High power prices drive some patients in Spain into poverty

By Nacho Doce

Filed Jan. 12, 2023, 2:59 p.m. GMT

Photography by Nacho DoceReporting by Nacho Doce and Horaci Garcia

Filed: January 18, 2023, 8 a.m. GMT

Jose Maria Casais's 2,700 euros-a-month income from a pension and incapacity benefits ought to leave him better off than most of his fellow Spaniards.

But Casais, a retired engineer living in Barcelona, says he is being forced to raid his savings every month after his energy bills soared because of his reliance on an oxygen machine to alleviate his chronic obstructive pulmonary disease (COPD).

For the past two years, Casais has been plugged into the oxygen concentrator for up to 24 hours a day. His electricity bill has almost tripled since Russia invaded Ukraine in February, he says, triggering an energy crisis in Europe because of its dependence on Russian gas.

He's part of a middle class in Spain being dragged into poverty by the crisis. Nearly 4% of Spanish households in the fourth income decile - a segment typically viewed as middle class - have spent more than half of their income on energy since the rise in prices last year, an Oxfam survey found.

Whereas before the energy crisis nearly half of households in Spain had the capacity to save, Oxfam estimates that now only three in 10 households can do so.

Casais spends between 300 euros and 400 euros a month on energy - about triple what he spent before the crisis - leaving little or nothing for other essentials after his other medical expenses, which include a live-in carer. By mid-month, he has to start drawing on his savings, he said.

"It limits everything else; leaves no option for other things," Casais, a former engineer at the state-run rail company Renfe, told Reuters in his Barcelona apartment.

Casais’ oxygen concentrator pulls air through a compressor, removing nitrogen and filtering oxygen to deliver to the patient. Depending on how much difficulty Casais has breathing on a given day, he will be connected between 17 and 24 hours.

"With this rise in electricity prices they have to decide between eating and breathing."

He is not alone. An estimated five million people in Spain suffer from COPD, said Dr. Sergi Pascual, pulmonology unit coordinator at the Hospital del Mar in Barcelona. It's the third largest cause of death worldwide and the fourth in Spain, the Spanish Association for Patients with COPD (APEPOC) says.

Patients in other countries are also suffering. A survey of more than 3,600 people with lung conditions by the charity Asthma + Lung UK found that one in five Britons surveyed with asthma reported life-threatening attacks as they cut back on medicines, heating and food because of the soaring cost of living.

Sufferers of other maladies such as kidney failure dependent on electricity-guzzling machines to survive are also struggling, two medical groups representing kidney disease say.

Without his oxygen machine, Casais said he would have to be permanently hooked up to a machine in hospital, losing his independence and costing the state more.

An irreversible disease

COPD is "a chronic, irreversible disease," Pascual said, "so these patients’ objective is to live a useful and full life and they therefore need the necessary funds".

It's not only oxygen machines that rack up bills. Pulmonary disease sufferers must carefully regulate their homes’ ambient temperature, which means relying on air conditioning in Spain's searing summers and central heating in its brisk winters.

"If the weather suddenly changes from good to a rainy day you feel terrible," Casais said. "The cold affects your breathing."

Fernando Uceta, 61, who had a double lung transplant in August and also suffers from COPD, says he avoids air conditioning and relies on easier-to-monitor electric heaters to manage his costs.

"There's an energy poverty that some call the invisible version, which is where people do what I do: put on less heating and not use air conditioning. Or people turn off their oxygen machine and don't receive the amount they need," Uceta said.

Between eating and breathing

Many electricity-dependent Spaniards are facing some stark choices, said Nicole Hass, a spokesperson for APEPOC: "With this rise in electricity prices they have to decide between eating and breathing."

APEPOC wants Spain's local governments to subsidise energy bills for all COPD sufferers, regardless of their income.

Spain's national health service covers the cost of oxygen but not of electricity, Hass said. "What use is the oxygen if we don't have the electricity to plug in the machine?"

