Search "Sundays in Spain"

Showing posts with label healthcare system. Show all posts
Showing posts with label healthcare system. Show all posts

Sunday, November 18, 2012

Working on Hope

There was a country-wide general strike in Spain on Wednesday. The pictures from Madrid, where it turned violent, were terrible. Down here on the Costa Blanca, we were hardly disturbed. School buses were not running and schools themselves were on skeleton crews, according to the two women (from different towns) in my book group who are mothers of school-aged children; they still managed to make it to book group that morning. I didn't notice any other disruption throughout the day as I drove by the usual commercial centers on the way to and from afternoon petanca. Our house cleaners came as usual and the results of their work were clearly evident upon our return.

Being a long way from industry, we have been removed from much of the economic turmoil caused by la crisis. Disruptions have stepped up recently, though. When we returned from a two-week vacation and went to fill a routine prescription, we found the pharmacy closed on a weekday morning. The pharmacists have not been paid by the regional comunidad--in our case, Valencia--for the prescription medicine they used to hand out free upon presentation of a personal health card and the doctor's RX. When you pick up a prescription, the pharmacists cut out a square of code from the package, plug some numbers into the computer, and presumably the data gets collected  and each quarter, the pharmacy is reimbursed by the comunidad. It seems those bills have not been paid now for a couple quarters, and the pharmacists have given up hope of prompt reimbursement. During the summer, new reforms went into effect that made most retirees pay 10% of the price of a prescription. That is not a problem for us, and I am glad to see that the pharmacies get at least a few timely euros. Now, a couple weeks into this particular crisis, I have learned that most pharmacies are open two days a week, and when one of our local drugstores is closed, the other is usually open. When at the regional medical center on Friday this week, I noticed a paper taped near the window of the reception area that listed six or seven pharmacies that were open. Presumably this list is changed often.

We have already had discussions with a physiotherapist, a nurse, and a doctor about the 15% cut in salary they have taken. I don't think that includes the Christmas bonus (equivalent to one month's income) that they were told in July would not be forthcoming this year. They are still working the same number of hours, just for less money. I am beginning to understand that this cut must include all public workers. Health and education, services for the handicapped--and jobless benefits, ironically--have been hard hit as Spain's conservative government makes promises to get out of its economic troubles. The European Union is apparently satisfied with the president's measures, and I hope it will be disposed to help pick up the burden of the long-term effects of such stringent budget cuts.

Budget cuts are one thing--just not paying people is another. I was shocked to hear this week about a town engineer who works as a contract employee two days a week--he has worked all year but not been paid since June. He hopes to receive the money owed him by the end of the year. And for months now there has been a light construction crew building a stone wall, landscaping, and generally creating a park at the entrance to our neighborhood, near an old train station that has been restored but never yet opened to the public. We knew it was a sort of make-work situation and speculated that the money was coming in some way from Brussels, because the area has been designated an "environmental project." Like any construction crew that I have ever seen--probably true the world over--many of the times you pass the work area, half the workers are standing around, apparently doing nothing. Now I can't say that I blame them, for now I have learned that, though they have worked for months, they have only the promise of pay at the end of the year, or the end of the job, or the end of the crisis. They have come to work for months without any paycheck.

