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Migrants Maimed By ‘The Beast’: Riding The Rails In Search Of A New Life




The only thing Santiago Álvarez remembers is the fit of laughter that struck him as “The Beast” passed just inches above his head. He didn’t feel pain. Or fear. He was nervous, he says, and the only thing he could do was laugh. He had fallen under the train and was stuck between the tracks, pinned to the ground as the clanging steel of the rail cars raced overhead. He waited for the train to pass. “It made me feel small and skinny, the tracks are so wide,” he says. When he looked up and saw the back of the rear engine a few meters away, he thought: “If I run, I can catch it.” Then came the worst seconds of his life. He tried to get up but a terrible pain tore him apart. He looked down at his right leg: it was broken and mangled, crushed under the churning steel of La Bestia – the train that carries thousands of Central American migrants through Mexico each year, leaving many dead and many more injured. Santiago blacked out.

Santiago tells the story sitting on a plastic chair at his home in Matapalo, a community in Honduras’s Choluteca department, near the Nicaraguan border. It’s a small, dusty town with narrow dirt streets, where cows, pigs, and chickens roam freely and emaciated dogs lounge in the shade to escape the midday heat, which is humid and suffocating. Santiago is a reserved man, perhaps a bit standoffish, and like many of Central America’s rural inhabitants speaks in slow, careful sentences, heavy on the monosyllables and punctuated with distrustful looks. As he talks, he rolls up his right pant leg to reveal the damage: his mangled leg has been replaced with a prosthetic.

The accident happened in 2004. Santiago had decided to migrate to the US after his cousins told him they had decided to leave Honduras – a country consumed by violence, corruption, and an apathetic and self-serving political class. “I said: I’ll give it a shot, and we’ll see what God has to say,” he remembers. Santiago and his cousins travelled north through Guatemala and the Mexican state of Chiapas, almost without a hitch. In the eastern state of Veracruz, they got on the freight train. It was August 2. “We were happy because now we were on top,” he says. Migrants ride on the roofs of the freight cars, jumping on when the train slows down enough for them to run alongside and swing themselves up. The plan was going well, until the train stopped at a crossing and some men with machetes climbed on top of the train. Thieves, preying on migrants. As the metal cars clanged to a start and began to pick up speed, the assailants ran along the top, jumping from car to car, chasing migrants and brandishing machetes. Santiago didn’t realize what was happening until he heard the screams of a young man being hacked in the back by the attackers. “I panicked and ran. A guy was chasing me. He was right behind me. I managed to jump between two sets of cars, but when I turned to look back, he was even closer. It was in that moment, when I turned to look back, that I went down, and fell down between the rails,” he recalls. It was two o’clock in the afternoon and a light rain was falling. “That’s when the dream ended,” Santiago says.

The prosthetics and orthotics lab at the Vida Nueva Foundation.Video: Nayeli Cruz

It’s the same dream that thousands try to make a reality every year. The figures from Mexico’s Interior Ministry speak for themselves: between 2013 and 2019, more than 820,000 undocumented Central American migrants were apprehended by Mexican authorities. Like Santiago, their hopes were dashed, either because they were captured and deported by Mexican immigration, killed or injured by criminal gangs, abused or left to die by coyotes, or suffered some other injury during their journey – or, as is too often the case, because they simply disappeared without a trace.

Santiago’s family in Matapalo thought that he was dead, because that’s what his cousins, who eventually made it to the US, had told them. Santiago recalls what happened next with an air of bitterness, his face twisted and tense: He woke up in a hospital in Veracruz, but he couldn’t remember how he had gotten there. “I only remember that I saw a person grab me, I think it was God who grabbed me,” he says. When he woke up in the hospital, his leg was gone. “I felt helpless. For me, it was like my life was over. I felt like I was no longer good for anything, I was no longer worth anything.” He was eventually transferred from the hospital to a shelter for migrants, where he met others who were recovering from similar injuries. A month later, he was back with his family in Honduras.

