Thirteen People Nobody Was Counting

Someone rents a house, puts up some beds, and takes in people whose families are abroad sending remittances.

Has dado en el clavo con lo de las remesas.

You've hit the nail on the head with the remittances point.

Sri Lanka tiene una diáspora enorme, sobre todo en los países del Golfo, en Italia, en el Reino Unido.

Sri Lanka has an enormous diaspora, especially in Gulf countries, in Italy, in the United Kingdom.

Hay familias que pagan por tener a un pariente mayor en uno de estos lugares porque es lo único que pueden costear, y porque confían en que, aunque no esté registrado, alguien lo está cuidando.

There are families that pay to have an elderly relative in one of these places because it's the only thing they can afford, and because they trust that, even if it's unregistered, someone is looking after them.

La alternativa sería que ese anciano estuviera solo en casa.

The alternative would be that elderly person being alone at home.

Which is a perfectly rational decision given the options available.

This isn't negligence on the family's part.

It's a rational response to a system that hasn't caught up with the demographic reality.

Y aquí es donde me parece importante no caer en la trampa fácil de culpar exclusivamente al propietario del local.

And this is where I think it's important not to fall into the easy trap of blaming only the owner of the premises.

Puede que ese propietario también creyera de buena fe que estaba prestando un servicio necesario.

It's possible that owner also genuinely believed they were providing a necessary service.

Que intentara registrarse y se encontrara con una burocracia imposible.

That they tried to register and encountered impossible bureaucracy.

Que simplemente no supiera que había que hacerlo.

That they simply didn't know it was required.

Todo eso es posible.

All of that is possible.

Lo que no es posible es que no hubiera salidas de emergencia adecuadas y que eso no tuviera consecuencias hasta que las tuvo de la peor manera.

What is not possible is that there were no adequate emergency exits and that this had no consequences until it did, in the worst way.

You know, I spent time in Jakarta in the nineties, and this pattern was everywhere.

Informal care facilities, often run by neighbors or community figures, operating in a regulatory gray zone that everyone tacitly accepted because the formal system was overwhelmed.

Es un patrón global.

It's a global pattern.

No es exclusivo del sur de Asia ni de los países en desarrollo.

It's not exclusive to South Asia or developing countries.

En España, después de la pandemia de covid, salieron a la luz docenas de pisos particulares que funcionaban como residencias de ancianos sin ningún tipo de autorización.

In Spain, after the covid pandemic, dozens of private apartments came to light that were functioning as nursing homes without any kind of authorization.

En algunos casos, gente mayor con demencia, encerrada en apartamentos de tres habitaciones con un cuidador sin formación.

In some cases, elderly people with dementia, locked in three-bedroom apartments with an untrained caregiver.

Y nadie lo sabía, o nadie quería saberlo.

And nobody knew, or nobody wanted to know.

That's a detail I didn't know.

So this isn't a 'developing world problem.' It's a problem of demand massively outstripping regulated supply, everywhere.

En todas partes.

Everywhere.

Lo que varía es el margen entre lo que necesitas y lo que el Estado puede darte.

What varies is the gap between what you need and what the State can give you.

En Sri Lanka ese margen es enorme.

In Sri Lanka that gap is enormous.

En Alemania es más pequeño, pero también existe.

In Germany it's smaller, but it exists too.

Y cuando ese margen existe, alguien lo llena, con mayor o menor diligencia.

And when that gap exists, someone fills it, with greater or lesser diligence.

Let me push on the Sri Lanka angle for a minute, because there's something specific here.

The country went through a catastrophic economic crisis in 2022.

Currency collapse, fuel shortages, a government that literally ran out of money.

What does that do to public health infrastructure?

Lo que hace es devastador y duradero, y a menudo no se ve en los titulares porque no ocurre de golpe.

What it does is devastating and lasting, and often doesn't make headlines because it doesn't happen all at once.

Los hospitales públicos pierden equipamiento porque no hay divisas para importarlo.

Public hospitals lose equipment because there's no foreign currency to import it.

Los funcionarios de inspección no cobran o cobran tarde, y dejan el sector público.

Inspection officials aren't paid or are paid late, and leave the public sector.

Las reformas legislativas se aplazan indefinidamente porque hay cosas más urgentes.

Legislative reforms are postponed indefinitely because there are more urgent things.

Y mientras tanto, la población sigue envejeciendo, y la demanda de cuidados sigue creciendo.

And meanwhile, the population keeps aging, and the demand for care keeps growing.

So the 2022 crisis essentially widened an already-existing gap.

