At the age of 33 he developed a technique to operate on cardiac patients which is now used all round the world and bears his name. He is very pleased to have discovered this technique, because it helps so many people. Now aged 82, Norberto González de Vega no longer performs surgery but he continues to study and keep up to date because, as he says, doctors who love their profession never stop being concerned about other people. For 25 years he was the head of the cardiovascular surgery department at the Carlos Haya hospital, as it was called then. A non-conformist with an enquiring mind, who does not hesitate to criticise those in power, Dr González de Vega says in this interview that "the public health service in Malaga has always been badly treated: under Franco, the UCD, PSOE and PP". This cardiac surgeon, who was born in Granada and trained as a doctor in Madrid, describes Malaga as "a marvellous place, many people are jealous of it".
Why did you decide to give up surgery?
One night four years ago, I went home after operating on a Swedish patient at the Clínica Santa Elena and realised that 50 years had passed since I operated on my first patient, and I thought that would be a good time to stop. It was a hard decision to make. Now, though, there are days when I say I have three operations going on: one in London, one in Malaga and a third in Madrid. These are patients to whom I have recommended a particular surgeon.
How long is it since you left the health service as the head of cardiovascular surgery at the Carlos Haya hospital, as it was called them?
I didn't retire, they retired me. I was 66 then and I'm 82 now, so it was 16 years ago.
As you are such an active person, I imagine you keep up to date with medical matters, don't you?
I dedicate my time firstly to my grandchildren, taking them to school at 8am, then I read and keep up to date not only with cardiac surgery but medicine in general. At the moment I am excited about three things in particular, they are all very new in medicine.
Which three things are they?
The first is microbiota (intestinal flora) and its importance in cardiovascular, digestive and mental illnesses and obesity, and faecal transplant, which is the solution for some patients. The second is the way we can improve how we care for patients who have had a heart attack, and the third is phage therapy, which seems to be the only way to beat illnesses which occur because of germs which are resistent to antiobiotics. I am very interested in these three things. When a doctor who has enjoyed medicine has to retire or decides to retire, he or she continues to study in order to help others.
What do you think about the health service in Malaga?
In my view, Malaga has always been badly treated in terms of health, ever since we have had the use of reason. It has been completely neglected, while the city has grown exponentially. It was the same under Franco, the UCD, PSOE and PP; the situation has not changed. When I came to Malaga in 1980, there were only the Carlos Haya and Civil hospitals, because the Clínico had been built but there wasn't enough money to get it up and running. When I had been in Malaga for a year they inaugurated the Materno, which is the best hospital we have architecturally.
How do you feel about the way the Junta de Andalucía has treated Malaga?
In terms of health, the regional government has always behaved very badly towards Malaga. That isn't a matter of political parties.
And what do you think of the decision to build a hospital in the car park at the Civil?
Well, that's a good idea. It's something I have been defending, actively and passively, for many years. What they have to do is make a building which has room for growth, to cover future demand. I have dreamed about this new hospital so many times, connected to the Materno Infantil and the Civil hospital. I have always thought the Civil is a building which deserves to be treated as well as they have treated the old Tabacalera building. The Civil hospital is wonderful, but they just patched it up when things went wrong. I hope this new hospital project will finally go ahead. I have been saying this for 40 years. It has to be done now, once and for all.
So you are in agreement with the Junta's plans for this project?
Yes, I am. I made a nuisance of myself everywhere, saying a new hospital had to be built there. Malaga needs this hospital. I hated the idea of the macrohospital, though. I want people to understand that a hospital isn't just a building. It is an organisation which needs trained staff, a hierarchy, tradition and good management. The soul of a hospital can't be created overnight.
You knew the old Carlos Haya hospital well. What do you think of it now?
It became obsolete a long time ago. I'll give you an example. When I came to Malaga they assigned me two operating theatres which were 15 years old. Forty years later, they are still using them.
What do you think the health service has to do to meet the needs of the public?
I believe there is a need for more GPs. In Spain, 80 per cent of medical care is specialist and hospital-based and 20 per cent is from health centres. It should be the other way round. If health centres are well equipped, people will go less to the Emergency Department. And if people don't use the Emergency services so much, fewer will have to be admitted to hospital. However, it seems there is a reluctance to make that move.
So the work of GPs is key to the health system working well.
