Disillusioned healthcare workers battling one of Europe's worst outbreaks of coronavirus in Spain are making plans to join the exodus of doctors and nurses from the country over recent years.
After being hailed as heroes in the battle against the first wave of Covid-19, exhausted doctors and nurses say they are being forced to consider leaving Spain's crippled healthcare system at a time of extreme crisis.
With the official Covid death toll above 34,000 and and the country on Wednesday passing the 1 million milestone of confirmed cases, health authorities are struggling to contain a second wave of Covid-19 by recruiting students and trainees.
But medical associations and leading professionals have criticised a lack of investment in human resources leading to burnout as the coronavirus second wave intensifies.
The problems are particularly acute in Madrid, where more than a quarter of all Covid cases have stretched the system to breaking point, while the region’s nurses say they are treated “like slaves” on short-term contracts in random postings that do not take into account their specialisations.
“I am thinking of leaving Spain again, and this time it will be for good,” said Juanjo González, a 27-year-old Madrid nurse who has previously worked in the UK and is now looking into New Zealand and Australia as possible destinations.
The strong second wave in Madrid, unchecked in the summer when the region’s test and trace system was slow to start, has convinced Mr González that his future lies elsewhere. The spectacle of a power struggle over recent weeks as Spain’s national government’s demands for stricter lockdown restrictions in Madrid were resisted by the regional administration has added insult to injury.
“We feel our work has not been valued. We were called heroes when we saved lives, and then no lessons have been learned and politicians are fighting amongst themselves,” Mr González told The Telegraph.
Mr González worked in a hospital in the Manchester area between 2014 and 2017 before deciding to return to Madrid to study a Masters degree in emergency nursing to be able to serve in ambulances. But the Madrid regional health department’s contract allocation system tends to ignore specialisations, posting Mr González to one of the city’s primary healthcare centres this year, where he was infected by Covid-19 like more than 63,000 other health workers in Spain.
“It’s frustrating. In the UK, they take your profile into account. Here it’s a kind of slavery,” Mr González said, explaining that nurses who do not have permanent contracts are assigned postings from one day to the next anywhere in the region. If you refuse, you are expelled from the system.
“During the pandemic, there has been an excessive movement of people – including sending nurses to ICUs when they are not trained for that.”
Spain’s health ministry announced in March that 50,000 extra healthcare staff would be incorporated into the system to face the Covid crisis, comprising students, trainees and retired professionals, and the door was recently opened for a further 10,000, including foreign workers from outside the EU who have yet to fully validate their qualifications.
“That was like putting a plaster on a gaping wound, and it did not stop the haemorrhage,” said Pilar Serrano, secretary of the AMASAP Madrid public health association, explaining that the new influx of healthcare workers in the capital region, around 10,000, did little more than compensate the absence of professionals who fell ill or went on summer leave.
In nursing, Spain has one Europe’s lowest ratios, with 5.9 professionals per 1,000 inhabitants, compared to an EU average of 9.3. Healthcare associations estimate that at least 8,000 Spanish nurses are working outside their home country, with, according to statistics from 2018, more than 3,000 of these in the NHS.
For doctors, Spain is about average in the EU, with 4.0 per 1,000 inhabitants, but last year saw a record number of medics, more than 2,500, apply for professional certificates to allow them to work overseas.
Héctor, who did not wish his surname to be published, is another Madrid nurse who has decided to pack his bags, although he is likely to choose another destination in Spain, such as the Basque Country, where pay and conditions are better and, he said, there is a more enlightened approach to nursing that recognises specialisations and research capabilities.
“I don’t feel valued as a professional,” said the 41-year-old who is currently studying a Masters degree in community nursing, noting that other regions in Spain paid healthcare workers Covid bonuses, but not Madrid.
“There has been a lack of investment over more than a decade and now we’re paying for that,” said César Carballo, an emergency physician from Madrid’s Ramón y Cajal Hospital.
“Back in March we treated the Covid situation as if it was this generation’s war moment. This was what we had been trained for all our lives, and we literally exhausted ourselves in the effort. Now we’re seeing it’s a marathon and that is having a negative psychological effect.”