Tiago Villanueva: Spanish doctors and the revolution in the streets of Madrid

Tiago_VillanuevaWe’ve all seen the recent images on television in Spain, with tens of thousands of people taking to  the streets of Madrid and occupying its main squares. After Tunis and Cairo, the Spanish capital has been seen some of the people’s momentum that toppled governments and dictators just across the other side of the Mediterranean. Many young doctors have also been taking part in the protests and in ongoing discussions about healthcare.

I had a chance to discuss the current events and its implications with my colleague and friend Roberto Sanchez (his blog is at: http://1palabratuyabastaraparasanarme.blogspot.com/), who is a newly qualified GP working in Madrid. With his permission, I reproduce below the conversation we’ve had by email.

Tiago: The 15M movement gathered thousands of people, initially in Madrid, and then it spread to other Spanish cities, and even to other parts of Europe, like Portugal. Why did this 15M movement start in the first place and what is generating this movement of widespread discontentment?

Roberto: Firstly, it started because of the perception that people’s opinions weren’t being taken into account by politicians, and that they were losing their influence. Secondly, because of the absence of a truly participatory democracy. Now a vote every four years is a blank cheque for politicians to do what is most convenient to them, even though it is what is less convenient for citizens. Politicians, regardless of whether they were the ones you vote for, are nothing more than public servants. The management of the current financial crisis without bearing in mind the opinions of citizens was the last straw. We can’t stand it anymore.

Tiago: What are you fighting for? What are the main concerns driving Madrid’s junior doctors participating in this movement and what results do you expect to achieve?

Roberto: 15M is a revolution of both shape and content. I think the important thing about the movement is that citizens have not just told politicians that “we don’t like this world you are building” but also “this is the world that we like and we want you to build it because you are our representatives.” In this sense, we gathered in committees, and one of them was healthcare. I think the most important thing is to fight for general consensual aspects such as the fight against corruption, reform of the election law, transparency in public sector macro management, just to quote a few. Regarding healthcare, this is the moment to fiercely defend the public healthcare system and to make supporters of the pro-privatization movement aware of what we’re doing.
Some young doctors like me have been involved in this revolution, because we care more about the sustainability of the public healthcare system than about our wages and our personal aspirations, and we call for the healthcare system to correct the social inequalities of the population and provide adequate patient care.

Tiago: Are the problems of young doctors in Spain similar to those of the majority of the Spanish population?

Roberto: Yes and no. For instance, I can’t compare myself with the majority of the general population. In my country, there are five million people unemployed. The minimum wage is around 700 euros. Construction workers work the whole day in exchange for almost nothing. As a trainee, I received 2000 euros per month, and now as a GP I receive around 2500 to 3000 euros. It is also true that I have no choice but to accept unstable, temporary contracts, and only be able to access a permanent position in 10 to 15 years time. Moreover, I have to put up with bureaucracy, face lack of social prestige and despise by the healthcare system and the administration that hires me. I also have to work my whole life to buy a house. But 15M is not a movement to change the conditions of Spanish doctors, it is an attempt to bring about mentality change in politicians.

Tiago:What results have you achieved so far?

Roberto: This was an absolutely historical moment, and what has happened seems like a dream. We citizens, being traditionally passive, said “we’ve had it.” It was an example of dignity and indignation. But it wasn’t a dream. After those days, the fight goes on. 15M is not the end, it is a beginning.

Tiago: What are the next steps of these people’s healthcare assemblies and those movements of young doctors?

Roberto: People are working on a consensus document about what is to be achieved in the realm of healthcare. The work is carried out in assemblies and through the internet, and a discussion group has been created. Once we reach an agreement, we shall see. I believe the goal of the protests is to make the population aware of the improper things politicians and managers are doing with public healthcare, in order to be able to pressurise them. Acting otherwise will probably not have any effect, since politicians are not very sensitive to the healthcare professional’s petitions in favour of the improvement of the healthcare sector.
Tiago: Do you feel optimistic about the future? Why?

Roberto: Of course. It is impossible to see 14 000 people in the centre of Madrid fighting for a cause so just and worthy and not feel optimistic.

We doctors usually just think in the very short and medium term, we are very self-centered, we adhere very well to the cause-effect paradigm but we have a hard time understanding the multi-causal. We have a hard time understanding that change comes at the cost of a lot of effort and time. Removing a conscience is not the same as making a patient take a drug. Our problem is that we’re convinced that patients take the drug, when in reality many don’t. We live in our world, and we have to come down to the real world.  And this is about politicians also coming down to the real world. I hope that a really representative political way that accumulates the ideas of the movement comes out of this. I believe in politics, after all, but in another type of politics because I believe in the human being.

Tiago Villanueva is a newly qualified general practitioner and former BMJ Clegg Scholar and editor, studentBMJ