Ghosts of Spain Page 28
Spain’s state health system is a command economy. My view of it is of course, largely subjective. Once you have got beyond primary care, you are there to do as you are told. You fill out this form, stand in that queue and remember that ‘el doctor’, or ‘la doctora’, knows best. Spaniards are normally wonderful, imaginative abusers of bureaucracy or rules of any kind. Given the chance, they will charm, cheat or bulldoze their way through them. Stand them in front of a man, or a woman, in a white coat, however, and they go meekly wherever they are led. Doctors, pharmacists and even the owners of health food shops – who have adopted the uniform to hide their quackery – are all treated with a degree of respect, even awe, that their counterparts elsewhere could only dream of.
The long, complex words of medicine are magical to Spaniards. Their ability to discuss illness, in a combination of detailed medical jargon and vivid, no-holds-barred descriptions of symptoms – pustules, bowel movements and genital itches included – is prodigious. In newspapers and radio programmes footballers’ injuries are described in minute, loving detail. One player, I read in today’s sports daily As, has a fracture to the escafoides carpiano of his hand. Another has torn the cápsula posterior of his knee. Does your average Spanish soccer fan know what these remote corners of the body are? Or is it just that, as I suspect, the medical words are too mysteriously impressive to miss out? The magical remedies spelt out by their doctors, and the machines used on them, are named, word-by-staggeringly-scientific-word, as if they were the potions of ancient alchemists – electroencefalografía, res-onancia magnética, artroscopia.
Spain has a historically high caesarean rate. One study, from 1998 and concentrating on Catalonia, showed 26 per cent of births were done by Caesarean. This was two and a half times, for example, the rate in Holland or Sweden. Numbers were rising rapidly. One hospital reached 38 per cent. Some other western countries are now beginning to catch up with that figure, but others have kept them down to around 10 per cent. Medical intervention, in Spain, does not end there. Episiotomies are performed on nine out of ten first-time mothers. Enemas and pubic shaving are also a routine part of the mother-to-be’s trip down the birthing production line at Spanish hospitals. All this, the report pointed out, contravenes a World Health Organisation (WHO) resolution on the rights of pregnant women. The fact that the rate of caesareans surges on Friday and Saturday mornings suggests some are performed for the convenience of doctors keen to get away for the weekend (though some mothers are also keen on ‘convenience’ births). Private hospitals are the worst, performing 30 per cent more caesareans. One child I know was, her parents now suspect, delivered several days early by programmed caesarean just so a doctor could get his bill in before the end of the second quarter. I would like to think that was not true. But a theatre nurse said she once threw a doctor’s surgical instruments to the ground – so they would require re-sterilising – because he was trying to rush an operation so he could get to a Real Madrid game.
Spanish women rarely complain about any of this. Respect for the man, or woman, in the white coat is absolute. Only 1 in 4,000 births takes place outside a hospital (compared to more than a quarter in Holland). Doctors say Spain has cut its perinatal mortality rate considerably over the last couple of decades, thanks to hospital births. It may just be, however, that Spaniards are not squeamish about the scalpel. This is estimated to be the country with the highest plastic surgery rate in Europe. It also has one of the highest rates of organ donorship.
Spain’s public primary health care is especially good. Wherever you are – even in remote country towns – there is a doctor on hand twenty-four hours a day at the local centro de salud. Spain, unlike other European countries, has too many doctors. It currently exports them, especially to Britain and Portugal. This surfeit means there is a large pool of semi-employed, part-time doctors. They are still willing to sit up all night for not very much money. The primary health care they offer is one reason, along with a Mediterranean diet heavy in fresh fruit and vegetables, fish and olive oil, why Spaniards outlive almost all other Europeans.
