I have been reading about “the Italian health care system, one of the best in the world,” yet unable to keep pace with the novel coronavirus, COVID-19. Let me be honest and unpopular: the Italian health care system is rotten, and the coronavirus pandemic is showing it to the world.
I am an Italian physician based in Los Angeles. I was 25-year-old when, nauseated by a health care system dominated by corruption and ineptitude, I decided to leave. Poor leadership and scarce resources have shaped a health care system that is overstretched and insufficient at best. My American friends and colleagues ask me why the mortality associated with COVID-19 is so high in Italy. While the elderly Italian population is massive and makes for the majority of the deaths, I believe that this praised health care system plays a key role in the outrageous mortality rate.
Italy is corrupt, and this is no big surprise. Corruption is money being allotted to the health care system, yet distributed into the pockets of politicians, which directly translates into a lack of resources for the Italian hospitals. Corruption is unfit political leaders, at times uneducated, unable to allocate resources even if they were willing to. Providers are forced to work with insufficient equipment and staff, striving to save lives in an inadequate setting. Hospitals struggle to find physicians and nurses willing to work under such pressure without resources to do their job. Those who decide to work in the ER do so by committing to a life of overwork, low salaries, and no protection in case of the inevitable malpractice. The same applies to providers in intensive care. Corruption is a health care system dominated by medical leaders placed in their positions by politicians or “friends.” Department chairmen are often assigned not because of their achievements or knowledge, but because of “who they know.”
At times these leaders happen to be good doctors; however, oftentimes, they are not. These are the leaders tasked with making critical decisions during a pandemic. These are the leaders that should “educate” and shape the next generation of bright trainees. Young doctors are left with few choices: they can either model their unlikely educators or emigrate. In recent years, many young physicians like me opted for the latter, choosing to pursue the rocky path of a career abroad rather than compromising because of a mediocre system. De facto, leaving the already broken Italian health care with fewer providers. The politicians praising the job of so many overworked physicians in the pandemic are the same politicians that have ignored the needs of the medical class. After spending tax money to train the next generation of physicians (medical school is mainly free in Italy), they passively witnessed the exodus of Italian providers to more meritocratic and less corrupt countries.
This dynamic of corruption and incompetence of the Italian system translates into poor care and poor outcomes. I have experience of this both on the provider side and patient side. Only one year ago, my 88-year-old grandma was diagnosed with pneumonia in the ER of one of the most prestigious academic hospitals in Rome. She was left on a stretcher for one week. It was no surprise when, after a few days, she started to develop bedsores. The ER personnel is insufficient and overworked, so nobody could make sure she was fed. Due to starvation, she ended up with pancreatitis (a rather severe inflammation of the pancreas). One day, my mother called me from the ER, still waiting to get news about a bed, telling me about a paranoid young man that was brought to the ER. Nobody could see him for hours, and he eventually threw himself out of a window, breaking some bones but still alive. As a psychiatrist, I feel confident that if something like that had taken place in the United States, that same center would no longer have an ER open.
The faultiness of the Italian system is accepted as normal in a country where citizens are taught that this is, indeed, the best of the best. Many assume that it is the best because it is free, and what is better than dying for free? On the 8th day in the ER, my grandma was transferred to the medical floor. Once there, my family could finally assist her and make sure she could eat and recover. The Italian health care relies on families to fill the void left by the lack of resources. The COVID-19 pandemic separates families from their sick relatives, preventing exactly what the Italian system relies upon. Once hospitalized, it is common to have patients with a catheter in their bladder, not because of any medical indication, but because there is not enough staff to assist everyone to the bathroom. This common practice favors diseases, and my grandmother, like many others, ended up with a urinary tract infection due to the catheter. My grandmother had to survive not only pneumonia for which she initially presented to the ER, but pancreatitis, the bedsores and the urinary tract infection caused by this “excellent” health care.
The last hospitalization of my grandmother is emblematic of a system praised internationally because of propaganda rather than facts. Medical excellence in Italy does exist, as testified by decades of relevant academic work from the most prestigious universities. However, it is patchy, leaving most of the country in a precarious condition. Italy needed a pandemic to unveil the reality of a collapsed national health care system. COVID-19 does not spare anyone, not even corrupt politicians, and this should be a wake-up call for the Italian government. Italian physicians are fighting at the front line of this pandemic unequipped, in the desperate effort to suffice where the government failed them. Nobody is truly ready for COVID-19. Better health care systems will be hit hard and possibly fail those in need, yet the Italian experience is not to be taken as a model of first-world health care.
Roberta Zanzonico is a psychiatrist.
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