Tuesday, March 03, 2009

Medical Care in Italy and Germany Highlights Problems with Universal Healthcare

It's easy to want to try something new and different, especially when we are unsatisfied with what we already have and wish to exchange it for something we don't have. The assumption of course is that what we don't have - can only be better. Case in point: "Universal Healthcare".

As a U.S. citizen who lived overseas for over 30 years in Europe, and as a sickly patient who has been through the Italian and German health care systems, I am very well acquainted with Universal Healthcare and wouldn't wish it on my worst enemy. But perhaps for someone who has never experienced socialized medicine first hand, these brief stories of what happened to me might provide some better insight into what lies in our future, in order to be prepared for social medicine.

In 1982, I worked the summer in a German Castle with a restaurant, hotel, antique furniture store and general tourist site in Bonn, Germany. One day while a co-worker and I were working in the antique furniture store just upstairs - we found a hollow spot on the wall. We picked at it and it turned out to be a hidden weapons room from medieval times that was walled in. It was common practice to hide weapons and supplies when about to become overrun by the enemy.

To express his gratitude, the owner of the castle told us we could each sort through the ancient weapons and pick one for keeps. I picked a sword and my co-worker picked a spiked ball chained to a stick. I wrapped my sword in multiple layers of plastic bags and went home.

While crossing at an intersection, I casually bumped into a street pole with my wrapped sword causing the tip of it to twirl and stab me in the leg. A few days later I became very ill with a serious fever but couldn't see a physician because I didn't have health insurance as a seasonal worker. I was 17 years old and still covered under my father who lived in Milan, Italy. Because I was getting worse by the day, I resigned, boarded a train to Milan (a 12-hour trip), met up with my father and checked into Milan's Niguarda Hospital.

I was to spend the 4 months fighting for my life afflicted by what was later to be determined as Sepsis from Staphylococcus. Although I survived and paid absolutely nothing upon discharge, the old adage "you get what you pay for" really came into play. At the time, Italy's socialized medical system was administered by a government agency called Unita' Socio-Sanitaria Locale, or USSL for short (in English, the local social-sanitary unit). I found both the hospital and the universal healthcare system (socialized medicine) to be much worse condition than I was.

For starters, we had a "Turkish Bathroom" on the wing floor - not to be confused with a "Turkish Bath". A Turkish bathroom is basically a bathroom without a toilet. Instead of a toiled, there are two ceramic footprints with a hole in the middle. The proper way to "use" this type of facility is to completely remove your pants and underwear, place your feet on the designated footprints and "release" your feces. In practice, it never works that way because of several "hygienically" challenged complications.

There is no place to hang your pants and underwear, so you have to lay them on the floor. Experts ball it all up and hold them under their armpits. Then, there is the splash-back caused by the tall drop of feces into the hole, causing a nasty mess on the exposed legs.

To make matters worse, these facilities weren't sanitized, but simply kept clean with a worn out broom leaning in a corner. This is what the facility looked like early in the morning right after the cleaning lady left and nearly every patient who could walk would storm in.

As the hours of the day passed, no one would dare to go back again because of the horrors that would escalate the situation. Many sick patients didn't have what it took to aim correctly. Many would miss the target (the hole), thereby causing the feces to splatter all around including on the positional footprints. No cleaning lady would dare to come back during the day to clean up such messes simply because they felt they weren't paid enough to deal with such monstrosities. Despite all this, no one would loose their appetites because skipping meals kept us constantly hungry.

For breakfast we were served "caffelatte" (coffee with milk), or at least in theory. Far from Starbucks, the caffelatte was 100% white and tasted like milk only. The word on the ward was that the nurses who were in charge of preparing breakfast stole the coffee. The milk was hot, in a large pot on a cart and served from room to room. I was scooped out with a ladle and poured into a bowl, for each patient.

Occasionally, the attendant would run out of caffelatte (they kept on calling it that to perhaps create at least a mental image that there was actually coffee in it), so the last patients would have to do without in exchange for a promise that the attendant would start from the other end of the ward the following day. So we drank hot milk every morning and ate. absolutely nothing. No donuts, no croissants and of course no cornflakes.

Lunch and dinner were almost just as bad, but at least we had choices. For lunch and dinner the kitchen prepared two large pots for the attendant to distribute. One with pasta and the other with rice. The attendant would go from room to room and ask each patient whether they wanted pasta or rice. Sometimes, to make it seem as if we had more options, the follow-up sentence contained the same two choices in reverse order. The pasta was nearly white because - again, someone on staff was taking home all the cans of tomato sauce. The rice was bland, and there was never even a trace of any condiments. This was it.