Sitting in the entryway of his home in Matapalo, Santiago recounts a series of spiraling tragedies: After returning home, he decided to go back to Mexico in search of a prosthesis, which he eventually found, thanks to the support of a human rights organization. He would up in Nuevo Laredo, on the Mexico-US border, where he was assaulted, along with some companions, by a group of men from Los Zetas, one of Mexico’s most dangerous and bloodthirsty criminal gangs. “Those fuckers pulled us out of the car we were in, beat us and poured gasoline on us,” he says. “They were saying they were gonna set us on fire, but they couldn’t find any matches, so they just beat us with the butts of their guns.” After recovering in a local hospital, Santiago decided to attempt to cross the Río Bravo and enter the US. “I carried the prosthetic leg in a bag, because I was afraid it would get wet,” he says. But the current was too strong, and he had to let go of the leg to save himself, grasping for some bamboo branches to keep from being swept away. He managed to cross the river and crawl up onto the bank, but by then he was desperate: He turned himself in to the authorities, and was deported back to Honduras.

Back home, Santiago sought the support of an association that provides assistance to migrants. He was able to get a new prosthesis thanks to a program supported by the International Committee of the Red Cross (ICRC). Eventually, Santiago was able to find a job as an assistant in a clinic run by the Honduran Ministry of Health, where now he earns 9,000 lempiras (about $360) a month – money that, he says, is not enough to support his wife and their eight-year-old son, Dylan. He managed to rebuild his life, but has yet to overcome the trauma of the injury. “At least I’m alive,” he says. “It’s a miracle.”

Placing all hopes on a prosthesis

Santiago found support from the New Life Foundation for Integral Rehabilitation (Fundación para la Rehabilitación Integral Vida Nueva), an organization founded in 2003 to help landmine amputees who had lost limbs during Nicaragua’s armed conflict in the 1980s – a bloody civil war that left tens of thousands dead and wounded. “Some people fled to Honduras and lost limbs trying to get there,” explains Reina Estrada, the Foundation’s executive director. When the land mines along the border between Nicaragua and Honduras were finally cleaned up, under the supervision of the Organization of American States (OAS), the foundation turned its efforts to another tragedy: the growing number of migrants returning home with amputated limbs, after attempting to reach the US.

For many, The Beast has been their best and often only option for reaching the US, but the routes and means of travel used by migrants have shifted in recent years. “We’ve identified a decrease in the use of the train, as a result of increasing insecurity,” says Lorena Guzmán, regional coordinator for the International Committee of the Red Cross (ICRC). Guzmán says that migrants have been forced to seek out new routes, which can be even more dangerous, where they face assaults, kidnappings, and extorsion. The train remains an option, however, and every year it claims more victims.

In addition to the violence suffered by migrants at the hands of organized criminal groups, the Mexican government’s increasingly hostile immigration policies have meant more crack downs and more detentions, often accompanied by excessive use of force on the part of state authorities. In its efforts to curb migration to the US, the administration of President Andrés Manuel López Obrador has turned to military force. A report published in mid-May by the Foundation for Justice and the Democratic Rule of Law (FJEDD, for its acronym in Spanish) shows that in places like Tapachula, an entry point for undocumented migrants on the border between Mexico and Guatemala, the Mexican government has deployed 28,397 military personnel with the aim of controlling and repelling undocumented migration. Of these soldiers, 13,663 are members of the Army; 906 are from the Navy, and 13,828 are with the National Guard.

The day EL PAÍS visited the New Life Foundation’s headquarters in Choluteca, the sweltering, windowless building was buzzing with activity. Huge fans hummed constantly, in an attempt to dissipate the suffocating heat. Estrada works here with a small team that includes a Nicaraguan psychologist, a young man in charge of administration, and two other key figures: orthopedist Walter Aguilar and his assistant, Yenser Pineda, who together are in charge of fabricating prostheses. Aguilar and Pineda make the artificial limbs in their on-site workshop, where they have all the materials and equipment necessary to manufacture the devices that represent a chance at a new life for many Hondurans who have suffered an amputation.

