Visits to sheepherders to administer syntrom. Vaccinating 96-year-old grandmothers in towns with fewer than 200 inhabitants. Trying to convince men who live alone in large farmhouses that it would be better to go and live in the nearby nursing home. Treating bipolar patients, disabled since the age of three and who spend a good part of their time in bed. These are some of the cases treated at the Ribes Campdevànol Basic Health Area (ABS Ribes Campdevànol), which has been treating 5,644 people for twenty years.
Adiva Koenigsberg has followed the operation of this CAP that manages mountains of care in this Pyrenean valley and the surrounding area, in the midst of a pandemic. It is healthcare in the rural world.
Pere Bonada
Pere Bonada (88) lives in Serrat, where he takes his one hundred and fifty sheep out to graze every day. In the image, he receives his monthly Sintrom check at home, to see if his blood is too thick. This service means that Pere does not have to travel to the CAP in Ribes de Freser. During the week he receives his medication prescription by email, which his son, with whom he lives, receives.
Temporarily, without a doctor
The Pardines dispensary is located inside the village hall and is currently operating at half capacity. Before the pandemic, a doctor visited the village once a week. But with Covid-19, services and care have changed.
Single man, large farmhouse
Pere Camprubí Cunill (77) lives in Gombrèn (186 inhabitants), in a very large farmhouse. In the image, nurse Alba Marty checks his mental health, habits and memory, pointing at the computer: "Who is the president of Catalonia?" "What did you eat?" "Who is shopping?" "What day is it?" Alba works with two doctors, a nurse and a social worker who assess whether Pere can continue living alone in the farmhouse, as he wants, or they should try to convince him to go to a nursing home.
PCR for workers
Lourdes Foz Crespi (58), a worker at the Ribes de Freser residence, receives her biweekly PCR from laboratory technician Eva Cardona, while her granddaughter, Joana Delgado (18 months), has fun playing at the foot of the chair. Eva basically works outside the CAP, to reduce the risk of contagion and to monitor chronic pathology in men. This job was created during the pandemic.
In sickness and in health
Six years ago, Maximiliana Cabello Heredia (78) had her legs operated on, and now has limited mobility. Since then, her husband, Vicenç Vives Garcia (80), has been taking care of her. They have been married for fifty-six years and have five children and eight grandchildren. They live in Ribes de Freser (1,766 inhabitants) and have been retired for seventeen years. Mrs. Cabello has just received treatment with Sintrom.
Bringing immunity home
Feliça Palmerola Lloses receives the Pfizer vaccine at home from Anna Martínez Sibat, head of infectious diseases at the Campdevànol Hospital Foundation. Shortly before, Anna had vaccinated her daughter, Judit, and her husband, José Antonio, the people who take care of her.
Ninety-two years of Teresita
Three years ago Teresa Desel Roca (92) broke her femur and her mobility was greatly reduced. She is known as Teresita and lives in a farmhouse in Pardines, where she can no longer tend the garden or harvest plants for her remedies. Today she received a visit to continue her treatment for Sintrom. She lives with her son, a cook at the Can Serra restaurant, which was closed a year ago due to the pandemic. The number of people over eighty-five in the Vall de Ribes and Campdevànol is 24% higher than the average for Catalonia.
Continuing education
Doctors and nurses at the CAP meet every fortnight for training. In the image, they are being trained on abdominal ultrasound with a device that arrived six months ago. The device allows them to triage and determine whether the patient needs to be referred to nearby hospitals. The role of patient is played by the CAP coordinator, Mireia Zarco.
Ninety-five years, without a vaccine
Joan Coma Orriols (95) has not worked for thirty years. He was the last baker in Queralbs (188 inhabitants) and goes to the CAP de Ribes very occasionally. Today he receives a visit from the medical team at his home to be tested for Sintrom. Despite being ninety-five years old, he has not yet received the vaccine.
