“Last year, our medical team treated 25 neonatal kids of 1,500 g. and 10 of less than 1,000 g.”

February 23, 2016

Despite having spent the last 30 years dedicated to medicine, and, specifically, to paediatrics, Dr. Manolo Baca still has the illusion and motivation to keep moving forward in achieving medical excellence. Though there was no medical environment in his family, he always wanted to be a pediatrician, because he likes “the specialities in which people get healed”.

Why did you choose that speciality?

I have enjoyed treating patients with positive results. Paediatrics has its complications, like the others, but it is in practice a positive speciality when it comes to solving a problem.

What has been the biggest achievement in your professional career?

Being able to adapt to the circumstances. Everything has changed so much since I started studying the Degree, such as the appearance of new techniques. Adapting to different situations and environments has been very important to me and my career.

What is the difference between the job now and the job as it was 20 or 30 years ago?

Thirty years ago the work could be considered more crafty, with the advantages of craftsmanship, but with imperfections involved. There was relatively little consistency in the performance. It is true that today there are differences in what each professional does, but there is also a more coordinated action, more consensus on what is done, in the sense of trying to work with evidences and aim for excellence. I there have been great advances from a technological point of view, because there is a lot of technological involvement now. Everything that is supposed to be artificial technology is in continuous adaptation. That goes from social networks, that are having a huge impact on my speciality, to the measure of inconsistent children’s constants. That digital artificial part is having much impact on pediatrics.

And what was the best thing about the job years ago?

Due to that artisanal mindset, there was a more personal involvement. Certainly, we could not benefit from the current technological advances but, on the other hand, the pediatrician was much more integrated in the families, unlike today, when  we are having a detachement beacuse of the current circumstances, and that means there is not such implication anymore. 

The idea of the pediatrician as a family member has diminished in intensity. The prescription is driven by much more medical criteria standards, and currently no antibiotic is prescribed without justification, and there were times when this was not handled with the same delicacy. Therefore, in the prescription field, things have improved a lot and the processes are much more refined. There is a much greater awareness, a more scientific point of view. In contrast, the treatment and the family involvement have decreased. This is a consequence of the immediacy; if we have a child with a fever, we don't wait for the pediatrician, we take him to the emergency room, in which a series of fantastic professionals would resolve the situation, but the contact with the patient is different. In the field of prescription there has been an improvement, medicines are not prescribed so easily.

Why private health?

Private health should not have been born to cover for what was missing in the public, but with the aim to cover everything. The potential for innovation should be higher, because having more effectively managed resources enables to continue locating resources for that purpose, whereas public health has to make a distribution with an equity that certainly doesn't allow it to reach all the possibilities. 

Currently the rate of investment is higher in private, which for years had not been not the case. The strength of investment now belongs to private health.

What do you think of the current situation of private medicine in Andalusia and, more specifically, in Málaga?

Well, Andalusia is much bigger than many countries in Europe, I don't know the whole autonomy, but I do know the big nucleus such as Málaga, Sevilla, Granada or Córdoba. The level of our private health is iconic, specially in the case of Málaga. We have the same development level in medicine as any other European region with the highest development standards. 

What are the best positioned specialities in our province?

The ones with a high technological qualification, such as surgery or oncology. We still need to take a major leap in my field, pediatrics. The birth of preterms and all the assisted reproduction techniques are taking a tremendous strength in the western world. Our country has a legislation that allows having a wide development of all these assisted reproduction techniques. We have enough technology development to enter in the areas of greatest intricacies, regarding the genetic diagnosis in the fetal treatment. There will be a tremendous development when it comes to pregnancy, fertilization and having a happy birth.

What are the pioneer centres in ginaecology or pediatrics?

Well, in Quirón for example, we have the only neonatal ICU in Andalusia, with ten neonatal intensive positions. Last year we had twenty neonatal children of 1,500 g. and 10 of less than 1,000 g. We do all the surgeries to preterms, such as digestive, urological and complex neurosurgery. From the first day we have bet for that development that is now comparable to any national and international center. That is why, of all these children that I have been naming, of the three hundred children admissions, possibly a 30% were foreigners.