Today, several patients are waiting for Aguilar to see them – that is, to analyze the condition of their stumps, to verify that the wounds have healed well, and to take their measurements and set a date for them to return to be fitted with their prosthesis. Or, as is often the case, to check the old and damaged prostheses of men who, compelled by misery, found work in construction or in the fields and have damaged their prosthetics on the job. “Remember, you can’t carry that much weight, you’ll put too much pressure on the prosthesis,” Aguilar chides one of the men, affectionately. “I have to work,” the man replies. “I have to eat.”

Among the Foundation’s visitors this morning is a strong and stocky, dark-skinned young man, with a radiant smile and an inquisitive expression. His name is Francis Espinoza Reyes, he’s 21 years old, and he was forced to migrate for the same reason that many young Honduran men are forced to migrate: because of the gangs that assault, extort and force the country’s youth to choose between joining las maras or fleeing for el norte. Francis left in 2019, when he was 18. He had managed to make his way through northern Central America and the better part of Mexico, but misfortune eventually struck in Monterrey, the large industrial capital of Mexico’s northeast state of Nuevo León. “We were on the train, and two of the people who were traveling next to me stole my stuff and threw me off the train,” he says. The Beast crushed part of his right foot when he fell. He remembers being taken away in an ambulance. When he woke up in a local hospital, he was given the terrifying diagnosis: the doctors recommended amputating his leg. “I told them they didn’t need to amputate it, that I had only broken the bottom part [of my foot], and I didn’t want them to cut it off,” he says. “When they did it, I didn’t want them to bring me back here [to Honduras], because I felt so bad for the people who would have to see me come back like this. That was the hardest thing to get over,” Francis says, dropping his gaze to the ground.

Francis was depressed for a long time. He felt like a burden, like he was worthless. Depression affects at least 64% of migrants detained in Mexico, according to a collaborative 2018 study conducted by five organizations. This is even more pronounced for migrants, like Francis, who survived traumatic attacks or accidents. Francis says it was only thanks to the support of his family that he was able to rebuild his life here in Honduras. He eventually found assistance through the ICRC program, and then his brother helped him buy a motorcycle cab, which he uses to make a living in Lempira, a department in the west of the country. “It’s been hard to get used to [the prosthesis], because it’s not the same as having two legs,” he says. “But it’s way worse to walk with crutches – I can’t live a normal life on crutches.”

A shelter for disabled migrants

Not all migrants who suffer an amputation en route to the United States want to go return home. Many stay in Mexico, often in one of the country’s migrant shelters, with the hope of eventually trying their luck at the border again. One such shelter is in the city of Celaya, in the central Mexican state of Guanajuato, and is run by Ignacio Martínez Ramírez, an unconventional evangelical pastor willing to help anyone who knocks on his door. In Martinez’s shelter, guests can take theater classes and listen to music whenever they want, and aren’t subjected to the dogmatic rules or conventions common in many of the country’s other religious shelters. This has earned Martinez the criticism of other pastors, who see him as a lost sheep, leading others astray. His shelter houses 31 migrants, 13 of them disabled. Most of them (80%, according to the pastor) are from Honduras – a percentage consistent with the figures for care provided by the ICRC program in the first quarter of 2022, when of the 83 total patients the clinic assisted, 56 were from Honduras.

It’s an early summer morning, and the shelter is bustling. The building has two stories, and a large open courtyard where a teacher is directing a group of migrants as they rehearse a play. They wear white masks, and each actor repeats his lines from memory. Other guests are lying on bunk beds, glued to their cell phones, while women who made the journey with their children tend to their youngest. At lunchtime, everyone sits and eats together at the tables, and then the real party starts: tropical music blares from the shelter’s loudspeakers. “Celaya is an obligatory stopover point for migrants, and I felt that the authorities were not adequately taking care of this forgotten population,” Martinez says. “We started by bringing food to where migrants would gather along the train tracks. Sometimes there would be as many as 200 people, and my wife and I felt sad because we didn’t have enough food for everyone and there wasn’t anything else we could do for them,” the pastor says.

