In this ever increasingly materialistic world it´s quite interesting, and actually gratifying, to find a person who is selflessly interested in helping others, and even more so if that person is a doctor. That´s what I discovered when I went for my interview with Dr. Tornero. Upon entering his impeccable office in Tijuana´s Zona Rio neighborhood, I was greeted by his assistant and also by a soothing background of classical music, which permeated every corner of the office creating an atmosphere of peace and equilibrium. His first words gave him away. ¨Medicine has interested me since childhood, because I discovered that I could help people.¨ This feeling has not diminished with time, on the contrary, it has been a motivation that has driven him to discover shortcomings in the practice of medicine. In addition, it has helped him to create a practice that provides patients with a professional, personal and affordable service that everyone deserves.
¨Medicine has interested me since childhood, because I discovered that I could help people.¨- Dr. Manuel Tornero
A graduate of the school of medicine at the Universidad Veracruzana in his hometown of Jalapa, Veracruz, he later decided to move to Mexico City. He specialized in gynecology at the Universidad Nacional Autonoma de Mexico, and finally in laparoscopy and colposcopy interventions where he became known as a leading physician in the field of gynecology.
Why did you decide on this specialty?Laparoscopy surgery, at the time, was the latest thing and lead to an upsurge in the practice of non-invasive surgery (surgery that does not require large incisions as in traditional surgery). With the laparoscopy technique, three to five small incisions are made in the abdomen where laparoscopic instruments are inserted, such as a video camera, a microscope and other fine delicate surgical instruments. This type of surgery tends to greatly reduce the risk of hemorrhages and other complications because the incisions are very small and manipulation is at a minimum. I studied this sub-specialty for six months and later decided to study colposcopy in relation to uterine and cervical cancer, the Human Papilloma Virus and all pre-cancerous lesions.
Have you seen many cases of cancer while studying this specialty?One sees life very differently when you are only a gynecologist as opposed to being colposcopy gynecologist because as a gynecologist you are given a brief introduction to cervical and uterine cancer, the Human Papilloma Virus, etc. However, when you see and treat so many patients, sometimes 40 or 50 per day, one can see the many different realities in this country, and one of them is the poor practice of medicine. The Papanicolau (pap smear) test is free, yet there continue to be so many cases of cervical cancer, which in fact is the leading cause of death for Mexican women. I have my theories on this subject. To begin with, the person administering the test often is not well trained. If the test sample is taken to a laboratory with insufficient capabilities then the test results may show normal because in general they don´t take the test samples where the lesion is located. Improperly taking a test sample and poor laboratory conditions are all factors that can affect results. Another important factor is the person interpreting the test results. If it´s a good pathologist they can see when there is a problem. If it´s a bad pathologist; or if things are done very quickly; or if they are overwhelmed with work, they can overlook results which can be fatal over time. Unfortunately, since colposcopy is also in fashion, many doctors call themselves colposcopist, but the only thing they do is fool their patients and don´t really know how to do a proper diagnosis. And, if the diagnosis is poor then that can adversely affect the work of the pathologist, as well.
What can a person do to assure early detection of cancer?This is a point against the “colposcopist” because by the time cervical cancer shows symptoms it usually means that it´s at an advanced stage. Symptoms are pain and bleeding when the person has sexual relations, foul odor, tumors, a heavy feeling in the pelvic area. All these symptoms cause the patient to come see us, but more often than not, it´s too late.
Pre-cancerous lesions that are called dysplasia and they do not have symptoms. Only a colposcopist will be able to determine after taking and examining a Papanicolau (pap smear) if the patient has something more. In fact the Pap smear and the colposcopy can work together. It would be ideal for all women to do a colposcopy, however it´s an expensive procedure. The cost can vary between 1000 and 3000 pesos (about $80 - $243 USD), and not everybody can afford to pay that kind of money. That price includes the visit, the Pap smear and the colposcopy. It´s recommended to do this study because it´s very precise. The microscope allows us to see lesions that otherwise might go undetected.
Why don´t gynecologists generally do this type of study?Mostly out of ignorance. In the ideal world, both the patient and physician would have better knowledge of what a colposcopy is and how it is done. In addition, Social Security, ISSSTE and other state health facilities would have specialist that do colposcopy procedures free of charge.
It occurs to me that you learned all of this while in Mexico City. How is it that you decided to move to Tijuana?I first came to this city many years ago and it was very interesting to me how easy it was to have patients from both sides of the border. I´m coming from Jalapa, Veracruz, which did not seem like a good place to grow professionally. I was offered a good job in Mexico City, where I had studied, but it seemed like an overly stressful city to live in. So, I decided it would be better to move to Tijuana. That was seven years ago.
