• Read all the interviews of the contra

Javier Padilla . Madrid, 1983. This doctor was going to present his book "Who are we going to let die?" Next Wednesday in Seville, but the coronavirus crisis has disrupted the plans of the entire country. Now he is focused on his work in a Madrid health center.

With the coronavirus crisis, his work as a doctor in a Madrid health center has become a high-risk profession. There is no doubt that, as health personnel, we are quite exposed and concern has settled, above all, to be able to be transmission vehicles towards our families and the people with whom we live. However, in addition to recognizing this high exposure to contagion by the coronavirus, it is also necessary to keep an eye on people who are working outside the health sector in other highly exposed tasks, such as cashiers, cleaners and caregivers of residences, who have less means of protection than us.Is public health in danger of collapse? It is undeniable that this is one of the fundamental risks of the current situation. Attempts are being made to expand the capacity of the healthcare system to meet needs, suspending surgeries, canceling consultations, transforming certain units into hospitalization floors for Covid-19 or intensive care, hoping that this, together with the distancing measures social, can make people receive the care they need. In a few days we have gone from "it's like a flu" to "everyone locked up at home". Everyone can 'predict' the past, but decision-making adequate and proportionate at the right time is the complex. In the case of coronavirus, there is a need to transmit an adequate message about its clinical severity, given that in the majority of the population it is a mild disease, and extreme precautions must be taken in the most vulnerable people, with the requirement of stopping a new epidemic to try not to establish itself as a new common microorganism in our seasonal epidemics. We are locked up at home, mainly, because for the most vulnerable people this is more than a flu. It is a serious epidemic, why? Because it is transmitted quite easily, although there are mechanisms to reduce its expansion, because it affects more severity to people whose health may be more compromised and because their ability to generate many cases in a short time puts at risk the ability of the health system to give an adequate response. Are governments making the right decisions? In a few months we will look back, We will compare some answers with others and we will be able to make value judgments and plan what system we will need for the next similar situation. To this day, there appears to be some government paralysis in many countries, and hopefully this does not particularly attack countries with weakened health systems. There is much criticism that Women's Day demonstrations were not suspended. The European Union advised against six days before 8-M to allow "crowds". Now it is easy to say that these demonstrations should have been annulled, and if it is done, I believe that it must be accompanied by the rest of the crowds of people. We point the finger at the exceptional crowds, but we forget about the multitudes that congregate daily or weekly, whose infective capacity is the same and that go unnoticed because they are not so ideologically marked. If there was evidence and awareness of community transmission -which is the key there- it was necessary to have canceled the massive crowds of all kinds in those places, demonstrations or receptions for soccer team players, but I only see myself able to affirm that in a situation Analogous in the future, perhaps what happened will change the ways of acting, but it is not fair to judge from the outside and backwards those who have to make certain decisions. A few days ago, an Italian doctor warned that they were already deciding who to treat and who to treat. no, "as in war". Will we get to this situation in Spain? Probably, and it is the greatest fear of those who work in the Intensive Care units and those who design action plans in these cases. Therefore, it is essential that, as we expand the system's capacity to respond, there are people addressing how to distribute resources equitably and with a perspective of social justice. The title of his book 'Who are we going to let die? ? raises a disturbing question. The title now has multiple meanings, of course. It is a way of recognizing that the decisions made in the field of politics leave a mark on our bodies and our lives that often ends up causing people to live longer and better than others, not for genetic reasons, due to biological conditions. or by individual decisions, but by social factors related to those policies. If there is something that characterizes the Spanish health system it is its "perpetual crisis situation", he tells in his book. Indeed, the crisis is a characteristic of an eternally poorly financed system that it tries to oscillate between maximum levels of guarantee of well-being and attention to the population and constant and increasing levels of dynamism of the private health system with public funds; As they are two irreconcilable poles, we are always in crisis. The bad? That living in crisis gives a feeling of perpetual apocalypse that prevents us from moving forward, what good? That this apocalypse does not come and the system continues to subsist. Why when the economy becomes ill or decreases do people die less? At the beginning of the economic crises, the decrease in economic activity translates into less accidents at work, fewer trips by car, pollution decreases; This means that there are data that mortality may decrease, especially in population groups with some cushion to endure these early phases of a crisis. However, we have to be able to think about futures where we do not need economic crises to die less, because those crises will always have more vulnerable people and groups that impact more strongly. Spain is at the forefront of Europe in drug consumption. Spain has historically been the second country in Europe with the highest consumption of medicines per inhabitant; the causes are varied, since the health system is the only public service with a perspective of universality -even if it is not totally universal-, which means that many problems of different kinds end up in the health system; Once there, a system focused on the doctor and with little time for assistance makes medication the main way to respond to people's discomfort, when perhaps other non-medical responses (psychotherapy, community activities, physical therapy) ) would have to have another role. The message "put a hospital 30 minutes from home", error or success? An error to put it like this. People must be guaranteed adequate and accessible care for their health care needs, sometimes that will require bringing the system closer to the population, and other times it will be necessary to facilitate the forms of access of the population to the system (transport, accommodation, coverage of care, ...). What the population must have close and very accessible is a primary care network in which they find a good answer. In his book, he says that to harm a public system it is not enough to expel the most vulnerable, but there are also than generating disaffection among the upper classes. Explain it. Exactly. The universality of public health systems cannot be only downward, but also upward. Universal health systems are sustainable because they improve the health of the population, improve the efficiency of the system and generate social cohesion; It is necessary for high-income people to see that the system provides them with quality services in exchange for the taxes they pay, as well as that these systems generate societies with greater well-being for society as a whole, not only for the most disadvantaged. contribution of the health system to the health of each one is only 10%, the rest depends on the socioeconomic situation, the environment, genetic factors ... how is it possible? The health system is what sustains us until we learn to walk in the air, taking words from a song by Leonard Cohen, but the disease develops outside the system, in working conditions, in being at risk of eviction, in living in an area with healthy food establishments and green areas or in have time and income to be able to dedicate myself to get together with my friends or cook. And then there is the health system to help us when this fails, but the great inequalities in health that make life expectancy in our cities go through neighborhoods are not only solved from the health perspective. With this panorama, it is not uncommon for many of its Colleagues emigrate from the country in search of better jobs. The high rate of temporary employment and precariousness of health workers, as well as the conditions for those with greater stability, means that, in effect, the number of professionals going abroad increases year after year. Perhaps after the health crisis we have now, it is time to think about how it is possible that the public on many occasions leads the temporary and precarious situation of its workers, because now we are seeing that, when everything fails, only the public services They can give what we need. How long will the coronavirus crisis last? It will depend on how we comply with the measures that are imposed and what other measures we are seeing. Of course, not less than two months, which is the important part of the crisis, but then there is another crisis, both social and health, which is to lick our wounds and see how to recover from what is happening. Citizenship for what is above us? Today it is more than yesterday and tomorrow it will be more than today. We must be clear in communications, know how to transfer the uncertainty management scenario we are in and know how to understand that not everyone can mentalize at the same rate.

According to the criteria of The Trust Project

Know more

  • Spain
  • Europe
  • Madrid
  • Coronavirus
  • Covid 19
  • Final interview

Open shops They are also heroes: 400,000 'super' employees working relentlessly

HealthLast hour of the coronavirus | Italy closes all businesses in the country, except basic necessities

Consumption Coronavirus: Why will there not be a shortage in supermarkets?