These days, different voices are being heard about the Insular Hospital and its future.
I would like to contribute some ideas from my knowledge of the institution, which only aim to make contributions to this debate.
Firstly, the building, its condition and renovation.
This year marks the 75th anniversary of the opening of the Insular Hospital. Construction began in 1945 but it was not until 1950 that it became operational with a medicine room, with separate spaces for men and women, a pavilion for tuberculosis patients, an asylum and a children's home. These were the needs of the time. As Eva R. de León Arbelo points out in her work: Hospital Insular, Historical Synthesis 1950-2000; architecturally it belongs to the style of the Economic Command, which makes a continuous appeal to history, using elements of tradition such as the neo-Canarian, with others of rationalist modernity. Stone from the Arucas quarry is used for the access staircase. The sources of inspiration for the building's style are Néstor Martín Fernández de la Torre and José Enrique Marrero Regalado, which has its precedent in the Palace of Justice of Santa Bárbara, California in the USA, designed by James Craig Osborne. The result of the whole was considered of great humanity, unsuspected in the hospitals of the time. Due to its scale and rationalist design, the whole work is considered an exception.
It is therefore a valuable building, with an outstanding heritage value that clearly defines the landscape of that part of a city like Arrecife, so in need of preserving its heritage.
At the beginning of the 2000s, a public competition was announced for projects to renovate the building, with the same team of architects who would later design the Dr. Negrín Hospital in Gran Canaria winning. This complete project is archived in the Technical Office of the Island Council. The cost of the renovation amounted to about twelve million euros, but there was no decision to carry it out and a valuable opportunity was lost.
In 2019, after its integration into the Canary Islands Health Service, the technical services identified structural deficiencies affecting the floor of the right wing of the main building, which is supported on a basement and whose beams were seriously damaged. A consultancy was then commissioned to draw up a master plan to renovate the Insular Hospital, in which I had the opportunity to participate together with the rest of the team. This was the preliminary step to size the services and spaces, which would serve as the basis for commissioning an architectural project and then determine the corresponding costs of the renovation. The master plan was completed, despite the fact that the pandemic absorbed all the time and all the energies; and it was sent to the central services for approval, but I am not aware that the process continued either at that time or now.
Currently, work is being done to transfer the services of the main building of the Insular Hospital to the annex of the Dr. Molina Orosa Hospital. This transfer seems to be definitive, as it is not being done to carry out renovation work, since there is no plan to remodel the Insular Hospital at the moment. However, in my opinion, at least a project should be drawn up so that the building, once vacated, does not deteriorate irremediably. The fragility of the materials with which it is built, the need for continuous maintenance that it has had until now, the structural deficits mentioned and the importance of the building, should lead the Government of the Canary Islands, its owner, to draw up a conservation plan and prevent the building from collapsing or that abandonment and neglect end up destroying it. I am not exaggerating, I remind everyone of the state of the modernist house in Famara and some old buildings in the centre of Arrecife.
Secondly, how to ensure that the decisions taken not only do not affect, but improve the Geriatrics Service.
This is not the time to make a history of the healthcare role that the hospital has played on the island. In the sixties, its modern operating theatre for the time saved the lives of many Lanzarote residents and sailors who were victims of accidents, from the powerful Spanish and foreign fleet that operated in the Canarian-Saharan Bank. Dr. Don José Molina Aldana told me that he often had to perform operations at dawn to help these people, as the operating theatre of the Insular Hospital was the closest to the fleet in this area of the Atlantic.
I think the story of how the Insular Hospital became a benchmark in Geriatrics is also well known. It was number 33 of the current 53 services, which in Spain have postgraduate teaching accreditation and therefore the capacity to train nurses and medical specialists in Geriatrics. It is still the only one in the Canary Islands.