For 4 months, I ate pasta or rice for lunch and pasta or rice for dinner, 7 days a week. Eventually, I was put in a room dubbed "the room for the dying" (the moribondi) by the patients on the wing because the only way out was on a stretcher headed to the morgue.

Once, a nearby patient who insisted he was supposed to be on another floor due to his heart condition felt really bad and asked me to buzz the nurse (many buzzers didn't work). No one came, so I continued to buzz the nurse approximately every 10 minutes, for roughly the next 3 hours. I tried to cheer the guy a little by cracking some jokes but he seemed to ignore my little humor. When the male nurse finally came (the same one who painted my feet black when I was asleep a few weeks earlier), he seemed very upset and screamed at me "what the hell do you want". I told him I was buzzing for the gentleman to my left who didn't have a working buzzer and felt really bad. So the nurse stormed over to my neighbor and asked him literally "what's your f***ing problem pal", several times. Not having received an answer, he took the guy pulse and simply said "oh". I asked what was going on and I was told not to worry about it because it wasn't my problem.

I tried to make some small talk later and asked my neighbor how he was doing. Still he ignored me. I had a gut feeling something was wrong at this point, but thought perhaps that he was sound asleep, so I discontinued talking. About an hour later, an intern came in with the male nurse and an EKG machine and made a recording of the man's heart that seemed to have slept through the procedure. They whispered a few things to each other and left the room. About another hour after that and right before dinner - two orderlies came in with a stinky, rusty metal casket on wheels.

Now I knew the score; I had just spent the afternoon trying to strike up a conversation with a dead guy. I was 17, scared out of my wits and thoroughly horrified. The orderlies were engaged in a conversation about their wives, paused briefly, casually pick up the body and dropped it in the casket and then resumed the conversation about their wives. I was stunned. I knew from that moment on I wasn't going to go before my time in that filthy, raunchy, disease infested hospital. There was a time and place for everything but this place just wasn't meant for me.

The medical staff still had no idea what I had because all of my blood tests were inconclusive. To be safe, they shot me in the arm 3 times a day with 300cc's of antibiotics. This went on for nearly the entire 4 month period that I was there. My screams routinely scared all visitors away evoking the sounds one might hear when approaching a torture chamber. Eventually, my father took a sample of my blood to a private lab he paid out of his own pocket and I was found to have the sepsis from staphylococcus in my blood. The hospital's excuse was that it was such a rare occurrence that the hospital lab did not routinely test blood for blood infections from the past (the sword, the sword!).

The medical staff however told my father to prepare for the worse because at this stage, the sepsis had already infected all of my organs - a sort of point of no return. But in a nutshell, I got better and was later discharged to the amazement of the medical staff and even the resident catholic priest who had performed the last rites on me earlier. This was my experience with socialized medicine, where quality health care is substituted with quantity. Socialized medicine is free to everyone because the cost of it all is seriously brought down by taking away the motivation of going to nursing and medical school by paying medical staff little more than minimum wage.

The only benefits are the overtime pay and the night and week-end differential. It severely cripples the morale just to think that had they been born in the USA, these people would have been earning a good living. In a wing of approximately 30 patients, we always had one nurse on duty with 12 hour shifts, and patients taken care of by mostly interns and nurses while resident doctors, lead surgeons and senior charge nurses smoke cigarettes on the balcony all day together with some of the "gomer" patients who seemed to live in the hospital year-round.

Wake up America! While Italians have been trying to improve and reform health care in Italy all these years, who in their right mind would want to degrade our healthcare system in the United States of America? Of course there was always better health care available in Italy, but only for the wealthy. Italy was and still is full of private hospitals with the best of care, better salaries, sterile facilities and excellent food. But the lower and lower middle classes simply cannot afford them, so they are taught to rely on socialized medicine.

I challenge anyone who thinks that universal healthcare would retain quality to spend one week in an Italian socialized hospital, with feces splattered on floors and walls, no regard for individual special dietary needs such as diabetic meals or low carb meals, one set of bed sheets for an entire hospital stay, broken x-ray machines and no advanced technology such as computers and MRI's.

I'm not talking about a third world country of one of the former Soviet controlled countries in Eastern Europe. I'm talking about Italy - a modern (western) European democracy. A country where income tax is only the tip of the iceberg. A country that taxes everything, including death...


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