Health: The two faces of primary care in Madrid: frenzy without doctors at the Puente de Vallecas, tense calm in the center | Madrid

Health: The two faces of primary care in Madrid: frenzy without doctors at the Puente de Vallecas, tense calm in the center |  Madrid

It takes about 40 minutes by public transport to get from the Las Cortes health center, 200 meters from the Congress of Deputies, to Villa de Vallecas, south of the capital. The first is on a crowded street in the Centro district, where there are nearly 140,000 residents, but few passers-by enter the building. The second is located on a quiet street in the Villa de Vallecas district, which has some 115,000 inhabitants, and everyone who crosses it has just entered or left the health center. The morning passes differently in the two, and this is a reflection of what is happening these days in the 265 health centers of the community: while in the south the queue of patients does not go down to any moment of the 15 people and six doctors are missing, in Las Cortes the workforce is complete, eight doctors, and no more than seven people accumulate in the hall. However, the professionals of both criticize having been overworked for a long time, and that their situation has worsened due to the chaos of the reopening of extra-hospital emergencies.

“There is the tail? ” My mother!.

The Villa de Vallecas health center is located in one of the poorest areas of the capital and has been receiving patients continuously throughout the morning of this Monday. At noon, 10 people lined up to be served. An hour later, they were a little more than double. “I’ve been here a long time now. They sent me an emergency electrocardiogram, a nurse came and went,” a woman tells her husband, waving the appointment flyer. A baby is crying in his mother’s arms – “ch, chhe whispers to her, “the comings and goings of doctors and nurses are constant, and the four administration employees don’t have enough hands.

“For December 2, at five minutes to four.

-December 2?

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“Yes, December 2.

― Vaya…

Almost every conversation they have with patients is similar, and they comment that long lines and overcrowded consultations are not a one-time event. “You went to choose one of the worst off places,” one of them said as he left. “Look at the list of requests, heads and a half and I’m half done. Now I can’t do anything else. When I’m done, we’ll talk, but I still have…”, adds a doctor from the centre. And he comes running through the automatic door.

Her name is Margarita Miguel, a family doctor at the center for nearly 20 years. At half past three in the afternoon, he comes out again, again with his tongue hanging out, and says he only has a few minutes. He has just completed the face-to-face consultations ―54 patients― and he still has the telephone ones. In total, it will serve about 70 people in a single day. He should have left his shift half an hour ago, but he believes that “at least until five o’clock” he will have to stay: “It’s devastating. We do not provide Six doctors have disappeared for a year and a half and their consultations are shared between us who remain”.

She is one of the family doctors who have decided to support the indefinite strike of general practitioners and pediatricians, which will begin on November 21, and which is in addition to that called by the doctors’ union (Amyts) against the reopening project. out-of-hospital emergencies. “Today, we had to attend, in addition to the appointments, 15 emergency doctors. We don’t even reach a minute per patient and almost every day it’s like that,” he explains.

International organizations recommend that each professional attend to 20 or 25 people in a day, but Miguel’s schedule, like that of other doctors in Madrid, usually exceeds 50 patients a day. “The problem with primary care is that no leave is covered. In all the time I’ve been here, I’ve never seen anything like it. Before the pandemic they weren’t replacing either, but now the burden is huge. If the extra-hospital emergencies worked well, there would be less serious things going there, ”he adds before answering another call.

She’s not the only one complaining. Ángeles de Madrid and her husband, aged 77 and 82 respectively, have been at the center for two and a half hours. She needs a flu shot – there are about 25 people in the waiting room for the same – and he needs a wound in his forehead to be treated. “Yesterday [por el domingo] We were at the demonstration. From covid to this part, everything fell apart. It’s out of control. To make you pass a test, they take months, ”he criticizes.

