“I agree! Do I have to sign?” Marisa confirmed, approaching a small table in front of the Vicente Soldevilla health center in Puente de Vallecas. at this point. Under the banner of defending public health, Feder spent half the morning soliciting support from dozens of neighbors who attested to the unsustainable conditions in which his clinic found itself. “Everything was terrible and I didn’t want to go into the private sector because I’d been working for something my whole life,” the 59-year-old continued.
Seven months after unions reached an agreement with the health ministry to end a 123-day indefinite strike, problems remain in centers such as Puente de Vallecas. Mainly concentrated in the afternoon shift, positions that are difficult to fill. On Wednesday, during that shift, Vicente Soldevilla received only consultations from Dr. Daniel García and Dr. Beatriz Arribas. In order to take care of her daughter, she reduced her working hours by 50%, and her departure time is 5:30 pm. Him, 80%: Thursday and Friday afternoons, Monday mornings and Wednesdays from 11 a.m. to 6 p.m. Since then, there have been no doctors at the center.
Specifically, the medical center serves about 25,000 people, more than half of whom work afternoon shifts, and is structurally supposed to have eight doctors. Only two people, not a full shift. Then come down. There were four a few weeks ago. This Tuesday, there are three left. A worker signed on Wednesday. “In both cases, they left after being left alone,” Garcia said, lamenting the “feeling of helplessness, overload, and being unable to do anything more.”
The doctor was allocated a quota of 1,840 cards. There are 1,840 potential patients. But they’re not the only ones she cares about, as they also include colleagues who are on sick leave and the nearly 5,000 residents in the area who don’t have a doctor. Alibaba quota is 1,600. In both cases, they violated any recommendations that limited them to providing high-quality care to 1,500 patients throughout the day, and they failed to do so.
It’s not easy to say you’re not going to serve them because no other colleague can do it.We are caught between responsibility and guilt: we have to be responsible for the health of our people, but in this case we cannot guarantee this responsibility
These quotas will not stop increasing due to the good intentions of professionals who try to mitigate the shortcomings of the system through overtime. “Five or six new people come in every week and because they don’t have a doctor, they ask you for a doctor. You can say no and turn them down, but it’s not easy to tell them you’re not going to be there for them because you know No other colleague can do this. We are between responsibility and guilt because we have to be responsible for the health of the people, but if we are honest, in this case we cannot guarantee that,” Garcia explained.
While talking to the doctor, at the entrance of the health center, a woman came over with tears in her eyes. “Thank you,” he told the doctor. Her 21-year-old daughter has been hospitalized since Friday with pneumonia and colon problems. “Every time she comes in, she’s seen by a different doctor and they tell her it’s a cold until you get her to the hospital,” Nancy Martinez continued. “This time it was me who discovered it, but it was someone else who discovered it because it can happen to all of us,” the doctor admitted. Arribas was listening to the conversation, and he responded to a warning that professionals have been issuing for years: “If this patient has a designated doctor who knows her and knows that she doesn’t usually come, or that she comes twice in a row, , then it doesn’t work for her, even if the symptoms are not obvious, what you give her, the alarm goes off, but because of this overload, we can’t provide ongoing help.”
Nancy now has to check if she is sick. In his hand he holds a ballot scheduled for voting this Wednesday. “He told me the appointment didn’t exist,” he protested. When the doctors saw that the time on the ticket was 7:55 pm, they discovered the reason: “Of course, she is a patient of the colleague who signed in today.” Either they took care of her, or there was no one at that center to take care of her.
