A Tale of Two Stories

by Shaker laguiri

Two events related to swine flu cases have caused great alarm in Spain in the last two months, and they're worth a comparison. First of all, you need to understand some basic facts. The public health system is fundamentally universal and free. The national government is Socialist, but the government of the Madrid Community is Conservative. Only one hospital in Spain can confirm cases of swine flu and it takes them 24 to 48 hours to confirm a case from samples.

Now, the first case. In the middle of the electoral campaign for the European Parliament, several cases of swine flu appeared in a military base in a small town near Madrid, Hoyo de Manzanares. The problem was that this was officially announced on a Thursday, May 23rd, the soldiers had been ill for a few days already, and on Wednesday, a school had visited parts of the base. There was an understandable concern, to the extent that many children didn't go to school even though classes were not officially cancelled.

On Monday, Conservative leaders asked for the resignation of the Defence Minister (yes, this defence minister) and said that her attitude of secrecy the previous week was intolerable. Minister Chacón made a series of appearances in Congress and with the press, in order to tell her version of events. In short: the first cases broke out the two days before the school visit, but they were so mild that they were indistinguishable from a cold. Such outbreaks are frequent on military camps where soldiers live close together, but the first swine flu suspicions started because it was more contagious than any normal cold would be. The school children were always at least 500 metres away from the area where soldiers were quarantined. And there had been no "secrecy"—in fact everything had been revealed to Congress and to the press even faster than usual.

The flu was not transmitted to children, the electoral campaign went on, and everyone forgot the insinuations that Minister Chacón had plotted to kill all the children in Hoyo de Manzanares.

Let's fast forward a few weeks. Dalila Mimouni is a Moroccan immigrant in Spain. She's very young, only 19, and she's married to another young Moroccan. She's pregnant. And this is what happened to her (translated and condensed from here):

• June 11th: Dalila goes to the Gregorio Marañón Hospital. She has a high temperature, joint pain, lower back pain, a headache, and a sore throat. She is diagnosed with a throat infection. The lower back pain is blamed on her pregnancy. She's given treatment for the infection and she's sent home.

• June 13th: She's not getting better. She goes with a 39.5º C / 103ºF temperature to the emergency services to Fuenlabrada Hospital. They confirm the previous diagnosis and send her home.

• June 15th, 5:00 a.m.: She goes again to Gregorio Marañón. Same symptoms, same fever. She's diagnosed with an infection and asthma. She's given paracetamol and amoxicilin, and she's sent home.

• June 15th, 19:50: She goes back to hospital. She has difficulty breathing. Her new treatment includes more antibiotics, bronchodilators, and antipyretics.

• June 15th, 21:00: She gets worse and is sent to intensive care. She's diagnosed with pneumonia. More antibiotics.

• June 16th, 9:00: She's put on artificial ventilation. The swine flu diagnosis is confirmed.

• June 29th, Dalila's 20th' birthday: Her baby is born via cesarean section, at 28 weeks.

• June 30th: Dalila dies.

By the way: Dalila's family denies she was asthmatic, and the Madrid Health authorities say that this detail had always been on her medical records. Apparently, she was a healthy woman who liked to run the 1,500 meters.

Let's pretend that there aren't political interests in the two cases. What can anyone, especially any woman in Spain, infer if we compare the two incidents? First of all, that if you are the Defence Minister you are supposed to have magical powers to know the state of health of any of the tens of thousands of people under your responsibility. It is an intolerable breach that you are not informed on a Tuesday that some soldiers had been diagnosed a cold on Monday. If you're informed on Wednesday night that they suspect swine flu, and the new diagnosis is officially declared on Thursday afternoon, there was negligence in allowing some schoolchildren to visit the same building complex where those soldiers were quarantined.

But now, if you are a doctor in a hospital it is perfectly understandable that you send a woman home with antibiotics if she has most of the symptoms of a flu, "swine" or common. You can do this for four times in the course of five days, until the woman stops breathing. Respiratory infections don't give you joint or back pain? Not a problem! It's the pregnancy, stupid! That is why the emergency doctors sent her to gynecology on her first hospital visit. Because of course, when a woman is pregnant, she's simply a warm, walking cradle for the itty-bitty-cutie-baby inside her. No more, no less.

Right now, the health authorities in Madrid are defending the doctors that neglected Dalila, saying that they believed they were doing the correct thing, and that they behaved "according to the protocols" (source). The tragedy is that these politicians are probably right. The doctors only did what they are supposed to do, which, in my experience in this country, is to follow to the letter all the principles of Bikini Medicine. That's the protocol they were using.

The Gregorio Marañón is a university hospital. All I can hope for the future is that right now, a student who doesn't plan to specialize in gynecology is shocked enough by this case to realize that there is not enough medical investigation of the way that 51% of the population receives medical treatment as if they were a deviation from the norm.