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.

Madrid Rocks!

Once upon a time in a galaxy far far away called my youth, I lived in this amazing city called Madrid, Espana. It has been so long since I have visited that I feared my good memories were actually fantasies. But, alas, they are not and the city looks and feels even better than I remembered it. Madrid is officially my favorite city in the whole world, although New York is a close second.

Why does Madrid rock, you ask. Well, first of all, the people here are friendly and fun! The weather is almost always sunny, although they do have winter here. The architecture is stunning, the food is good, the nightlife is so amazing it even spills over to the mornings and evenings. Traffic and the city are easy to navigate and my favorite thing of all is that it is a city has room for families.

Someone asked me today why it wasn't enough to visit the city periodically. The best part about this city is not the tourist destinations or shopping, but the pulse and rhythm of the people, which is not something you can tap into unless you are a member. It is their attitude, culture, and lifestyle that is such a draw here. I am a city girl at heart although I love the outdoors too. But, I never even dream about city life with a young child.....enter Madrid and I begin to re-evaluate my whole city-banning proclamation. Now all I need to do is find a job, $2 million euros to buy an apartment and remember how to speak Castilliano. Details, details.

NATURES BOUNTY - living off of the land

I am so impressed by the way that people here really take to heart the theory of "locally grown" or what they call "nostrano" which simply means "ours". Stores always label plants and animals as nostrano when they come from the immediate region so people can elect to 1) support their local economy, 2) be healthier, or 3) save money. But, it definitely goes further than that. People here sort of practice what I'll coin as "free gardening", which means plant anything that will grow, wherever. Then, anybody is free to take what they need when it is in season.

In the garden in front of the building where I was staying the first couple of months in Roseto there are several plants that can be eaten or used for cooking. There are two blackberry trees (I was pretty sure these grew on bushes but I guess this kind grows on trees). If you want to make jam for a crostata or to add to your breakfast, you just shake the tree and pick up the ripe berries that fall off. Additionally, the entire garden is spotted with tiny little chamomile flowers. They can be picked and dried to make tea.

We also have rosemary, laurel (bay leaf) and lemons growing right outside our door. But, there is also the sea where many people go when they want a free meal. On any given low tide morning people walk in ankle deep water grabbing little clams out of the sand. There are also black muscles which are the best I ever tasted. A little bit harder to find are tiny tasty crabs that can get added to pasta and if you are willing to go out on a little fishing boat there is a whole lot more. If you feel like going in the hills you can forage for wild asparagus or a green vegetable they call cicoria, which grows abundantly and I imagine has a ton of iron. Each of these plants has a fairly small window of time where it grows naturally so there are many people who go out hunting when the time is right. For older people in particular it is a popular past time. I think it is awesome that on any given day you can make almost an entire meal of of foods that were foraged within 5 minutes of your own house. In 2010 that is a rare accomplishment, at least in the land of to-go cups and bags, where I come from.

So the next time you polish off an apple or orange, try throwing it into the dirt and see what comes about. You may be pleasantly surprised at how easy it is to "free garden".

Buon Apetito!

EXPOSED!

Who needs coffee in the morning when the view does plenty to jump start your heart. Now that summer is in full force, the shoreline has two lanes of people walking up and down the coast every morning, some at a crawl and others at a hustle. The view is so consuming one rarely abandons people watching to glance at the breathtaking, glass-like Adriatic.

People probably think I am out of my mind crazy since I cannot help but to break out into full-blown laughter at the sight of some very original characters. Today, my favorite was a man who had hit the middle-aged benchmark a couple years back. He was jogging steadily down the coast, wearing those puffy black socks that I thought they discontinued selling to teenage girls in 1988, solid black tennis shoes, a sleeveless white tee (is there an American Apparel store here?), and to bottom it all out, black speedos that seemed a little loose on the bottom. I had to wonder what the hell was this man thinking when he geared up in the morning. Doesn't he have a wife that plays interference before he leaves the house like that? And, who the hell jogs in speedos unless you are running in a triathlon.

