The pains of public health after ten years of recession and austerity have unleashed an unusual event in a Spain reluctant to conjugate the verb to resign. A score of heads of health centers in the region of Vigo They resigned en bloc to their positions last December not to be "accomplices" of the destruction of the cuts. His rebellion from the heart of the system has done more damage to the Government of Alberto Núñez Feijóo than the massive citizen protests of recent years and has led to the call for a strike in all Galician primary care on the next 9, 10 and 11 April. "We have felt like cargo mules with earmuffs," sums up the pediatrician Luciano Garnelo. "Those at the top told us that if we were not able to do more with less, we were bad professionals and we believed it. Until one day we realized that no, that the fault was not ours ".
Garnelo is one of four resigned medical leaders who have agreed to tell how they have lived through this decade of budget cuts. He and his colleagues have had to fit, on the one hand, the pressures of those responsible for the Consellería de Sanidade that ordered them to "reorganize the service with crumbs." And, on the other, face the obligations of an increasing demand of patients, increasingly aged and beaten in their physical and mental health by the emprobrecimiento that caused the crisis, and the complaints of their overworked colleagues. "The work of the intermediate command has been tremendous during these years," laments Pilar Cobas, former head of the Val Miñor outpatient clinic and another one of the doctors who are now fighting for the Galician government to give primary care of the means it deserves.
The edge of the budget scissors began to be felt in the outpatient clinics when the Galician Health Service (Sergas) abruptly retired all 65-year-old doctors. Some people found out because "they cut their email." "They came to their office one day and told them that they no longer worked there; they even retired people by burofax, "recalls Cobas. After dismissing the experienced, it was the turn of the MIR, who began to abandon en masse public health at the end of their training because of the precarious work that was established.
It was like that, they explain, how Spain was running out of doctors, a lack to which in Galicia the Xunta blames all the ills of health, but which, according to reproach professional associations, unions and scientific societies, did not fall from the sky. "We also came to believe that there were no doctors and that's why they did not cover the losses of the comrades, but there are no substitutes if you treat them badly and go somewhere else. We were slow to see all this, "confesses Susana Aldecoa, former service manager of the Beiramar de Vigo health center and president of the Galician Association of Family and Community Medicine.
The work multiplied and the professionals waned. He also began to resent the material. "If something broke, you had to send 20 writings to be heard. Then they told you that they had already sent it to you, but you did not get anything, "says Luis López Vilar, former chief of the outpatient clinic in the Vigo neighborhood of Teis. While they "managed the misery" with great difficulty, the Administration announced and inaugurated a new health center. "It's more colorful than keeping the old," says Cobas.
To that "politics of facade and appearance" attribute the resigned former health leaders the reason for primary care has been the great loser of this decade of cuts. In Galicia, since 2009, health centers have lost not only -400 million euros budget, according to the Galician Association in Defense of Public Health, but their management has become dependent on the hospital managers of each health area. "Here I like the appearance policy very much, presenting new gadgets to get in the press," rejects Garnelo.
In Vigo this decompensation has been much worse, they add, because in the middle of the crisis a new hospital was built to merge two old centers and It opened in 2015 with a very conflictive move. "The drainage of funds to the new hospital Álvaro Cunqueiro was total and waiting lists increased," they say. It was precisely when he tried to refer his patients to the specialist when these doctors came face to face with other of the "perversions" of sanitary austerity.
The "traps" of the waiting lists
Garnelo, Cobas, Aldecoa and López are run over when they describe the "traps" in which they fell during these years while trying to refer their patients to the hospital. It extended, for example, teleconsultation, a system of hospital consultation without the presence of the patient in which the attending physician makes a first trial with the specialist to gauge the severity of the case. What started as an option became the only possibility of access to these appointments and, according to them, the obstacles to finally getting the patient treated were constant. "It was a way to close the door of the hospital to our patients," Garnelo describes.
But it was not the only one, they emphasize. When a patient was not given a hospital appointment due to a lack of space, he went to the so-called "virtual mailbox", a "black hole in which there can be thousands of patients waiting for them to go to the health center to ask 'what's mine. " There are other cases in which the name of the patient requesting the appointment is noted and "he is told that he will be called", they add. "These are all ways of camouflaging data used by health managers to create a fictitious reality about the health situation," says Garnelo.
Pressed by the resounding resignation of 80% of the heads of the Vigo health centers, the Feijóo Government set up work tables to design a new model of primary care throughout Galicia. The draft reform that came out of those meetings has not satisfied almost anyone for its lack of concretenessn. "No proposal has specific figures and deadlines," criticizes Aldecoa, who recalls that they have been warning the Administration for years that "this was going to burst" and that the letters they sent to health managers "were not even answered." The Xunta signed last year a strategic plan for the Vigo area agreed with the professionals, but "then put it in a drawer". "That came out of two years of work and was not applied and now they want us to create the new model of primary care that they have done in eight hours of meetings," adds López Vilar.
The twenty resignation of heads of Vigo, which define themselves as a "plural group, oblivious to partisan positions," has already announced that it will support the three days of strike convened in April by the Galician Coordinator of Primary Care: "We accumulated between 20 and 30 years of experience. We are the ones who in the eighties created the primary care, those who made the programs and the evaluations, those who put the tables and chairs. Now our discomfort has exploded. "