica. Instituto Mexicano del Seguro Social. México. 1974.
7. Instituto Mexicano del Seguro Social. IMSS una historia compartida. 1943-1993. Editorial Gustavo Casasola, S.A. de C.V. 1993. México. pp. 163-164
8. Instituto Mexicano del Seguro Social. Manual de Organización de las Unidades Médicas de Alta Especialidad. IMSS. México, 2004. pp. 1-7
9. Sepúlveda-Vidosola A.C. Silvestre Frenk, el médico investigador que eligió como reto la salud de los niños. Rev. Med Inst Mex Seguro Soc. 2014; 52 (3): 52 supl 2:56-7.

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