Sunday, July 15, 2012

Austerity Measures

Agreement between Spain and the European Union, the European Central Bank, and the International Monetary Fund--are those all the players?--has now been reached, and Spain's president of the government, Mariano Rajoy, announced a new series of austerity measures this week. Here's the list, as I interpret it, from an article in El Pais the day after the announcement. Since there was an awful lot I did not realize or understand about the Spanish economic system before the crisis and the announcement of improvement efforts, it can certainly be that I don't fully understand some of the measures announced. 
  • Changes to IVA, the value added tax on almost everything, will certainly affect the most people--literally everyone. Spain having had "one of the lowest VAT rates in Europe," the current base rate of 18% will go up to 21%. I have previously written about the ins and outs of the IVA tax and I am sorry to see that now it is changing and becoming even more complicated. But I am glad to see that there will continue to be a reduced IVA for most food items, sanitary products, transportation, hotels, and admissions to cultural events--even though that category will go up from 8% to 10%-- and that the super-reduced IVA of 4% for basic necessities of bread and vegetables will remain the same. A subsequent story later in the week, however, alludes to several categories of the "reduced IVA" products being moved to the regular 21% category--primarily entertainment products like TV and entrance fees (Internet services?)--but not food.
  • Government workers--including elected members of parliament--will lose their annual Christmas bonuses for, at least, 2012, 2013, and 2014. A long tradition in Spain, the Christmas bonus typically was equivalent to one month's salary, so in essence these people are taking a 7 1/2 percent pay cut for three years. 
  •  Unemployment benefits will be reduced, starting in September, for new recipients. Nearly 25% of Spaniards are unemployed.
  • "Green" taxes will be increased, including at least a 3-5 cent per liter hike in fuel taxes.
  • The pension system will be reformed to make it more sustainable. It looks as though early retirement will be targeted.
  • The number of municipal workers will be reduced by 30%. Mayors and city councilors will be required to make their salaries public. Provincial government will play a greater role in order to maintain public services evenly throughout regions.
  • A popular tax deduction on the purchase of new properties will be eliminated.
  • Taxes on energy will be changed. Details to follow.
  • The government will continue reducing and even eliminating state-owned companies at the local level that "duplicate or even triplicate services."
  • Subsidies to political parties, labor unions, and business organizations will be reduced by 20% --they have already been reduced 20% this current year.
Lest anyone think that Spain has not already taken some stringent fiscal steps, let me tell you some of the ways that the country is already cutting back spending.

First of all, the regional governments are paying some bills very slowly. This has been going on for months, but it is coming closer to home now. Local pharmacies were closed for at least two days in the past month in protest because they had not been paid by the Valencian autonomous comunidad for medications they had issued to customers.

Co-payments are being instituted for drugs and medications. Whereas you used to be able to have prescriptions filled for free, as long as you had the script from your local public doctor and a valid health car, consumers are now going to have to pay for part of the cost. How much? Some reports have said 10%; others imply more. A list of at least 400 drugs has been targeted, some for them for "routine but chronic ailments" such as diabetes, blood pressure, and heart disease.

Spain has cut down on those who qualify for free medical care. Undocumented residents, or those who have not successfully completed the process of acquiring accepted documentation (and I was in that category once) will no longer receive health services. Exceptions are made for certain groups: infants and children under the age of 18; pensioners, age 65 and older; pregnant and nursing women.

Life here is definitely becoming more expensive. Some will feel it more than others, but I think we will all feel it somewhat from now on.

Sunday, June 24, 2012

"Can I Help You?"

This blog post is dedicated to the lady who appeared suddenly, unnoticed by me, behind my back in the Consum parking lot yesterday morning, offering help in getting a wheelchair, which I had just--for the first time--succeeded in disassembling according to plan, into the trunk of the Ford Fusion.

I turned toward her, startled, and her eyes said it all. "I've been there, too," she said. "My husband had a stroke and I had to learn about wheelchairs and everything suddenly. He's better now, he can walk again and has a "rollator" with a seat. But no one understands how tiring it is to move this stuff around--and no one ever thinks about the caregiver."

At least she said something like that. I may well have gotten the details wrong, because I am, admittedly, very tired from my unexpected care giving duties and I find it increasingly hard to focus and remember all the things I need to remember. Not that I didn't anticipate that this summer would feature a lot of fetch and carry--of course I knew that a knee replacement patient would have a hard and painful recovery, with lots of exercises to concentrate on in order to regain full use of the leg. We knew that driving was off-limits for six weeks and that he probably wouldn't be able to handle stairs for a long time, so we had prepared a downstairs bedroom and explored options for an in-tub chair, since the downstairs bath does not have a free-standing shower. But we also had talked with everyone we knew who had ever had a knee replacement--or knew someone who had--and they all told us that within 24 hours they were expected to be up walking with assistance, that strenuous therapy began immediately, and that one soon moves from a walker to crutches, to perhaps a cane. And that it is important to do the exercises!