This is the case of María Ángeles Fernández, 36, who could not get an answer by phone. She called several times because she is lucky: a few hours ago, she learned that she was pregnant. But the illusion was short-lived, at the center he was only given an appointment on December 12. “How am I going to wait a month to be seen in person during my pregnancy. I know it’s not an emergency, I will wait until three hours, when the consultations are over, if necessary. Everything is going wrong worse,” he says. Her husband insists that they go to another health center, but Fernández doesn’t quite agree, she prefers her “usual” doctor to take care of her. .

Carmen de la Morena has been in line for about 15 minutes and leaves angrily. She met a friend who was given an appointment for November 29: “It’s horrible. They gave me 25 days for a stye. Before you came and it was overnight. But they [los médicos] They are not guilty, it is the fault of others [por el Gobierno de Ayuso]. I usually wait and we have to come, because if you call… nothing. They don’t take They are that they can’t take it anymore”.

At the Las Cortes health center, every time the phone rings, someone from the administration answers. They almost always have an appointment available for two or three days. “It depends on the doctor, sometimes it’s 10 days, but not a month, never,” explains one of the workers.

Two people outside the main door of the Las Cortes health center in the Centro district of Madrid on Tuesday.
Two people outside the main door of the Las Cortes health center in the Centro district of Madrid on Tuesday. alvaro garcia

The metal benches in the waiting room, more than 30 and placed one behind the other along the corridor, in front of the doctors’ offices, were practically empty at eleven o’clock on Tuesday morning. About 10 people were seated waiting to be served. “Do you know how long that takes? asked a young boy. “No, it’s fine, it’s fine,” replies a woman. The flow of patients is more or less constant until noon. Then comes the peak of influx. The room fills up, the tension mounts, the pace of work is high, there is hubbub and a small queue of five people forms at the entrance. Some patients complain of having had to wait half an hour, others, the majority, feel they have been served rather quickly.

Javier Larrañaga, a family doctor for 35 years, considers the center to be well organized. He joined the team of eight doctors – all working – last April. Before, he was in the Lucero health center, in the Latina neighborhood, south of the capital, and in Pascual Rodríguez, in the same area and which has been closed since the start of the pandemic. The professional admits that daily life in Las Cortes is not as hectic as in the centers of neighborhoods with low per capita income – the average income in the Centro neighborhood is almost 33,000 euros and in Villa de Vallecas around 25,000-, but that the workload is also above ideal. “Higher-income neighborhoods have less pressure on health care because those with greater purchasing power can seek private insurance and those with lower incomes cannot. Yes, I feel the pressure is less here, although I wouldn’t say it’s low,” he said.

He takes care of an average of 40 patients a day: “I could exaggerate and say that I arrive at 60 or 70, but in this center I don’t see that. Even so, it’s a very short time per patient, about six or seven minutes. And in winter the pressure skyrockets.” He, like the Villa de Vallecas doctor, will also join the strike on November 21 and participated in the massive protest last Sunday. “The institutional mistreatment of doctors by the Community of Madrid, and not only of the family, has been going on for years. The pandemic has exposed the failings of the system that politicians are trying to hide. I feel neglected. Fortunately, there are eight of us here, but if we go on vacation, they do not replace our position and the questions are distributed among the remaining colleagues, ”he criticizes.

Madrid is the wealthiest community in Spain and the one that spends the least money on health, despite the regional government claiming otherwise. In 2021, this item represented 31.58% of the Region’s Budget, a percentage that has been falling since 2005. In addition, it is at the bottom, ahead of the Balearic Islands, in number of family doctors per 1,000 inhabitants and in During over the past two years, of the 443 family and community medicine specialists who completed their residency, only 37 remained in the capital. “When they say there are no doctors, it’s not that there aren’t any, it’s that they’re fleeing because of the terrible conditions, the lack of institutional recognition and the very low wages,” complained Larrañaga.

He leaves his office and a man approaches, he seems angry.

“Are you the doctor?” I waited 20 minutes.

-You see? It’s not paid.

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