The life of Mallorcan Joana Bauza, 42, is linked to a bag of urine. The gender violence and sexual assaults she suffered a decade ago caused urinary incontinence that led to interstitial cystitis, a chronic condition that causes pain and pressure in the bladder and prevents her from voluntarily regulating urination. She had an ostomy performed in 2021 and, since then, she needs the collection container. But in recent months, she has added another difficulty to her daily life: not being able to get bags at the pharmacy due to the general shortage in the country, as reported on Wednesday by the Federation of Associations of Ostomized People of Spain (FAPOE) in a statement. .
An ostomy is a surgical operation that consists of making a hole in the abdomen to remove the digestive or urinary tract and allow the passage of urine or feces. Once the intervention has been carried out, patients attach the collection bags to their bodies to store the waste that is subsequently emptied. The average age of people who undergo this operation is between 45 and 55 years and it is performed to relieve pain caused by disparate diseases, such as cancer, an infection, intestinal obstruction or fecal incontinence, among others. others. Bauza is one of the 200,000 ostomy patients in Spain, according to data estimated by FAPOE.
There are several types of urinary bags depending on capacity and usefulness. The daytime ones are attached to the abdomen and hold around 300 milliliters, so they must be emptied several times throughout the day. The night or bed ones, on the other hand, have greater storage, which is usually around two liters, but they are separated from the patient's body and are less manageable. These second ones are used so that they can rest during the night without having to empty them every two or three hours. And these are also the ones that have been in short supply on the market for months.
The Spanish Agency for Medicines and Health Products (AEMPS) explains that the lack of material is due to the closure of a manufacturing plant of the Coloplast company in Denmark. This company was the one with the largest market share in Spain. By stopping manufacturing them, national marketers that had a financing agreement with the autonomous communities and the General Directorate of Pharmacy have seen their purchasing capacity reduced. This financing agreement allowed them to set an affordable purchase price and thus be able to include them in the Social Security of patients, who obtained them for free or for a very low amount in pharmacies. In the absence of the main supplier, the bags are arriving in dribs and drabs and pharmacies do not have stock.
The alternative is to buy them online, where the price is around two euros per bag, although it varies depending on the company, and the quality is more dubious. Bauza opted for this solution once, but the experience was not pleasant. “When I tried to use the ones I received, they didn't fit well with the valve,” he recalls. Furthermore, in his case it would mean an expense of about 50 extra euros per month, since he changes the bags practically every night.
To fall asleep
The shortage has forced Bauza to break his sleeping routine because he cannot use a night bag. “I set my alarm four times throughout the night: at twelve, three, six and eight. And in each one of them it is my turn to empty the container.” This prevention mechanism has caused “chronic insomnia” and “constant stress and anxiety,” he says. She was granted permanent disability and left her job as a nurse in a nursing home, but there are other people with ostomies who continue to work.
The alternative to not give up quality sleep is to speed up the useful life of the bags. In theory they should be changed every two or three days at most, according to the president of FAPOE, Yolanda Fernández, but there are patients like herself who are putting up with them for more than a week. “I use bleach to wash them because I have been with them for many years and I have skills, but not everyone can or knows how to do it,” she explains. She underwent an ostomy 15 years ago for bladder cancer.
Extending the duration of the containers for too long poses a risk to the health of patients. When containment is rushed and there is a greater concentration, the chances of suffering from a urine infection increase. This is confirmed by Bauza, who recently suffered one.
The AEMPS announced in mid-February that 1.6 million bags were going to enter “the pharmaceutical channel for distribution to patients”, although it recalled that “the legal framework for health products, unlike that for medicines, does not establish an obligation manufacturers to guarantee supply.” From the AEMPS they explain that there are a series of processes and measures, such as the certificates required by the European Union, that slow down the search for other suppliers and add that they are aware that “this amount is not enough.”
The lack of supply has been noticeable for a few months, according to Bauza and corroborated by the president of FAPOE. “It's a problem we've had since the end of last summer,” she says.
After several months of increasingly aggravated shortages, this federation of associations urges the Government to solve it “urgently.” Bauza is satisfied with being able to fall asleep without interruptions. “I only ask that I not have to get up every three hours at night to empty the bag,” he says.
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