So it came as a complete surprise to us both when the surgeon explained that for this procedure, the patient could not put any weight on the operated leg for a minimum of six weeks. Not only did that restriction delay the recovery period considerably, it changed it completely. I put away the crutches and cane we had acquired and rented a wheelchair. By using a Zimmer frame stationary walker and a 5-wheel rolling office chair, the patient can make his way around the first floor of the house fairly well; the walker and wheelchair--and someone to manage them--are necessary when leaving the house. And it was necessary to leave the house almost immediately, for trips to change the dressing, for doctor's appointments, and just to get out in the world to maintain sanity.

The man in the rental store showed me quickly how neatly the wheels and foot rests come off the wheelchair, and then with one upward hand motion, the seat comes up and the chair folds in two and can be placed easily in the trunk of the car. Yes, watching it and doing it, and then doing it again, and alone, are two different things. I wasn't even able to get the chair from the trunk of the car into the house without getting grease all over my pants and shirt the first time. Reassembling the chair that first evening was not difficult, but when it came time to take out the four movable parts and whack the seat upright, I had lost the secret. I am not mechanically inclined, and the subtleties of design of a black-on-black apparatus are beyond me. Fortunately my husband is mechanically inclined and can see the various working parts. With practice over the past two weeks, we have slowly gotten to the point where we can do a chair-to-car transfer of both patient and chair in five or six minutes and without too many visible sighs of frustration on my part.

The worst "practice" session was in the basement parking garage of the Habaneras shopping center, curiously unlighted, where I could discern no handicapped parking spots and so was panicking that a car would pull in to the "empty" spot next to our car where patient and chair were situated far too long in various stages of assembly. Of course I'm not sure whether we legally qualify for a handicapped spot during this temporary situation and don't really have time to investigate that, but on the way out of the shopping center, I left the patient in his chair at a well-lighted, extra-wide, "pre-mama" parking space, went and retrieved our car, and drove it into the expectant mother's slot--clearly one that we were not authorized to use. But it worked, and no one criticized or hit us.

A couple days later when we went to the grocery store, it wasn't busy and there were lots of parking spaces, and lots of light in the ground-level parking lot. I had no trouble at all assembling the wheelchair, and we both went into the coolness of the air-conditioned Consum to do our shopping. Leaving some time later, I discovered that a motorcycle had parked smack dab in the middle of the regular spot next to me, so there was plenty of room to get the patient into the car and dismantle the wheelchair. This time it only required a couple extra motions, and no swear words passed my lips. It was just as I went to lift the chair into the trunk that the nice lady hailed me. So she didn't need to help me lift the chair in--or worse--dismantle it. But she helped, just by understanding and sharing the experience. Some things you can understand, appreciate, and sympathize with in theory, but some you really can only understand by living them. Our brief talk, and hearing her story, lightened my load. She also pointed out a handicapped spot closer to the store, for next time.

There was one thought I did not share with her, because apparently I am a lot luckier than she was. My friends do think about the caregiver--almost all the people who have written and asked about our patient have also asked me how I am doing. So have the visitors who have made it to the house. That is very comforting, and it also helps lighten the load.

The patient improves a little more every day, conscientiously does his bending but none-weight-bearing exercises, and is counting the days until the end of the six-week prohibition. And the caregiver is hanging on.

Sunday, June 10, 2012

Hospital Time

I never got back to the Algorfa ayuntamiento to deposit entries into the tapas festival drawing. I got so tied up in the busyness of knee replacement surgery that it slipped my mind until--amazingly--almost the exact hour of the drawing last Friday. At that time I was in a hospital room with the official photographer of this blog, into whose knee a prosthesis had been placed on Tuesday afternoon.

I had no personal experience with knee surgery before, so I cannot offer comparisons between anyone else and the way it went for us, but it has certainly been an interesting and tiring week. When we arrived at the hospital on Tuesday noon, we were shown to a room which was to become home for the next several days. There was one of those mechanically sophisticated hospital beds with all sorts of contraptions, a sturdy chair with movable arms, a long and fairly wide couch, and a private bathroom with toilet, sink, and shower. I've stayed in less well-fitted hotel rooms. In the next two hours various persons came into the room and prepared the patient. Then at 3:00 they wheeled him out in the bed, and at 9:00 that evening they wheeled him back in. Surprisingly and disappointingly, no meal was available at this time, at least for this patient who had been fasting for over 24 hours, so I went out and bought a sandwich for him at the vending machine in the hall. Nurses came in to check various signs and one brought me sheets and a pillow for my couch bed. In the morning, they offered me towels in case I wanted to take a shower.

