Rosa Oviedo has waited for a doctor’s appointment since last August. Her pre-surgery appointment (she did not disclose her illness) was scheduled for Nov. 29 at San José’s San Juan de Dios Hospital, but when she showed up, hospital staff informed her the appointment had been cancelled. She has no idea when she’ll be able to reschedule.
“They asked me for my phone number and told me to expect a phone call in order to reschedule my appointment,” Oviedo said.
Oviedo is one of thousands of patients who have been affected by a two-week strike by Social Security System (Caja) anesthesiologists. This week, thousands of doctors belonging to the National Medical Union from hospitals across the country joined the 58 striking anesthesiologists in walking off the job.
As of Thursday, more than 3,000 surgeries and 15,000 appointments have been cancelled.
Anesthesiologists say Caja officials have failed to implement a 2009 agreement to improve the infrastructure of operating rooms across the country. The agreement also called for more vacation days to reduce work hazards such as exposure to potentially harmful gases, including nitrous oxide.
“In a single surgery, we can be exposed for several hours to a tube that releases gases that in the long term are detrimental to our health,” said Esteban Salas, vice president of the Costa Rican Anesthesiologists Association. “Operating rooms in public hospitals do not have adequate ventilation systems or appropriate equipment to reduce our exposure to those gases.”
Members of the association and the Caja board of directors met three times in the past two weeks to negotiate an end to the strike, but as of press time, those talks had failed.
Last week, the Health Ministry ordered the anesthesiologists back to work, threatening them with legal action should they stay off the job. The order went mostly unheeded, leading to the firing of two anesthesiologists last Friday. Esteban Salas, a doctor at San Juan de Dios, received noticed Friday evening that he’d been fired.
“[Hospital staff] handed me a notification that demanded I immediately return to my job. I refused, and two minutes later, they gave me a dismissal letter,” Salas said.
The Caja’s decision to fire the anesthesiologists prompted other doctors to join the strike, and representatives from the National Medical Union – the country’s largest public doctors union – took over negotiations with Caja board members.
The exact number of doctors who are on strike isn’t clear. According to the union, 80 percent of union members, or 3,000 doctors, are on strike. Caja officials say only 548 union doctors participated as of late Tuesday.
“We hope to reach an agreement with the Caja this week,” said Andrés Castillo, a union negotiator. “We understand that our [strike] is affecting the public, but [patients] are entitled to decent conditions in the operating room.”
Faced with numerous protests and strikes from different sectors this week, and with thousands of patients left without access to treatment, government officials are feeling the pressure to act. President Laura Chinchilla announced on Tuesday that anesthesiologists from Mexico would be flown in to fill the empty posts.
“We cannot allow a labor conflict to take precedence over the public’s health,” President Chinchilla said Tuesday. “The measures taken [against the fired anesthesiologists] are still valid, but we will keep acting in good faith to foster more dialogue.”
Caja Executive President Ileana Balmaceda said the plan to hire foreign doctors would be a safe option for patients. “We understand that we have to follow a very strict process, and that the Costa Rican Doctors and Surgeons Association would have to monitor this process, but it is an option that will benefit every patient waiting for surgery,” Balmaceda said.
Members of the doctors association oppose the plan.
“According to the law, the Costa Rican Doctors and Surgeons Association is the only entity capable of authorizing the practice of medicine in the country. Any foreign doctor practicing medicine [here] will have to undergo a number of evaluations to test professional qualifications,” a statement from the association said. “Our association opposes efforts by the government and Caja officials to bring foreign doctors here as a way to weaken the medical unions’ actions.”
Meanwhile, interim Labor Minister Eugenio Solano and Ombudswoman Ofelia Taitelbaum became mediators this week to try to bring both sides to an agreement.
“We need to reach a solution as soon as possible for the sake of Costa Ricans,” Taitelbaum said.
So far an agreement has been elusive. Members of the doctors union have refused to negotiate with Caja Medical Director Zeirith Rojas. On Wednesday, negotiations scheduled for 11 a.m. were delayed nearly five hours while the two sides discussed Rojas’ presence at the negotiation table.
“This has been a tiring process for us. We hope that Caja [officials] will understand our petition and change negotiators,” said Ileana Azofeifa, a spokeswoman for the anesthesiologists. “We are hurt that [President Chinchilla] would rather bring foreign doctors here than work harder in favor of Costa Rican doctors.”