London – Dr. Chiara Lepora never imagined being stationed in her home country Italy. As a physician for the international relief agency Doctors Without Borders, she was accustomed to caring for people in countries such as Yemen and South Sudan amidst extreme poverty and war.
But earlier this year, as the novel Coronavirus spread from Asia to Europe, Drs. Lepora pressed himself into service in the northern Italian region of Lombardy, one of the wealthiest places on Earth.
Anchored by Milan, Italy’s financial and fashion capital, Lombardy has sophisticated industry and world-class medical facilities. Still it was Overwhelmed by the first wave of global epidemic, Forcing doctors to go to ration ventilators and hospital beds while deciding who was alive and who died.
A portion of the devastation in Italy’s most prosperous region was a result of handing over the majority of the public health care system to private, profit-making companies. Over the last quarter, substantial investment has flowed into attractive features such as cardiac surgery and oncology. Frontline areas of epidemics such as family medicine and public health have been neglected, making people highly dependent on hospitals for care.
“If you consider the benefit to be the endgame of health care rather than health, some people will be left out,” Dr. Lepora said. “Pandemic exposes all those vulnerabilities.”
Unlike the United States, where there is more 30 million people lack health insurance, Europe remains a land of universally accessible, government-equipped medical care – including Italy. Nevertheless, in the most difficult region Lombardy, the epidemic has revealed the loss of a poorly executed push to open the system to private providers.
“Experts such as hygiene and prevention, primary health care, outpatient clinics, infectious diseases and epidemiology have not been considered sexy enough, not strategic assets,” said Michael Michel Usseli, a neonatologist in Milan. Center-left Più Europa Party.
“So we have a health system very well prepared to treat most complex diseases, but not fully prepared to fight something like an epidemic,” Dr. Yusuleli said.
The same can be said of many wealthy countries, including the United States and Britain, where state-of-the-art medical care has provided no immunity against the epidemic. Only a handful of places – among them Taiwan, South Korea And New zealand – Stand out for their effective reactions to the epidemic.
But Lombardy claims the distinction as one of the worst places on Earth. According to Italy, there are more than 760 deaths per million people World Health Organization, More than the United States and almost as much as Britain. Half of Italy’s nearly 17,000 deaths have been infected. Lombardy.
The roots of Lombardi’s reshuffle go back to 1995, when Roberto Formigoni, a fiery politician by name, became regional governor. He enacted legislation allowing private providers to serve patients while collecting payments from taxpayer-funded regional health care systems.
Many adopted change as an innovation that brought competition, forcing public hospitals and clinics to improve. But privatization was done with corruption.
Mr. Formigoni will remain in prison for more than five years for a scheme in which he accepted yachts, holidays at Caribbean resorts, and miscellaneous gifts from private medical providers in exchange for private medical providers running the area’s business.
Experts say the scandal was nothing short of an indicator of the forces holding privatization, a reality that continued even after Mr Formoni left office in 2013.
Many argue that the problems in the regional health care system are an indictment not of privatization but of the failure of local government leaders to ensure that private companies have provided essential services.
“The problem lies in the administration of hospitals and clinics,” said Francesco Paolucci, professor of health economics and policy at the University of Bologna.
Regional authorities may have conditioned their willingness to seek treatment at state-of-the-art cancer centers on promises that private providers would provide less attractive services such as geriatric care. But that altercation was the profit that was to be made.
Dr. “They allowed the private sector to open up more or less,” Usuleli said. “This was a full opportunity to make private companies accountable to their social responsibility.”
The focus on profitable specialties created an incentive for doctors to find jobs in those fields while abandoning general medicine.
In 2016, Lombardi – home to more than 10 million people – saw only 90 medical school graduates pursuing specialized studies towards becoming general practitioners. He received an annual scholarship of 11,000 euros (about $ 13,000), preparing less than half of the people for specialties like cardiology. The number has increased in recent years, but not enough to retire general practitioners, medical associations say.
With the best medical minds focused on advanced therapies, Lombardi’s ability to provide basic medical care and protect public health gradually deteriorated. During the last decade, total health care spending in Lombardy increased by 11 percent, while support for primary care was cut by 3 percent, Drs. According to the official data analyzed by Usselli.
Lombardi has combined its problems with a 2015 law that centralized services for chronic illnesses, such as hypertension, in hospitals reduce the role of general practitioners in helping to keep their patients healthy.
“It was about rationalizing costs and avoiding waste,” said Marco Cambelli, a gastroenterologist who heads a consortium of doctors and dentists in the city of Varese. “But this worsened the relationship between patients and their general practitioners.”
In the neighboring region of Veneto, a health care system focused on so-called community care – in which family doctors and nurses visited the home with an eye toward prevention – fared better. There, primary care physicians and an effective contact tracing effort prevented people from reaching hospitals.
“Family doctors are a cost,” said Philippo Anelli, president of the National Federation of Doctors and Dentists. “If the mindset is that you need to make money from health care, then investment in community medicine clearly looks less remunerative.”
When the first wave hit, Milan – a city of more than 1.3 million – that had only five doctors specialize in public health and hygiene, said Roberto Carlo Rossi, president of the Guild of Physicians and Dentists of Milan. He was responsible for establishing a test and contact tracing rule.
The area has since hired more. As recently as last month, Lombardi’s health department informed doctors that the agency “may no longer conduct an epidemiological investigation.” This notice was untimely because it was disturbing: Rose Kovid dies of Italy Has increased nearly threefold in the last two weeks Lombardi leading again Trend.
Dr. Lepora, a Doctor Without Borders Physician, was en route to her base in Dubai in February, returning from a trip to the United States when she stayed with her family to move to the northern Italian region of Piedmont. The epidemic closed the airports, leaving him frustrated.
Two dozen other Italians working with doctors without borders were equally trapped. He set up a support unit at a public hospital in the city of Lodi.
The doctors were experienced in the disaster areas, and were surprised to see that Italy had become one. His Italian colleagues were moving into intensive care units filled with Kovid patients without adequate protective gear.
Dr. Lepora attempted to establish a ration system by limiting the number of people entering the hospital. But she said the plan collided with the operations of private companies that provide food and cleaning services. He refused to limit his visits, worried that he might be accused of breaking his contracts.
By the time she returned to the Middle East in June, Drs. Lepora had diagnosed a worrisome problem. “The service was placed at the center of attention rather than the patient,” she said.
Erica Conforti, 35, opened her practice as a family doctor in Milan in February. He took a practice from a retired doctor, worked in a private office in an apartment building.
Under the rules governing Lombardi’s health care system, general practitioners were thought to be responsible for more than 1,500 patients, but Drs. Conforti initially inherited 1,800, including 500 elders.
She was drawn to general practice with a desire to help people suffering from everyday illnesses. “I love speaking with patients,” she said.
As the epidemic spread, he found himself working 12 hours a day, and still failed to maintain a barrage of calls and emails. She struggled to visit patients suffering from coronovirus. The regional system lacked protective gear such as masks and gloves, so it bought itself.
As the second wave gathers, Dr. Conforti said that the same sufferings are at work. The area includes hospital beds, but there is a shortage of nurses and anesthesiologists.
“If there are not enough people who know how to work in a hospital setting, then increasing the number of beds is pointless,” she said.
At their own practice, 30 of their patients recently tested positive for Kovid-19, while more than 50 were quarantined, awaiting results that took five and six days to test.
“I want to be able to contact positive Covid patients at least once a day, but I don’t have the time,” Dr. Confort said. “I worry that every little distraction of mine has serious consequences. I am scared because I am working. “
Gaia Pianigiani contributed reporting from Italy.