Egan Schmit, A.K.A. Michael Svarg

My search in Google did not turn out any results for those names, so I thought it should have an entry in the Internet. Perhaps in some specialized pages about the Spanish Civil War, the International Brigades and the battle of the Ebro river, in 1938 he may be remembered, I do not know.

However, last weekend I went on a trekking hike through the Pàndols mountains in the province of Tarragona, Spain. The purpose was to visit the remains of the monument the members of the International Brigades built in 1938, right in the middle of the battle, to honour their fallen comrades.

I had been there before. In 2000 I participated in an expedition to restore the long lost, or at least forgotten, monument. A reference can be found in

That web page will send you to the beginning of the story of the rehabilitation of the monument, although some cyber-tracks are lost in the ether and no longer available.

The walk is a steep path set across the C-34 road, from Bennisanet to Gandesa, right over the K-8 milestone. You may leave your car in the abandoned track of the old road, on right side, cross the road and star climbing. A few meters into the bush there is a circular metal sign announcing the monument that says “BBII-XV”. This past spring there have been quite a lot of rain and the thorns and brambles are overgrown, almost completely hiding the path. Some 35 minutes of climbing takes you to the top on the ravine. On the right side and over a stone margin, facing east, you find the monument.

The situation is 41º 02’ 08” North and 0º 28’ 52” East. The coordinates are 288.490 y 4545.927, although it may be some little error in those figures.

The modest monument is set on concrete, shaped like a zigurat of three tiers with the names of their fallen comrades chiseled. There you shall see names like Maurice J. Millar (Inglaterra), James Codi (Can-nada),José Salvador, Dave Doran (USA), Vicente Pelaez (Murcia) Louis Clive (Inglaterra), Joe Bianca (USA), Francisco Fernández (Granada), Niké Makela (Canada), Harry Swidorski (Canada), and other more dificult to read.

On one side lays a large engraved stone, actually also set on concrete, that reads: Egan Schmit (Michael Svarg)- LATVIA, Caido el 19-8-1038 Ofensiva Ebro. The slab was broken in pieces and was restored back in 2000, cemented in one piece.

Seventy years have gone by and I cannot say who and what Egan Schmit was. Just another European antifascist who came all the way from the Baltic, to die amongst thousands of others fighting in the Pàndols mountains some hot summer day.

Long life Egan Schmit!. ¡Viva la república!

La batalla del Ebro, 70 años después

... el ejército del Ebro/Rumba la rumba bum/ una noche el rio pasó, ay! Carmela, ay! Carmela...

Y se quedó allí ciento quince días para intentar, por última vez, cambiar el rumbo de la historia, que no ya el de la Guerra Civil Española.

Como episodio histórico ha merecido este fin de semana pasado, alrededor de la festividad de Sant Jaume, un congreso internacional con más de quinientos asistentes.

El Ejército del Ebro, la Agrupación de Fuerzas del Ebro o el Ejército de Cataluña siguiendo los planes del general Vicente Rojo, llevó a cabo una ofensiva con el objeto de fijar el avance de las fuerzas hacia Valencia y Cataluña y, con ello, ganar un tiempo que permitiese a la diplomacia de la República negociar un armisticio con las potencias europeas. El objetivo inicial se cumplió, pero en septiembre se firmó el compromiso de Munich y la República se vio abocada a la derrota.

La batalla, cuyo desarrollo militar resultó ser una mezcla entre los batallas de masas de la 1ª Guerra Mundial y lo que serían las batallas de la 2ª Guerra, dejó más de ciento cincuenta mil bajas entra ambos lados contendientes: una muestra del encarnizamiento y el poder de destrucción en lo que se entiende ahora como guerra moderna convencional. Un auténtico desastre.

En medio, el acontecimiento recoge el anecdotario, los episodios, las pequeñas historias y los compromisos emocionales y humanos: hermanos contra hermanos, luchadores por la libertad, la antesala de la lucha contra el nazismo, la bravura, las masacres, el plomo, el polvo, la sed y, sobre todo, la muerte.

Con la perspectiva de setenta años y mi mayor interés por la geografía que por la historia, ocupé el fin de semana en recorrer otra vez los escenarios de la batalla. A pie. Y procurando coincidir con la época y las horas del día.