So, he asked for support from some local groups, from his fellow church members, and from other residents, and in 2015, he opened the shelter, with the idea that migrants would have a place to sleep, shower and eat on their journey through Mexico. But this idea grew into something bigger, and today, for dozens of migrants who have seen their dreams shattered, the building is more of a home than a shelter. Here, migrants receive care, understanding, and the support of the ICRC program, which finances prostheses made in a workshop run by the Guanajuato Institute for People with Disabilities (INGUDIS, for its acronym in Spanish). They also receive rehabilitation therapy and other specialized care.

The shelter is home to 24-year-old Evert Rodríguez, a chubby, somewhat grumpy young man who doesn’t his frustration at the bad luck he’s been delt. “My wings were cut, I’m stuck,” he says, sitting in a wheelchair. His left leg was amputated and he hasn’t been able to get a prosthesis – his one hope for leaving the shelter and rebuilding his life. Like so many others, Rodríguez says he left Honduras to escape the gangs. “If you don’t want to be a violent person then you leave,” he explains. “I don’t want to go back to my country, I don’t want to have problems.” It was during his attempt to escape this violence that Rodríguez fell from The Beast. He had climbed on the train in Orizaba, in the state of Veracruz, around six in the evening. “We got on without a problem, but my backpack got stuck when we were climbing the ladder,” he recalls. “I tried to let it go but I fell, and the train ran over my leg. I’m a brave person, and I cinched the wound down with my shoelaces.” In a state of shock, Rodríguez had not yet realized the magnitude of what had just happened. He was rescued by some locals, who took him to a nearby hospital, but due to the severity of his condition, he was transferred to the Veracruz General Hospital.

At this point in his story, Rodríguez’s face twists into a grimace as he remembers the treatment he received at the hospital in Veracruz. “They did such a crap job,” he says. “Just imagine! They messed up the operation so bad that now my tendons are trashed. I’ve been like this for 14 months and they’re gonna have to do another operation. It’s all such garbage, such bullshit. Fuck, it’s been such a trauma, man. “If I at only had movement in this leg – because I don’t even have that – I’d already have gotten the prosthesic, but since they screwed it up so badly… It makes me want to…” He bites his lip and stops talking. Rodríguez can’t move the injured leg, which is why he needs another operation. This is his only option for getting a prosthesis, and with it, a new life. Sitting around him, his friends continue talking among themselves. Those who are expecting a prosthetic soon sit next to their crutches. Those who already have one are joking and playing games with each other. “What I want is to have my own one,” Evert says. “I like to work. I know a lot about agriculture, planting coffee, beans. That’s the work I’m good at: farming.” He looks down, rests his head on his palm, and moves his right leg around. The other leg stays motionless, unresponsive. He curses La Bestia. He curses his bad luck. “But I’m brave,” he says.

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Nicaragua’s Daniel Ortega Escalates Diplomatic Crisis With US And Europe



Nicaraguan President Daniel Ortega.
Nicaraguan President Daniel Ortega.JAIRO CAJINA (AFP)

Nicaraguan President Daniel Ortega has decided to break ties with the Netherlands in what is the latest diplomatic feud to be sparked by the former guerilla. The Nicaraguan Foreign Ministry said in a statement on Friday that it had severed all diplomatic ties with the European country because it “offended and keeps offending Nicaraguan families.”

The decision to break ties was made after the Dutch ambassador for Central America, Christine Pirenne, informed the Nicaraguan government that the Netherlands would not be funding a $21.5 million hospital promised long ago. The news outraged Ortega, who accused the ambassador of treating Nicaragua as if it were “a Dutch colony.”

“Those who come to disrespect our people, our homeland, they should not appear again in Nicaragua. And we do not want relations with that interventionist government,” he said during his speech on Friday, which marked the 43rd anniversary of the founding of Nicaragua’s repressive National Police. “We [the Sandinista government] continue to open hospitals, even when we are met with human misery. The human misery of a European country, the Netherlands!” he added.