Time, especially mealtime, is different in Spain than it is in the U.S., but maybe hospital time is more similar across cultures than normal time. Since I have never been in a hospital more than over one night in the U.S. I don't really know. This patient was mighty glad when the breakfast service came in the next morning at a little after 8:00, even though breakfast turned out to be only coffee (decaffeinated) and a choice of bread, donuts, or sweet rolls. Not too substantial, but meriendas came at 10:30: this snack offered fruit drinks, coffee or tea, and cookies. At some time each morning a one-liter bottle of still water also appeared. Lunchtime was served at about 1:30--early according to Spanish custom, but per Spanish custom, comida consisted of a first course, a main course, bread, and dessert. Never what I would call noisy--even when we left the door to the room open, any personnel coming in to attend us would automatically close it on the way out--the hospital became very quiet after lunch. It was, after all, siesta time. Almost on the dot of 4:00 siesta was over, the shift had changed, and the merienda service came by again with its cart of beverages, cookies, and more sweets. The main event of the "afternoon," as this period of time is called in Spain, was the doctor's visit. The first day he came at 7:00 PM; we figured that was probably exactly 24 hours after the end of the surgery. Then at 8:00 (this is more like Spanish dinner time) dinner, or la cena, arrived. Here again there was a first course, main course, bread, and dessert. I left after dinner, so I do not know if meriendas were offered again as a bedtime snack; I doubt it.

When dinner came the first night, we were also presented with a menu for the next day. Three choices were offered for each course for comida and cena, including soup or salad as a first course; fish, meat, or a somewhat vegetarian main course; ice cream, pudding, yogurt, or "fruit natural" for dessert. During his stay, the patient had some excellent fish that was completely boneless, roasted chicken, a French omelet, sliced tomatoes with olive oil dressing and salt (the only time I saw a vegetable as an accompaniment, except for the salad starter), and some delicious cremas, thick "creamed" soup, and one was crema de alcochofa, artichokes, a specialty of this region. He never graduated to caffeinated coffee--I asked--but no one objected when I went down to the hospital cafeteria and ordered two cafes con leche para llevar. I usually ate the individual bread loaf that came with the meal, sans butter, and I also appropriated the "fruit natural" ordered the first day--a kiwi, unpeeled, hard as a rock (which at first I mistook for a baked potato) with only a regular dinner knife to peel it. It's sitting downstairs in my kitchen still, ripening--maybe tomorrow for our lunchtime fruit salad.

Each day was long and tedious, punctuated only with meals, exercises, a sponge bath, the room cleaning, various nursing checks, and the doctor visit--typically, everything was quiet until the patient fell into sleep and then someone knocked on the door and came in to do something. And yet, we were only there three days following the procedure. When the doctor came at 5:30 Friday afternoon he was satisfied with the progress and offered the patient the choice of going home that night or Saturday morning. You can guess what the patient chose (and perhaps what his caregiver would have preferred). "The discharge instructions will come from the doctor in 20 minutes," said the head nurse. An hour and 30 minutes later, the instructions came. The patient could go home either in our car or in an ambulance, but he might have to wait for the ambulance. Given the experience of time for dismissal so far, it was our car. They wheeled him down to the main entrance while I fetched the car, and we left the luxury of the hospital to be at home. And that began a different adventure.

Sunday, April 15, 2012

Economic Changes

One measure of the way the worldwide economic crisis has hit Spain is the statistics about unemployment: approaching 25% according to the most recent reports, and nearly 50% of youth between the ages of 16 and 24. Another measure is the general strike of March 29, which did not cripple the country by any means, but was inconvenient, especially if one was traveling, and a noticeable reminder that government workers and services are being especially hard hit in the search for remedies. The slowdown in government services was one reason we found ourselves this past week in the waiting rooms of San Jaime, the private hospital in Torrevieja, for a third cataract operation.

