Last January 1st, it was five years since the effective integration of the Hospital Insular de Lanzarote into the Canarian Health Service, thus beginning a new cycle in the life of that center, the old hospital with a long history, founded by Dr. Molina Orosa and the first modern hospital in Lanzarote.
But many are unaware, and others may not remember, the context that led to this integration and its importance.
I dedicated many years, practically my entire professional career, to the Hospital Insular, and from that very personal perspective, I would like to share the experience of this last stage of the center.
I started working very young in the so-called Residencia Sanitaria Virgen de Los Volcanes, better known as Casa del Mar. I alternated my work as an emergency doctor with that of a volunteer assistant in the Internal Medicine Service, with Drs. Guadarrama, Sánchez, Arribas, and Solera.
In 1983, I was offered a contract at the Hospital Insular to care for the officials of the Cabildo de Lanzarote and their families. But I always had Sor Lucía, one of the hospital's nuns, patiently waiting at the door of the office for me to finish. She would ask me to visit the elderly who were in the old asylum or in one of the rooms on the ground floor.
In the mid-80s, the hospital had lost much of its healthcare activity and was an asylum institution, with very precarious resources, in a very old building with great needs for renovation. The staff was scarce: a community of nuns, 30 assistants who were also in charge of cleaning, and two nurses.
The floor in the best state of preservation was empty, and the operating rooms functioned sporadically with some intervention.
Little by little, I dedicated more time to work in the hospital, until it became a full-time activity. We began to occupy the floor with patients referred from internal medicine, traumatology, and some who came from hospitals in Las Palmas.
As you know, the hospital at that time depended exclusively on the Cabildo de Lanzarote. An administration so close that sometimes it facilitated things, but it also made them difficult on occasions. But thanks to the competent administrator of the hospital, Mr. Juan Betancor, the impossible was almost always achieved. I have come to know 12 presidents of the Cabildo and many more health councilors. I remember them all, and they all made contributions to the center. But there are some unforgettable ones, such as Antonio Rodríguez, who bet on the hospital by hiring more doctors and nurses, which allowed us to configure the initial team, organize the service, establish guard shifts, and provide better care.
Another memorable person was D. Nicolas de Paiz, president of the Cabildo, who ordered the interior of the hospital to be renovated, and left it as it is still today, invested in new equipment and furniture. Nor can I forget Enrique Pérez Parrilla and Florencio Suarez, who renovated the residence for the elderly (the only one on the island at that time) and undertook two extensions. They also achieved the first agreement with the National Institute of Health, before the health transfers to the Autonomous Community. Minister Ernest Lluc came to Lanzarote to sign that agreement, while visiting the hospital.
We were young and very restless, but we had more and more work. The team was expanding, and we had considerable autonomy. We started an intense relationship with the Spanish Society of Geriatrics and Gerontology, and that was an opportunity to learn about experiences throughout Spain: we visited services in Barcelona, Madrid, and Zaragoza. Two members of our team, Silvia Camino and Carmen Nuin, spent a week in Paris to visit a Cantou, a unit for the adequate care of Alzheimer's patients, a disease little known at that time, but whose ravages we were already witnessing.
Dr. Fernando Perlado, head of the Geriatrics service in Zaragoza, made several visits and offered us valuable guidance and recommendations. We made a proposal to D. Nicolas de Paiz to adapt the hospital's reforms to the units we intended to launch, so that in 1991 the first major interior reform of the hospital was inaugurated, and officially the first Geriatrics Unit with the following levels of care: Acute, Medium, and Long stay, Geriatrics Day Hospital, Cantou, Outpatient Consultations, and Geriatric Care at Home. The team already included at that time, apart from doctors and nurses, a physiotherapist, an occupational therapist, a psychologist, a social worker, and an animation technician.
At that time, the initial Geriatrics team was already configured, with doctors Elisa Corujo, Sinforiano Rodríguez, Mariola González, Olga Fernández, and later doctors Carmen Alastuey and Blanca Torres, who had trained in Zaragoza, joined. Doctors José Antonio Benítez, Antonio Peña, and Mirian Sotomayor were in charge of the Otorhinolaryngology, Pediatrics, and Family Planning Center units, respectively. Always with the invaluable help of Rosa Mesa and Lourdes Luzardo, social workers.
Around that time, we were founders of the Canarian Society of Geriatrics and Gerontology, which a few weeks ago celebrated its 34th annual congress in Lanzarote.
But in the nineties, we also worked in palliative care. The patients of Lanzarote needed it, and at that time there was no device of this type.
We attended one of the first palliative care meetings in Spain in Mallorca. We were one of the first hospitals in the Canary Islands to use oral morphine with prolonged release (MST continus), and together with the Candelaria, the first two hospitals to use transdermal fentanyl in the Canary Islands, two authentic therapeutic novelties of the time.
We had a lot of contact with Dr. Gómez Sancho, who was developing one of the first palliative care units in Spain at the Hospital El Sabinal in Gran Canaria.
Meanwhile, we continued our intense activity in Geriatrics. We always considered ourselves a support hospital to the Molina Orosa. With a good informal relationship with the Emergency Department, which referred geriatric patients with acute illness, who benefited from a short stay in our hospital. The relationship with Internal Medicine has also always been excellent, and we received patients who, after their stay in said service, needed a period of convalescence. In addition, we admitted patients from Traumatology, who after a fracture, needed a period of rehabilitation either admitted or on an outpatient basis, through the Geriatrics Day Hospital. The goal was always that older patients could return home, being as independent as possible, for activities of daily living.