Our patience with public health ran out, however, with the preparation for childbirth. We had found ourselves locked into a dreary routine of seeing tocólogos, specialist doctors who monitor pregnancies on a monthly basis. They performed this task with all the zest of bored mechanics forced to check the oil, filters and tyre pressures of two dozen cars a day. So we went to see a private gynaecologist who was one of the few survivors of the first women’s clinics that emerged in the 1970s. These had been places where contraception was not a sin and women could talk freely about abortion. She kept her medical implements wrapped up in silver foil on a shelf, like so many take-away bocadillos – the plump, bready sandwiches of the Spanish emergency lunch. We had gone from one extreme to another, for the new gynaecologist was an impassioned enthusiast. She gave me long, ecstatic descriptions of my partner’s cervix. ‘What beauty!’ she exclaimed. Invitations were even issued to join her at the viewing end of the examining table. But no, she could not recommend a hospital in Madrid, private or public, that specialised in natural birthing.
So we did our own market research. And that is how we ended up at the Ciudad Sanitaria Doce de Octubre, the Twelfth of October Health City, a huge public hospital covering Madrid’s southern neighbourhoods. This we picked because it allowed a partner to be there at the moment of birth. It was not our designated hospital, but we applied the logic of Spanish rule-breaking and reasoned that they would not turn away a woman in labour. We also organised some enchufe, swapping the private services of the enthusiast for those of one of the hospital’s chief gynaecologists, a youngish man we had met at a dinner party. That way we could drop his name at the admissions office.
At first sight, this vast medical ‘city’ looked like some remnant of a five-year plan in an ex-Communist state. It was a jungle of drab high-rise buildings and low, square, concrete blocks tucked between the warehouses and working-class housing estates of southern Madrid. Closer up, it turned out to be like a small, self-contained Spanish town. There were bars, restaurants, a bank, double parking, car thieves and tow trucks.
Appearances can deceive, however. Inside the tower blocks are some of the best facilities and finest researchers in Spain. More importantly, the Doce de Octubre had the best maternity ward in the city. It owed this honour to the fact that it was also the busiest. Spain may now have one of the lowest birth-rates in the world, at 1.3 children per woman of child-bearing age, but the country’s immigrants and gypsy families who populate the south of the city do not know that. In fact, Spain’s suddenly burgeoning community of immigrants, attracted by a dozen years of strong, constant economic growth, have already turned around a declining birthrate that hit a low of fewer than 1.2 children in 1998.
The day the waters broke, we sat nervously in the back of a big, white Mercedes taxi bumping our way along the hospital driveway while the taxista informed us excitedly just how wonderful his own two children, born at the same place, had turned out. Our experience of the joy, humiliation, anger and wonder involved in having a baby in Spain was about to enter its final, and defining, stage.
We had wanted this to be a natural birth, but recognised it was unlikely to happen. The baby was already two weeks late. Scans showed he was also very large. Connected to a drip, hours of exhausting contractions were gone through without any result. In the meantime, a constantly changing cast of doctors, nurses, cleaners and assorted others in green or white coats, wandered in and out.
A surgeon was, eventually, called. My request to be present during the caesarean was turned down. This was not unexpected. Surgeons and anaesthetists are by no means all keen to have visitors in the operating room. It was not, however, a strange request. Some Spanish surgeons, as we would discover when our second child was born, are quite happy to have the father there. Our mistake was to ask why, in this case, the answer had been no. ‘¡Porque lo digo yo!’ – ‘Because I say so!’ came the imperious reply. It
sparked an unseemly row – involving surgeon, mother-to-be and myself – in which British phlegm, that alien characteristic that so intrigues Spaniards, went out of the hospital window. The anaesthetist had to act as peacemaker.
All that was, of course, forgotten when I found myself, an hour later, holding the little fingers of a puce-coloured baby as he lay in an incubator in the neonatal ward. With his mother still out from the operation, I was tolerated as a visitor but sent home at ‘closing time’ that evening. He would have to spend his first night on his own.
Beside every bed in a state hospital in Spain sits an armchair, which also folds out into a bed. This chair, and the bed, are expected to be occupied twenty-four hours a day by a relative of the patient. Spaniards find it indignant, inhuman in fact, that these do not exist in all British hospitals. The relative is there to entertain, fuss, receive visitors and act as an extra, no-cost nurse, watching the drip and relaying messages to the hospital staff. He or, normally, she is joined during visiting hours by reams of other relatives and friends who, in the maternity ward at least, could be counted on to switch the television on full blast and start watching the football, especially if Atlético de Madrid – this end of town’s team – were playing.