This operation was not for me, but for Johannes. I have had two cataract procedures in the past two years, one on each eye, both successful, and both paid for by the public health system of Spain (which generally pushes costs for non-Spanish European citizens back to the "home" European country as in typical EU fashion, but the system is administered and services delivered by Spain). In 2010 when I needed my first operation, I waited for a few months after getting approval from the ophthalmologist and then I got a letter from the hospital that was to do the surgery: since the three month waiting period had been reached, I now had my choice of waiting until my name came to the top of the list, or going to the private hospital, where an immediate operation would be performed at public cost. I did not need a second invitation, and after I had had one eye done this way, I was able to get the second done several months later by the same hospital, same doctor, and according to the same overflow conditions.

This time three months passed after approval for the procedure, but no letter was forthcoming. In due course we went to the hospital for which Johannes was in line, and they would not give even a guess as to when he would make it to the top of the list. Apparently the public system is no longer paying for overflow procedures at the private hospital, which should not have been a great surprise since the newspapers are filled with stories of short-term strikes at pharmacies that have not received payments by the provincial governments for the drugs they have delivered free to participants in the public system.

On the day of Johannes' operation, the waiting room was not as crowded as it was when I had my two procedures, and instead of waiting several hours from beginning to end, it was less than two. As I sat in the outer waiting room and listened to the voices around me, I was surprised that most of the patients were Spanish. We were surrounded by families in which the women were well-dressed, with beautifully colored and styled hair. I had expected that they were European citizens who had elected to pay for a quicker procedure. But there was only one other English-speaking couple and at least four Spanish-speaking. It seemed as though Spanish women of a certain age were the patients; as this was cataract surgery, they were probably in their seventies or near them on either side. When Johannes came out an hour later from his procedure, he gave me the inside story of the conversations in the inner waiting room.

You have to disrobe and put on a hospital gown when you have cataract surgery here, and apparently that prompted the subject of clothing. The women were chatting about how, when they were growing up, they would have been dowdily dressed in straight black, dark grey, or navy blue skirts at this age, and certainly not undressing for cataract surgery. It is true; even today you see many short, older Spanish women, whether  in cities or pueblos, in their tight black skirts, nondescript dark blouses, dark hose, and flat black shoes. I look at them and guess that they are in their seventies or eighties, but I know that some, especially in the small towns, are only in their sixties or maybe even fifties. Only a generation, or perhaps two, separated the stylish women I saw in the waiting room from their mothers or grandmothers in the old-Spanish uniform. A generation, probably an education, jobs, the invasion of their country by northern Europeans, and presumably a little more wealth.

But the younger generation of today is probably not going to see the positive change that their parents did, if the country does not find a way to save its economy from itself and from the "Overdose of Pain" prescribed by the EU.

Monday, August 1, 2011

Como en Casa

I've been back in Spain for almost two weeks now, and I am coming to feel very much at home. Me siento como en casa. The jet lag is finally gone and I am sleeping through the night without a sleeping pill. Good sleep is always hard to come by after the transatlantic journey, and especially in summer, when the weather is hot and we alternate between the bedroom air conditioner, which eventually becomes too cold no matter how many degrees we set it for, and the overhead fan, which eventually allows the temperature to creep up to where we need the a/c again. And isn't it a pleasure to be back in the land of good and silent room air conditioners, instead of those noisy things that are still grinding away in too many hotels in the U.S.

This week has been a succession of small rituals that make up our pleasant everyday life in Spain. Tuesday and Friday we had petanca games with the Danes. We were only three players on Tuesday, and I lost both games, but it was still a bit of exercise in the sun, and I enjoyed it. Friday there were 20 people at least, way fewer than normal because many go back to Denmark to visit in the summer, but some Danes also come to Spain to visit, and I played against two visitors--and my team won both games.

Wednesday we went to Almoradí to the health clinic, in the first of several health visits that we hope will find a solution to Johannes' difficulties in walking. Health care could be a near full-time occupation in Spain, or maybe it's only because of our age? We had been to the regular doctor the week before--I hesitate to call him the primary care physician because the only care I've ever seen him provide is to enter data into a computer and dispense appointment papers and prescriptions. Next week's appointment will be the clinic that does blood tests, and then the week after that all the data will be assembled back at the regular doctor's. This is the way the system works when it's not an emergency, and that's all right, because after each appointment we enjoy a cup of café con leche with a media tostada at a local bar. Then I am reminded again of how civilized the coffee ritual is here, where you never see a paper cup unless you go to McDonald's--and you wouldn't do that normally because there you can't see a tostada.