“I went to the office and found the doctor”
On Oct. 4, Lori Munoz made an appointment for her mother. He turns 91 on Friday but still faces medication and cognitive decline. “They gave me an appointment for October 23. You can’t wait 19 days even for a cold, but for a 91-year-old it could mean the difference between life and death,” she said indignantly. They recommended she go to the emergency room, but her mother had mobility issues and couldn’t leave the house. “I went to the office and found the doctor. I met Danny and he was very humane like the rest of the team, but the problem was with them, they were overwhelmed. Another time I left a note and the doctor was in the evening Called me at 8 o’clock. Then I found out that he had reduced his working hours and I was supposed to leave at 5:30 pm. The doctor’s shortcoming was not “, she defended firmly. Why don’t they have a designated doctor? “My parents’ two female doctors over the years both left because the jobs were unsustainable.”
Although the Ministry of Health has promised to guarantee a maximum of 30 patients and an additional four patients in the emergency room, both Garcia and Arribas believe that number has not yet been achieved. By working part-time she usually reaches this number, which in her case should be half. Garcia far surpassed him. “The problem with the strike withdrawal agreement is that it is very difficult to implement smoothly without a real complement of human resources,” explains Isabel Vázquez, president of primary care for the Amyts union.
The problem with a strike-out agreement is that it is difficult to execute smoothly without a real human resource replacement.
Professionals and unions acknowledge that the economic part of the deal is being met, but as they warned in their demands, not everything is about money. The ministry has proposed a so-called absorption agenda run by volunteer doctors, which has eased pressure on some centres, but not all. “The centers that were good before, with less pressure on nursing, and few sick days, are also good now, but the centers that had sick days, retirements, more pressure, more patients without cards, etc. They didn’t have anyone to absorb them, and Those who are there have to take on what they face, which creates overload, syndrome Burned out, exhaustion, stress, and possibly ultimately hitting new lows. “It’s a cod biting its tail,” Vazquez said.
The union points out that in some centers, such as Vicente Soldevilla itself or Abrantes, Calabanchel Offrontera, the situation remains complicated, while in others, such as the one also in Vallecas Los Angeles or Buenos Aires, have been able to organize. Sources from the Ministry of Health show that more than 150 health centers, including Puente de Vallecas, have launched an absorption agenda since June, but it is too early to have “conclusive data on its impact”.
The Ministry of Health advises doctors: “Allocation according to their own needs”
In the specific case of Vicente Soldevilla, these same sources point directly to professionals. “It’s not a matter of lack of doctors, it’s that the doctors that are available are allocated based on their needs, whether for mediation or compensation reasons.” But those doctors who choose to work the morning shift either do so because there are vacancies at the time, Either because it is the position they got through competitive examination. Here, they can only guarantee a focused schedule on Thursday afternoons, when a colleague works four hours.
María José García is also a health care worker, although she retired six years ago. A former nurse at the center, she now works to maintain the Vallecas Public Health Platform, which organized a protest in front of the center at 7 pm this Thursday to demand improvements. “The situation in Madrid in general, and this neighborhood in particular, is a real disaster,” he lamented. “Can you make an appointment?” the author of the quote suggests. She took out her phone, entered the app, and requested, in front of several neighbors: “Your appointment cannot be managed at this time. Please contact your health center,” the screen read.
This “connection to your health center” also leads to overloaded management staff, which is the first line of deterrence in the face of (often legitimate) patient complaints. Even paramedics. “Starting today at 6:00 pm, only the paramedics will be left. They will not be able to vaccinate because there is always a doctor who must be available in case of adverse reactions. They will stay and wait for those who have been mentioned and who they can resolve to arrive people have any problem, but they can’t prescribe it, they can’t discharge it…”, Arribas lamented.
Neighbors and health workers are hopeful the situation will improve, though hopes are starting to look dim. Among the patients who came to sign, they felt an interest and desire to demand quality public health care, but also a certain fatigue that comes with requests that have gone unattended for months or even years. Doctors, meanwhile, are torn between quitting their jobs and worrying about their future selves and their own health, a not-so-distant distance due to the experiences of their colleagues who ended up calling in sick. “I was treating a patient yesterday and I told her I had to come back in three weeks, but I didn’t know where I would be then or what it would be like…”, Garcia gave an example.