The Doce de Octubre maternity ward was a riot, in the best sense of the word. It was also where, as we stayed a week while my partner recovered from the caesarean, we had our first lessons in being parents under the gentle guidance of the nurses. Our company included several gypsy women who seemed half our age but were already onto their third or fourth. Their other children occasionally ran wild, despite one mother’s threats that if they didn’t behave, ‘la paya te va a pinchar’ (‘the non-gypsy’, as the nurse was known, ‘will stick a needle into you’). It remains one of my favourite spots on earth. I could think of no finer place to start looking after a child, and no stranger place to go through the process of getting it out.
That said, we were back eighteen months later, with another large, very late baby looking set for a caesarean. This time we were better prepared. We had worked up our enchufe with the young chief gynaecologist further. He would perform the operation and, if he could persuade the duty anaesthetist, I would be in the theatre to see my second son being born. Permission was obtained after he had assured the anaesthetist, turning one brief experience in Bosnia into a lifetime of dodging bullets, that I was a hardened war correspondent with long experience of blood and gore. It was my responsibility to live up to the description, and not faint.
Even then, it was touch and go. At the last minute, I was handed a green hair-net and some green doctor’s pyjamas. I was told to sprint down a corridor, go into one of the doctor’s dressing rooms and put them on. This was a worryingly easy thing to do. The other doctors offered a polite ‘buenos días’ as I slipped on my disguise. To them, I was just a new doctor on the block. I found myself wondering how many other frauds there were wandering the hospital corridors. My mind went back to the dozens of sets of green pyjamas that had wandered through the labour room on the previous occasion. ‘Just checking!’ they had said cheerfully, before doing exactly that. If there was a next time, I decided, I would demand ID cards at the door. This time, in the neonatal unit, I was reminded how deep bull culture ran in Spain. My second son was ‘un torito’, a little bull, a passing doctor said.
Birth, we had already discovered, was about a woman and her doctor, not about a woman and her partner. Occasionally, it seemed to be about the doctor and little else. The gynaecologist’s other patients looked at him in a state of near adoration. It was hardly surprising that it seemed to have gone to his head. Our final goodbye to the Doce de Octubre, in a treatment room a few weeks later, was a reminder of how some doctors peered down at patients from their personal Mount Olympuses. He removed the last few staples from the caesarean wound – and arranged a golf match on his mobile phone as he did it.
All that happened in the late 1990s, and Spain will have changed since then. It seems, however, to be moving uncharacteristically slowly. One recent father-to-be told me he was just one of two prospective dads to turn up at prenatal classes. That is, I suppose, a 100 per cent increase on my experience. It is not, however, a revolution.
If the basic idea that women might want to be in control of how they gave birth to children had not taken off, it was hardly surprising that, when it came to looking after them, Spain had not moved on very far. The only man at the prenatal class soon became one of the handful of fathers at the playground in the Retiro park on weekdays. I was not there every day, as others were, but thank you Chema, Julio, Santi, Ramón and Marcelo for the male company. We were heavily outnumbered by mothers and the middle-class replacement for parents, la chica, ‘the girl’. La chica is an Ecuadorian, Peruvian or Colombian immigrant who, despite the name, may be aged anywhere between eighteen and sixty. She is the cleaner, nanny and, sometimes, cook in a middle-class, urban household. In posher parts of Madrid, and one apartment in my building, she must wear a maid’s uniform. Middle-class Spain would fall to pieces without her.
Spain, on paper, has managed all the advances of feminism that have been achieved elsewhere in Europe. Equal rights, equal salaries, equality itself, is enshrined in law. Women are in government. They accounted, in fact, for half of the Socialist cabinet appointed in 2004. That is a feat only previously matched by Sweden and Finland. When it came to celebrating their achievement, however, the ministras chose to do a spread for Vogue. The Spanish progre, progressive, woman may believe in boldly advancing forwards, but she is not going to ditch her attachment to glamour.