Meeting with great-grandmother
Lorenza Martínez (87) holds the hand of her great-grandson, Eytan Novas. The granddaughter, Arantxa Penya (39), has been five months pregnant with twins. The daughter, Anna Cabrera (59), tells her that she will be a great-grandmother again. She had already been told, but Lorenza has dementia and does not remember.
A complex picture
Joan Xibeli Duñach (71), in bed, lives with his younger sister, Mercè (67), and his brother-in-law Miquel in Cal Reganat, in Planoles (303 inhabitants). Joan has had a physical disability since he was very young and three months ago he broke his femur. The doctors recommended that he be bedridden. It was nothing new for him, who has bipolar disorder and already spent a lot of time lying down. In the image, the technician, Eva Cardona, reviews Joan's progress. 5% of the Catalan population are highly complex cases like Joan's. At the ABS Ribes Campdevànol, there are 7%.
Doctor Perpignan
Dr. Dolors Perpinyà has thirty-seven years of experience, and has been working in Ribes de Freser, where she was born, in a farmhouse for more than twenty-three years. The daughter of a veterinarian, she explains her bad day today: "I have a lady who has been very tired for two days, has no appetite, is ninety years old and lives alone. She is a widow, does not want to enter the residence and does not want help. She was very independent and has refused us help. In areas like ours there are fewer services, if you will, but we have the support of the neighbors."
Mobile phone addicts
Núria Coma Orriols (64), daughter of Joan Coma Orriols (95), shows the messages on her mobile phone that she receives from the CAP to specify visits and guidelines. Her father, deep down, does not know how to use a mobile phone. Health management has made many technological advances, but it creates a great dependency on people who do not master technology.
Overcoming three months of covid
Nurse Alba Marty (29) was born in Ribes de Freser, where she has been working for six months, with a permanent position. She is an exception: it is difficult to find professionals who want to live in the rural world. In the image, she performs an ultrasound on the veins of Mrs. Armengol (85) in the village residence. The patient arrived there two months ago with her husband, with whom they have been married for sixty-five years. Both spent three months in the hospital due to covid, which left them with greater dependency needs.
The German dentist
Dr. Stefann Oliver Braun (52) has lived in Campdevànol for twenty years. Burned out from his job in Stuttgart, Germany, in 2001 he took a position in Ribes de Freser because he values nature very much: "In my country you earn a much better living, but here you enjoy it more. In the rural world, people are very grateful. And here they are down to earth." A dentist, he also substitutes for a general practitioner, in the midst of Covid.
KM0 Care
In the image, the hands of Pere Camprubí Cunill, the gloves of the nurse, Alba Marty, and the drop of blood from the puncture. The neighborhood network is a plus of life in the countryside, because the doctor and the nurse are also neighbors. The health that is looked at is not only physical, but also mental and social. That is why the team that treats Joan also includes social workers.
The wisdom of forty years of career
On June 30, Dr. M. Pilar Vilà Arbonès will retire. After a long career of forty years, she says: "People used to know how to take care of themselves better than they do now, and they didn't go straight to the doctor for just anything. If they had a stomach ache, they used to try a diet, or rosemary water. Social security was a great step, because it offered universal access, but now we depend too much on doctors." In the image, Dr. Pilar, with Carme. She has had her as a doctor for seventeen years.
The cycle of life
The family takes their great-grandmother, Florentina, who lives in the residence, for a walk. From left to right: great-granddaughter Janina Garrido Cardona (8), grandmother Carme Soy Palmeiro (60), great-grandmother Florentina Palmeiro Hidalgo (89), great-granddaughter Abril Garrido Cardona (4) and mother, Eva Cardona Soy (43), a laboratory technician at the CAP. Florentina arrived in Ribes when she was four years old, during the 1936-1939 war. She and her two brothers were adopted by people from the valley and lived in three different houses. When the war ended, her brothers returned to live with their parents in Asturias. Florentina said she wanted to stay with her adoptive parents in Ribes. And she is still there. She was one of the first people to receive the vaccine.