One activity that I am not back to is my weekly Spanish lesson, because my teacher has houseguests and will until the middle of August. That's typical here--we break for visitors, who arrive frequently from the north, or when we ourselves travel, of course. So in spite of the fact that I have a private class and my lessons don't have to follow the usual Spanish pattern of pausing for the summer from June until September, they will, this year at least. There is a reason these patterns develop.

Thursday evening we visited the home of a Spanish-American couple we have come to know,  and enjoyed dinner and conversation with them on their beautiful terrace overlooking the pool and the lights in Torrevieja on the other side of the salt lake. By this time of day there were cool breezes and no flies or mosquitoes. We chatted over a drink and hors d'oeuvres from 7:30 until twilight fell, and then sat down to a simple dinner of pork roasted with vegetables, and grilled zucchini and tomatoes. Spanish recipes, my friend assured me, and we were definitely eating at Spanish time, which the two of us cannot normally manage. Suddenly we noticed that the clock stood at almost midnight, and we had no idea of how it had gotten that late.

Yesterday we skipped our usual Sunday Zoco market--the one close enough to us that we could walk to it but never do because we don't know how much we might buy and have to carry home--and went instead to the "lemon market," which involves a drive down Lemon Tree Road toward the town of Guardamar. It is much larger and some say "more Spanish" than the Zoco. Maybe so, and we certainly noticed that the prices of produce were far cheaper than at the Zoco. But that may be because we are in the midst of the plenitude of summer, and they were almost giving away tomatoes and plums, and even the grapes were less costly than usual. I was amused by a man demonstrating a wonderful fruit and vegetable slicer with three different blades--and could understand the "as seen on TV" promotion in Spanish even though I didn't catch every single word.  The utensil would have been perfect for our lunchtime salads and would not even have taken up very much storage space, but the price, which of course only comes out at the end, after tons of vegetable slices and curls have piled up in front of him, was "only" 25 euros.

After such a demonstration we just needed to sit down for a cup of café con leche, but we weren't able to find a place for a tostada at this "more Spanish" market. Instead we settled at one of the many "English breakfast" establishments, where we indulged in English bacon, sausage, an egg, toast, tomato, and an enormous cup of tea. Coffee would have been extra, so why not do as the "natives" do?

And that is multicultural Spain as I know it.

Sunday, August 15, 2010

Spanish Eyes

                                                        "Blue Spanish eyes...
                                      Teardrops are falling from your Spanish eyes ..."

Well, it's only one Spanish eye, and it's not teardrops that are falling, but eyedrops.

I had a cataract operation this past Wednesday, and now I have a new left eye lens, courtesy of the excellent Spanish health care system. The operation went well and was over before I knew it: "Finito" said the surgeon, while I was still waiting to be told to open my eye wider.

It was physically painless, and after I had spent four hours waiting in three separate waiting rooms, I was beyond any anxiety about the procedure--I just wanted it to be done! Between the time I was finally(!) wheeled out of the third waiting room to a gurney near an operating room down the hall, approached by the anesthesiologist who gave me dos pinchitos (two pinprick injections) and connected an IV, was wheeled into the operating room, greeted the doctor, felt a little scrape-scrape and heard "finito," I don't think that more than twenty minutes passed. Back to the prep room, which I now realized was also the recovery room, an orange juice (first sustenance of the day) and a precautionary pain pill, and soon I was dressed and walking out with a smile.

My right eye vision is poor, so with a patch over the left, I endured 24 hours of near blindness. I listened to more local radio (Spanish and English) than I ever had before, as well as a downloaded book (Liberty, by Garrison Keillor) through my library and OverDrive, and All Things Considered and Morning Edition--thank you, NPR, Thank goodness for the Internet!