Do you also believe the recession has affected the behavior of your patients over those seven years?
Yes, but I believe there is a lack of awareness on health issues in general. The majority of people go to the doctor when things have gotten pretty bad. There´s no awareness about having a periodic checkup. And now, with people so economically tight, it´s really difficult. A clear example would be the vaccine for the Human Papilloma Virus. A patient who is given the vaccine is protected from the virus for eight years. But, if this patient develops a pre-cancerous lesion or cancer, you´d have no idea how much money they could spend on surgery, chemotherapy, medical studies, etc. And, that´s not even counting the lost days of work.
Is there much awareness about the importance of getting the Papilloma vaccine? Is anybody a candidate to get the vaccine?
There´s still a lot of bad information displayed by the media regarding medicine, because they have not had the power to speak the truth. Three years ago, I attended the first conference about the beginning of the vaccine to protect against this virus. Only 50 gynecologists from Tijuana attended. At that time they said that the vaccine was only for women between 18 and 25 years old, but I wasn´t so convinced of this. I spoke with those who were promoting the vaccine and with the doctors who brought the vaccine to ask them about why only women in this age bracket. They told me that it all had to do with marketing because the studies were only done on women from 18 to 25 years old. The studies for both men and women from other age groups did not provide results nor did they have the proper permits that could validate the studies. With this in mind, I began to apply the vaccine to men and women of different ages. After three years we are continuing to have our meeting where the physicians can talk about their experiences. A year ago announcements started that the vaccine was for all ages and also for men, who are the principal carries of the virus.
What are the symptoms of the Human Papilloma Virus?Symptoms are similar to other viruses that cause cellular damage such as hepatitis. The Human Papilloma Virus tends to attack cells in the area of the cervix and the uterus. This is an area where cells are under formation and it´s here where cervical dysplasia can occur, which is a pre-malignant or pre-cancerous lesion in the cells of the uterus. There are three types of dysplasia; light, moderate and severe. Moderate and severe dysplasia are more dangerous and should be treated as a major risk which can transfer into cancerous lesions. Men are the principal carriers of this virus through sexual transmission. On the other hand, it´s rather difficult to attack the Papilloma Virus because to this date there are 120 known sub-types of the virus. When someone is vaccinated, the other sub-types of the virus are not affected. There is a vaccine which covers four types of the more common forms of the virus. Of these, two are the types that produce warts and two that produce cancer. People generally come to the doctor´s office when they realized that they have a wart because is very difficult for a woman to realized she´s infected with the virus, if there are no symptoms.
How can a person become infected?In 90 percent of the cases it is from sexual transmission, but it´s not the only way. Infection can also occur when there has been contact with the area around the genitals. For example, if a Pap smear is done with metal instruments that have not been properly sanitized, a patient can become infected. Also, infection can occur at a gymnasium, in a swimming pool or in a lavatory. Personal hygiene instruments should only be used by one person.
What is the treatment for someone who has become infected?There is no treatment for the Human Papilloma Virus. It can be brought under control, but it cannot be totally eliminated. We´ve seen that applying the vaccine not only can be used as a preventative, but also as a therapy. We´ve seen lesions disappear for patients who have 10 or 20 lesions when the vaccine is applied. Pre-cancerous lesions such as light to moderate dysplasia tend to disappear. The vaccine fortifies the immune system and blocks the virus´ development process.
So, this inspired you to form a group of physicians who would be more aware of their patients´ needs?
Yes, the idea came about to consolidate a group of physicians who placed the patient above just making money and who would practice medicine with the highest ethical standards possible. It has taken a bit of effort, but little by little, our group is coming together. Our goal is to have two or three doctors for each specialty, preferably a male and a female, to make things more comfortable for our patients. For example, in my case, I´m a gynecologics, but I´m not the only one. We have a female gynecologist, as well
What does this project involve?The project involves a group of physicians, laboratories, radiologists, hospitals and pharmacies all working together for the patients best interest so that they can have peace of mind that we are all ethically committed. All of us have official certifications and professional titles that correspond to our specialties. It´s a guarantee that we can provide to our patients. But it´s not just that. We also offer other services for the well being of our patients such as spas, restaurants, nutrition, beauty salons ad plastic surgeons.
What is the name of the group?
Grupo EME and it means medical excellence and ethics.
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