The emergencies of La Paz are saturated. It is news this week, but it could be from December or November of last year. And, before the expected collapse due to the pandemic, in 2019, 2018, 2017, 2016, 2015… and so on for years. Since social networks existed, the usual process by which an ordinary situation becomes news is very simple, according to a health worker from this Madrid hospital, Daniel Bernabéu. “Someone gets tired, makes a video and leaks it to a journalist or it goes viral.”
These are headlines that darken the brightness of other information about this public hospital north of Madrid that provides service to more than 528,000 people: the center best valued by Spanish health professionals for 58 years, the place where cutting-edge surgeries are performed worldwide. What’s going on?
Despite the continuous chaos in the emergency room, the disorder of the last few days in the La Paz emergency room is the largest that several health workers consulted can remember. On Monday, 571 patients went to the emergency room, when on a normal day about 400 usually attend, but due to the lack of available beds, 89 of them wait in the corridors for a space to be released. Almost half of these patients had been waiting for more than 36 hours. This Tuesday morning, dozens of patients, the vast majority of the elderly with respiratory problems, were waiting to be treated. In the corridors, almost a hundred patients took up to three days to get a bed on the floor.
“I have been in the emergency department of this hospital for seven years and it is the worst winter by far,” says an emergency room nurse, Guillén del Barrio.
The management of the hospital and the Ministry of Health have defended that it is a temporary problem, attributable to typical winter diseases. But the newspaper archives prove that collapse is normal, and that although viruses may have contributed to worsening the chaos, there are other underlying causes.
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At the gates of the hospital, a group of toilets denounced this Tuesday that the collapse is due to a lack of resources. “This is not a specific issue due to the time of year, but a structural problem and a shortage of beds that we have been dragging along for a long time and that has nothing to do with this specific peak of respiratory infections,” a doctor who did not know told reporters. he wanted to give his name but he said he was speaking on behalf of his colleagues. “We ask for help not for ourselves but for our patients. They are in deplorable condition. We do not demand better salaries or anything similar, just dignity for our patients, ”she said together with a group of doctors.
The health sources consulted point to a host of causes to explain the collapse. One of them is the building, which has become too small. This is an old hospital, inaugurated in 1964, which has been waiting for years for an expansion that seems never to come. For this reason, Marta Arribas, representative in La Paz of the Satse nursing union, criticizes that the remedy offered by the council, a reinforcement of personnel for the Winter Plan, is useless: “You cannot increase the personnel to include all in the same hole. According to a spokesman for the ministry, Madrid public hospitals were reinforced in December with more than 1,300 health workers, an increase that adds to the almost 350 contracts also authorized in the Pediatric areas since the end of November due to the increase in cases of bronchiolitis. In children.
Other causes of saturation must be sought outside the hospital, in primary care and out-of-hospital emergencies. They are two pillars of the health system that should contain the flow to the emergency rooms of Madrid hospitals, but both areas have been neglected by the Community of Madrid for years. Madrid is at the bottom of Spain in spending on primary care and is the penultimate in family doctors per thousand people (only surpassed by the Balearic Islands). It was the only community to close out-of-hospital emergencies during the pandemic, and when it reopened in October, many of the 78 centers were understaffed.
Due to its preventive nature, the primary has a role that should serve to alleviate the pressure of the entire system. People get sicker if no one attends them in their nearest center, recalls Guillén del Barrio, who is a representative in La Paz of the MATS (Movimiento Asambleario de Trabajadores de la Sanidad) union. “A patient with uncontrolled diabetes can lose a leg.”
And another explanation is found in a demographic change that has been taking place for some time: the aging of the population. A good part of the patients who enter the emergency room these winter days are over 80 years of age, a profile that suffers from chronic diseases and requires much more medical attention than the rest of the population. They are patients whose admissions to the emergency room tend to take longer than usual because chronic patients are referred to two extensions of the hospital, in Cantoblanco and Carlos III, and they often ask for an ambulance but it takes hours. “When they call Summa 112 from the emergency room, they tell us that they have no more resources and that they are doing what they can,” says Daniel Bernabéu, spokesman in La Paz for the Amyts union (Association of Physicians and Higher Graduates of Madrid).
La Paz serves an increasingly aging population. In an area of influence that covers 528,992 people, 98,332 are over 65, according to the hospital’s 2021 report. In 2013, the number of people over 65 was 87,528.
And a related problem is the lack of ward beds to care for those chronically ill. The health management expert and former Madrid deputy of the PSOE José Manuel Freire regrets that in Madrid there is a shortage of medium and long-stay beds. Hospitals of this type are found on the periphery of the region (Fuenfría, Guadarrama or Virgen de la Poveda). An alternative, within the urban area of Madrid and 4 kilometers from La Paz, could be the old Hospital Puerta de Hierro, which has languished since 2008 in a state of abandonment. The Madrid Assembly approved in 2016 a Proposition Not of Law promoted by Freire to convert that building into a hospital for chronic patients. “Nothing has been done since then. Not a brick has been moved ”, laments Freire.
The situation desperates the toilets of the La Paz emergencies who feel that, after so many years of collapse, the Ministry does nothing. “We have a good reputation, but our house is a ruin,” complains the nurse Del Barrio. “People don’t deserve to see the glamor of the surgeries and the rankings on TV and then come here in person and find a packed room.”
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