Mi intención inicial era subir desde el rio hasta la cota 705, la más alta de de la sierra de Pándols. Cruzar el rio no formaba parte de mis habilidades ni disponía de embarcación. La tarde del 24 hice un paseo desde y hasta Pinell de Brai donde me quedé a dormir.
La operación del cruce del Ebro había comenzado a las 00.15 horas del 25 de julio. No he encontrado justificación en lo que he leído de la batalla que explique ese cuarto de hora después de la media noche. Supongo que se trata de una argucia táctica del Estado mayor del ejército republicano. Las tropas nacionalistas estaban acostumbradas a recibir ataques por la noche. La infantería republicana que siempre estuvo escasa de soporte artillero o de aviación y que, además, reconocía la superioridad en esos ámbitos de sus enemigos, generalmente realizaba sus ataques al amparo de la noche. Pero en un frente que llevaba varias semanas inactivo, si daban las 12 de medianoche era más que probable que centinelas y mandos se relajaran y dieran al descanso. Quince minutos contribuían al factor sorpresa. En muchos puntos, los primeros en cruzar apenas dispararon un tiro ni encontraron resistencia.

Como tampoco se trataba de romperme la cabeza a oscuras, comencé mi andadura a las 6.00 de la mañana desde Pinell. En realidad las fuerzas del V cuerpo de ejército de la Agrupación del Ebro que entonces mandaba Enrique Lister, no alcanzaron Pinell hasta las nueve de la mañana del 25 y a través de la carretera de Miravet que es por donde habían cruzado el río. Tome una carretera de servicio que lleva hasta la fábrica de cerámica, hasta llegar a la C-34 que es la carretera que conduce a Gandesa. Sube un poco y se ve dominada por el cingle de Pico de l’Aliga.

A la altura del km. 8 la carretera nueva deja a la izquierda un tramo de curva pronunciada del antiguo trazado. En ese punto comencé a subir por el barranco que, a mano izquierda asciende hasta Pándols. A pocos metros una señal metálica circular anuncia que, más arriba, está el monolito de la Brigadas Internacionales. La subida es pesada y llena de abrojos y espinos, de manera que se pierde con facilidad, pero como la barranca es estrecha, solo cabe seguir la ascensión. Ese camino ya lo conocía porque participé en el año 2000 en la expedición que lo restauró . Hice un par de fotos del monolito y luego seguí hasta que la senda se cruza con la del “Camí de la Pau” procedente de la sierra de Cavalls.

Desde allí una senda rompepiernas te lleva a las cimas de Pándols hasta un punto en que se hace visible la ermita de Santa Magdalena y, arriba, el pico de la cota 705. Hay que dar un amplio rodeo por lo que se conoce como “el racó de l’abaexo”, peculiar nombre pues no veo la relación del bacalao con los barrancos, hasta que encuentras la pista forestal que te sube hasta la cota 705.
En total me tomó cinco horas, teniendo en cuenta que mi forma física no es la de un chaval de 17 años que es la que tenían los muchachotes de la “Quinta de Biberón”. A ellos se dedica el monumento y la celebración que tuvo lugar esa mañana.

Allí estaban algunos de supervivientes, desde la cumbre de sus 87 u 88 años intentando recordarnos a todos que desastres como la batalla del Ebro no deben volver a repetirse.

Retorn al blog, back again

Una mica avergonyit de haver deixat passar quasi vuit mesos sense tocar el blog, rotorno ara. Deu-n'hi-do el que m'ha arribat a passaraquests mesos, entre feina, activitats diverses, problemes de salut feliçment superats, viatges i altres mandangues. A veure si em formalitzo.

A bit ashamed of letting eight months go by without even touching the blog, here I am again. Quite a few things had happened to me these months past: work, various activities, some health troubles fortunately overcame, travels and some other hassle. Will see if I keep up the compromise.

Avergonzado de haver dejado pasar casi ocho meses sin tocar el blog, ahora vuelvo de nuevo. Me han pasado unas cuantas cosas en estos meses, entre trabajo, actividades diversas, problemas de salud felizmente superados, viajes y otras mandangas. A ver si me formalizo.

A day in court (more on child abuse)

Four months alter the affair described in the previous entries the case was brought to court. The father, allegedly responsible of the child injuries, was indicted as the sole perpetrator of the battering. He was found guilty of two charges of child maltreatment and eventually sentenced to 4 years of imprisonment, fined 12.000€ and a restraining order not to contact the child in ten years.