Now, with the patch removed, we are into aftercare, a tedious regimen of three different kinds of eyedrops, one of them every eight hours, two every two hours. Eyedrops will be regulating my life at least for a week. It takes two to three weeks for vision to stabilize after this procedure, I understand, and right now I have periods when I can see well, but progress is not consistent. Just when I think I'm getting the hang of coordinating my eyes well, the two-hour timer goes off and it's time to drop the left one full of liquid medication so it looks as though I'm peering out of a rainy windshield for the next 15 minutes.

But they are eyedrops, not teardrops. I am grateful for my new Spanish eye, and I give thanks to the Spanish health care system, San Jaime hospital, Dr. Fernandez, and the anesthesiologist who gave me the pinchitos. I don't remember her name, which means she did her job well.

Thanks also to my aftercare provider, who is calling me now for the next set of drops.

Sunday, March 21, 2010

Health Care in Spain

This Sunday in Spain I am going to be watching the health care vote in the United States. Whether it passes--and whatever it may be that eventually squeaks through--it will still be years, or decades, before the U.S. has overall health care as good as that in Spain.

The key word, of course, is "overall." The U.S. has excellent health care for those who can pay. It's just that fewer and fewer individuals and companies can afford to pay exorbitant rates for health insurance and procedures. In Spain, if you are a legal resident, you can get pretty good health care for free, and if you want to pay, you can get health care equal to the best in the world. Spain has a public healthcare system that is administered through its 26 autonomous regions. That's why, when we moved from Roquetas de Mar in Andalucía to Alicante in the Valencia region, we had to get new health cards. Spain also has a thriving industry of private healthcare providers. I have used both public and private services during the years I have been in Spain.

This week I was approved in the public system for a cataract operation. Yes, I have to wait. There are three boxes on my authorization form: my condition is not Urgent, nor is it Preferred. It's just Ordinary. Within three months, the ophthalmologist at my regional Centro de Especialidades told me, I will get a phone call from the Vega Baja hospital. Then I will go in to talk with the specialists there, and it may take up to a month after that before the operation can take place. Well, I don't mind waiting, since with my particular eye history and my complicated schedule, I'm not quite ready to look this laser in the eye just yet. But it is amazing to me, as an American who has experienced several private insurance plans over the years, been in a few HMOs, and paid a lot for private individual insurance, to think that I might have this surgical procedure without producing money or processing paperwork. All I have to do is show my card.

All my previous eye care in Spain has been through private providers, because it occurred before I became a legal resident and obtained my health card. It was excellent, with the most up-to-date equipment and knowledgeable personnel. Because I had experienced the same procedures in the U.S., I can say that the Spanish care was equal to that in the U.S. The costs, though considerable, were significantly less--about half.

I have also used private care for a couple minor walk-in problems--a bad back spasm, a mysterious skin rash--and paid prices that I believe are comparable to what I would pay in the U.S. as a non-insured patient. When I severely twisted my ankle on a Saturday night just before getting ready to leave for Argentina on Monday, however, I went to the public clinic, because it was open on Sunday, and they sent me on to the public hospital for X-rays, binding up, and prescriptions for crutches, a painkiller, and injections to avoid complications during air travel. Since I did not at that time have my health card, I got a bill for that service a few weeks later, payable to the teller at the corner bank--a total of something like 117 euros and some cents, obviously the amount that some accountant has figured that particular event costs the system.

I do have some complaints about health care in Spain. Over-the-counter medications are expensive, so my suitcase on returning from the U.S. is always packed with the Meijer or Target equivalent of aspirin, vitamin and mineral supplements, and Ocuvite (which I can get here, but at more than twice the price). Medications prescribed by a private practice are also expensive, but the same compound prescribed through the public system is free. Dental care is not a part of the public system, so there is lots of competition among lots of dental practices.

Spaniards can buy medical insurance if they want to use the services of private practices, and judging from the number of Spaniards I have seen in the waiting rooms of the private clinics I have been in, they do. Private practices are also heavily used by foreigners who do not have access to the health card or who prefer medical staff who speak their own language, or at least English.

Public and private health care seems to work quite well in Spain, providing several options for the diverse population. I expect to continue to be a consumer of both. I wish the options were as good for people in the United States.

Sunday, February 28, 2010

¡Vive en España!

