One thing that concerns a lot of people considering a move to a new country is the healthcare situation, and I am pleased to be able to say that firstly our experience here is limited, but also that secondly all that we have observed and encountered here has been very positive. Much as been written about the Mediterranean climate and lifestyle and how these factors contribute to wellbeing, but despite all that we all need medical help from time to time, especially with a young family.
We don’t have private healthcare, as we are paying into the system and have our SIP cards, entitling us to the equivalent of NHS care. This is provided regionally, and some of what I say may not apply to every autonomous community, but I can only speak as I find. Registering with the local clinics was easy and straightforward, but we have found a number of differences between the primary healthcare experience in the UK and Spain. The card is used to access your medical history at any point of care, to gatekeep your access to various services, and to make appointments online.
Your kids are assigned to a paediatric specialist, not the same family doctor (GP) as you. The first time we took our youngest in with a chest infection we were in there for about 20 minutes, vs the NHS’s typical 7, I believe. As well as being weighed so that the correct dose of paracetamol could be accurately advised, her throat was swabbed (great unexpected fun with a feverish four year old I recall), before an antibiotic was prescribed. They then immediately made a follow-up appointment for a week later, so they could make sure the antibiotic had worked and she was OK.
I was greatly impressed with this sensible approach to controlling antibiotic overuse, as I had read that they were frequently disbursed by the farmacias without a prescription. But whilst we were waiting for her prescription to be made up I was coughing loudly myself, having nursed her through the weekend and inevitably picked up my own dose of the bug. So the farmacista brought out a strip of pills as well – ‘these are for you,’ – the adult course of the same drug.
The Spanish infant paracetamol didn’t go down too well however, and indeed there seems to be a different attitude to treatment and kids – no ‘spoonful of sugar’, just take your damn medicine already. I also asked in both a health food shop and a farmacia about palatable kids multivitamins and both times the response was that this was a ridiculous idea – making medicines or supplements attractive and tasty to kids was irresponsible and dangerous. They could take them as they were, because it was good for them.
So, I still stock up on both Wellkid chewables and Calpol whilst in the UK, because frankly, when you have a young kid with pain and fever the last thing you need is a battleground, and sometimes only Pink Princess Medicine will cut it. Actually there used to be one of the local English mini-mercados who smuggled the stuff in and would sell it (at considerable expense) if directly asked, they couldn’t sell it openly as they weren’t a licenced farmacia… under-the-counter Calpol, if you knew who to see. In a brown paper bag.
As well as taking medicines the Spanish seem to love getting tested for things. I was given an appointment for a blood screen at the centro salud in our small town, it was for something like 7.40am – in winter, I walked there in the dark… to find what felt like half the town crammed in there for the same clinic. For some of the older contingent it appeared to be a lively social occasion as well, with the usual levels of noise and chaos, fond greetings of old friends each wielding containers of random bodily fluids and gossiping loudly about their symptoms and situations. I wasn’t even sure I was in the right place until I finally got through to a kind of milking-room production line, where about 12 booths of slick sterile nurses whisked out the requisite armfuls in moments and hastened us along the queue. So many tests occurring for such a small town, whatever could be wrong with all these people? But to hear some people talk getting screened for things is something of a hobby and an extremely routine occurrence.
I know one of the big criticisms of the UK NHS is waiting times, and honestly we haven’t enough data to compare having thankfully never needed either emergency treatment or urgent referrals here. I was frustrated to be told to expect a 3 month wait for a non-urgent MRI, but it actually happened (at very short notice) after about 8 weeks, and after that many hours of physio was promptly scheduled. Our one paediatric referral was also non-urgent, very prompt, and thorough. Our local hospitals are clean and well equipped, and everyone we have met is friendly and professional.
Of course the language barrier presents challenges, but I usually Google some key new vocabulary, and/or translate a written history a bit at a time if it’s complex, before going in – you don’t want misunderstandings on matters medical. Occasionally the misunderstanding is mine such as the time I filed up for what I thought was a routine test, only to find myself having to give a full gynaecological history – with no planning or vocabulary prepared. Resorting to the good old fashioned Art of Mime to communicate the concepts of both caesareans and a vasectomy was fun. Luckily the consultant also had a sense of humour, and we got there in the end. Another bonus is that a lot of the medical terms you need are actually not that different in Spanish, or the Spanish word is closer to the Latin medical word, so you can work out what is meant.
At times the language problem can create friction in non urgent stuff, as just another layer of drag in something you would put off anyway – niggling medical problems the same as financial planning or getting our new driving licences or whatever, the thought of having to sort it in Spanish just increases the ‘uhhhh – laters’ inclination. That is simply laziness on our part though not a problem with the system on offer. We chose to put ourselves in a situation where we have to do things in a second language, and that is part of the deal.
We do have some experience of the private system as our school has a health policy, and any accidents and incidents on site get referred up to the local private hospital. As our youngest seems to go in for these on a regular basis at the moment we have seen them a few times and always very fast and friendly – in and x-rayed and consulted and home again within an hour. And someone usually speaks English to us.
There also seems to be much more overlap and communication between private and state health systems, such as a GP recommendation to get a mole removed privately for speed – but then bring him the biopsy afterwards. That seems very different to the UK where getting any private intervention has been reported as a total opt out of the state system – never again darken our doors!
However, we have never had reason to be concerned enough about the state provision to invest in private health insurance, which is very expensive in Spain as it includes primary healthcare. There doesn’t appear the be the kind of policy more common in the UK where you still see your local GP but are then covered privately for referrals only, and which you might not use from year to year but is truly there as insurance for anything awful or urgent.
At our local hospital there is an expat-run voluntary scheme called Help, which offers free or fixed price translation services, and they are a huge asset in a coastal area. They have translators for about 5 languages, a desk in the main reception, and cover at Urgencias… a friend of ours whose child was admitted with a scary fever and suspected meningitis a few years ago, had a Help volunteer stay with them throughout the night as their son was treated – an inevitably terrifying situation involving specialists and tubes and beeping machines, made slightly more bearable by someone communicating and translating and advocating continually, to keep the alarmed and exhausted parents in the loop.
I have used Help for planned translation assistance, they are friendly, helpful and affordable, and some volunteers are also retired nurses. As well as translating they are also a big help in navigating the appointments and referrals process, and provide things like respite care, driving assistance and equipment loan, for people isolated in Spain with no extended family support when medical disaster strikes.
The Spanish do appear to take a very different approach to nursing and social care outside of the immediate medical sphere, and the expectation is that family or community will be there to help, even during hospital stays – where every bed has a fold-out bed chair alongside. Nurses are there for medical matters, not feeding or bathing, because why would you want a stranger to attend to that kind of thing? And they definitely do not arrange flowers.
Help of Denia always welcome fundraising and voluntary assistance