Interview with Sofie Merckx from Medics for the people (Médecine pour le people, MPLP) Belgium

Medics for the people is a network of 11 first line health centers in Belgium. At the moment, 65 doctors and a total of 250 (doctors, nurses, other paramedical as well as reception and administrative staff) are working in those centers. ...) together with many volunteers. 25 000 patients have been subscribed to one of those centers.

Good evening Sofie Merckx. You are general practitioner at the health center of “Medics for the people” in Charleroi in Belgium. How is the situation in the health center right now?

The Corona crisis became urgent in our health center about a week ago. Since then we have completely changed the way we work. Usually the people come to our center by appointment. Now we do 90 percent of consultations by phone. We try to see as few patients as possible face-to-face, weather they show symptoms of COVID-19 or not. In case someone needs treatment then we send the prescription electronically. We also try to help via phone, but sometimes we still receive patients at our center. The last days we had many patients with influenza-like symptoms, which could be connected to COVID-19. The problem is that general practitioners in Belgium cannot test for COVID-19, so we don’t know if a patient carries the virus or not. We tell the patients to stay at home, then we call them back to see how they are developing. Today we had the first case of a patient who needed to be admitted to the intensive care unit. This person had called us and told us that he has fever. So we contacted him again, but in the meantime he had been hospitalized.

…because the health centers are not hospitals, you don’t have intensive care units…

• Yes exactly. The health centers of the Medics for the people are not hospitals. We are general practitioners

And how can the health centers contribute to fighting the corona virus?

• Our work is very important because we are in the first line. All our patients who are getting in contact with us, we either try to help them or we try to get them to be hospitalized. But to avoid that everyone is going to the hospital we do a first screening. This is very important, because the more people go to the hospital, the greater the risk that they get infected there.

The president of the Workers' Party of Belgium (PTB), Peter Mertens, launched a request for volunteers for Medics for the people. What happened?

• I cannot give you the exact number of the volunteers that contacted us. Right now we have 25.000 patients in treatment in our 11 health centers. All these persons are in lockdown, like everyone else in Belgium right now. So we have very sick people who call us, who cannot go outside to do their shopping or to go to the pharmacy. As well as people who are not sick but still cannot leave their homes because they are fragile. So we need to contact them. The volunteers do phone calls to find out what our patients need, or to go shopping for them. We also got contacted by people who volunteer with making protective masks. The masks they make are of course not intended for nursing staff. But there are care workers who don’t have masks at all and who are in constant contact with people. We give the masks also to those nurses.

So there seems to be a shortage of protective masks in Belgium. What else is lacking right now in Belgium?

• Well I think one of the large problems is what we call the “fragmentation of competences” in Belgium. Belgium is a federal state and we have 9 ministers of health in Belgium: The federal minister Maggie De Block, but there is also a francophone minister, the minister of the German speaking community, the Flemish minister, the Walloon minister and so on. So there is an enormous fragmentation of competences, which poses a problem to act coherently. A coherent strategy from one region to the other is missing right now. Thus there is a lack of quick reaction and implementation of measures. The second problem are the cuts in the health sector during the past. A recent study showed that today we have in Belgium much less nurses in the hospitals than we used to have. And this shortage is felt even stronger today. So these healthcare workers are already struggling, recently they had been on strike because of that.

There is also a shortage of supply. Hospitals in Belgium are calling publicly for donations because they need money to buy ventilators. It is a shame that the hospitals have to ask the people for financial donations because the government has cut the spending. Many hospitals in Belgium are in the red and have serious financial problems.

You are talking about problems that have built over time. A lack of financing, and people that cannot afford proper health care. Tell us a bit more about the idea behind Medics for the people

• Well, we have a social security system in Belgium that should guarantee the right to health and the access to healthcare. This is why Medics for the people has ever since worked without extra charges, with is different from free of charges. It is the social security system that pays the charges, but Medics for the people doesn’t ask for additional payments that need to be paid from the patients’ own pockets. And because we do not ask for extra charges like the private medical practices, the people who come to our health centers are more often precarious people who don’t have the means to go to a regular practice. A lot of precarious workers come to our health centers as well. Today many of these people, who think that they may have been infected with corona virus, contact us. When we tell them to stay at home, they say that they cannot afford the loss of income. They are very afraid of losing part of their income because it is the health insurances that covers the sick leave payments, but only a reduced amount after a certain period of time. Therefore, it is important that salaries are guaranteed for those who have COVID-19, but also for those who need to stay home because they need to take care of others or because the schools are closed.

You are also member of the Belgian parliament for the PTB. Could you tell us about the political demands of the PTB in face of the corona crisis?

• A lot of measures have been implemented to fight the corona crisis, but one thing we can clearly see, is that the economy is put before the health of the people. A lot of people go to work and put themselves in danger, even if their jobs are not in essential sectors like health or food. Of course the essential sectors have to work, but we see sectors, like the automotive sector or the construction sector, where people are put in danger, where the economy seems to be of more importance than the health of the workers. Therefore, we have a number of demands: The income of wage workers but also independent workers need to be guaranteed; there should be a ban of layoff during the crisis; we also ask for a suspension of water and gas bills, because the bills will rise when people need to stay home; we ask for a deferral of mortgages payments, for those who cannot pay the rates for their homes anymore; we also ask for bonus payments for workers in essential sectors; we ask to give time off for parents who need to stay at home because of their children; and we ask for full reimbursement of costs for medical treatment. Because if you are hospitalized because of Covid19 in Belgium, and you don’t have a private hospitalization insurance, then this can become very expensive.

Regarding the management of the health crisis, we think that the confinement needs to go further, but on the other hand there is also a second path that needs to be followed: That is to know exactly who got infected with the corona virus. We need to do much more tests, and then to isolate those who are infected and their surroundings. Other countries were successful with this measures, but this is not at all done in Belgium. Instead Belgium is poking in the dark here. For example, I had a patient who was sick, maybe COVID-19 maybe not, who is working in childcare. She asked me if she could go back to work, but I don’t know if she had the corona virus or not, and if she is still infectious or not. I had another patient with influenza symptoms that works at the meat counter of a large supermarket, she has a lot of direct contact with the customers. She will go back to work next week. But what if she is still contagious? We need to know very clear, who can go back to work and who should rather stay at home.

Since a couple of days Belgium has a new government. The prime minister Sophie Wilmès asked for a vote of confidence. Why did your party deny the vote of confidence?

• First of all, we support a clear strategy on the federal level on how to tackle this crisis in Belgium. So from this point of view we think this is a very positive step forward, because we want firm measures against the coronavirus. Also “in the field” like we are doing it with Medics for the people, where we are in the very first line in the battle against the virus. But we still think that we are needed as an opposition party. There are still a lot of problems, a lack of protective gear, not enough testing, and an inconsistent containment strategy where in one enterprise they ask the managers to work from home but demand the other workers to come to the workplace. This is why we want to continue to ask questions instead of giving a blind vote of confidence. Because the fight against the coronavirus in not yet effective enough. 

The interview was conducted by Florian Horn, project manager at Rosa Luxemburg Stiftung Brussels, on 23 March 2020.