APEPOC wants Spain to emulate countries like Argentina, which in 2017 made electricity free for electricity-dependent individuals. In New Zealand, electricity retailers are obliged by law to provide discounts for so-called medically dependent consumers.

Health policy in Spain is determined by its 17 autonomous regions. An initiative last year by Catalan party Esquerra Republicana to include patients dependent on medical devices in a list of vulnerable consumers who receive help with their energy bills stalled in the national parliament.

In response to Reuters questions, Catalonia's health ministry pointed to a protocol approved by the regional government in 2020 that guarantees no-one has their electricity cut off. The measure does not offer subsidies to help patients with high bills.

Casais has already altered his diet to cut costs. He now lives on one-euro packets of processed meats and tins of tuna. He's now considering remortgaging his apartment to cover his medical and energy costs.

"They should give a direct discount on electricity bills to everyone who is electricity-dependent regardless of their income or where they live," he said.

Casais uses a device to turn the heating up during a bout of flu, as he sits in a wheelchair in his house in Barcelona, Spain December 8, 2022.

Alvaro helps Casais into his bed, in Barcelona, Spain December 21, 2022.

Alvaro administers eyedrops to Casais, in Casais's bedroom in Barcelona, Spain December 11, 2022.

An imprint of a nasal cannula is left on Casais's face, while he is helped by Alvaro to dress in his house in Barcelona, Spain December 14, 2022.

Herbert, 32, a caregiver, shaves his client Casais in front of a picture of Casais's parents hung on the wall inside his house in Barcelona, Spain January 4, 2023.

Alvaro talks with doctors over the phone about Casais, who has the flu, in Casais's house in Barcelona, Spain December 22, 2022.

Casais looks at a photo of himself (standing on the right) with friends at a party in Barcelona's Gracia neighbourhood taken ahead of his compulsory military service in his late teens, in Barcelona, Spain December 13, 2022.

Alvaro and Casais talk while cooking in the kitchen, in Barcelona, Spain December 14, 2022.

Antonela, 11, the niece of Casais's caregiver Alvaro, wishes a merry Christmas to Casais, while he sits in a wheelchair in Barcelona, Spain December 22, 2022.

Casais talks with the Spanish Association for Patients with COPD (APEPOC) spokesperson Nicole Hass over video call, while sitting in a wheelchair in his house in Barcelona, Spain January 5, 2023.

A medical oxygen cylinder, for use in case of a power outage, stands next to Casais's wardrobe, in Barcelona, Spain December 14, 2022.

Casais, who has the flu, rests on his bed before trying to sleep, as he uses a portable oxygen concentrator respiratory machine connected to electricity to breathe, in Barcelona, Spain December 12, 2022.

Casais uses an oxygen nebuliser in his bedroom in Barcelona, Spain December 11, 2022.

A photograph of Casais (R), then aged 35, alongside photographs of his mother, Teresa Naveira Varela, and brother, Emilio, are displayed in his living room, in Barcelona, Spain December 9, 2022.

Alvaro helps to dress Casais, in Casais's house in Barcelona, Spain December 14, 2022.

Casais uses a portable oxygen concentrator backpack with a battery to breathe, as he and Alvaro travel by bus to his house in Barcelona, Spain January 5, 2023.

Alvaro pushes Casais's wheelchair as he gives a sandwich to Enrique, who is homeless, on a street near Casais's house in Barcelona, Spain December 14, 2022.

Casais talks with bar worker Gloria while he drinks a coffee, in a bar in Barcelona, Spain December 14, 2022.

Casais sits in a wheelchair in a park next to his house in Barcelona, Spain December 9, 2022.

Casais sits at Barceloneta beach, in Barcelona, Spain January 5, 2023.

The Wider Image

Photography: Nacho Doce

Reporting: Nacho Doce and Horaci Garcia

Writing: Charlie Devereux

Photo editing: Kezia Levitas and Eve Watling

Text editing: Daniel Flynn

Design: Eve Watling

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