There were several runners up in today's contest of whose exposure was least appropriate, but the circus's Mr. Stromboli won by a slim margin. This man was all out buff, the kind of man who has huge square shoulders and pecks and has an upside-down triangle shape with a little tightly packed backside. He was blanketed in curly black hair, and was sporting one finger speedos on his ultra-tanned body, or maybe the hair just made him seem really dark? The kicker was that he was out on the beach chasing after two pink-clad girly toddlers. It just didn't seem to fit the bill. When I thought of the reaction my friends would have if they were on this walk with me, I couldn't help but smile a big smile.

Of course for every nightmare I pass, I see several beauties on their morning strolls, usually opting for bathing suits rather than work out clothes. In case you didn't know, Italians are obsessed with getting tan, and they will strip their clothes at the slightest sun bathing opportunity.

It makes me proud that I live in a place where people of all walks of life, rich, poor, ugly, fat, families, searching singles, all alike can hit the beach and feel at ease strutting their stuff down the coast without reprisal.....well, maybe just a little from a foreign american girl who chuckles under her breath every once in a while when things that should be left to mystery are exposed for the early morning crowd to take in. I still say bikinis are reserved for people under 60 and speedos should be left for triathletes and strippers, but I guess that's why I am the foreigner here.

ADAPTATION?

Its been little over three months since my permanent move to Abruzzo, Italy and I am surprised at how quickly I have adapted my habits and expectations to my new environment. During previous long-term stays in Europe my acceptance of "off-habits" did not come so easily, probably due to some subconscious awareness that I could soon desert those cultural norms in favor of my home culture.

When I first arrived, I was thoroughly irked that I had to drink my coffee in less than 2 minutes, all the while standing at the bar elbow-to-elbow with all kinds of strangers. And, don't even get me started about the driving here! I thought I was going die the first couple of weeks I spent in a car here (most likely by attack since I wanted to scream at people who seemed to have a death wish by driving on the wrong side of the road).

I'll admit there was some serious resistance to the reintroduction of simple carbs back into my diet and to say I didn't look down my nose at those who drowned their food in olive oil, would be a flat out lie. But, now I eat pasta AT LEAST once a day, and most of the time its floating in olive oil. I like it and have stopped my criticism since my cholesterol and pant size seems to be in-check. I have also begun to reciprocate the once annoying 3x repetition of "ciao, ciao, ciao" and the well-wishing of every miniscule activity "good sunday" "good lunch" "good work"??? At least they are polite..

This new level of comfort dawned on me yesterday when I darted into a bar in between a doctor's appointment and a run to the store. I parked my chest at the bar and ordered a "caffe normale". **Yes, I still need to add the normale because when they hear my american accent they assume I want a caffe americano if I just say caffe***I sipped it down in about 30 seconds, paid and was on my way. Not once during this entire transaction did I silently curse the lack of to-go cups or a proper spot to sit. I was actually glad that I could fit in a caffeine fix. This is progress!

Then, today my suspicion that I was slowly adapting and assimilating was officially confirmed. Parking is hard to come by in this city once the summer starts. I darted against oncoming traffic when I saw a spot on the other side of the street. Just to make a u-turn is a logistical nightmare here and I was stoked to find a spot at all so I didn't even hesitate to play chicken with the approaching Mercedes E Class (which definitely outweighs my car by a long shot). I parked facing the wrong way, quite illegally I might add, and was able to run in to get my errand accomplished. Who cares about the brush with death compared to spending 20 more minutes circling decrepit one-way streets which were designed for hot-wheels sized cars.

Of course there are a few adaptations I have yet to make and maybe I will never make. I am still a firm believer in bagels and keeping a variety of ethnic foods at your finger-tips. I still think that closing your store all morning on Monday for your "weekly rest" after you just were closed all day on Sunday is absolutely stupid and downright lazy and I really would love to see people stop throwing their cigarette butts on the ground right next to an ash tray.

Who knows, maybe in a couple more months I'll be drinking Grappa and eating Mazzarella. (Yuck!)

New Slang