The court accepted that the child had been injured in two occasions, two months apart. No mention was made of the fact that the first incident, reported to the court and Child Protection services, did not prompted any action, allowing for the second battering to take place.

This did not surprise me. But it really made me mad and I could not help myself but to go to the press. I published an article in the local press that reproduced part of a recent paper on child abuse I published in a Social Work journal, with a strong criticism to the judiciary and the Child protection services.

A rough translation from Spanish of a excerpt follows:

“…probable, the worst aggression against the rights of children is the one perpetrated by those designed by society precisely of their protection. The shiftlessness, the laziness, the incompetence of agencies and their professionals and officials in situations of child abuse is the worst treason that can be inflicted to a minor and his rights…
… the cronyism of the judges, the cover up policies of government agencies, more interested in preserving their lazy seats is of no use to defend the trampled rights of the victims of abuse and represents no guaranties for future victims under the present circumstances….”

A full text can be found in Agathos, num. 3, sept 2007, pp 28-34, ISSN 1578-3103.

Even though I have proof that the text has been not just read, but reviewed both by the judges and the Child Protection agency officials, no one has dared to answer or comment publicly.

I do not know whether this affair is finally over. I expected some reaction to my -say-exploits but nothing is coming my way just yet. I am bracing myself because I trust no one and it would not surprise me some delayed action of reprisal. Will see. And, no one doubt it, I will respond in kind.

CYA protocol

In the aftermath of what is recounted in the previous post, a series of actions were taken by the different agencies involved in the snafu. The general purpose was to clarify what had really happened, to determine responsibilities and to revise the protocol of child mistreatments currently active.

That was not to be. Gradually, one by one, the different agencies and institutions issued statements justifying their activities, claiming their faithful adherence to the protocols established and putting the blame on no one.

By a peculiar serendipity I could follow part of the investigations proceedings in the Department of Welfare, in Catalonia currently named Department of Social Action and Citizenship (“citizenship“ in here had nothing to do with immigration nor naturalization. The term has captions closer to “being neighborly” and a responsible citizen), because my sister-in-law got named chief inspector for the enquire. It was just a coincidence that she had to report to her superiors, but she was cleared and given the go ahead to continue on with the investigation.

The Catalonia ombudsman finally issued a conclusive report with a summary of facts, the different agencies reports and a final evaluation of the issue, titled: “On the deficiencies of the system of infancy protection”.

I was expecting a more clear statement of the deficiencies and the system and an also clear definition of who had acted properly and who just neglected their duties, but the report collected the facts and spread thinly the responsibilities onto everyone involved, with a call for better coordination procedures and blaming the services overload of cases as the most detectable cause of the poor handling of the case.

Curiously enough, the report was published the last day of July, just before the long vocational period that closes up most of the judicial system and the administration agencies, and the news media rest in the hands of young professionals and students taking summer jobs in newspapers and TV stations, and the whole scenario turns to rather light matters.

The head of the Department of Welfare, who had declared that “her hand would not tremble” if there were decisions on the responsibilities to be taken, apparently has reduced her doses of Akineton, because all she claims is a reorganization of the on-the-job training for the officials involved in cases like this one. No heads will roll, nor will legal actions involve anyone but the parents of the mistreated child.

Altogether this all means that the “Cover Your Ass” protocol is functioning actively, and let’s turn the page. September will bring new things to worry about.

But I am not going to put up with this lack of accountability. I am going to fight for the application of common sense and go to the press with the whole affair now that everybody is on holidays. I hope someone will get a bit burn from other thing than just the Mediterranean sun.

I’ll keep you all posted.

A SAD BONFIRE OF STUPIDITIES

Honoring my profile, I'm lazy enough so I hardly publish one entry a month in this blog.
The following text is rather long for blogs but the intention is not just to publish it but to make sure stays online. Its is about a rather sorry affair I am not sure will end well. It is written in English because I follow the Miranda advise that anything I say may and will be used against me. So be it. But at least they will have to take the trouble of translating it into Spanish.

Keep on reading:

Child abuse mismanagement in a modern society

Modern societies are supposed to control and rationalize the miseries of everyday life. Child abuse is one of those miseries with a sad tendency to mismanagement. Over the years, the society has produced a vast array of laws, policies, regulations and norms, as well as it has created a number of agencies whose aim is to provide, foster and regulate child protection.

