“The self-service doctors’ strike really kept me up at night”

Portuguese former minister of health Maria de Belém Roseira, tells iSleep that the so-called self-service doctors’ strike in 1999, completely unannounced, really kept her up at night. As to running for next presidential elections, she says that “that question is still far from political agenda”.

 

How would you describe the time you were jurist in the office of the then secretary of state for Social Security, Maria de Lurdes Pintasilgo, and then minister of Social Affairs at the provisional governments, right after 25th of April 1974? Did people sleep less in those days because of the novelty and political frenzy?

The month I have spend there were times of hard work and great enthusiasm. The high motivation of that time, when we all felt incredible unending transforming energy, made us work endless hours through the night, with no sign of being tired. We did sleep less, a lot less actually, but we got up in the morning feeling strong and willing to embrace one more day of work.

What about after 1975? There are pictures of that time showing politicians stopping in the middle of meetings to take a nap… Do you recall any funny story?

Pictures of that time are historically very interesting. I do not recall experiencing any funny story of that kind, but I do remember the images on television showing never-ending debates in the Portuguese Assembly, which inevitably included deputies (who were not directly involved in the debates) sleeping…

You have devoted many years to running the Portuguese Institute of Oncology (IPO). Insomnia is a frequent side-effect of serious conditions that undermine people’s structure. Have you dealt with those kinds of situations?

Yes, it is true. I have dealt with stories of real terror, sometimes creepy in fact. Those personal and family stories are indeed tragic and naturally they undermine anyone’s live. The time to sleep – and specially to dream – looses all its meaning, as well as the usual everyday rhythm. Everything is messed up and out of control. It is inevitable.

After that, you have been vice-chairman of Santa Casa da Misericórdia (Portuguese charity institution) of Lisbon. Did you feel that poverty and the lack of assistance are so imposing that sleep completely stops being relevant?

Yes, totally. It was in those institutions, IPO and Santa Casa, that I learned the true priority scale. One can hardly imagine the suffering there is in some people’s lives. Coming face to face with it makes us find a new meaning in our own lives. It is impossible to escape that feeling – at least it was for me.

During the time you were minister of Health at Antonio Guterres’ government, was there an especially difficult period that affected your sleep?

Yes. The problems we were dealing with and the lack of means to solve them were very distressing. But what hurts most are those really bad things that could have been avoided. I am referring, for instance, to the self-service doctors’ strike, which the Public Prosecutor’s Office later considered illegal. It seriously undermined the principles of medical ethics, to the point that its self-regulation ability in terms of professional deontology was no longer considered unquestionable. But it did happen; it affected many patients and it shook the reputation of medical practitioners in general. It really kept me up at night!

Do you recall any minister not resisting sleep at the Council of Ministers?

I recall ministers with obvious signs of jet-lag, looking very tired and closing their eyes inadvertently. However, because they could be replaced by the Secretaries of State, I think that they did not attend the Council meetings when they were too tired, so I never experienced any of those episodes where their heads would fall on the table…

Which department is more efficient in ruining sleep, Health, Education or Finances?

Each of them is complex and heavy, but I think the Health department is really non-stop. It goes on every day, 24/7. The complexity of it is not merely political, it is also technical and scientific and it is permanently exposed to unforeseeable risks which may have an either positive or dramatic effect in peoples’ actual lives. Naturally, it all depends on the way we work in these departments and of the people working with us. I am proud to say that I had an exceptional team working with me, not chosen for political or partisan criteria, but because they were wholeheartedly working toward a clear health politic. Whoever has that privilege does not waste time with trifles and minor problems and can devote himself to do whatever is necessary. Of course the intensity and complexity of the matters inevitably affect sleep. But it is worth it.

During the years you held government positions is there any order you recall signing or contributing to in which the concern with rest and leisure was central?

I think all the orders connected to health staff’s careers and the preceding negotiation with syndicates always had something to do with it, at least for security reasons. This is a crucial problem in health professions, and often virtually ignored. I had that experience from policy formulation, since very early in my career, and I also had experienced it in-field, at Santa Casa and IPO. That gave me a due knowledge of the matter and it also gave me greater sensitivity to the particularity of that factor. In the end, deciding upon it was easier.

