An Insightful Rant By A Scorned Patient. What's Wrong With The Medical System in Abruzzo?

Usually I try to keep my writings positive, but some things just need to be aired. Lets chat about the utter lack in efficiency in some italian public service sectors. I am infuriated by the joke of a medical system here in Abruzzo, ASL. This article is not meant to attack the socialized aspects of the medical system,  which is something I vigorously applaud. But, its rather a look at the logistical nightmare that is medical care in Italy. 

Here, we have a nationalized medical system which is, in theory, inter-connected not just with all of Italy but all of Europe. But each region runs its own medical program starting with each municipality dividing its residents up amongst a list of general practitioner doctors ("GP") in their respective municipalities. Its relatively easy to get in touch with your GP; and like America's HMO's the GP is your gateway doctor. If you want the medical system to cover your test costs - and I use the term cover very loosely - you have to start with your GP and get a paper prescription for a specialist, test, or prescription. Here's where the nightmare begins. When you go to the next step you hit major roadblocks and confusion. For the sake of time and clarity I will list the major issues:

1) You must carry your own medical records from one appointment to the next. They have NO centralized or electronic medical sharing here. NONE!

2) Depending on the urgency, you could wait months or more to get into a simple test appointment.  In September, they wanted to book my appointment for February 2011! And, I have heard worse stories. 

3) Even if you want to stay in the nationalized system, you still have to pay an admission ticket at the hospital every time you do a test or see a specialist. So, in fact you pay twice. First through a boatload of taxes, then again for your individual care. 

4) You pay even more if you want to avoid the confusion and go "private" which basically means you pay a pubic doctor for his private time. 

Now, I will say that their private payments are nothing compared to what a U.S. uninsured person would pay. And, I love the fact that I can pop into virtually any specialist and pay 80 Euro for a consultation. But, I have had to undergo comprehensive allergy testing and it has taken approximately 3 months so far, and I am not done yet. Its always "go to this hospital, do a consult, go to another hospital take 2 test, but then another location and take a blood test on yet a different day." Its not uncommon to get misinformation at one appointment so you are unprepared for the next. There seems to be little to no dialogue between offices or even between the hospitals administration and the practitioners.

During this process that has become not a bad chapter in my week, but a bad chapter in my year because it takes so long, I have had to play russian roulette every time I eat something during this five month long period. And, don't forget I am lugging my records from one place to the next because they don't transfer them internally. I can only imagine what it it takes for someone who is really sick. I will admit that if you have a grave emergency things go on the fast track, but how many people have tumors growing inside them as they wait for stupid little screening tests to be completed before they realize its something more serious. 

For me it almost always comes back to efficiency; what is the damage to the Italian economy for such inefficiencies? When people have jobs, and need to miss work 11 times over 6 months just for testing, there has got to be a large economic cost to their employer in the way of lost productivity. Then, you consider the lost productivity of someone not feeling well during that entire diagnosis period. Even if they are jobless, they are surely not hunting down a job when they are in this long drawn out holding position. And, the same goes for a lot of things. We end up waiting at the post office for 20 minutes only to get useless information at the front of the line and have to return another day. Or, I am constantly told to come back another day at a store or service point because they are too busy or about to close, etc. What is the deal with never wanting to push through and complete a transaction? 

If you want further information on the economic impact of this (please note how totally ecstatic I am that I actually have time to look up stuff like this solely because I want to!) Italy ranks higher than most in GDP per person working, but still lower than the US. They did, however outrank UK and Germany in this respect, which was a personal shock to me. (See pages 35-36 for some country-by-country statistics on GDP and productivity. (http://www.bls.gov/opub/mlr/1999/07/art3full.pdf). or see Eurostat website, an EU agency that tracks European statistics on a country and regional basis. (http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/themes) 

Someone asked me the other day if the experiences I am having are unique to my region, as in maybe I am living in the Italian equivalent to Mississippi, which by all accounts is not the crown jewel of our United States. When I go on the attack, I must remind myself that I am living in one town, in one of twenty regions in a relatively large country of 60 million people. After doing some of the statistical research on Italy, as referenced above, I have to conclude this inefficiency or lack of desire to complete a transaction must be a regional issue and is not the plight of the entire country. The statistics do not lend themselves to a conclusion that Italians as a whole are not productive. 

And, as I am often reminded by those in my Italian family, Italy is a very young republic which explains the difference in the regions and the lack of logistical co-ordination of so-called national services. Italy, as a constitutional republic has only been around since 1946. Before that it was comprised of several nation-states that were unified between 1815-1870, still much later than the United States unification with the original colonies. 