The different agents and administrations involved, however, often collide in their efforts and a child may end up a victim of “institutional abuse”: the wrong results of the combined actions taken by those responsible of caring for the wellbeing of a child.

Social services, child protection agencies, juvenile courts, medical pediatric services, foster homes, concerned parents, NGO’s saving children, foundations, school boards, charities groups, law enforcement agencies, police, district attorneys and many more, seem to include in their charters a special concern for the children and their mishaps. But all too often the firemen trample over each other water hoses and the end result is a one more disgrace overcoming an innocent child.

Such has been experienced recently in our country when a child, placed for adoption because inability of his biological mother to care for him, after three years was returned to this mother by a court order, just to become again a victim of abandonment and abuse by his mentally deranged mother. The legal battle that ensued occupied vast spaces in the news and the “bleeding hearts” television talk --or rather, bark-- shows for weeks. It was called “el niño del Rollo” case, for the name of the little hamlet of El Rollo, in central Spain, where it started.

About a year ago, in Catalonia, a 6 year old girl was diagnosed by the doctors at a large university children’s hospital of being the victim of child abuse. The report to Social services and the judges got sidetracked. The child, who was discharged from the hospital to her parents, was readmitted some weeks later, this time with severe head injuries that left her brain damaged and wheelchair ridden for life. When the situation hit the news it generated a tremendous turmoil in the media, and prompted an interagency revision of child abuse protocols. It was called “el caso Alba”, after the name of the poor child.

This past week another scandalous case loomed over, closer to me. On late April a 5 and a half month old baby was admitted by our Trauma unit with a spiral fracture of her mid femur. She had been sent by her family pediatrician with the suspicion of child abuse. No good explanation for the injury was provided by the family. The doctor sent a regular routine court notice of an injury. The X-Ray survey showed a periostal thickening in the tibia compatible with a previous fracture or injury. With that we reported the case to the judge, in Spain “juzgado de guardia”, judge-in-court on duty. Our report stated clearly that it was a case of child abuse and asked for a forensic evaluation. We also made sure the court had received the family physician initial report. The forensic doctor came over to see the child and we gave him a detailed summary of the medical proceedings that have been carried out (head ultrasound, skeletal X-ray and blood work), with the working diagnosis of child abuse, 995.5 in the International Code of Diseases (WHO-9^th ed., the one current in our midst).

It took (!) two days to contact Social Services, in Catalonia the “Direcció General d’Atenció a l’Infant i Adolescent (DGAIA)”, the General Directorate for Care of Childhood and Adolescence. To overcome delays, I sent a personal e-mail to the local DGAIA delegate, with whom I maintain occasional correspondence and a reasonable close contact: we meet once a month for a Child Protection Coordination Conference. She acknowledge the receipt of the report and informed she was starting actions.

The “juzgado de guardia”, the judge on duty shifted the case to another court, the nº 3 “Juzgado de instruccion”. The Spanish court system calls for an “instructor judge” to initiate court actions instead of the equivalent to district attorneys, the “fiscales”, who have no investigation responsibilities. Knowing this, we sent all the information by telefax to both courts and made a telephone call to confirm the reception. We also warned them that the child will be up for discharge from the hospital in a weeks’ time, as soon as the Orthopedic service was able to fix the fracture after few days of extension treatment with weights.

During these days supposedly Social Services contacted the court, the court interviewed the parents and, when we called the day before discharge to the court for instructions regarding the child’s custody, we were told to “do what we have to do”, so the child was sent home with her parents to be followed by the Orthopedic Out-patient clinic and the family physician.

I was going to regret that decision.

On June 10^th, the little girl, now almost 7 mo. old, was brought to the ER by paramedics because she had been taken by her father to an emergency clinic in her home town with what appeared to be a grand mal tonic-clonic generalized seizure. She had been administered one dose of diazepam and was in a post convulsive unresponsive state. She also had a bruise on her right malar (cheek bone) area. No explanation for this was given. A CT scan showed a midline subdural fresh hemorrhage, and a subdural effusion of liquid (not blood) content, compatible with a head injury or “shaken-baby” lesions.

Because of the hemorrhage we set the child for transportation to a hospital with Pediatric Neurosurgery facilities in Barcelona in case it might need drainage, which eventually did. And again we started the proceedings to notify the courts and the Social Services, sending over by fax the complete summary.

