From “Demons” To Telemedicine: Epilepsy Care in Mexico - Dr Yanin Rivera, Hospital Regional Tlalnepantla ISSEMyM, Mexico
Paediatric Neurologist Dr Yanin Rivera shares how cultural beliefs, limited access to healthcare, education, and innovative telemedicine solutions are shaping the landscape of epilepsy treatment, care, and prevention in Mexico! Transcription and links are below! 👇🏻
Reported by Torie Robinson | Edited and produced by Carrot Cruncher Media.
Podcast
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00:00 Yanin Rivera
“They think already that this condition of epilepsy it's because you know like a punishment of the gods or, like, you know, like, demons and witches and all of like supernatural things and you know, unfortunately, we still have these beliefs.”
00:23 Torie Robinson
Imagine having to translate everything about epilepsy - in detail - into 68 languages - just for one country! And you need to work with patients, families, and communities who believe epilepsies are due to punishment from a god, demon, witch, or other supernatural creature. Well, challenges like these are way more common than many realise, especially in LMICs such as Mexico! Today, Yanin Rivera from Mexico, tells us how she is challenging all of the above in her country through education, community work, and telemedicine!
If you haven’t done so already, please like and comment on this episode, and subscribe to our channel, so that we can get way more people around the world learning facts about the epilepsies!
01:08 Yanin Rivera
I am Yanin Rivera and I am from Mexico. I am a paediatric neurologist and I am working in a hospital, like a second level here, and the name is Hospital Regional Tlalnepantla. I am looking patients with epilepsy, and this is my job; to see kids and all kinds of patients from childhood to adolescence with epilepsy. And we are already preparing everything to be a reference centre of epilepsy here in Mexico City.
01:48 Torie Robinson
So, what is access to care for people with an epilepsy like in Mexico?
01:55 Yanin Rivera
We are 2000 neurologists, but we are only 600 paediatric neurologists in Mexico. But most of us, we are living here in the city. So the access - it’s very limited in the rural areas.
02:19 Torie Robinson
So, tell us about the demographics of people in Mexico and how is that related to the epilepsies?
02:24 Yanin Rivera
We are a very crowded country. have 130 million people living here. And the poverty here; it's so much. It's like for 7 million people, they are in poverty, but in extreme poverty, like 9% of these. So, we have very limited resources in health with these extreme poverty people. So, they don't have enough access to get opportunities to attend all the conditions like epilepsy. And the thing here is like we need it. We need to be doing more access the health to them.
03:16 Torie Robinson
Can you tell us why people who are living in poverty in Mexico are more likely to actually have or develop an epilepsy, please?
03:25 Yanin Rivera
It's because they have like very limited education and they don't know how to be taking care like in special of the pregnancy. So, they don't have enough access to the information. Some of the patients that we detect with epilepsy, it's because they don't have like a good pregnancy; like all the antenatal factors, they don't have very good control. And that's why the encephalopathy (hypoxic-ischemic encephalopathy) at the birth; it's a very common aetiology of epilepsy here in Mexico. The lack of education here is playing a very important reason to have very high numbers. So, if we have prevention and we have education in mothers, so we can have, you know, reduce the numbers in epilepsy. If we are checking the aetiology - like all the causes of epilepsy here in Mexico, we have number one, like the structural things that like dysplasia, you know, agenesis of corpus callosum, and all of the structural things that cause epilepsy. And in the second number, it's this one, like all about the asphyxia, birth asphyxia. And the third, it's brain injuries/trauma, because the people is having this risk in especially in the rural areas, that they don't have enough access to arrive to medical attention after they have accidents.
05:32 Torie Robinson
Mmmm.
05:32 Yanin Rivera
And then we can say about the brain tumours, infections like metabolic or genetics. We don't have too much access as the high-income countries to do the genetic things.
05:50 Torie Robinson
Mmm-hmm.
05:50 Yanin Rivera
But we already know that it's important to have accuracy in the diagnosis.
05:57 Torie Robinson
How do cultural beliefs and perceptions affect some people's approach to a diagnosis of epilepsy or treatment of an epilepsy?
06:08 Yanin Rivera
Here in Mexico there's a lot of rural areas still, and most of the people they don't want to have medical attention because they think already that this condition of epilepsy it's because, you know, like, a punishment of the gods or, like, you know, like, demons and witches and all of like supernatural things, and, you know, unfortunately, we still have these beliefs. It's hard for the medicals to go to the rural areas because also the languages that we have here; it's like, you know, close to 70 different indigenous languages. Yeah, it's very hard already to get the information. Yeah, it’s already hard to get the clinicians…
07:05 Torie Robinson
That's kind of cool as well. Sorry, just to say that's kind of cool to have so many languages. I mean, I was like… whenever I think of Mexico, think, Spanish language, but it's so much more than that, right?!