No matter whether this is a regional problem or a national problem, I am demanding change. Italian, like most Europeans, pay a ton of taxes, approximately 50% of their earnings and 20% sales tax. Supposedly, this is to pay for the medical services, schools, and other essential public services. However, we end up paying point-of-service for medical as well. And, according to those I have talked to its not cheap. Tests run anywhere from 100E to 200E, plus patients pay an admission tickets, drug costs, and for specialist visits. It seems a little bit like double taxation since its all going to the government. Same goes for the toll roads or "autostrada" and other supposedly socialized services. And, the schools, while they may provide a great education, are hosted in decrepit outdated buildings which are not up to par with technology or even a designated parking lot.  I am 100% in support of pooling our tax money to provide services, but I must ask where is this money going in our area? Italy is ranked the 18th most developed country in the world, but it seems a long cry from my home in California. 

I am told that in the north things are a lot faster, cleaner, and modernized. Of course, they also have more stress so there is always a trade-off. But, I must admit that I am at the end of my wits the way things move so slowly here. Why can't I sign the inscription form and pay when my daughter starts her first ballet lesson. Why do shop owners repeatedly offer to call when something comes in, and I have yet to receive one call when that happens. Why is it always pushed off for a later time? And, when it comes to something as important as medical care, there is no room to be lazy or disorganized. We must start demanding better and take nothing less. In the end, only the squeaky wheel gets the grease. 

"I think I'm turning Japanese, I think I'm turning Japanese, I really think so!"

What's the worst possible place to be in the entire world if you are allergic to wheat? We'll let me tell you - ITS ITALY!!!

I'm totally relieved to figure out why I have looked pregnant for the last year ( I always knew I was secretly svelte under my protective layers!) but to be gluten intolerant in the land of waiving wheat is practically a life crisis. I live across the street from a wheat field for Christ's sake!

Not only is it difficult to avoid bread products in the land of pasta, but people for the most part, have no clue what gluten intolerance is. At dinner the other night I told the waiter I had a gluten allergy so I couldn't eat pasta. He suggested a pizza in response. Hello????

When I go for breakfast in the morning I now eat air because the only breakfast option here is a croissant. Of course they have a variety of fillings, but there is no fruit, no yogurt, and certainly no gluten free bagels to speak of in any local cafes.  Truth be told, I have been so desperate to order a chocolate croissant and lick out the filling....breakfast of champions.

Seriously, it turns out that being gluten intolerant is doable, but you have to make some major adjustments. I even brought a rice "pizza" dough to a pizza party the other night so I wouldn't be left out of the festivities. I am accepting the reality that I will be one of those eccentric food-totaling people for the rest of my life.  Gucci cooler anyone...

I have tried a variety of gluten -free pastas and the corn flour pasta is not that bad. But, for the most part, I am getting in touch with my inner-asian since most gluten-free products are rice based. There are some great chocolate rice cookies and rice crackers, too. Mostly, I have turned to more whole foods like legumes, veggies, meat and fruit. So, maybe this is what they call "a blessing in disguise". I want to use this diagnosis as an excuse to eat reduce the empty calories and increase nutrient rich foods. Is anyone out there buying this?

So far its been about 6 weeks of a gluten-free diet and I feel a whole lot better. More energy, less fatigue, no nausea and less, em, "private problems". I wonder how many people feel just generally physically crappy but not bad enough to be bugging the doctor for a reason. I would venture there are a lot of us out there who just don't know that their diet is making them sick. Maybe this article can help you.

But, what does it all mean Basil?

Why has human consciousness evolved enough to search for meaning and purpose in their life, but not enough to figure out that purpose?

Anybody who has ever passed the book store's self-help section knows that the struggle for meaning in this life is a challenge suffered en masse. Its a realization that sometimes hits like a ton of bricks, perhaps after becoming a parent, or after college, or - like in my case - watching someone die prematurely. Others may drift into malaise slowly and steadily once the buzz of youth wears out - probably sometime in their thirties, just as the reality of mortgage payments and the repetitious responsibilities of parenthood come their way. At some point, I am convinced, that most of us find ourselves asking WHY? WHAT IS THIS ALL FOR?

Here's what I know: we are animals, but we have evolved. We made fire, built fences and farms, which has allowed us the freedom to think. I'm starting to think this is where we went wrong. Now we have attained enough consciousness to wonder why but not enough sense to provide an answer to that burning question. Is it better not to wonder at all, and to live without the thought of future and past? I would venture that it is certainly less-overwhelming to live that way, but having no direction may result in feeling empty and helpless. And, at the end of the day I imagine our minds are incapable of achieving the stillness of living wholly in the present.