An essential part of the Geriatrics Service is the Day Hospital. The first geriatric day hospital was opened in 1957 at the Cowley Road Hospital in Oxford, UK. Its creator was Dr. Lionel Cosin, who had been in charge of a unit for chronic patients at that hospital. He managed to reduce the average stay of inpatients by half. Since then, geriatric day hospitals have been an essential part of the services of this speciality. So much so that having it was one of the essential requirements to accredit the teaching unit. The day hospital is much more than a rehabilitation room, it is a team of professionals that works integrated with the whole service, with patients and their families to optimise the return home of frail patients, admitted to conventional hospitalisation units: acute geriatrics, orthogeriatrics, surgery, neurology, internal medicine and others, which account for almost 70% of patients. It is a bridge unit between the hospital and the home that rehabilitates the physical, mental and social functions of patients, so that they can function independently in their environment. It is a powerful device for the prevention of dependency. But it also serves to adjust treatments, make clinical check-ups, administer medication, parenteral iron, transfusions, analytical controls, ulcer treatment. The geriatric day hospital, due to its functions, should be next to the acute units and the outpatient clinics, from where it receives most of the patients. Also for functionality, for performance and to optimise the functions of the staff: the physiotherapists, occupational therapists or speech therapists and other professionals, go to see the patients at the bedside in the acute units, on admission to assess them and before discharge, giving indications on the necessary interventions, sharing them with the geriatricians and with the other professionals. In this way the staff is optimised and does not need to be duplicated. Let us not forget that staff is the most costly factor in health services.
Being united with the rest of the service allows direct admissions, avoiding the need to go through the emergency room, which in the case of frail and multi-pathological patients is fundamental.
On the other hand, moving the day hospital together with the whole service, favours that it benefits from the technology, laboratory, radiodiagnosis, specialities and other advantages of being in the Dr. Molina Orosa Hospital.
Therefore, it is a question of ensuring that if the transfer has to be made, it is to improve the Geriatrics Service, which is already excellent, not to harm it by amputating such an important part as its day hospital. Patients will be the main beneficiaries if we take advantage of this opportunity for improvement.
And finally, I am concerned about another issue that is no less important. People who suffer from an illness tend to lose their appetite and if the illness is prolonged, this loss is prolonged over time. Paradoxically, malnutrition is often a complication of hospitalisation if adequate preventive measures are not taken. Malnourished patients have more pressure ulcers, mental confusion, complications of underlying diseases, prolonged hospital stays and higher mortality. Frail patients, and almost all geriatric patients are, often enter with malnutrition problems that only prevention, attention, careful care and current knowledge of nutrition and feeding can correct. It is not only about the quality of the food, but also about the texturisation to avoid choking and aspiration; the presentation, palatability, etc. All factors that manage to open the appetite, avoid malnutrition and its complications and therefore improve the health of patients.
The kitchen of the Insular Hospital works with its own staff, which depends directly on the management and for years has been working to ensure that food is another factor in the cure and improvement of patients. In fact, one of the best valued services of the Insular Hospital is its kitchen and the menus offered. From the first day of admission, many patients spontaneously express this. For this reason, I propose to the current managers that this value should not only not be lost with the transfer, but should serve as an incentive to improve this aspect in all hospitalisation areas.
In conclusion, hospitals are places of hope for humanity. People come in search of healing, relief or comfort. In ours, many people were also born, as it was a maternity hospital for years. But we have also said goodbye to many relatives and friends in it. That is why the Insular Hospital is part of the emotional geography of all of us and is in the heart of the inhabitants of Lanzarote. If the services are going to be closed and transferred, let's take advantage of this opportunity to introduce elements of improvement in the Geriatrics Service, without losing the values it now has and which have cost so much effort. And let's do everything possible to preserve the building.
I encourage the current managers. Despite the difficulties, these are possible objectives. As Cesar Manrique taught us, with a good reason in our hands, almost everything can be achieved.
Domingo de Guzmán Pérez Hernández.
Honorary President of the Canary Islands Society of Geriatrics and Gerontology and former director of the Insular Hospital of Lanzarote.