Later in the day, two officers of the Guardia Civil showed up in our floor asking about the child and the father. “La Guardia Civil” of some infamous fame during the Franco dictatorship in the 20^th century, now-a-days acts pretty much like the State troopers in the US: highway patrols and inter-county law enforcement. They stated that the mother, who apparently was absent from the home when the child had the seizure, did not know what had happened and had reported the disappearance of her husband and baby the since the night before. Further, in taking the baby to the emergency, the father had abandoned another 4 y/o little girl on her own in the home, that the mother found as she came home from work.

All this seems hard to believe now-a-days when just about everybody carries a cellular phone. During the (short) hospital stay in our service, the nursing personnel had been unsuccessfully trying to contact the mother. The father could not provide information of her whereabouts, nor was possible to contact her workplace, closed at those hours.

As the abandonment of the other sibling and the strange family relationships constituted more than suspicious of another case of child mistreatment, I sent the Guardia Civil officers to the court and called myself to report the incidence.

As I was talking to the court clerk, I mentioned that in this sorry affair we all will not be looking very good. At that moment, the judge in charge (a woman judge) picked up the phone and gave me an overly exaggerated rundown on keeping from criticizing court decisions or I would be charged in contempt (!!). I mumbled an excuse and ended the conversation, surprised of the overreaction which soon enough will regain its meaning.

That evening, with the child being transferred to another hospital, the intervention of the Guardia Civil and the rest, the incidence hit the news agencies. The next morning it was all over the front pages and radio news bulletins, and… the bonfire of vanities came to reality.

It was quite obvious that neither the court nor the Social Services had been diligent enough to make decisions to avoid a second incidence of severe case of child abuse.

It has been some time since I knew the difference between an event and the news related. The event was a perpetuation of child abuse while the victim was supposed to be under official watch. The news was the lack of coordination between agencies and the judicial system. Reminding the “Alba case” it hit the front pages with a vengeance.

I spent more than eight hours, under instructions of the hospital administration along with our PR unit, answering radio stations calls, giving interviews to newspaper journalist and being filmed by 6 or 7 different television stations and networks, telling what had happened.

The social services, the DGAIA refused to answer in the press directly but issued an statement claiming that when, one month before, they have asked the court for a ruling o, at least, information about the case and the family court statements, this had been denied by the judge in the ground that they had not appeared in the initial arraignment. Therefore they carried no further actions. Nothing, nada.

The police, acting under court orders had detained the father in Barcelona, while he was in a waiting room by the ICU at Sant Joan de Deu Hospital, the best children’s hospital in our area, were the child had been sent. The father appeared in court but the judge again released him without charges.

The next morning the media pressure was overwhelming and the different agencies administration officials became hysterical. The hospital Administration was relatively quiet because they though we have done all we could and, particularly, because I was taking all the burden of public appearances in a situation that nobody would look very pretty. But soon enough I was going to suffer the consequences of bureaucratic frantic attitudes.

I had been invited by a major television network to next morning’s talk show, a quite influential show anchored by Josep Cuni, a popular television newsman. I had appeared in that show a few times in the past, usually in matters related to child care, emergency medicine and the overcrowding of ERs in our country, bioethics and, also, child abuse. So it was just natural they invited me this time. They were going to send me a courtesy car to go to the TV station, just to minimize the inconveniences and shorten my time compromised.

That was not going to happen. The shit had really hit the fan and different government agencies were scurrying around and setting up CYA (“cover your ass”) actions and barriers and enlisting all the spin doctors they could get hold of.

The government officials got wind of the possibility of that TV appearance of mine and I was urgently summoned at the, for Spanish schedule standards, ungodly hour of 7.30 a.m. by the Regional representative of our Health Department, with the specific purpose of cajoling me into not appearing at the TV show. They even claimed they were under instructions of the Chief of Staff of the presidency of the Catalan Government, apparently worried sick for another case of governmental agencies malfunction. That really pissed me off. It was not just the obvious lack of confidence on me and on what I would say, but just the sheer censorship in a matter that, by then, was of public record. Along came the idea that our (current) government was not very happy with the TV anchorman, Josep Cuni, and his frequent criticism of the Administration. But to me were just bureaucratic hysterics and a clear form of information control I had thought had gone away with Franco thirty years ago. Bad deal.