"¡Vive en España!" That's what the Spanish man in the waiting room at the local health clinic said incredulously to the woman with whom he was chatting across the aisle, as an English man disappeared through the door into the doctor's office. And he sighed. And the meaning was clear: "This man lives in Spain. Why can't he speak Spanish?"

The English man had asked us, as he rose to take his turn when Johannes and I came out of the doctor's office, "How do you say "It's getting better" in Spanish?" And Johannes, ever helpful and a near-native speaker of Spanish, volunteered to go into the office with him and help him say to the doctor that it--whatever it was--was getting better, and perhaps to facilitate the conversation a little more. After all, we had just come out of that same doctor's office, and we knew he spoke no English, that he spoke Spanish very quickly and not clearly, and that he was difficult to understand even if you were a near-native speaker.

I sighed when I heard "¡Vive en España!" because it was said in exactly the same tone and with the same disapproval that I have heard too many Americans express when talking about Hispanics and other immigrants in the U.S. "But they live in the U.S....!" and presumably should be able to speak English on demand.

I sighed because I always suspected, and because I now know from experience, that it is one thing to be able to speak Spanish, or any foreign language, and another thing entirely to be able to speak it well enough to feel competent when the subject matter is technical or the situation is stressful.

I sighed because I know that I, despite many years of studying and practicing Spanish in the past, and many more scheduled for the future, know in my bones that there will most likely be times ahead when I will not feel comfortable or competent--in the medical emergencies, legal proceedings, and other dependent situations that must be faced as we get older.

And I sighed because I wanted to be able to explain to the Spanish man and his conversation partner that most of us foreigners know that we should try harder in Spanish, and some of us do try harder than others, but that proficiency and fluidity in a foreign language do not necessarily come with a certain degree of effort or after a certain number of years--and definitely not when one moves to a new country at the age of 60 or more--and that speaking to a doctor can be one of those emotional circumstances that just seem to make you forget whatever it is that you have learned....and that all of this is no excuse.

But this matter of hearing, for the first time, two local Spanish residents give vent to some impatience and frustration with the large number of European immigrants that Spain by and large has welcomed to its Mediterranean coast for decades, made me a little surprised and emotional. And I did not trust myself to be able to embark on a complicated conversation about language in a language in which I am not fluent. So I did not take upon my shoulders the burden of defending immigrants with insufficient language skills. I buried my head in my book and continued reading in Spanish until the man and his translator emerged from the doctor's office.

Sunday, February 21, 2010

Microsoft Research Center in Torrevieja

For two weeks, the free foreign newspapers in the southern part of Valencia Community have been buzzing with the news that Microsoft was considering establishing a health research center in Torrevieja. Details in most of these papers are usually sorely lacking, and this time has been no exception. Since most of these newspapers are weeklies, it's been hard getting a straight and up-to-date story. Not only was Torrevieja in the running for the Microsoft center, but also the larger cities of Alicante itself (the provincial capital) and Valencia (the Community capital). But the latest round of the free press seems to be saying that the new and very modern Torrevieja hospital has won out over the the capital cities.

Now the national paper, El País, is lending credence to Torrevieja's win. Yesterday's newspaper carried a story saying that Bill Gates had received Community president Francisco Camps at Microsoft headquarters "in the American state of Washington" (which was more likely than some of the reports that said the meeting had occurred in Washington, DC). But El País still reports that Camps had gone to lobby for the Valencian Community--specifically one of the capital cities. Apparently it is Microsoft that prefers Torrevieja, based on a successful installation of Microsoft's "Florence" medical system software that has helped reduce the average waiting time for emergency intakes by 50%--from an hour to a half hour--over the past year.

It's not clear to me that the Microsoft research center is going to do anything more than research even further improvements in software development. The 300 square meter facility is supposed to employ ten people and cost the Community, Telefónica, and CAM bank 800,000 euros over two years. But the story is getting a lot of play locally, as just the latest in the accolades accorded to the very modern and efficient Torrevieja hospital since its establishment in 2006. So far I've only driven past the huge campus less than half an hour from my home, but I suspect that at some point in the future I'll have need of its services. So it's nice to know that the computer systems will be up to date.