Diplomatic sources told EL PAÍS that the Netherlands had suspended the hospital project due to the “mishandling of funds, lack of transparency, and the serious human rights situation in Nicaragua.”

“The Netherlands regrets the disproportionate decision by Nicaragua to break off diplomatic relations. We take a firm stand on the worsening democratic structures and human rights violations in Nicaragua,” Dutch Foreign Minister Wopke Hoekstra said via Twitter on Saturday. “Other countries have also noticed difficulties in maintaining an open dialogue with Nicaragua. We will discuss our next steps with the EU.”

The clash with the Netherlands followed a week of heightened tensions with the European Union and the United States.

On Friday, Nicaragua’s Vice President Rosario Murillo, the wife of Ortega, also announced that the Central American country would not accept the new US-appointed ambassador Hugo Rodriguez as its representative in Managua. Ortega initially signed off on the appointment, but withdrew his support in July after Rodriguez told the US Senate Foreign Relations Committee that he would continue to advocate for an end of human rights violations in Nicaragua.

“The United States has spoken out against these abuses, and, if confirmed [as ambassador], I will continue to do so, not because we have any intention to determine Nicaragua’s internal affairs, but because it is our commitment under the Inter-American Charter, which both the United States and Nicaragua signed in 2001,” Rodriguez told the committee.

Despite Nicaragua’s objections, the Joe Biden administration appointed Rodriguez as ambassador on Thursday. Ortega railed against the decision during his speech to police forces. “The candidate for ambassador to Nicaragua appeared before the Senate, and what did he do? He insulted and disrespected us,” he said on Friday. “So we immediately said ‘get out, get out and stay out, and he can continue yelling whatever he likes out there, but here in our country, our flag is respected.’”

On Thursday, in another speech, Ortega attacked the Vatican, Chilean President Gabriel Boric and Brian Nichols, White House Assistant Secretary of State for Western Hemisphere Affairs, who he described as a “poor Black man” with a “bulldog face.” Boric and other Latin American leaders, who have called for the release of political prisoners, were branded as “lapdogs” of the United States and the European Union.

And on Wednesday, Nicaragua declared the European Union ambassador, Bettina Muscheidt, “persona non grata” and gave her three days to leave the country. The decision was made after the EU delegation demanded freedom for Nicaragua’s political prisoners at the United Nations General Assembly last week.

“The EU profoundly regrets and rejects this unjustified and unilateral decision,” the European External Action Service (EEAS) said in a statement released on Sunday, a day after Muscheidt left Nicaragua. “The EU also profoundly regrets the disproportional and unjustified unilateral decision taken on Friday by the Nicaraguan government to cut diplomatic ties with the kingdom of the Netherlands and expresses its unwavering support to the Dutch government,” it added, warning that it would respond in a “firm and proportional manner.”

In recent months, Nicaragua has also rejected all proposals for dialogue, including those put forward by Pope Francis, Colombian President Gustavo Petro and the US government.

“Ortega’s strategy is to escalate the crisis to a point where only the use of force will solve it, but he knows very well that the use of force is not an option the international community is going to consider,” Eliseo Núñez, a former opposition deputy in Nicaragua, told EL PAÍS. “Everyone believed that they could push Ortega to the brink of the abyss, but he has taken the international community to that brink and is forcing it to choose between two options: a global economic blockade, which would collapse Nicaragua, or to sit back and wait to see what happens.”

Some analysts believe that Washington is seeking to exhaust all diplomatic routes with Nicaragua via Ambassador Rodriguez in order to justify future action against the country, such as expelling it from the DR-CAFTA free trade agreement.

“Ortega has been using vulgar, racist and blasphemous rhetoric,” Arturo McFields, Nicaragua’s former ambassador to the Organization of American States (OAS), told EL PAÍS. “It is a narrative that is aligned with Russia’s foreign policy. Right now, Russia is facing NATO, the United States and the European Union. Ortega is sticking in a parasitic to the foreign policy of Moscow and China.”