Listen to what I'm about to tell you. I have enjoyed being a surgeon more than anyone else in the world, but if I were born again I would probably become a GP, because I realise how important they are, and so are health centre nurses. Why should a patient have to spend a week in hospital? They need a wound treated and to be given medication, that's all. The patient can walk through the hospital corridors. If a nurse could go to their home to change their dressing every day, they wouldn't have to spend so much time in hospital
Going back to the health service in Malaga being neglected for so long, since the time of Franco, what is the reason for that?
I believe there are two reasons. Although I wasn't born here I feel more 'malagueño' than anyone and I think it is such a wonderful place that other people are jealous and resent it. That's an irrational feeling that I can't demonstrate. What is demonstrable, though, is that Malaga has grown thanks to tourism and there have been major improvements in air connections and rail travel. The roads have also been substantially improved. These changes have all been planned and have taken place, but they forgot about the hospitals. If a foreigner arrives at Malaga airport, or the AVE railway station now and is suddenly taken ill and loses consciousness, they are taken to Emergencies at the Carlos Haya and when they wake up they must think they have been transported to a hospital in India from 100 years ago.
Why has that happened?
All I can say is that they have forgotten that health is the most important thing in the world. Like the saying goes, it's even more important than money and love.
What is your opinion about the way hospitals function?
Look, a hospital, which is where I have always worked, is very complicated to run. At the top of a hospital there needs to be someone highly trained in two fields. They need to know about finance and about medicine. They also need a very competent team around them. If that isn't the case, the hospital can't function. In the 25 years I spent at the Carlos Haya, there were 21 managers. The only attribute they shared for the job was that they were part of the governing party. That can't be allowed to happen. I'll give you another example. I once went on a Mediterranean cruise with my family, and there were 3,000 passengers on that ship. Everything was really well organised, which I admired, and I mentioned it to one of the staff. He said "this works because only one person is in charge here: the captain, who delegates to people he trusts" .
But a hospital isn't a ship.
No, obviously not, and although it sounds strange, if there isn't a chain of command with moral authority, things fall apart. In hospitals, many of the heads of deaprtement are temporary and are chosen by the manager, and if they are not the best then the people under them don't respect them.
You have also worked in the private health sector. Do the same mistakes occur there?
There are mistakes in the private health sector as well, it isn't a panacea. In my opinion, we shouldn't divide health into public and private. We should talk about good and bad health care. There is good care in the public and private systems, and also bad care. I was head of department for 25 years and I worked in the public health service for 50 years, but I pay over 300 euros a month for health cover from Sanitas. In Malaga, private health care has grown tremendously and it is full of managers who used to work in the public sector. It's what is known as revolving doors. I don't like that.
Did you feel coerced or under pressure while you were the head of cardiac surgery?
Well, you're asking me that but you already know the answer. When I came to Malaga I wasn't the candidate they had wanted for the post. For a couple of years I was fine because I was employed by Madrid, but when the system changed I felt I wasn't just a candidate they hadn't chosen, I was definitely unwanted. Everything was a continual battle.
Do you think decentralising health care is a positive or negative thing?
The decentralisation of health care is one of the worst things they have ever done. There should be a national health service. The National Transplant Organisation (ONT) and the Paraplegics Hospital of Toledo, which are nationally run, work very well. That is the health model they need to follow.
A technique in cardiac surgery has been named after you. That must be satisfying from a professional point of view, I imagine?
It gives me the greatest satisfaction. A surgeon can operate on thousands of patients during their life, but if you are lucky enough to develop a technique which is used all over the world (De Vega tricuspid annuloplasty), you realise you have contributed to the wellbeing of sick people everywhere.
And when did you discover this technique?
When I was 33, in Madrid at the Jiménez Díaz Foundation. Because I was so young, people thought it must have been my father who discovered it, not me. I published the work and called it 'Selective annuloplasty, regulable and permanent'. It was the cardiac surgeons who started calling it De Vega tricuspid annuloplasty in their reports.
Is it still being used today?
Oh yes, very much so. The last time I was in Beijing, in a hospital where they do 16,000 extracorporeal operations a year, they were using my technique 40 times a day. What gives me the most satisfaction is that something that occurred to me, which I began to test on a pig heart in my kitchen at home, assisted by my sister-in-law who was a nurse, is still used to operate on patients today.