MADRID — For years, we have heard Spain’s leaders say that we had “the best health care in the world.” This political fantasy has now met with a rude awakening. We have learned the hard way that being deemed the healthiest nation in the world by the World Economic Forum is not the same as having the best health care system.
The health care workers at the forefront of the pandemic — garbed in trash bags for protection and forced to choose which patients to connect to respirators — had long tried to debunk the myth surrounding the superiority of health care in Spain, denouncing serious deficiencies in the country’s hospitals. We now know they were right. What we may never know is how many lives could have been saved if the country had heeded their warnings earlier.
Spain has both one of the world’s highest coronavirus mortality rates, with over 17,000 people, and the highest rate of infected health care workers. But hospitals had reached their limit before the first Covid-19 patient arrived. It was not uncommon for single a doctor in a hospital to treat up to 60 patients a day. Last year, medical professionals took to the streets, demanding dignity for their profession and better compensation. They are now being battered by the pandemic.
The government’s delayed response to the pandemic, coupled with an aging population and the physical affection that tends to characterize Mediterranean people, contributed to Spain becoming an epicenter of the epidemic. However, some of the decisions that undermined the response were a result of the austerity measures imposed after the 2008 financial crisis.
The country spent a decade under the Excessive Deficit Procedure set by the European Commission. Budgetary restrictions forced the central and regional governments to make cuts to education, social welfare and health care, which increased inequality and poverty. A reduction in the number of doctors and hospital beds in recent years has become one of the most lethal consequences of focusing on numbers, not people.
Public health in Spain has been sustained for over a decade by low-paid professionals with temporary contracts, which is unfair given their level of responsibility. There is a chronic shortage of nurses in the country. Since the health care cuts began, more than 8,000 nurses have migrated to the United Kingdom, France or Germany in search of work. Those who opt to stay in Spain are paid around 1.000 euros, or about $ 1,080, a month.
The shortage of personnel is among the major backlogs facing hospitals. About 700,000 patients were waiting for operations before the crisis, according to the Spanish National Health System. There is very little data on what has happened with those patients since. We don’t know how many patients with pathologies unrelated to Covid-19 have died or have continued to decline because they could not be treated. Information provided by authorities in towns and cities around the country suggests there could be thousands of Covid-19 undiagnosed victims.
The government has had to call in medical retirees and students to fill staffing gaps in the midst of the emergency. For weeks, a lack of resources has meant that three generations of health care workers have had to face the trauma of seeing the sick become terminally ill and comforting patients far from their families with a lonely final goodbye.
The pandemic is testing health care systems around the world. With exceptions like Germany, most countries were unprepared. It’s still too early to determine with absolute certainty why Germany’s patient mortality rate is much lower than Spain’s, but there are some apparent reasons. Germany’s health care system has three times the number of intensive care units than in Spain does, laboratories with the capacity to carry out massive testing among the population and enough ventilators to meet an unforeseen demand. And in recent years its leaders have endeavored to improve care.
Spain was unable to pull together a coordinated response in the first weeks of the epidemic. Each of the country’s 17 autonomous communities has a different health care model, which were all placed under a unified command after the declaration of the state of emergency. Until then, politicians from different parties made disparate decisions, competed among themselves, and sent contradictory messages. It took President Pedro Sánchez’s central government too long to bring order and coherence to the response. Overconfidence in our health care system took care of the rest.
Our leaders have spent years making the mistake, deliberately or not, of equating the quality of the health care system with life expectancy; Spain leads in that indicator because it benefits from factors such as nutrition and lifestyle. Now that the myth of infallible health care has been dispelled, and we’ve paid a high price for upholding that illusion, it’s time to build a model that’s capable of meeting the needs of an increasingly elderly and vulnerable population.
Every day at 8 p.m., we applaud our health care workers from our windows and balconies. Politicians continue to remind us that without their efforts the situation would be even worse. This is fair recognition that will amount to empty words if it isn’t backed up with concrete measures. Many health care workers will need psychological support, which should be provided. Job insecurity and exploitation must end. Personnel shortages will need to be covered. After the creation of a parliamentary commission to investigate mistakes made, the fragmented public health system must be overhauled to improve coordination. And resources should be provided to our health workers, if not at the level of “the best health care in the world,” then at least at a level corresponding to a developed European nation. This time no one will be able to say Spain’s health care workers don’t deserve it.
If the current emergency has taught us a lesson, it is that the most vulnerable in society end up paying for cuts in essential services. Austerity policies can never be valued over people’s lives. As Spain faces difficult times once again, like the rest of the world, we cannot forget that the decisions we make to resolve this crisis will determine the fate of future generations.
David Jiménez (@DavidJimenezTW) is a writer and journalist. His most recent book is “El director.” This article was translated from the Spanish by Erin Goodman.
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