The formal sector contracted, the informal sector expanded to compensate, and the enforcement capacity to monitor that informal sector also shrank.

Everything moved in the wrong direction at once.

Perfectamente resumido.

Perfectly summarized.

Y lo más cruel es que los que más dependen del sector informal son los que menos recursos tienen para protegerse si algo sale mal.

And the cruelest part is that those who depend most on the informal sector are those with the fewest resources to protect themselves if something goes wrong.

No tienen acceso a abogados, no tienen dinero para pagar tratamientos privados si resultan heridos, no tienen influencia política.

They have no access to lawyers, no money to pay for private treatment if they're injured, no political influence.

Son invisibles hasta que hay un incendio.

They're invisible until there's a fire.

Invisible until there's a fire.

That's the episode right there.

Y lo que ocurre después del incendio también es predecible: hay una investigación, hay declaraciones de los ministros, se prometen reformas.

And what happens after the fire is also predictable: there's an investigation, there are ministerial statements, reforms are promised.

Puede que incluso se clausuren unos cuantos establecimientos no registrados, lo cual no significa que los ancianos que estaban ahí tengan a dónde ir.

Some unregistered establishments may even be shut down, which doesn't mean the elderly people who were there have anywhere to go.

Y en seis meses, la atención pública ha pasado a otra cosa.

And in six months, public attention has moved on to something else.

I've watched that cycle play out in so many countries.

A disaster, a wave of outrage, some regulatory theater, and then quiet.

Until the next one.

Lo llaman 'regulación reactiva', y es la norma, no la excepción.

They call it 'reactive regulation,' and it's the norm, not the exception.

El problema es que la regulación reactiva llega siempre tarde.

The problem is that reactive regulation always comes too late.

Regulas después de la tragedia, no antes.

You regulate after the tragedy, not before.

Y en el ámbito del cuidado de personas mayores, 'tarde' significa que ya hay muertos.

And in the field of elder care, 'too late' means there are already people dead.

What would proactive regulation actually look like in a country with Sri Lanka's resource constraints?

Because just saying 'better enforcement' feels like telling someone to run faster in quicksand.

Hay modelos que funcionan con pocos recursos.

There are models that work with few resources.

Algunos países han creado sistemas de registro simplificado, donde el coste y la burocracia de inscribirse son mínimos, pero a cambio hay visitas de inspección periódicas con listas de verificación muy concretas: salidas de emergencia, extintores, ratio de cuidadores por residente.

Some countries have created simplified registration systems, where the cost and bureaucracy of registering are minimal, but in exchange there are periodic inspection visits with very concrete checklists: emergency exits, fire extinguishers, carer-to-resident ratio.

No hace falta una agencia enorme para hacer eso.

You don't need a huge agency to do that.

Lo que sí hace falta es voluntad política y consistencia.

What you do need is political will and consistency.

The political will part is doing a lot of heavy lifting in that sentence.

Sí, siempre.

Yes, always.

Porque los ancianos en residencias no registradas no votan de manera organizada.

Because elderly people in unregistered facilities don't vote in an organized way.

No tienen grupos de presión.

They don't have lobbying groups.

No financian campañas.

They don't fund campaigns.

Son exactamente el tipo de ciudadanos cuyas necesidades se postergan indefinidamente porque no hay ningún coste electoral inmediato en ignorarlos.

They are exactly the type of citizens whose needs are postponed indefinitely because there is no immediate electoral cost to ignoring them.

And there's something almost perverse about that.

These are people who built the country.

Who paid taxes for decades.

And at the end of their lives they end up in a building with no fire exits because the system they supported never got around to caring for them properly.

Y ese argumento, que es completamente válido, se complica cuando lo comparas con lo que Sri Lanka sí ha logrado en salud pública.

And that argument, which is completely valid, gets complicated when you compare it with what Sri Lanka has achieved in public health.

Tiene una mortalidad infantil muy baja, una cobertura de vacunación alta, una red de atención primaria razonablemente funcional.

It has very low infant mortality, high vaccination coverage, a reasonably functional primary care network.

No es un estado fallido en materia de salud.

It is not a failed state in terms of health.

Es un estado con prioridades que históricamente han favorecido a los jóvenes sobre los mayores, lo cual en parte refleja qué tipo de política pública genera retornos electorales más rápidos.

It is a state with priorities that have historically favored the young over the old, which in part reflects what kind of public policy generates faster electoral returns.

That's a genuinely uncomfortable observation.

And it applies to most democracies, not just Sri Lanka.