How would you describe your speciality?

It includes all aspects, ranging from children care and development to paying attention to the whole family, taking into account the social conditions that can have an influence on it. On the technological side, which is much needed now, it ranges from pediatrics intensive care to the development in all specialties. We have endocrinology, rheumatology, nephrology, digestive and even more special things such as medical consultations for adopted or anorexic children.

What are the pioneer techniques the market is currently offering and which ones do you include in your medical equipment?

With neonates it is vital to find out the position of the intrauterine fetus and this is achieved, sometimes, with very complex technological gadgets ranging from special gases that allow the development of the lung, such as nitric acid, to highly sophisticated data that enable the development of that lung of a 400 g. child, and make sure that, during those two months of assistence, it works correctly. Not to mention the field of neurological range, because to get the development of a brain that during pregnancy did not give negative signals, but then started to give problems, we have to rely heavily on monitoring very specific parameters. For older children and when the epidemic of respiratory problems arrives, we have gases such as helium (I think we are also  pioneers when it comes to using it) or anything related to neurosurgical and the control on the evolution.

What are the most common cases?

There are two major points of attention: the healthy newborn and the child with fever in the emergency room.

In our urgencies we have a system with a special consultation, where we value if the patient's symptoms are severe, so that no child with something really important has to wait his turn, that's called immediate attention. Being able to contribute with something new each year gives peace of mind to the families. Last year we had 40,000 children in emergency rooms, go figure!

What have been the most complicated cases? 

Today pediatrics encompasses much. Small prematures atract much attention, the first one we had in Quirón was the seventh delivery we did and it was a premature named Irene that weighed 700 g. We also had a great achievement when we reconstructed the pulmonary vein to one of our babies. Usually one, two or three stents are placed in the pulmonary vein and we had to put 17 in that girl.

Each single speciality has brought us complex patients. In patients with a genetic syndrome, that currently have such a complex diagnosis, some of them have to be rejected from other centers, but in our case, having all molecular diagnoses has given us the opportunity to make really complex diagnoses.

What are the difficulties in comparison to a grown-up? 

Pediatrics specialties have nothing to do with adult ones. Child diabetes is different from adult diabetes, like psychiatry or hyperactivity or autism, they are nothing like the grown-up's. The elderly and the children have their own specialties that operate in parallel, but that have nothing in common, not even the techniques used.

What is, in your opinion, the difference between private and public health? 

I worked for twenty years in public health, so I know both of them well. They are like a couple who has to come to an understanding, but each with their own space. Public health has the advantage of having a huge apparatus that is the State, with all that this entails, and that affects on the staff and the resources. Private has been going on for less time and is more homogenous, it depends on the area where you live in the country, but it has started trying to solve certain loopholes that existed on the public. My sense, from the outside, is that the management of the structure is much more efficient in private than in public health. Whereupon, resources have a higher capacity for utilization and performance. 

What's your opinion on health tourism?

I think that health tourism is one of the best things in the world, because the treatment possibilities do not depend on the geographic location. Málaga gathers all the possibilities for health tourism. Leisure tourism was born as an undervalued concept, but years went by and the province of Málaga became the engine of the Andalusian economy thanks to the tourism. And with the sanitary tourism I think it will happen the same. There is still not enough entity to consider it as an engine but I'm convinced that, as years go by, the engine of our health in the province and in the autonomy will be the health tourism. If we have a very potent medical unit for any speciality, why a person is not coming here to get an operation if besides he has the best weather conditions, services and attention for their better and prompt recovery? If even when you are healthy you want the best conditions, much more when you're sick.

I want to thank you for making this kind of activity, because many times we do not value enough that there are groups such as Malaga Health engaged in thinking and having the imagination to promote new projects like this that generates quality and richness.