HEALTH: Living in Portugal, Giving Birth in Spain

By Mario de Queiroz Reprint | | Print |

Mario de Queiroz

LISBON, Mar 29 2007 (IPS) - Drastic public health budget cuts in Portugal have led to the closure of emergency and maternity services and prompted protests against the government of socialist Prime Minister José Sócrates.

As a result of economic reforms and austerity measures adopted by the government to reduce the budget deficit, Portuguese women in some border areas must now cross into Spain to give birth.

Hospitals in Spain have signed agreements with their counterparts across the border in Portugal. One such case involves the cities of Badajoz in western Spain and Elvas in eastern Portugal.

The battle for Portuguese women’s right to give birth in their own country is not the only consequence of the budget cuts in the health system, although it has drawn the most attention in Portugal and has given rise to the oft-repeated slogan chanted by demonstrators: “Badajoz for giving birth, Portugal to die”.

The austerity measures have also included the closure of health clinics and emergency services in public hospitals in small towns, and an increase in fees charged for medical care.

The impact is considerable in a country where medication is already more costly than in countries like Spain, France and Italy.

The result has been catastrophic. Elderly people have died on the way to the nearest hospital, and women have given birth in ambulances. In some cases the drive, whether to another town in Portugal or across the border to Spain, is over 200 kilometres.

The measures, criticised by the opposition on the left as well as the right as focusing on macroeconomic indicators at the expense of the needs of the public, have been justified by the government on the basis of arguments that they are financially rational.

Authorities argue that it makes more sense for people along the border to be served by well-equipped hospitals in nearby, wealthier Spain than to maintain substandard maternity wards in small towns.

“Mothers in this country cannot afford the extravagant luxury of having our children in Portugal,” Eva Assunção, a young woman from a small town who was recently able to give birth in a Lisbon hospital by using the subterfuge of establishing her residence in the capital a few days before her child was born, quipped to IPS.

In the name of economic efficiency and improving the quality of health care, Health Minister Antonio Correia de Campos ordered a restructuring of the country’s network of emergency units and the closure of maternity wards, to concentrate maternity services in larger towns or cities in Portugal, or in some cases, have expectant mothers served across the border in Spain.

Despite protests in the town, the maternity wards closed included the one in the port town of Figueira da Foz, some 200 km north of Lisbon on the Atlantic coast. To give birth, women in this town of around 32,000 must now drive 35 km to Coimbra, the capital of the Centro region.

In the last few weeks, two women have given birth in the ambulances of the volunteer fire department of Figueira da Foz, on the way to Coimbra.

The head of the local fire fighters, Lidio Lopes, told the Portuguese Radio and Television station RTP that “everything went well in both cases.” But he stressed that “it is clear that if any complications arise during a birth, the situation could be dangerous for the mother and the baby.”

The interview was widely reproduced by the media in Portugal.

Minister Correia de Campos announced last week that an investigation would be carried out into the question of births in ambulances. But he added that he “does not regret in the least” having closed the maternity ward in Figueira da Foz.

He even blamed the fact that the births occurred on the road between Figueira da Foz and Coimbra on “people who don’t use the national health service properly,” and said “what leads to the birth of babies in ambulances is inadequate prenatal monitoring.”

In terms of the closure of emergency services and limitations of medical staff and infrastructure in rural areas, the public was shaken by the cases of two elderly people in the southern town of Odemira who, within just a few days of each other, died in ambulances on the way to a hospital 140 km away.

Another problem facing people who depend on the public health system is the endless waiting lists for surgery.

The Health Ministry reported on Mar. 20 that 225,409 people were on surgical waiting lists as of late 2006, just 6.6 percent less than in 2005. The list included 122,858 people who had been waiting for over six months and 25,191 who had been waiting for more than two years.

Users of the public national health service waited an average of 6.9 months last year for an operation, although the government says the waiting time for surgery has been considerably reduced. But Víctor Quiroz, a Chilean immigrant, told IPS: “That’s not true. I have been waiting for an operation since late 1999 – in other words, for more than seven years.”

Quiroz described to IPS the response he received when he asked again for an operation for sinusitis in the Egaz Moniz public hospital in Lisbon.

“When I asked the doctor if my surgery could be moved up, because of my increasingly frequent problems with sleep apnea (a sleep disorder characterised by pauses in breathing during sleep), she responded that cancer patients were given priority for surgery in the otolaryngology department.”

“All I could do was respond with dark humour that I would come back when I got cancer,” he said.

Prime Minister Sócrates said last week in parliament that thanks to the curbs on public spending, the budget deficit had been reduced in 2006 to 3.9 percent, below the 4.6 percent target set by the government.

The drastic cuts in health and education spending contributed to the government’s success in meeting the budget deficit target assumed when it took office two years ago.

Members of the euro currency group must keep their deficits below three percent of gross domestic product (GDP), something that Portugal – which has the highest deficit of the 13 euro countries – has failed to do.

Sócrates noted that in March 2005, when he was sworn in, the deficit left behind by the conservative administration headed by the current president of the European Commission, José Manuel Durão Barroso (2002-2004), and later by Pedro Santana Lopes (2004-2005) was 6.83 percent.

The prime minister promised the European Commission that the deficit would be reduced to 6.2 percent in 2005, 4.7 percent in 2006, 3.7 percent in 2007 and 3.0 percent in 2008.