Are we just here until we die like all other animals and plants on this world? If its so easy for us to accept for all "lower" life on this earth, then why do we think our lives are that much more purpose-driven? Are we over-thinking it? Maybe it's a bit depressing to believe we are just another body taking up oxygen, but it could also be liberating. Taking on this believe means embracing the idea of seizing the day since today may be all we have. In that case, maybe the answer to fulfillment is simple: more volunteer work, compassion for those less fortunate? It is called the Golden Rule for a reason, right?

If humans went back to struggling with daily tasks of survival, we would ask less questions and concentrate on the basics: food, water, shelter. Such may also be the case if we lived in a time of death (war, famine, or disease) and we accepted that this moment is all we have. So, it seems that in order to attain "zen" and live in the present, which is a more advanced mind-set, we must regress to a less-developed state where we are only concentrating on our survival. I know true nirvana takes that stillness of mind within our surroundings, but is that a realistic expectation in today's world? And, Buddhist monks don't count since they are sheltered from the real world and rely on others to work hard to support their spiritual journey.

Here's where I am: I want purpose and a direction, but do not look to religion for it. I am still open to finding a greater-meaning, but am not hopeful. I will not trick my mind into believing something that is not there solely to be consoled. I, instead, try to live moment by moment, acknowledging that most moments are filled with the mundane. But, there are these all-consuming moments of joy that overtake me every now and again which make my life worth living. They fill my heart up so full that it is replenished. The most spectacular thing is that almost all of these moments consist of such basic events, that I wonder if simple living is the best way to have more of them. Swimming alone in the calm Adriatic with my daughter as the sun sets and a warm breeze catches my face. Listening to a great song while jumping on my bed. Having a laugh with an old friend until our faces turn red. These are the tiny fleeting moments that keep me going. They are so simple, but are they my purpose? Maybe abandoning the search for purpose is the way to have more joyous moments?

Clearly I am full of more questions than answers. But, without pondering these issues, aren't we doomed to just slog through life, never knowing? Every person must come to their own conclusion and form a life that suits their desires and goals. Unfortunately, for me I expect it will take a lifetime, or more to figure out.

How Olive Oil Is Made

Last night, on our way to dinner we stopped by at an olive oil manufacturer and asked for a tour and a fresh bottle. The owner happily agreed, which is the reaction most italians have when they get a chance to showcase their culture and traditions. Although it was 8:30 p.m.. it's machines, tractors and employees were all buzzing around. In all, the whole operation only took about 12 employees in a room no larger than 900 sq. feet. but they had a steady stream of oil coming out of the spigot. I learned a lot about the liquid gold of Italy while I was there and thought I'd share for all you other fans out there. (We go through practically a bottle a week in our house. Yikes!)

Olives are harvested only about two weeks out of the year so these factories run for 24 hours a day during that time. Around here most landowners have at least 10-20 olive trees on their land so you will see the entire extended family outside harvesting the olives by hand since such the size of their harvest doesn't justify hiring help. I think they mostly use the olive oil for personal use I am told that many true italians never "buy" oil from a store because someone in their inner circle grows and presses their own olives.

Once the olives are harvested - some green, some black depending on where they are on the tree and how much sun they got - they are de-stemmed. The olives, pit and all, are then poured into an ancient looking vat which has 3 giant stone grinders that roll over the olives turning them into a paste which looks similar to tapenade.

Then, this paste gets spread out about an inch thick on a thatch-wooden disk. This process is repeated, one disk on top of another, at the rate of about 10 disks a minute. After there are about 75 disks stacked up, they are moved between two metal disks that are pressurized. Functioning much like an elevator on hydraulics the bottom piece raises out of the ground and squeezes the stack. A watery brown liquid squirts out the sides and drains to a basin on the bottom. Maybe not the best analogy, but it looks like the juices coming out of gyro meat when it is being cut. This squeezing process only takes an hour and a half.

In the olden days (or modern day personal producers) the liquid would then sit for a day to allow the oil to rise to the top and the water (which is the brown part) settle on the bottom. The oil would simply be scooped up and bottled. Now the commercial producers use a really small machine that spins and separates the oil from the water. It then has a faucet that pours out a greenish yellow olive oil. This is the cold pressed, first pressed olive oil. The best of the best.

We bought a litre from the factory for 7Euro and the owner bottled ours right from the spigot. It was almost opaque once bottled; and the color of water after cooking an artichoke, which is to say a little more dingy than algae but indisputably green, not yellow. I am told the color will mellow as the months go on, but surely our bottle will never live to see that day.

So, how does it taste? Well, we cracked open the bottle at the restaurant to give it a try. It was excellent. It was fruity and pungent and creamy. No wonder italians don't bother with salad dressings. Sometimes less really is more.