Rural Round-up: returning to rural health in Catalonia


In this month's rural round-up, Dr Josep Vidal-Alaball describes rural medicine in Catalonia and his return to rural practice.

In Catalan we have an expression that says “roda el món i torna al born”, it means that after travelling for a while; people have a tendency to come back to their native place. In my case I have come back to Catalonia, and I have gone back to work as a rural family doctor after some time developing other medical skills.

I was born in a small rural city north of Barcelona named Berga. After finishing my medical education in Barcelona, I decided to train as a family doctor in the south west of England where I completed my training at Abbey Surgery (Tavistock). After this, I took an academic post at the Department of General Practice in Cardiff. I had the most exciting 2 years of my live, being involved in research, medical education and being a part time family doctor in some of the most deprived areas of south Wales. I also completed a Masters in Public Health, which took me to work in Public Health for two and a half years. By the end of 2006, I decided to finish my British adventure and come back to Catalonia to work in a rural practice.

Luckily this was possible and I started working as a rural family doctor in an area north of Berga. Sooner than I probably would have wished I got involved in primary care management and after becoming director of my local primary care team, two years later I was called to a higher post in regional primary care services and eventually I became deputy medical director of the region. This was a very convulsive time as the country started a terrible economic recession, but this also offered opportunities and we could start some very successful programmes for example in Telemedicine. Eventually after 5 years I returned last year to full time clinical work and I was fortunate to be able to work again in a rural practice.

I am now based in Artés, a town of about 5,600 inhabitants near the city on Manresa at the centre of Catalonia. It is an industrial town but also is well known for its agriculture and production of wine. The Basic Health Area of Artés consists of one Primary Care Centre located in Artés and 5 local medical offices located in 5 smaller towns and villages. It is a rural region with 11.267 inhabitants and an average population density of 75,8 inhabitants/km2.

Photo: Josep and his nurse-  both great supporters of FC Barcelona

I work for the Institut Català de la Salut, the main public primary care provider in Catalonia. Primary care in Catalonia is organized in Basic Health Areas, each one with doctors, nurses, administrative staff, paediatricians, health workers, dentists and midwifes. The primary care teams are organized so that a family doctor and a nurse make up what we call a Basic Care Unit. This is one of the strongest points in our primary care system as this unit jointly takes care of a population around 1,500 habitants and facilitates doctors and nurses to work very closely. This collaboration is especially important in rural areas. As in other rural areas, allied health workers visit patients in several practices during the day as most of towns and villages have their own medical centres.

Family doctors in Spain are called “médicos de cabecera” which means doctors who stay at the bedside of the patient. I think this is a wonderful way to describe the work we do, especially in rural areas. In our team, we try to be very close to our patients and communities and provide them holistic care; from the day they are born until the day they die. In our team, we provide a 24/7 service for our community and our staff cover the majority of on-call hours, providing continuity of care for our patients. Of course, it is not all good, in our rural medicine as we feel the effects of isolation and the distance from the training resources and hospitals.

Returning to rural medicine after five years has provided me the opportunity to analyse how rural medicine has changed during this period in my area. I have noticed the huge advantages of having a very well developed electronic medical system, that allow us for example to do all prescriptions and referrals electronically and to have access to hospital notes, discharge letters and all tests done in hospitals. I am also enjoying using the telemedicine system that I helped develop and see it has made a big impact on dermatology waiting lists. All these advances have made my daily work easier, but on the other hand I have noticed the impact on of an increasing aging population with chronic diseases that make my consultations much more complex. We also feel the pressure to trying to reduce referrals to hospitals.

Photo: Josep at a motor vehicle accident (luckily no casualties)

Not having managerial pressures has given me the chance and the time to get involved with WONCA. I am now an active member of international section of the Spanish Society of Family and Community Medicine (semFYC) and I am representing the Society at the WONCA EUROPE network of the European Rural and Isolated Practitioners Association (EURIPA) where I am currently the treasurer.

It has been marvellous to return to my homeland Catalonia and to be able to practice rural medicine again. Now I feel really at home!

Dr Josep Vidal-Alaball (Twitter: @jvalaball)