McFields recalled that Nicaragua was one of the seven countries that did not want the president of Ukraine, Volodymyr Zelenskiy, to appear remotely at the United Nations General Assembly. “I believe that in the next few days, Ortega is going to break diplomatic relations with other countries in the European Union,” said McFields.

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Six Takeaways From Brazil’s Election



Brazilians waiting to vote in Rio de Janeiro.
Brazilians waiting to vote in Rio de Janeiro.RICARDO MORAES (Reuters)

Luiz Inácio Lula da Silva, Jair Bolsonaro and six other candidates faced each other this past Sunday, October 2, in the first round of Brazil’s presidential election.

These were the key takeaways of the day:

Run-off. None of the candidates obtained enough votes to clinch the election in the first round. Luiz Inácio Lula da Silva received more than 57 million votes (48.38%), two points short of the figure required to win a third term outright. That means that in four weeks he will again face off against the president, Jair Bolsonaro. On October 30, Brazilians will choose between two antagonistic models for running the country.

Bolsonaro’s strength. The incumbent’s performance has been much better than any of the polls had predicted. He is only five points behind Lula when the polls had placed him between 10 and 15 points behind his leftist rival.

Failure of polls. For months, Bolsonaro and his followers had been insisting that polls underestimated his strength, just like in 2018. And they were right. Although several surveys have been published each week in recent months, none of the most reliable ones foresaw such a close presidential race.

-Victory in São Paulo. Nobody was expecting it: Bolsonaro won comfortably in the wealthiest state in Brazil. His candidate in the race for governor, Tarcísio Gomes Freitas, a former minister who is from the rival city of Rio de Janeiro, obtained a seven-point lead over Fernando Haddad, a former Workers’ Party (PT) candidate and former mayor. Both will fight it out in the second round of voting.

-A right-leaning Congress. The next president of Brazil, whoever he may be, will have to govern with a clearly conservative National Congress. Bolsonaro’s Liberal Party (PL) will have the biggest presence in the Chamber of Deputies, with 99 seats. The lower house has 513 seats, but it will be nearly impossible for Lula’s Workers’ Party (PT) to build a majority.

– A five-hour vote count. Although Brazil is twice the size of Europe and its electorate exceeds 156 million voters, electronic ballot boxes reach every corner of the country, including the remote villages of the Amazon. This facilitates a speedy vote count: in just five hours, 99% of the votes had already been counted.

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‘Time Is Brain: The Longer You Take To Go To The Hospital After A Stroke, The Worse The Damage’




To find out if the brain development of a newborn baby is normal, doctors usually look at – among other things – a small reflex action, triggered by exerting a tiny amount of pressure on the palm of the hand or the sole of the foot. This little movement in the first months of life provides invaluable information.

Lluís Barraquer Roviralta – considered the father of neurology in Spain – first utilized this technique over a century ago at Sant Pau Hospital in Barcelona. A full 140 years of scientific advances (and three generations of Barraquers) have now passed in the neurology clinics of Sant Pau. Today, specialized services in this area of medicine have taken giant leaps, thanks to the development of imaging technology.

“This is the decade of neurology,” proclaims Albert Lleó, the current director of the department that Barraquer created. The 50-year-old neurologist recently received a lot of media attention after his team successfully treated the 92-year-old former premier of Catalonia, Jordi Pujol, after he suffered a stroke. Pujol was released from hospital last weekend.

This interview has been translated and edited for clarity and brevity.

Question. How has the field of neurology changed in 140 years?

Answer. Neurological disorders are becoming more frequent. Many of these are age-related diseases – this is to be expected, given that people are living longer. It’s projected that the prevalence of degenerative diseases could triple within the next 30 years.

