Health and rural medical practice: a holiday chronicle

September 28, 2009

The Ancares valley in the Bierzo, near Leon , just bordering the Galician province of Lugo and Asturias includes 10 villages. Candin is the municipality for the valley. Extraordinary views, pure air, calm, excellent food, summer village festivals, friendly people and if you so wish some night life in local pubs, playing cards and plenty of chatting … a good choice for your holidays, for relax and why not, to live and to work through the web. The village of Candin also hosts the local council building and in one of its rooms, Luis, the local GP runs his clinic from Monday through Friday. Pili, the local nurse, also works there.

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 Luis has 400 people in his list, mainly over 75s, women, widowed and living alone. It covers the whole municipality and relies on the neighbouring Fabero health centre. Fabero is an old mining centre 20 kilometres away through a mountain road. Kindly he accepts to answer my questions.

 What is best in rural medicine? To practice family medicine ; he can devote as much time as he needs to every patient: listening, visiting them, meeting the family, knowing how they live, enjoying a coffee together and at the same time caring for other family members even if that was not planned. The meaning of time is different: closeness and direct communication create a relationship beyond treatment: he helps with formalities, listens to their problems, coordinates referrals to hospital colleagues directly (at least with those specialists who do cooperate because not all of them do that and that will lead us to the issue of “mass” care in hospitals) . Patients do ask questions of any kind and trust is created for several personal decisions and advice is taken without major questioning. For Luis, that is an advantage if compared with the city where patients do question constantly medical diagnoses.

 Patients do not get crossed if they should visit an emergency room and have to wait. Time means something different in cities. More advantages: good relationship with the local pharmacist, only 200 meters away. A call to or from the pharmacists, Manuel, clarifies any doubt in seconds.

 What about disadvantages? Lack of diagnostic tools: no ecography, no X rays and waiting lists with the specialists that may last 4 or 5 months.

 Any professional problem? To be on call for more than 36 hours without a rest. That leads to fatigue, that may affect patient care. A work problem? May be the transport: no National Health System vehicle, using his car with expenses never fully covered.

 

Major health problems encountered?

 Those of the elderly: hips, knees, osteoporosis, back problems, arthritis. Also, cholesterol, hypertension, plus treating insomnia and depression, probably the same as in an urban environment.

 And problems with less prevalence?

 He mentions low incidence of cancer and dementia. And even when they appear their evolution is slower. An important fact is the healthy aged population: Over 85s regularly walking 3 kilometres to attend the surgery, taking care of their own vegetable garden with complete mental capacities. Why? We should research it… may be the climate, may be nutrition…

 Differences by gender?

 Among women, osteoporosis. And some depression related to loneliness, They find difficult to accept they cannot cope with all what they were used to. It is more sadness, melancholy rather than real depression… may be that is also different in urban settings.

 And how a rural GP relates with the drug manufacturing industry?

Dr. Rubio believes pressure goes now to the pharmacists to induce buying a particular brand or continues in hospital care with specialists, interested clinical trials … In GP practice, for him, there is no pressure. He prescribes mainly generics or active principle and is up to the pharmacist to deliver a given brand. He believes is a reduction in prescription power; it does not affect rural GP practice but it is a real change.

 What about “media diseases”?

 We refer to swine flu (H1N1) or to HPV (Human papiloma virus) so prominent recently in Spanish media. He does not feel the pressure. HPV is not a problem for him. No patients eligible for vaccination. He is just now thinking whether we would recommend swine flu vaccination. His patients will follow his advice without questions.

 The Regional Health Service of Castile and Leon ( SACYL: Sanidad Castilla Y León), also buys hospital care from the private sector.

 Olga Fernández Quiroga

Candín,  August 2009


Cibernàrium: 10 years on.

September 26, 2009

Monday, July 13th; the day to celebrate the 10th anniversary  of Cibernarium , the first Barcelona multispace devoted to technological promotion with the specific mission to promote information an communication technology among citizens, professionals and companies. There are different events all day round although I can only attend the last minutes of a round table on “Young entrepreneurs: 2.0 projects in the internet” chaired by  José Manuel Pérez Tornero, Professor of Journalism and Communication Sciences at the Autonomous University of Barcelona and Genís Roca, Director at Roca Salvatella. I can also attend two lectures; one by Sixto Arias, General Director of Mobext (Group Havas), “The best prophet is the past: 10 years of internet in Spain in 10 words” and the other by Enrique Dans, Professor of Information Systems at the IE Business School, “Future Scenarios in the web: genesis or apocalypses”. 