Miserably altogether a fool’s errand: I called the TV station to decline my appearance. The station had enough footage from my interview the day before, so they just edited it in between interventions of the rest of the program guests. That way I ended up having a larger show time than what I could have been allotted had I been present. Not that I could care less. By then I was pretty fed up with the whole affair and very unhappy with the censorship.

The next morning the Sant Joan de Deu Hospital issued a statement on the child status and mentioned that, along with the injuries previously described, a more careful review of the images showed evidence of a parietal skull fracture. On those grounds the judge. Who obviously had been chastised by the press and, undoubtedly, her peers, ordered the immediate arrest of the father again.

I was then called to testify in court. The judge, after informing me of my rights in a rather, and probably hardly legal, perfunctory way, announced that she only wanted to take my statements in regard the second admission of the child. Then she went on asking about the skull fracture and “how in earth had we had missed that(!)”, which to her was of paramount importance as she had had to put a man in jail because of it. Knowing the judge demure from this and the previous contact, I contained myself as much as I could. I tried to illustrate Her Honor of the clinical significance of two serious intracranial lesions such as the subdural hematoma and the subdural effusions, versus a hardly clinically significant linear skull fracture which, in its own merits had not been accompanied by intracranial lesions, would have not required other treatment than watching. The same that the more than 60 cases of accidental asymptomatic linear fractures in small infants we may see in a year in our ER. But she was all excited by the skull fracture, I gathered because that had been diagnosed in a major hospital and all that. I cut myself short of asking if the tremendous femoral fracture of the first admission had any meaning to her.

All the agencies involved in the case: the Social services (DGAIA), the Overhead Committee of the Supreme Court that watches over judges, and the Department of Health (in behalf of the hospital) issued statements saying that, with the information available, all services had followed the protocols and that they did not contemplate any mishandling of the situation (sic!).

Probably out of surprise and concern, the Catalonia Ombudsman, Mr. Rafael Ribó, a former leader of the Catalan Communist Party, now retired from politics and a sensible man --not all communist had horns and devil’s tails—called for an interdepartmental conference on the case held this past Friday, but from what I heard in the news, the Ombudsman office will take a distant stance until specific responsibilities are cleared at the departmental levels.

It has been some time since I read Tom Wolfe’s “The Bonfire of Vanities” but the scenario came to me very vividly. I do remember, however, quite distinctly the scene in the movie of the same title where Morgan Freeman, acting as the presiding judge in one the final sequences, made a strong call for DECENCY to all present. That again is what I found missing in this sorry affair.

The child remains in the SJDD hospital pediatric ICU. They inserted a drainage in his head and are waiting for recovering.

The little sister, who was also a victim of abandonment, to my knowledge is in care of her mother who does not seem a very reliable person, something meriting revision.

Meantime the press is watchful of further developments and promising more exposés in the near future.

As for myself, I will stick to my guns and probably review the chapter on child abuse of the new edition of my book on Psychosocial Pediatrics. Probably I will recommend the readers that, in case of child abuse, if they want things done, report to not only social services and the courts, but to the press as well and all at once. It is possible that under the public eye the bureaucrats may be more diligent.

La “gola de mitjorn” y el cambio climático

Pues no es que vaya a comparar una observación puntual con el fárrago de estudios científicos de sesudos investigadores que ominosamente nos anuncian el fin del mundo tal y como lo conocemos. Es que ya estoy un poco harto de jeremias y casandras y de las quejas de “la caló”, cuando a mi me parece que hay poco nuevo bajo el sol que nos calienta y que el tiempo meteorológico siempre ha estado un poco loco y nunca llueve a gusto de todos.

El caso es que el 5 de mayo de este año del señor, la “gola de mitjorn”, la boca más meridional del río Ebro, no llega al mar. Una barra de arena de unos 40 centímetros de altura retiene las aguas del río y las blandas olas mediterráneas lamen la lengua de arena suavemente, algo tímidas por el poniente que sopla y que las mantiene quietas. Metí el dedo en las aguas de uno y otro lado para probarlas: una dulce y la otra salada. Por delante de mi nariz un oscuro cormorán vuela hacia tierra. A mi espalda, en una de las charcas de la isla de Buda, un bando de flamencos se despereza mientras una grulla cruza con paso solemne el camino de tierra que me ha traído hasta esta apartada orilla. Hace fresco aunque el sol haya roto los retazos de nubes que quedan de la última borrasca.