At the Parliament, where you are deputy for many years now, there have been a few cases of deputies being caught with their eyes closed…

Yes, it also happened to me. But that does not really have to do with the length of the debates, which today have more reasonable time frameworks, but with the particular circumstance of the deputy, who might be attending the plenary meeting in a condition of extreme tiredness or exhaustion.

Do you feel that your fellow deputies are aware of the importance of sleep hygiene to a healthy balance?

As in all large and diversified groups, some of them might be and some of them might not. I think that younger deputies might be more resistant and have a different priority set when it comes to sleep amount. Older ones, in turn, may require a different amount, but maybe they also respect the essential sleep amount. Though I can say that, in this group and this activity, it is very hard to have sleep discipline.

We know you read a lot. Which book would you choose for a sleep citation? Which passage?

Shakespeare’s Macbeth. I would choose the passages about tragedy and remorse through sleepwalking and nightmare – of how sleep as a mirror of the soul and of how live should be lived so as to prevent the various forms of punishments we are subject to.

Which is your favourite painting about sleep?

For me, Dali is unique in that sense. He is the painter of sleep, especially of dreams and its unreality, with mesmerizing transparency.

I believe you are deeply Christian. What do you think about the expression that God does not sleep?

The Portuguese poet Antero de Quental used to say that Christianity is feeling and the Church organization. In this sense, I can say I am profoundly Christian and I am constantly wondering, because Christianity is a collective life project. According to my conception of God, He surely cannot sleep!

Is sleeping upon a problem really helpful?

It is for me. Recent scientific knowledge about the various sleep stages can now confirm this. Sleep leaves the problems to rest and prevents or blocks rash impulses that might spoil everything…

I guess you are cautious when it comes to sleep hygiene, keeping regular sleep schedules, avoiding coffee, etc.

Yes, I do have rules, but sometimes it is impossible to stick to them. Being deputy and member of a political party, I have frequent meetings at night, often scheduled in the day before or on that same day. In these conditions, it is impossible to program anything, especially sleep…

Do you have any curious personal story related to sleep?

At the Queima das Fitas [literally, ribbon burning, a traditional Portuguese festivity of the students celebrating the end of graduation], when I was in college, I went to the prom right after an economy class and the lecturer had been there but had left early. I must have slept for just a few seconds – despite the seats of the lecture theatre, that were terribly uncomfortable – and I dreamed that he said to me “So the lady went to the prom all night and now she comes here to sleep?”. I immediately woke up and felt so disturbed that I could not fall asleep again…

Can you tell us about a particularly fanciful dream or nightmare you have had?

I honestly cannot remember… Usually I only remember my dreams when I wake up, but then I forget them in the course of the day. I do not know whether it is normal or not.

Does it happen to you to wake up in the middle of the night with an idea? Do you usually write it down?

Yes, when I am worried about something, I wake up in the middle of the night with that worry. I agree that that moment is very inspiring and, when I am able to get up and write it down, it is extremely helpful in the day after.

You play an important part in fighting for gender equality. Portugal has not have had a female prime-minister since Maria de Lurdes Pintasilgo.

It’s true. Political life as we know it in Portugal is probably not very appealing to most women and it will be difficult to break the male primacy of which it’s made.

Portugal has never had a female President. Would you point out anyone for that position? You have a long career in the public sphere, as political leader and deputy, and you generally raise consensus about stimulating ideas…

That question is still far from political agenda, although some seem to raise it now. The upcoming legislative elections are very important indeed. I believe we have to change policy. The ones being executed by the current government, which is ideologically eager to take advantage of the bail-out program in order to demolish the welfare state and privatize all national assets, must be stopped and reversed in its most destructive aspects. Portuguese people who are in particularly vulnerable circumstances have been regarded as mere side-effects, they are considered irrelevant. I feel we are living in a time in which the “banality of evil” dominates, in which dutiful and uncritical employees follow the dictates of an economy which is deployed of ethics and tries to convert everything and everyone in formless, apathetic and invertebrate things at its service. This is unacceptable… My struggle is to contradict this state of things and conformism.

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