[ExI] Class Differences Among Black People

[Amara Graps]

Olga:
>I've had friends who lived under the Italian health-care system for many
>years, and there are friends who still do.  The get medical health care
>whenever they've needed it - they live longer than Americans do - what's
>not to like?

The long lives of the Italians is due to their excellent eating habits
(ignoring, for the moment, their sugar-caffeine breakfast) and their deep
social and familial support network which is also, incidently, absolutely
necessary to navigate the country's broken infrastructure.

The health-care system is broken like the rest of Italy's
infrastructure. "Broken", meaning that one waits an average of 3-12
months for an appointment with a public doctor (some kinds of doctors
are more available than others). The Italians use frequently private
doctors to manage this situation, and get their medical expenses
deducted from their taxes (if they want). Newly educated, and
interned-practiced, doctors wait in a long queue (which includes a
competition "concorso") in order to enter the public medical system and
practice, and I don't know what is the reason for this, only that the
queue and wait increased drastically under Prodi, this year. There
remains a shortage of doctors in the Italian public medical system,
generally.

There is however, one aspect of the Italian health care system that does
work, under certain boundary conditions, and that is Emergency Room
("Pronto Soccorso") care, something that I became intimately familiar
with, this past winter, when I first helped a visitor/colleague/friend
manage the system when he needed emergency treatment while he was in Rome
last Christmas, and then two weeks later, in January, I needed it for
myself. So for the latter, I will tell a story....

(Once upon a time .............  she begins)

There are plenty of signs in the past year of my body is telling me to
stop being stressed. After another difficult Fall and Winter, now I feel
desperate to leave Italy. In the second week of January, my body had
'enough' about the tension I'm carrying around, and on a Monday night,
my back 'went out'. It was difficult to move but I soldiered on, because
I knew that it was important to keep the blood flowing.

After a painful night not sleeping well, on the next Tuesday morning, I
got up and felt a little dizzy. Went to the bathroom, where I felt even
more dizzy, and so sat for a bit waiting for the dizziness to pass. Then
I got up and bamm!, I passed out. It was so fast that I didn't know
where I fell until I woke up a minute later and saw that I was in the
hall outside of my bathroom. Nothing was broken, only a nasty bump on my
chin where it hit the hard floor, and I had the knob of the food pantry
drawer in my hand where I had apparently grabbed it as I went down. The
two bottles of wine that were standing on the floor next to the pantry
were only knocked over by my fall, and luckily did not break.

So what happened? I have my medical book and with that and the Web, I
learned that it was probably not anything serious. Everyone once in
their life faints ("syncope"). Often it is first thing in the morning,
and sometimes in the bathroom too, due to 'liquid' change in pressure. I
wasn't on medication (even though my back was killing me, I hate taking
aspirin), however, I didn't have influenza either, so I asked the doctor
boyfriend "Gianluca" of my good friend in my town if he could check my
blood pressure. Soon after, he checked it, and said that it is low, but
not terribly low, and he guesses that there might have been
stress-induced heart arrythemia that caused less blood to my head for a
brief moment compounding the other pressure change stuff, that was why
it happened so fast. He said though, that if he were me, he would see his
regular doctor to be sure.

Maybe you can guess the sequence of events from this. Of course he was
right, that I should have it checked, but this is Italy. What followed
the next week were two visits to my 'medico' (general practitioner) and
four visits to hospital emergency rooms in my area and enough stresses that
if my life before was not enough to cause me to faint, then I was going
to faint anyway.

Apparently on January 1, all of the rules for when you can go to the
emergency room changed. You can still go if you have something SERIOUS,
no papers required, and you just go, and the hospitals are required to
accept you, and it costs nothing. But if you see a medico before, then
the medico must 'categorize' you into different levels of 'seriousness',
then you must go to the public health office and they must find you a
hospital within 3 days to take you and treat you and they give you yet
another document with their permission.

My medico didn't tell me any of that, she didn't know. She only wrote on
a prescription form the specialists that I must see, and she told me to
show that to the Emergency Room and say that I must see one
'immediately' (subito). Such an action instead put me in a gray limbo-land
where I had 'too many' papers for normal emergency room access, and 'not
enough' papers to follow the latest, set of convoluted Italian
bureaucracy.

But we first had to solve that I didn't have a public health
certificate (my other expired like all of my other legal documents three
years ago). After devoting two days on that (her open office hours are
two hours per day, the public health's open office hours are 4 hours per
day), I had my certificate and tried again to go to the Emergency Room,
and again they turned me away. I needed her 'categorization' and those
other permissions still.

It was at a height of frustration and my worry that maybe something
really was wrong with me (a screaming headache for one thing, guess
why?), that at this point, I told my working group, and they changed
from being their hurried moods to being helpful, and my boss arranged
the institute technician to go to the Frascati Hospital Emergency Room
with me (now my 3rd time to an Emergency Room, different place), where
he 'talked' for me and lied through his teeth. We showed _no papers_. He
said that I only fell 3 days before (when in reality it was one week
before), and that I was in my office in the morning when it happened.

And Voila! The doctors saw me, they checked me thoroughly, with a
complete blood test too. Nothing obvious turned up, but they wondered
about vertigo, so they sent me the next morning to the hospital in the
next town, where an ear specialist checked my ears. With the exception
of a loss of high frequencies in my left ear (happened in an injury when
I was a kid), there is still no obvious cause, and so my fainting
doesn't look serious. In one month (which is considered extremely fast
for normal appointments with specialists in the Italian public health
system..) I had a scheduled 'dynamical' ecg but another long story
prevented me from making that appointment, and the neurologist I saw in
that time could find nothing wrong either. He wished to schedule an MRI,
but the soonest they had room for me was in Novmeber, so I stopped.

Overall, this experience of trying and eventually seeing a doctor,
ignoring for a moment that it occupied almost a whole week of my time,
taught me one thing: The Italian Pronto Soccorso (Emergency Room) system
is the first thing I've encountered in Italy that actually works. If you
go with _no documents_, and have a serious problem, they see you. They
take it seriously. They send you to more and more specialists, as
needed. You might have to wait a little while inside of the waiting
room, but the doctors _will_ see you. And treat you. And it costs
nothing. This is true for Italians as well as for Visitors.

Amara

-- 

Amara Graps, PhD      www.amara.com
INAF Istituto di Fisica dello Spazio Interplanetario (IFSI), Roma, ITALIA
Associate Research Scientist, Planetary Science Institute (PSI), Tucson