Q. How has the prognosis of these diseases evolved?

A. Thirty years ago, there were very few diseases that had effective treatment. In most cases, the causes and mechanisms were not well understood. For strokes, there were only antiaggregants, such as aspirin. Practically nothing was known about degenerative diseases. As for neuromuscular diseases, only cortisone or very broad-acting immunosuppressants were available. What has happened in recent years is that more knowledge about the causes has resulted in more effective treatments.

Q. It used to be said that neurologists know all about the diseases, but they can’t cure any of them…

A. This belief is totally obsolete. There are effective treatments for cerebral vascular diseases, for stopping blood clots from growing or causing problems… there are very effective treatments for migraines, there’s gene therapy treatment being carried out for spinal muscular atrophy. Perhaps the most difficult diseases to treat are Alzheimer’s and Parkinson’s.

Q. These are good times for neurology, then?

A. We are in a fantastic era, because of the therapeutic tools we have access to. But the rise of neurological diseases is also, in turn, a time bomb, because it can squeeze health services. We have aging populations, a greater prevalence of chronic diseases… all of this comes at a very high cost, the treatments aren’t cheap. This is why it’s very important to have adequate plans for Alzheimer’s, for example, or for other neurodegenerative diseases, to prioritize where we’re going to put the money – do we put it into long-term care homes or do we put it in research?

Q. Last week, former Catalan premier Jordi Pujol was proof that strokes can be reversible, even at an advanced age.

A. Today, more and more work is being done on biological age rather than on chronological age. That is, you can be 60 years old, but have the brain of an 80-year-old, because you’ve had an unhealthy lifestyle.

The rise of neurological diseases is a time bomb, because it can squeeze health services

Q. Mar Castellanos, the head of neurology at A Coruña Hospital, said in an interview with EL PAÍS that strokes don’t just take place among the elderly – more and more often, they are affecting the working age population. Why is this happening?

A. A stroke is highly influenced by lifestyle: smoking, diabetes, high cholesterol, a sedentary lifestyle, high stress levels… age is not the only factor.

Q. Speaking of lifestyle… even though we’re living longer, are we living worse? Are we harming our brain with our habits?

A. I think there is still a lack of awareness regarding the prevention and early detection of neurological diseases. In the case of a stroke, for example, there are people who still think that it’s not necessary to go to the emergency room, that you can wait and see if it goes away. We see this every day. And why is this happening? Because cardiovascular or cancer prevention campaigns began in the 1970s, but in neurology, they started much later – we’ve been repeating this message for less time. In the case of a stroke, time is brain: the longer it takes to get to the hospital, the more brain damage there will be. Neurological diseases have been largely neglected from the point of view of awareness campaigns and funding.

Q. There’s a kind of knowledge black hole when it comes to neurodegenerative diseases, which still have no treatment. Why?

A. Alzheimer’s, Parkinson’s… these are very difficult diseases to study and treat. Sometimes, many years may pass before a person notices the first symptoms. By the time they begin to notice and seek help, there is already significant brain damage. When someone has a tumor, oncologists do a biopsy of the tissue, analyze it and look for viable treatment options. But you can’t do a biopsy in the brain: we depend on imaging techniques, which don’t have microscopic resolution. We aren’t able to examine these diseases in detail in the early stages – not knowing what’s happening during these critical years makes it difficult to find treatments.

In Alzheimer’s, there are more than 50 genes involved – it’s very difficult to know what the sequence of events is. Even so, I would say that much progress has been made. And it’s also very clear that the greatest advances have been made in the degenerative diseases that have received the most funding, like Alzheimer’s and MS. The common thread of all chronic diseases – except for strokes – is to understand the immune system in our brain, about which very little is known. This will be essential research over the coming decades.

Q. How can the healthcare system remain sustainable?

A. It’s necessary to carry out a cost-effectiveness analysis. If we manage to reduce or postpone the onset of Alzheimer’s for five years with effective treatments, we can reduce the number of total cases and, most importantly, improve people’s quality of life. This has a very high cost, but maybe it will buy patients a few extra years of life outside of long-term care.

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