“The system is collapsed, if in the next two weeks we continue like this, it will collapse.” Natividad Gil García does not hide his despair over the emergency that Primary Care is experiencing in Madrid, the main focus of Covid-19 in Spain with about 175,000 infections since the start of the pandemic and almost 9,000 deaths, of which 115 only in the last week.
Gil works as a pediatrician at the Monóvar health center, in a neighborhood of the capital where the cumulative incidence of coronavirus is above four hundred cases per 100,000 inhabitants. Although other areas of the city practically double that figure, the health service warns of the rapid worsening of the situation: “Normally, in September and October I used to have between 20 and 30 children a day, but this year I am already 55 and still the return to school has not finished. What is going to happen when all the students join and the contagions increase? ”, He asks himself at the doors of his workplace, under a banner with a green heart that has become a symbol of the defense of public health.
Threat of indefinite strike on September 28
Like her, practically all the personnel of this health center, around 30 people, have supported the 15-minute strike called by several unions before, what they consider, “the abandonment and contempt of health professionals” by the government from Madrid. This is just the first notice; Primary Care doctors have already announced that they will go on indefinite strike on September 28 unless the regional executive sits down to negotiate.
“It is our last resort, none of us want a strike because it means putting lives at risk. Our job at this time is to help the most vulnerable people, but with all the necessary means and we do not have them ”, explains María Teresa Hernando, a family doctor at Monóvar.
Spain is, behind Russia, the European country with the highest number of confirmed cases of Covid-19, more than 600,000. It also has one of the highest mortality rates in relation to its population, with 64 deaths per 100,000 inhabitants. In the fight against the coronavirus, health centers have become the first line of containment of the pandemic, an added burden for a basic pillar of care that in Madrid has suffered a serious deterioration since the economic crisis of 2008. “The pressure we face is tremendous. In these years, the number of patients per doctor and the bureaucracy has doubled. But, now, with the current situation caused by Covid-19, the workload has skyrocketed, there are doctors who may have up to three and four patients in the same consultation slot at the same time, between phone calls. , face-to-face visits, emergencies, home care and nursing home care. It’s desperate, ”denounces Julián Ezquerra, general secretary of the Amyts union, the majority among the Madrid medical group and promoter of the strike call. “We want an improvement in working conditions, but not only that. Madrid needs more doctors. Of the last promotion of family medicine, half have preferred to go abroad, to other communities or abroad, because they are offered better contracts. And we must not forget that in five years the pensions will be around 25% ”, warns Ezquerra.
To this is added that, at the moment, around 15% of the workforce is out of work, many due to the situation of work stress caused by the pandemic or because they are people at risk when they are over sixty years old. The lack of doctors is preventing some health centers from opening in the afternoon. “Yesterday they called us from another nearby health center to go and help out because there was only one doctor, he was doing two shifts in a row but still he could not treat all the patients he had mentioned and they were going to have to close,” he says Hernando.
The health workers of the Monóvar health center recognize that Covid occupies 80% of their time: “We attend to the cases that arrive, we act as trackers because there are not enough, we request PCR, we make calls to give the results and the subsequent follow-up …
The parallel pandemic of chronic diseases
This saturation of work is suffered by all the people who make up Primary Care, but also by the patients ”, Gil laments. In fact, the coronavirus has caused what Carina Escobar, president of the Platform of Patient Organizations, describes as the “parallel pandemic”, that is, the one suffered by people with chronic diseases who have seen the urgency of Covid-19 in many cases it has left them without medical follow-up. “We have not learned anything from the first wave. We ask for more information, protocols and Covid-free spaces in order to continue going to health centers. But the fact that none of this has been foreseen and that Primary Care is collapsed makes us go back to being risk patients ”, Escobar explains.
Hours before the protest held in front of the health centers, the president of the Community of Madrid, Isabel Díaz Ayuso, announced the investment of more than 80 million in Primary Care to improve the working conditions of its professionals and increase the workforce in a way progressive. “We need them and we recognize them. Primary Care needs a profound change in the entire National Health System and the Community of Madrid wants to lead this transformation ”, Ayuso assured before the regional Assembly. A promise that, so far, has not been able to convince family doctors. “We cannot take any more. There are colleagues who have fallen in the fight against Covid. We don’t want promises or numbers, we want facts ”, Gil concludes. At the moment, the strike call is maintained.