07:17 Yanin Rivera
Yeah, that's, you know, we are trying to like do guidelines, but in different languages, like... because we are closer that like 68, by the way, now 68 different indigenous languages. Spanish here is the natural language, but if the people are living in these rural areas and they are not having the communication as well, we wouldn't [sic] have very good control and already don't have the, you know, how to express, you know, how they feel, how they can, you know, get the information about the treatments, diagnosis. So, we are ready to work on this.
08:03 Torie Robinson
So, what is being done to challenge this whole situation and improve the quality of life of people in Mexico, particularly those in the more rural areas affected by the epilepsies?
08:16 Yanin Rivera
We have like a Priority Epilepsy Program, that is working like 40 years. Like the last count, it was 93 centres in epilepsy and it's very important to have these reference centres in epilepsy because these centres have enough resources - the EEG, the MRIs, and they already have the medications. So, we are trying to get all of this structure in the very rural areas to try to go and educate. We are very few (as I said ) as paediatric neurologists, but we want to educate, like the general medical…
09:16 Torie Robinson
Yeah, community doctors, general practitioners.
09:18 Yanin Rivera
If we educate the family doctors, the practitioners in the community, they will have the knowledge like a nurse, like these practitioners. So, the main goal of this program is to arrive to the very, very high town in Mexico and to let them information in epilepsy subjects.
09:49 Torie Robinson
And it sounds good to me because you can't create more clinicians overnight, right? So instead, you're putting the power into local communities and local clinicians through education. It sounds much more realistic and empowering for local communities, too. So, are you involved in an ILAE program?
10:13 Yanin Rivera
I am involved in the task force in telehealth medicine. In Mexico, we already have some programs in telehealth but not as strong than in North America or in Europe. And the goal is to do a very big program to have this, to get close to the people. And we are working on that.
10:41 Torie Robinson
But now you can do it on phones, right?
10:44 Yanin Rivera
Now you can do on phone and also you can do in the, like, message, and, you know, video call. It's very easy…
10:54 Torie Robinson
Mm-hmm.
10:54 Yanin Rivera
…to have access. Everybody has a cell phone/a mobile and it's easier to have control. And we’re also doing, like, applications here in the mobile cells. And yeah, to have like this register of seizure and to have, like, better control of epilepsy.
11:17 Torie Robinson
Yanin’s dedication, empathy, resilience, and stamina (because her work is a long-term game) is really admirable. We are all of the same species, only a few hours away from each other on a plane - so I believe that we need to work together, globally, to improve the health of our fellow homo sapiens.
Check out more about Yanin at the website torierobinson.com where you can access this podcast, the video, the transcription of this entire episode all in one place. And also, if you haven’t done so already, please do like and comment on this episode (it really helps us with the algorithms!) so that we can reach out to far more people around the world. And, if you haven’t yet, please also subscribe to our channel! Share this episode with your friends, your colleagues, patients, and families, so that we can get so many more people, around the world, learning facts about the epilepsies! See you next week!
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Dr. Yanin Rivera is a Paediatric Neurologist from México who works at:
The Hospital Regional Tlalnepantla ISSEMyM;
The prominent paediatric centre for neurorehabilitation “Centro de Rehabilitación Integral Teletón, and;
her own practice at the Hospital San Angel Inn
Yanin studied medicine at the Universidad Nacional Autónoma de México and completed residencies in both Paediatrics and Paediatric Neurology.
Yanin continuously furthers her knowledge of the epilepsies through specialist training courses, including (to date):
2024 Latin American Summer School on Epilepsy (LASSE): Emergencies in epilepsy throughout life, São Paulo, Brazil;
2023 San Servolo Advanced Epilepsy course, Venice, Italy;
2022 EPIPED Course: Diagnosis and Related Treatment Strategies, Gerona, Spain;
2021 Diplomatura of Epilepsy, Universidad Nacional Arturo Jauretche, Buenos Aires, Argentina, and;
2020 Latin American Summer School on Epilepsy (LASSE): Treatment of Epilepsies: State of the Art and Challenges, São Paulo, Brazil
Since 2022, Yanin has formed part of the ILAE Telemedicine Taskforce.
In her spare time, Yanin loves to run and do marathons!
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LinkedIn yanin-michelle-rivera-ayala
Facebook drayaninr
Doctoralia yanin-michelle-rivera-ayala-3/neurologo-infantil-pediatra
University UNAM
Hospital Centro de Rehabilitación Integral Teletón
Hospital Hospital Regional Tlalnepantla ISSEMyM
Hospital San Angel Inn Hospital | Mexico City
ORCiD 0009-0001-2922-5428
ILAE yanin-rivera1
ILAE Telemedicine Taskforce Telemedicine Task Force