The emptied Spain is held right now by hands like those of José Antonio Ruiz Aponte, a 62-year-old Venezuelan surgeon which landed in Spain in 2012 and, eight years later, goes to the health center of Molina de Aragón, the town of Guadalajara that has become the informal capital of Spanish Lapland, one of the regions with the lowest density of Europe population.
Before that, this doctor with a strong rural vocation has wandered through other unpopulated regions from Asturias or Castilla y León.
Different dialogues but the same script: remote places where Spanish doctors, by urbanites or ingrained, never ask for a place. In the waiting rooms there is an aging, dispersed and often sullen population abroad, to which they have had to get used to the force. Currently, of the nine doctors of the Molina de Aragón ambulatory, six are extra-community.
"Dewell, Dominican, Stéphane, from Haiti, Fatima and I, from Venezuela, Leo, from Colombia, Ivan, from Ukraine, Miguel, Jesus and Nieves, Spaniards," lists the surgeon. "The Most Spaniards do not come to these sites and those who come, either do not have the MIR performed – important issue – or are very old and avoid the pressure of care. "
Ruiz Aponte arrived in Spain with 55 years after practicing for three decades in his country, but his entire history as a doctor was erased upon landing. The Venezuelan was forced to do the MIR and, behind him, compete for positions –and salaries– newly graduated. He began to meet here and there with up to nine compatriots of his same class and even with the teachers who had taught them. All in the same situation, working in rural health centers and other various destinations.
When they arrive in Spain, their curriculum is reset: "The president of the Urology Society of Venezuela is employed doing psychotechnics"
"The president of the Urology Society of Venezuela was employed here doing psychotechnicians and looking for another job", remember.
What do you do in town?
Ruiz Aponte's sons said of their father that he was a "mountain and snake" doctor, always asking for destinations away from the big crowds. "I like rural because it allows me to be a doctor: being able to manage time with my patient, not having only five minutes, "he explains to El Confidencial." And in a population with such a high average age, you cannot expect a grandfather of 80 to find out everything in five minutes, He doesn't deserve to make you dizzy quickly".
Since entering our country he wanted to be assigned to the rural area, for residence Molina de Aragón asked and they didn't give it to him. The most 'rural' that they offered was Cabanillas del Campo, a dormitory city of 10,000 inhabitants five kilometers from the capital of Alcarreña.
The first obstacle for non-EU doctors is that cannot be made indefinite nor occupy interim positions, which makes it very difficult to rent a home or buy a car. However, some regions (Castilla y Leon, Asturias, Extremadura or the Valencian Community) modified that rule and offered indefinite positions, so that Ruiz Aponte left.
His first destination was Asturias. Paradoxically, this community is the sixth in Spain with more doctors per 100,000 inhabitants. But, as can be deduced from the Venezuelan experience, the reality is not as it is reflected in the statistics. "If doctors are missing here, in Asturias it is ho-rro-ro-so"he exclaims." We complain here because we have to cover two companions when they go on guard, and if another goes bad or goes on vacation, there are three and sometimes four. Sometimes up to four. That 'sometimes' here is normal in Asturias: there, when you are lucky, two are missing".
If doctors are missing here in Guadalajara, in Asturias it is ho-rro-ro-so
"Medicine in Asturias is focused on administrative work: the doctor gives appointments, the doctor gives the boats in the laboratory … Everything to save himself from hiring more staff. "So he packed again, this time in the direction of the plateau." I was offered the same thing in Castilla y León: Black, come 'paca' that we are looking for doctors and I give you an indefinite contract in interim. "
The extra-community bottleneck
In order for this rural surgeon to access MIR, it was essential to standardize his degree. The exam in which you participated He was the last to be celebrated for many years, giving way to a long desert without extra-community doctors could aspire to regularize their situation. At the end of 2019, seven years were terminated without these processes, but in between there has been a mountain of foreign professionals who can only practice as temporary doctors and make substitutions. Others have managed to homologate their medical degree but not accredit their specialty, so they are again reduced to the level of private doctor.
"Although the royal decree that regulates this approval says that an exam will be carried out every year, we have been without them since 2012," explains Pablo Mejía, a Colombian traumatologist who has been 18 years old. working as a specialist in Spain without the recognition of its official title. "We are more than 1,000 specialists working without a title right now in Spain, both in public and private, without so far we could find a solution with the Administration, "adds Mejía, who chairs the Association of Extra-Community Specialist Physicians.
According to the complaint, the mere review of their files by a commission involves a process of about two years. If something is complicated and they find it difficult to prove that they have the years of basic training of the specialty, they enter into an endless and expensive legal gibberish. It is simpler, therefore, go to the mountain in search of places that do not require MIR. All these professionals can spend years working in the same center, but one day the phone rings and the next, as happened in Galicia a few months ago, 40 foreign doctors go to the streets without questioning.
As also happened to Ruiz Aponte himself.
"They took it from me in Castilla y León, we all went outside the community"he explains." The thing is that they made a public offer of employment, and it is logical, they have to take away the place that has been chosen; but it turns out that they took us out of those jobs without anyone having chosen the place and those who were going to decide did not decide, then they called us again. Now wait for me. "
None of them returned. In Spain there is work to spare for those who travel where nobody else wants to go. The Venezuelan phone rang again. His guardian of the residence in Guadalajara had been promoted and offered to return. And this time, to his longed for South Lapland.