Cibernarium          

Health and participation in health issues are not discussed. Reference is made to the web, its function, its history, what its future could be, how people are protagonist there, about creativity and about participation. These last discussions were of interest to the e-Criterium team. Eventually, our philosophy is  based in believing in people, in ourselves, as effective and potential change agents and in the web as a tool. A “powerful tool” -was said- where “we will recognise the best and the worse of human beings”. We are aware as citizens we must be held responsible for our actions and their consequences both positives as well as negatives. Just because of that we are on the side of those who want to preserve the web as a space for freedom, creativity and discussion.

We value this responsibility and we think when people criticize is because something is not working properly or simply does not work or because information is not available to understand why it is working in some way and not in another. However, people also praise, congratulate and highlights what is working properly and specially people are generous providing their own ideas. Generosity of time and effort for the common good has always been there; now the web offers the opportunity of multiplying its effects, its visibility, and the possibility of sharing with millions. And sharing all experiences do more than adding them, it creates new knowledge; it is collective knowledge for the health of the community.

We would like the web to be a space to generate ideas to be used in the improvement of the health system and to benefit them all.

And that will be our value. The value of people who believes that belonging to a health system is something more than owning a health card or holding a contract. People who believe that health institutions were are and will be the result of citizenship to serve citizens. Citizenship is what we have in common and as citizens we build our institutions as we believe they should be.

I was happy to verify we share with those who know well the last trends in the web the idea of a free and generous social net where our citizen’s rights can be used to promote participation to guarantee democracy. 

Olga Fernández Quiroga


Ecology and the city

September 1, 2009

Last July 1st I was invited to an event organised by the Barcelona Federation  of Neighbourhood Associations (Federació d’Associació de Veïns i Veïnes de Barcelona  (FAVB) :  the presentation of the book “Ecologia i Ciutat” (Ecology and the city, in Catalan).

 The book contents the proceedings of the 4th Barcelona Neighbourhood Forum (4t Fòrum Veïnal  Barcelonès) where the neighbourhood movement debated on urban ecology with the participation of several  other institutions and individuals linked to the ecologist and social movements in the city. The book can be obtained directly, free of charge, from the FAVB. It includes interesting papers such as the 21 proposals for a sustainable city, as emerged from the debate in the 4th Forum, the results of a survey on neighbourhood demands and their advances, a diagnosis on the environmental status of the city ranging from the concept of “biomimetisation”, the role of the women in urban ecology, sustainable mobility, energy, garbage management, the Collserola park (the green belt of Barcelona), the situation of the Montjuic hill and how the environment is affecting the health status of the inhabitants of the city.   

favb 1

 e-Criterium wants to promote citizenship participation in everything affecting health. Environment is a health determinant. We should think how unwise it is to create a health care system to deal with problems originated in environmental factors that adversely damage our health. Although some health determinants cannot be changed, such as age, gender and inherited factors, others, as the environmental ones, can be changed: nutrition, water quality, pollution (noise, light, air,..), radiations, chemicals in the household, work sites and elsewhere and several others dependent on how we live, our life styles, and the social and community  network.

 The neighbourhood movement should be leading alliances and converging with other institutions interested in those issues and taking them to the Health Couincils that are he participation bodies closer to the neighbourhood and at the same time are able to influence public policies .

 e-Criterium will be offering a web space to promote this leading role of the Health Councils. A communication tool between them and the  general population is being designed. Minutes of meetings could be downloaded, issues dealt could be reviewed, their performance analysed and best practices be shared to develop a healthier participation.

favb 2

 

And back to the event, a panel was presented  introduced by ,Esther Argelich,  environmental officer within FAVB. She also delivered a paper on “Challenges for sustainability in Barcelona city”. Other papers presented were:

– The Horta tunnel and the defence of Collserola park, by Roger Caballé, member of the Via Verda (Green Way) Group.

– The popular legislative initiative against transgenic production, by Miquel  Vallmitjana, member of “Som lo que sembrem (We are what we seed)” group.

 – The threat of the new incinerator by Víctor Mitjans, member of the “CEPA-Centre d’Ecologia i Projectes Alternatius  (Center for Ecology and alternative projects)”.

– The rebirth of nuclear power stations by Miguel Muñiz, member of “Tanquem les Nuclears (Let’s close the nukes)” group.

A lively discussion followed.

Olga Fernández Quiroga