On Franco’s death on 20 November 1975, Spanish women’s lives were governed by what, for most of the rest of Europe, were 1930s rules. The permiso marital was proof of that. Progress, then, has been remarkable. Spanish feminism, however, did not appear entirely out of nothing. As with so many other things, Spanish women seeking role models had to look back to the 1930s and the sudden, remarkable burst of reforming energy provided by those who got rid of the monarchy and founded the Second Republic in 1931. The Republic had set about reforming a Civil Code which declared, for example, that ‘the husband who, catching his wife committing adultery should kill her in the act, or the man … will be punished by banishment’. Even this minimal form of punishment, however, did not apply ‘should he cause them only lesser wounds’. In that case, it stated, ‘there will be no legal sanctions’.
A home-grown breed of feminist pioneers won women the vote in 1931. That was only three years after full women’s suffrage in Britain and more than a decade ahead of France, Italy or Belgium. ‘The concession of the vote to women caused considerable scandal in the debating chamber … The blue bench [of the ministers] was almost assaulted by deputies who argued with the ministers and gave signs of great exaltation,’ one contemporary newspaper report recorded. Women such as Victoria Kent and María Martínez Sierra drove through reforms. A year later they also gained divorce by mutual consent – almost forty years before this appeared, for example, in Britain and Denmark. It would be one of the first laws that Franco overturned.
One of the most remarkable of this new breed of progressive, reforming women was Hildegart Rodríguez, sometimes known as ‘the Red Virgin’. Her tragic story sums up the conflicting visions of women at the time. Hildegart, a child prodigy born in 1914 but dead at the age of eighteen, was the ambitious project of her mother, Aurora.
Aurora’s view of her own sex was decidedly warped. ‘Women, in general, lack souls. There are animals who have more delightful souls,’ she believed. ‘They are, it is painful to admit, the worst of the human species.’
Despite this, Aurora decided to create her own super-being. She already had money, so, ‘with no pleasure’, she found, and spent three nights with, a man to set the project going. The result, a baby girl rather than a baby boy, must have been something of a blow, but that did not hold her back. The programme of genius creation started during pregnancy, with Aurora changing position every hour in bed, in order
to stimulate the foetus. Proper training started as soon as the baby had popped out of the womb. Hildegart could read and write by the age of three. She was speaking French, English and German by the age of eight. Philosophy and sexual education, almost unheard of at the time, were high on Aurora’s list. The latter was there because ‘women lose themselves because of sex’.
Hildegart joined the Socialist Party at the age of fourteen. She started to publish in the newspaper El Socialista, without the editor knowing how old she was. When he found out, he declared she might become ‘one of the great figures of world socialism’. By the age of seventeen she had a degree in law, was studying medicine and was vice-president of the Socialist Youth Organisation. A controversial book entitled Did Marx Get It Wrong? saw her expelled from the party. By this stage the Second Republic had been born. Spain was experiencing a dizzying, if short-lived, burst of social progress. The teenage Hildegart was caught up in the excitement. She published more books, gave speeches, became famous and founded a League for Sexual Reform. She corresponded with, amongst others, the writer H. G. Wells, the British sexologist Havelock Ellis and, in the US, birth-control campaigner Margaret Sanger. At all times, however, she was chaperoned by Aurora.
Hildegart eventually decided to break free. She told her mother she was planning a trip to London to see, amongst others, Wells. Aurora was fiercely against the idea and they argued long and hard. One night Aurora sat beside her daughter for several hours, watching her sleep. Then she fetched a pistol and shot the teenager – one bullet through the head, three in the chest – as she slept. Aurora was carted off to the lunatic asylum. She remained stubbornly, deliriously proud of her crime. Hildegart, she claimed, had begged for death saying: ‘You who created me must destroy me. Punish me severely.’