"That's how I came back. I'm not indefinite but they offered me the rural one, which was what I wanted," he says. "When they finally gave it to me, they said 'look, Black, they finally gave you Molina de Aragón'and I lit up: I had to go there before they gave it to me! "
For a doctor from Molina de Aragón, the work does not end within the limits of the municipal term. In a 'demographic desert' like this – the population density of the region is 2.5 inhabitants per square kilometer – it is imperative to take the car and move to villages with just a handful of people. Aragoncillo, Torremochuela, Rillo de Gallo, Canals of Molina, Anchuela del Pedregal, Tordelpalo, Shoulders …
Studies say that many of these places are about to disappear. Ruiz Aponte says that they are already dead long time. "There are villages that I don't know: there is no one."
"These towns are in name, some tell me that they live in Pradilla or Torremochuela but it is a lie, they live here, there they are only registered," he reveals. "There are many villages in which there is 99% of those who say they are, and I know it because when they call for an emergency, the people in the center tell me: 'No, no, it's here. "You are never guided by the address that appears in the system but by the one the staff tells you. A good part of them only They live there 15 days during the summer.
Sometimes they call you urgently to go to those villages. "In one of them only two brothers lived and the couple of one of them, in another a grandmother with two children and three other gentlemen. The first time I went to Anchuela del Pedregal I saw eight people and when they came back they told me: 'Have you seen eight? Well, you've seen them all. "
Have you been to Anchuela del Pedregal and seen eight? Well, you've seen them all
It shows that, in those expeditions, it is when you really enjoy. You will see older people who spend alone days without crossing anyone, much more in winter. Clinical practice involves not only assessing the incident, but the context in which it develops. For some, loneliness is lethal, but for others the alternative could be worse. "Some of them have to be left in their surroundings and in that solitude, it makes no sense to send them to a residence, they just need a trained caregiver", because they often find old people taking care of old people, where one of them is the sick one, the other the caretaker, and Ruiz Aponte wonders, "But here who cares who?".
Caregivers are also, by the way, almost all foreigners.
Are there solutions to this problem?
In the next few days, the Ministry of Health will publish the results of the MIR exam held on January 25. From here will come 7,512 places, a higher figure than in 2019 but, for many people, insufficient to compensate for retirement losses.
"Our proposal was increase by 2,500 places per year, up to 10,000", Carlos Rus, president of ASPE, the employer of Spanish private health, says to this newspaper." On the other hand, giving more efficient way to doctors who are requesting approval to work in Spain, "about 3,000 According to your latest data.
Private hospitals are interested in hiring these types of profiles. Due to the limitations imposed by Health at the time that the MIRs can make their residence, only 150 doctors a year end up doing so in a private center. "For the public and in rural areas, it would be interesting to do clusters of dispersed centers where residents can rotate; there are communities like Asturias or Cantabria that would benefit a lot, "adds Rus.
From their consultation in Molina de Aragón, Ruiz Aponte agrees in the diagnosis: "They have to better guide the hiring of extra-community personnel, first because they need it," he says. "The amount of doctors that Spain produces is not enough with the existing needs, and what cannot be is that having this assistance pressure does not accelerate that process ".
Do they look here in the future?
The Administration, at all levels, is aware of the precarious balance in which rural health is sustained. The more than nine million Spaniards living in towns of less than 10,000 inhabitants, too. The plans are many – distribute warning bracelets or create networks of volunteer neighbors that attend to the emergency room until the doctor arrives – but the medical deficit remains on the table despite the incentive plans for doctors "in centers of difficult coverage" . But money is not everything.
Ruiz Aponte, for example, is sorry for not being able to continue his development as a doctor from Molina de Aragón. "I really like to study and I'm worried about the effort to stay. Here they don't provide facilities, for example, yesterday there was a talk about the coronavirus, but you had to go to Guadalajara. With today's media, why don't you prepare a streaming video or an activity? I'm doing an online course in geriatrics, but how long will I be investing in that, at what price? "
He says that at some point he will move to Guadalajara capital, especially thinking of his children, also doctors, currently distributed throughout Latin America and that they plan to come. Until then, the Venezuelan will continue with his expeditions to fading villages, with his guards, he will continue for a while to see how, with the arrival of the heat, the exiled locals return to their origins and ask for recipes, despite knowing – perfectly well – that they can't do that in another autonomous community.
In these times, only the elders rooted in the region grant him and his companions that former authority of 'village doctor'. "That has changed a lot, the locals or the Catalans who come to town think that those of us here are all palettes, that the doctor is in the last row, who has never studied and almost came with guayuco".
"What we do have to face extra-community doctors is racism, xenophobia: a Spanish doctor is Don Juan, we are Paco, Pedro, Luis", sentence. "As a lady, who in April of last year told us that we had a 'colorful snack' here and that to see who they sent her to: I told my boss that except in dire need I refused to go, that if I could go another doctor, that was: I don't go to a place where they mistreat me".
But, above all, it will continue to suffer daily consultations to elders to whom nothing really happens to them.
There is a joke in which two ladies are in the doctor's waiting room and one asks the other, "hey, why didn't you come yesterday?", And she replies, "I was sick." That chascarrillo is the reality that Ruiz Aponte lives daily in Molina de Aragón, or rather the drama: the only doctor who ends up trying often is the loneliness in which these people live who have made the visit to the doctor a form of socialization.
We have to face racism from outside the community: a Spanish doctor is Don Juan, we are Paco, Pedro or Luis
The big problem that these rural health centers throughout Spain are supported by non-EU doctors It is, of course, what will happen when one day they leave.