We also worked with people with Alzheimer's dementia, when the disease was beginning to be known and to worry families. The Cantou allowed us to have an admission unit for these patients, which was completed with work in outpatient consultations and with the support group for family members and caregivers, which has been meeting periodically until today; constituting a forum for learning, for sharing experiences, for accompaniment and support to family members and caregivers. We attended to the patients in the consultation, and Silvia Camino, a clinical psychologist, explained the disease to the family members and taught them to understand and manage the behavioral disorders, which so distort the lives of families.
The Hospital Insular would not be what it is today without nursing care. The work and dedication of an excellent team of nurses have made this reality possible. I would have to mention them all, but it is not possible. I believe that the spirit and professionalism of Carmen Nuin, Emilio Fariña, María Montilla, Paloma Andino, Juani García Caraballo, Raúl Vilariño, and Encarna Lamas, represent all the others.
The teaching unit of Family and Community Medicine of the Hospital Molina Orosa, began its journey in the mid-nineties and from the beginning we collaborated with it, welcoming residents in a rotation through the Geriatrics Service. The residents valued this rotation a lot, and we soon began to receive requests from other islands. That was our first contact with teaching.
Dr. Fernando Perlado had encouraged us to apply for teaching accreditation for the Geriatrics Service. We met many of the requirements, but we had doubts.
I remember that we went to share these doubts with Dr. Francisco Guillén Llera, who at that time was president of the national commission of the specialty and Head of the Geriatrics Service of the University Hospital of Getafe. That was a new hospital. They had recently moved from the old Central Hospital of the Red Cross, in the center of Madrid, which was considered the cradle of Spanish Geriatrics. Dr. Guillén Llera also encouraged us to present the application report, and in 1999 the Ministry of Education and Culture accredited us as a teaching unit to train one resident per year. I remember that we went through many difficulties, because the financing of that position was not assured, and it was later, when through an annual subsidy from the Government of the Canary Islands to the Cabildo, the continuity of said teaching activity could be assured.
Fortunately, today that unit has become a Multidisciplinary Geriatrics Teaching Unit (one of the 39 in Spain), with the capacity to train two MIRs and two EIRs per year, and we continue to receive requests for external rotation from all the islands and other autonomous communities.
Since the reform of D. Nicolás de Paiz in the 90s, the hospital building has only known small improvements. At the beginning of the 2000s, the Cabildo called a competition of projects with the aim of making a deep reform that would modernize and expand the hospital. The competition was won by the team that designed the Hospital Dr. Negrín of Gran Canaria. It was a magnificent project, but there was no vision or determination to carry it out at that time. After all this time, the Hospital Insular still has valuable content, but in an old, narrow continent full of difficulties for the work of the day to day.
Although the General Health Law and the Health Planning of the Canary Islands established the way to integrate the hospitals of the Cabildos into the Canarian Health Service (SCS); this path was also a via crucis, plagued with difficulties and misunderstandings, from my point of view, more on the side of the central services in Gran Canaria than on the part of those responsible on the island. Many efforts, progress, and setbacks were made, until finally, two key people managed to turn the situation around: Marci Acuña in the area of Health and Social Services and Pedro Sanginés in the presidency of the Cabildo, who knew how to get the necessary support in the Government of the Canary Islands. Then followed a long process of technical work, definition of legal instruments, union agreements, commitments with the staff, endless meetings and agreements; until finally the integration of the
Hospital Insular de Lanzarote, in the Canarian Health Service became effective on January 1, 2019.
These five years that have just been completed, have meant a great leap forward for the hospital: the improvement of the staff and the overcoming of difficulties and misunderstandings, by having as interlocutor an administration that speaks the same language as the professionals of the hospital. It has also meant a great technological leap, by being able to access the tools available to the SCS for clinical management: electronic medical record through the Drago system, electronic prescription, personnel management system, maintenance, and so many other human resource management tools, pharmacy, economics, supplies, etc. essential for the proper functioning of the hospital. All these improvements ultimately mean greater safety and comfort for patients, better care, and fewer difficulties in using health services for all citizens.
The Covid-19 pandemic, with all its succession of waves, health alarms, changing protocols, successive public health measures, but also a lot of fear and uncertainty; also made us stronger, reinforced the work of the team with all the services of the Management of Health Services of Lanzarote, of the SCS, from which we received great help. The pandemic taught us to row in a coordinated and supportive way, to share efforts and definitively accelerated the integration of the Hospital Insular into the Management. It was the decisive test. But we came out successful from that challenge with the help of everyone: our population of very old and vulnerable patients, from the hospital and the attached residence, was barely affected. It must be recognized that the work of the hospital staff, their involvement, patience, and commitment in this challenge, was the key to this collective success. I would not have words to recognize the selfless and disciplined work, in those hard months, subject to so much pressure; of all the geriatricians, resident doctors, nurses, nursing assistants, orderlies, physiotherapists, occupational therapists, psychologists, pharmacists, social workers, animation technician, radiodiagnosis and laboratory technicians, and administration, cleaning, reception, maintenance, laundry, and kitchen staff. All contributing the best of themselves.
The Hospital Insular today is a valuable reality. It is a center with a model of human care that the population appreciates. Its mission is the prevention, care, and cure of diseases, the rehabilitation of disabilities, the relief of human suffering, and also the comfort and accompaniment of patients and their families.
But the Hospital Insular also contributes a high added value to the economy, offers qualified work to young people on the island with high professional skills, and provides the population with highly specialized services.
The hospital has the most advanced Geriatrics Service in the archipelago and the only multi-professional Geriatrics teaching unit in the Canary Islands, capable of training doctors and specialist nurses in Geriatrics.
The current Hospital Insular is therefore an invaluable heritage, which belongs to all the inhabitants of Lanzarote and is the achievement of an entire generation. It is everyone's responsibility to bequeath it to the following generations, preserving its values and improving its conditions.
Domingo de Guzmán Pérez Hernández.
Former Director of the Hospital Insular.