O sea, que el nivel del mar no ha subido, de momento. Y el delta se despierta algo más húmedo porque estamos ya en época de siembra del arroz.

Lo que los científicos vaticinan como consecuencia de las evidencias de aumento de la concentración de gases con efecto invernadero son cambios a medio plazo y que los humanos no vamos a percibir. O por lo menos no lo vamos a notar en la factura de la calefacción.

Los registros de temperatura que afirman que los últimos años han sido los más cálidos del siglo (pasado) no me dan ni frío ni calor. Lo de los glaciares y el casquete polar está dentro de lo que puede pasar por mil motivos. Mientras el polo norte disminuye su hielo hay evidencia de que en la Antártica el grosor total ha aumentado. Las emanaciones de CO₂ y metano de los automóviles, con ser notables, se equiparan a los pedos de las vacas, que son bastantes. Pero nadie ha contado los de las manadas de gñus africanos. Es cierto que están deforestando la Amazonia, pero en Catalunya la superficie forestal es ahora tres veces mayor que hace cincuenta años.

Este invierno ha nevado poco en el Pirineo. Pero también nevó poco hace unos años en Sierra Nevada cuando tuvieron que suspender el mundial de ski. Si se mira al pasado siempre los tiempos, atmosféricos y vitales fueron distintos. En el siglo XV François Villon, en su «Ballade des dames du temps jadis» se preguntaba que a donde habían ido a parar las nieves de antaño (“Mais où sont les neiges d’antan?”). En la misma época Jorge Manrique opinaba que “cualquiera tiempo pasado fue mejor” y algo más sobre las vidas y los ríos que van a morir al mar.

Pues el ramal sur del Ebro no “muere” en el mar. Ahí sigue, vivito y coleando, alimentando grullas y regando arrozales. Y cualquiera tiempo pasado fue simplemente igual y, en algunas cosas, bastante peor.

Lo que no cambia es el interés de los poderosos en meternos miedo a los humanos de a pie. No sea que vayamos a creernos que el mundo es nuestro y no suyo y se lo quitemos.

Decidle a Al Gore de mi parte que, cuando se vaya, no se olvide de apagar el televisor.

La desaparició dels metges de capçalera

La imatge del metge assentat al costat del llit de la malalta, prenent-li el pols, en la espera ominosa de que afebleixi, que va pintar Picasso fa més de cent anys, està en vies de desaparèixer definitivament.

Continuem fent servir el terme per a referir-nos als professionals d’atenció primària que, en un disseny de pràctica assistencial desenvolupat al segle passat, se’n fes càrrec de l’atenció immediata dels malalts i en proximitat.

La gradual desaparició de l’assistència domiciliària, sobre tot a l’àmbit de l’assistència pública, així dita “de la Seguretat Social”, no dona lloc a l’encontre dels professional i el malalt al voltant d’un llit.

Això sí, els nous equips d’assistència domiciliaria reprodueixen el model, però no el concepte. El mateix que la figura de “metge de família”, la qualitat del metge de capçalera s’ha atribuït al seu coneixement proper del malalt, quasi íntim. Aquest coneixement proper era generador de confiança. I aquesta confiança, de respecte al diagnòstic i compliment de tractaments i recomanacions per part del malalt.

Una bona part d’aquesta confiança raïa en la memòria del professional. El metge coneixia al malalt i els seus antecedents i història personal. Però això és un luxe que al segle XXI ja no es podem permetre. Ningú pot refiar-se de que un professional se’n recordi de tot el que li ha passat ni que ho faci amb fiabilitat.

L’historial clínic, en les seves versions en paper o en memòria cibernètica ha esdevingut un eina de treball massa important, i la complexitat de les dades recollides i la multiplicitat dels malalts no permeten deixar els registres només que a la memòria humana.

El treball en equip, o el treball dels equips, també acaben per substituir al professional únic en l’atenció. Els malalts han desplaçat la seva confiança del professional únic cap als professionals disponibles, i tal és l’efecte que això te en l’actual inaturable creixement de la demanda als serveis d’urgències: la gent s’estima més que l’atenguin quan els hi convé, per part d’un professional desconegut, que no pas pel seu metge que només està disponible unes hores concretes.

No seré jo qui jutgi les bondats o distorsions d’aquesta realitat. Em limito a constatar-la. Però si que recomano que els responsables de la distribució de l’assistència ho tinguin en compta i que s’adaptin a la realitat.