A casi todas.

Almost all of them.

La política del cuidado de mayores es aburrida, técnica, y cara.

The politics of elder care is boring, technical, and expensive.

Los escándalos en residencias generan indignación durante un ciclo de noticias y luego desaparecen.

Scandals in care homes generate outrage for one news cycle and then disappear.

Lo que no desaparece es la demografía: en 2050, Sri Lanka tendrá una proporción de mayores de sesenta años similar a la de España hoy.

What doesn't disappear is the demography: by 2050, Sri Lanka will have a proportion of people over sixty similar to Spain's today.

Y España, con todos sus recursos, sigue luchando con este problema.

And Spain, with all its resources, is still struggling with this problem.

That's the implication that should worry everyone.

What Sri Lanka is going through right now, in a more acute form, is a preview of what every aging society faces.

The only variable is how much runway you have to fix it before the crisis hits.

Y la ironía más amarga de este caso concreto es que Sri Lanka invirtió durante décadas en mantener viva a su población más tiempo, en reducir la mortalidad, en mejorar la calidad de vida.

And the bitterest irony of this specific case is that Sri Lanka invested for decades in keeping its population alive longer, in reducing mortality, in improving quality of life.

Y ahora esa misma población mayor, que es el resultado de ese éxito sanitario, se encuentra en un sistema que no estaba preparado para recibirla.

And now that same elderly population, which is the result of that public health success, finds itself in a system that was not prepared to receive it.

El éxito de la salud pública engendró una crisis de cuidados que nadie anticipó con suficiente seriedad.

The success of public health gave birth to a care crisis that nobody anticipated seriously enough.

You saved people from dying young and then didn't build anywhere for them to grow old safely.

There's a kind of tragic logic in that.

Oye, quiero volver un momento a algo que dijiste antes, porque usaste una expresión interesante.

Hey, I want to come back to something you said earlier, because you used an interesting expression.

Dijiste que el sistema no había 'llegado a cuidarles'.

You said the system never 'got around to caring for them.' In Spanish we'd say the system 'nunca llegó a ocuparse de ellos.' That 'llegar a' is very useful and sometimes you use it well, Fletcher, and sometimes not so much.

En español diríamos que el sistema 'nunca llegó a ocuparse de ellos'.

Ese 'llegar a' es muy útil y a veces lo usas bien, Fletcher, y a veces no tanto.

Oh, I feel a lesson coming.

Is this about the time I told your mother I was very pregnant?

Siempre habrá tiempo para hablar de eso.

There will always be time to talk about that.

Pero no, esto es distinto.

But no, this is different.

'Llegar a' seguido de infinitivo expresa que algo alcanzó un punto determinado, a veces con esfuerzo, a veces con sorpresa.

'Llegar a' followed by an infinitive expresses that something reached a certain point, sometimes with effort, sometimes with surprise.

'Nunca llegó a registrarse' significa que nunca alcanzó ese punto.

'Nunca llegó a registrarse' means it never reached that point.

'Llegué a entenderlo después de años' significa que finalmente, con tiempo y esfuerzo, lo entendí.

'Llegué a entenderlo después de años' means that finally, with time and effort, I understood it.

Es muy diferente de 'llegar' simplemente, que solo indica movimiento o llegada física.

It's very different from plain 'llegar,' which only indicates movement or physical arrival.

So 'nunca llegó a registrarse' is almost like 'it never quite made it to being registered.' There's a sense of something that was possible but didn't complete the journey.

Exactamente.

Exactly.

Y eso lo hace mucho más matizado que simplemente decir 'no se registró', que es un hecho frío.

And that makes it much more nuanced than simply saying 'it wasn't registered,' which is a cold fact.

'Nunca llegó a registrarse' contiene implícitamente la posibilidad de que sí hubiera podido hacerlo.

'Nunca llegó a registrarse' implicitly contains the possibility that it could have been registered.

Hay una historia dentro de la frase.

There's a story inside the sentence.

That's a genuinely useful distinction.

English can do something similar with 'never quite managed to' or 'never got around to,' but Spanish packs it into two words.

I'll try to use it correctly.

No promises.

Con eso me conformo.

That's enough for me.

Y ya que hablamos de cosas que nunca llegan a ocurrir, esperemos que Sri Lanka no llegue a repetir este tipo de tragedia.

And since we're talking about things that never quite happen, let's hope Sri Lanka doesn't manage to repeat this kind of tragedy.

Aunque el escepticismo, en este caso, está completamente justificado.

Although scepticism, in this case, is completely justified.