A Tale of Two Stories, Part 2: Dalila's Son.

by Shaker laguiri. Part One is here.

The first death from swine flu in Spain took place two weeks ago. She was a pregnant woman whose son was born by Caesarean section, and this is part of his story.

I wrote about his mother's story in Part One, where I noted, "the public health system is fundamentally universal and free." When I wrote that post, I tried to avoid an important political issue, which is the management of the healthcare system in Madrid, a region comparable to an American State. Here, in public services, a government (local, regional, national) has two main options: Providing that service directly, with tax money that goes to pay for the buildings, the things, and the salaries, or to hire a company. A lump sum of tax money is given to a private company, which pays for the buildings, their contents, and the salaries. If ownership and management are 100% public, most workers are part of the civil service and their working conditions and benefits are a bit better than "normal" workers. If management is private, the vast majority of workers are "normal" ones. Tax-funded-but-privately-managed operations are normally cheaper than their publicly-managed equivalents, for the very simple reason that a private company wants to extract a profit from the original lump sum of tax money that it is given by a government.

Traditionally, conservative governments prefer these mixed arrangement for schools. Sometimes you get them in healthcare. In 2003, the Conservative Esperanza Aguirre became President of Madrid and begun a very fast creation of new hospitals and also the transfer of public hospitals to private companies. Hospital Gregorio Marañón, where Dalila Mimouni was diagnosed an infection, asthma and muscular pain as a result of pregnancy instead of swine flu, is one of them.

It is also the hospital in which Dalila's son, Rayan, born at 28 weeks' gestation, has died when he was two weeks old. His death has been blamed on a "terrorifical mistake," in the words of the Hospital's director. On Sunday, he was given baby formula by an IV drip instead of through a nasogastric tube. Prematures babies can't survive this, and he died about 15 hours later in spite of every medical effort done to help him.

That's the fact. Now, these are some of the circumstances.

The nurse who made the fatal mistake was alone and unsupervised on her first day on the Newborns' Intensive Care Unit. She had worked on five different sections in less than two years. She was covering up a lack of staff on the Newborns' ICU. At feeding time on Sunday, the nurse who was in charge of Rayan had to leave to take care of a coming emergency. I'll say that again in case it wasn't clear: The nurse that made the mistake was covering up an absence in the ICU. Her supervisor had to cover up an absence in Emergencies, leaving a nurse unsupervised on her first day working with critical newborns. According to a union, half the staff in the ICU are temps.

Did I say that Madrid has a lot of new hospitals? Yes, if you look here, you see a pretty blue box which shows that there are 8 new ones on top of the 23 older ones. Impressive, isn't it?

Now, if you look at that website, under "job offers," there are several headings. "Proceso de dotación de Nuevos Hospitales" = Process for the equipment of new hospitals. Clicking there, you can see that's not hiring. That's redistribution—spreading the staff of the old hospitals accross the new ones. Then there's "Bolsas para la contratación temporal" = temporary jobs. "Bolsas" means bags: They are open waiting lists with no disclosure of how many doctors are actually needed. Doctors can join the queue and sit by the phone until they get a temp job. There are three lists—nurses, pediatricians, and general doctors.

Now, the real jobs. Would you like to know how many non-temping jobs are offered in the public health system in Madrid this year? 5,288. There are 49 clinics and hospitals in Madrid, and about 6 and a half million people. So, we can safely assume that, yes, Madrid is working with 25% more hospitals and the same staff than it did five years ago. Probably less, because we had our own Baby Boom and the majority of Spanish doctors are near retirement age.

No wonder privately-managed public hospitals are so profitable.

The truth is, I feel bad I assumed sex discrimination on my first guest post about this tragedy. Maybe doctors saw her as the appendage to a fetus, but I'm not so sure anymore. Maybe all they saw was a lot of extra work through a caffeine haze, while each one of them was doing the job of a doctor and a half. Or maybe a job they weren't even properly qualified to do. For myself, I just hope I never get sick in Madrid.