De diversidad cultural

Discretamente avergonzado por dejar este blog tan desatendido, voy y me lio a publicar una previa de un artículo sobre cultura y salud. Al fin y al cabo es otro trozo de mi, para quien le interese.

Ahí va:

Durante siglos el conocimiento en temas de salud se mantenía con un cierto paralelismo entre la gente y los doctos. Aunque los doctos adquirían saber con el estudio y con la experiencia, el ritmo de la adquisición, aunque gradual y progresivo, se mantenía en unos límites humanos, por no decir personales.

El traspaso del conocimiento a la población se hacía por el contacto, la consulta y la observación de los aconteceres. Aún así, a menudo los doctos intentaban ocultar el conocimiento y, a menudo, su ignorancia lata, con el uso del latín en su discurso y la caligrafía ininteligible en sus prescripciones. Así mantenían una cierta distancia de seguridad.

Entre la población, los depositarios del saber eran las familias, generalmente las mujeres, las madres, que los trasmitían a su descendencia de forma más o menos fiel. Y la siguiente generación lo incorporaba y lo elaboraba gradualmente.

Con el desarrollo de la medicina científica el progreso del conocimiento adquiere características exponenciales. Una muestra es la progresión del número de publicaciones que aparecen en el Medline. El conocimiento crece y los profesionales lo adquieren en proporción también creciente, pero cada vez resulta más difícil traducir esos nuevos conocimientos a la población por la también creciente complejidad del conocimiento.

Ahí se genera un distanciamiento cada vez mayor, hasta el extremo que profesionales y pacientes apenas comparten conocimientos o, ni siquiera, un mismo lenguaje.

En esa distancia, que es ya cultural, reside la percepción de la población de que la asistencia ha dejado de ser “humana”. Pertenece a otra dimensión. El reto es salvar esa distancia de forma eficaz y recuperar la confianza de la población.

La llegada de nuevos inmigrantes procedentes de otras culturas ha puesto de manifiesto una distancia cultural obvia. Pero cuando se pregunta a los inmigrantes cuáles son las dificultades que encuentran para relacionarse con los profesionales asistenciales, relatan los mismos problemas que la población autóctona: “no me atienden, no me entienden, me dedican poco tiempo, no comprendo lo que me dicen, son distantes, no me miran, sólo soy un número…“ etc. etc.

Los profesionales deben adquirir nuevas habilidades, nuevas competencias para conseguir salvar esa distancia. Deberán ser más humanos, es decir menos “sabios cibernéticos inalcanzables”, ¿menos extraterrestres, quizá? Así se “humaniza”, se reduce a la dimensión humana la asistencia.

Breaking and entering

That’s the title of a recent movie starred by my much admired Mrs. Penn, Sean’s wife, neé Robin Wright, as an autistic child’s mother.

And that’s our most recent adventure when last Monday, in the wee hours of the morning, an intruder broke into our home through one of the kitchen’s windows. On hearing a minor crack in the stairway, I woke up, grabbed a long walking stick I keep by my bedside and confronted the bastard, shouting my head off: “I’ll kill you, son-of-a-bitch…!” and few other niceties the Spanish language allows. He run away and lost himself in the nearby woodland.

The only thing missing was my wife's purse that was sitting in a bench by the stairway, which we later found in the garden with everything but the money, some 100 €.

The police came over in a few minutes but there was no trace of the intruder. In the morning, when the police came by to finish their work up, they informed us that there had been five more homes in the neighborhood assaulted that very night, but the others did not found out they have been assaulted until they woke up in the morning. “Silent robbers” are called the bastards.

After more than twenty years of peaceful living in our neighborhood, not caring much for building fences or locking doors, a recent wave of robberies is making our life a bit uneasy. We are not sure getting anti-burglar alarm systems will restore our peace. Nor upgrading my walking stick to a more deadly weapon either. Mind you the walking stick is more of a pole: a four foot long, one and a half inch thick ash wood rod, with a thick knob in one end and tapered in the other, ending with a metal tip. This is used commonly by the Pyrenees shepherds. I bought it some years back in the valley of Broto, where my father’s ancestors came from. It is pretty much the size and shape of the old “pilum”, the weapon favored by the Ibers of old to fight the Romans. That historic stupidity has given me some sense of security I wonder if I will ever regret. Will see.