Either all, or none: this is how a health center in Vallecas was saved from “critical status” by the efforts of a group of six doctors | Madrid News

Until recently, at the door of the Vicente Soldevilla health center, located in the San Diego neighborhood of the Puente de Vallecas district of Madrid, residents posted a poster every day with the number of family doctors available on the afternoon shift. . The number was always decreasing, until they stopped counting them because there were none left to count. There were no doctors and the center was added to the list of those in “critical condition.” But this month, he went from zero to six doctors in that schedule. Resurrected.

As if out of nowhere, Sara, María, Miguel, Javier, Inés and César appeared to name the neighbors’ hopes and fill in one go the six places necessary to reach 100% occupancy in the afternoon shift. In the end, six arrived, but just a few months before the list of volunteers to work in this health center was even longer, and this was reported to the Health Department of the Community of Madrid.

The six insist on highlighting, during a group telephone conversation with this newspaper, that the story of how they came together is nothing short of epic. “It was very organic,” they say. Some were friends before starting the race and others met in the hallways of the different health centers in Vallecas where they did the MIR. Having worked there brought them together. They were clear that the health situation in these neighborhoods was getting worse and worse and that no doctor would want to be alone in critical places like Soldevilla. “It was going to attend to agendas of 80 patients,” says María Minue, one of the center’s new doctors.

Working a shift, at any time, is a titanic task. Dr. Estrella Sánchez-Gamborino knows this, who started in May at Soldevilla, the eve of one of the hardest stages, the summer, when a large part of the staff goes on vacation. During those months she organized to work not only her morning shift but also her afternoon shift some days of the week and she was always worried that an emergency would arrive and the other patients would have to wait until she finished treating them. .

Sánchez-Gamborino says that in other nearby centers they have taken care of patients from his own during shifts without staff. Through a joint initiative, external doctors created gaps in their agendas to care for those arriving from Soldevilla, referred according to their pathologies that were evaluated by nurses. Minue remembers that during the shifts at the Infanta Leonor hospital in Vallecas, many Soldevilla patients also arrived at the emergency room who had not been monitored by any doctor for a long time.

Faced with this situation, the ministry declared Soldevilla one of the 22 critical health centers in the region in May of this year, among which were also four others from the Puente de Vallecas district: Alcalá de Guadaira, Campo de la Paloma, the Peña Prieta and the Entrevías. After the recent graduation of the new MIRs in September, 94 of them chose to stay in the Madrid Health Service (Sermas), which represents less than 50% of the vacancies in primary care in Madrid. It was a higher figure than in previous years, so the ministry announced that with these new revenues it has been able to reduce the number of critical health centers in the region by 80%, which they now claim are only five, whose names are not known. has revealed.

The Soldevilla debacle began before the covid-19 pandemic, according to María José García Bernal, a former nurse at the health center and member of the Vallecas Public Health Defense Platform. He says that health personnel began to abandon their positions not only in primary care, but also in other branches of medical specialties. “For physiotherapy there is a waiting list of up to a year,” he says.

Since Dr. Daniel García started working at Soldevilla in 2020, he saw how little by little his colleagues resigned. In the fall of 2023, her only remaining colleague on the afternoon shift announced that she was leaving. In February 2024 it was his turn. “I left,” he says, “because I was alone and it was unsustainable.” This health center serves nearly 30,000 people and, according to the latest data that this newspaper had access to in December of last year, at that time 35% of the primary care workforce was not covered. Then it got worse, as neighbors and health personnel confirm.

What happened for everything to change? To begin with, neighborhood associations, family doctors and resident internal doctors took the initiative to conduct a survey on possible solutions to the health centers’ problems. This survey revealed professionals’ preference for long-term contracts and, a detail that ended up being decisive, the possibility of working and organizing in groups to distribute the workload and guarantee stable care. From this communion between neighbors and professionals, the possibility of finding a solution from the bottom up began to emerge. At the top was the Ministry of Health, which ended up understanding that offering economic incentives and, above all, accepting applications in groups could be a very effective solution.

The department tried to take credit for this good management and said that “informative meetings” were held with residents to learn how to improve working conditions, remuneration and conciliation possibilities. But the neighbors and health professionals know that it is their fight that has brought them to this point. Dr. García explains it: “The only merit of the counseling has been to remove a barrier that they themselves had put up, since this is the first time in Madrid that residents are allowed to occupy places in groups.”

Vallecas is very stigmatized, the new Soldevilla doctors are clear about it. Minue reaffirms that day-to-day life in his health centers is like that of any other: “There is a feeling that going to Vallecas is like going to work in a trench, and that is not the case.” But he recognizes that the district has “some very particular conditions,” such as the socioeconomic level of its population. “It is likely that in other neighborhoods you will not have to face health problems resulting from an eviction,” he says.

“Healthcare in Vallecas is the responsibility of Sermas and not of the neighbors or the doctors,” says Miguel Muñoz, a member of this group of six. He points out that the lack of personnel and the deterioration of health centers have to do with the same lack of attention to structural policies, such as housing policies. “The answers to the problems of these neighborhoods have to come from a global vision,” he says.

“This was a wonderful clinic and now it is chaos. They have abandoned Vallecas in every way,” says patient Felipe González in the waiting room. María Teresa Rodríguez is at the door of one of the consultations to hunt down the nurse who comes and goes. He has been trying for days to find time for a doctor to treat his mother, who is 100 years old and needs a certificate “that says she is still alive” to be able to collect her pension. Since the beginning of September he has been trying to get an appointment and the next one is for the end of October.

The six new doctors agree that the achievement does not have to do with them separately, but with the constant struggle of the neighborhood. “We have given voice to a process that we have only joined,” says Javier Valentín, another of the new doctors.
Dr. Sánchez-Gamborino, who also did her residency in Vallecas, affirms that the six new Soldevilla doctors have not accepted the position because of the salary in any case, but because they have all experienced how the neighborhood is doing without doctors in their health center. .

Minue is sure that medicine must be approached from a bio-psychosocial perspective and César Montero, one of her future colleagues, feels that working in primary care is a way to defend that medicine in which care is provided “at a medical level” but also “at the community level”. Despite everything, Montero sees it clearly. “We wouldn’t say we are the end-all, be-all. As long as living conditions remain the same in these neighborhoods, the pressure on health centers will continue.”