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.


 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