Navigating the Italian Health Care System: Part II

21 CommentsTuesday • January 30, 2007 • by michelle

Last week I went for my annual gynecological exam. Yes, TMI, so if you’re weirded out now (or at some later point in this post), well, don’t come a-crying.

I made sure to show up first so as to get out of there before noon. This meant arriving at 7.30 for a 9 a.m. appointment. Why you ask? Well because everyone gets 9 a.m. appointments–first come, first serve with a lot of “who’s last?” questions as the next woman arrives. No receptionist really, although a social worker does sort of act like one, taking the little referral slips from primary doctors and directing traffic from behind a locked door. Really. I’m only partially sure she’s a real person.

Oh, I should explain. You have to get a referral slip from your primary doctor first, then go that morning to the main health clinic office and get it stamped (I told you Italians love stamps), and then go wait your turn in the GYN clinic. FYI, this is what I looked at for most of that time:

And this was my choice of reading material, had I not brought my own book:

I used my alone time to swipe a few interesting articles from the Italian magazines to be discussed in later posts. But by the by, if you think I was a little over-anxious by arriving so early, by 8.10, there were 3 women after me.

So I was called in first (yeah!), and the doctor did the usual exam taking all of 8 minutes. But then she informed me that I’d have to come back for the PAP test when the technician was there. Yes, there was someone else in the room with us as well, but apparently neither of them were capable of scraping and placing cells on a slide.TMI? Sor.

She also told me that she saw something that started with a “u” I think, and that I should go get an ultrasound at the hospital. She told me it was most likely nothing, that it was actually quite normal, but it’s better to get it checked anyway.

And so began my GYN circus.

Now I’m not going to scare you all with suspense–nothing is wrong. We’re just going to run through the process.First the GYN has to write a referral to go to the hospital. Then you can get your pharmacist (or City Hall official?) to set up an appointment via the computer. Well, the local pharmacist couldn’t do this for me because I’m a straniera — not in the sense that I’m not Italian, because I am, but because I was not born in this area, meaning my info isn’t in the computer.

Alrighty then.

So P’s parents were feeling especially hospital-y and offered to guide me through the maze immediately. Which was very nice, because if left to my own devices, I probably would’ve put it off for weeks, dreading further bureaucracy. I have a quota per week, you know. And it’s very low.

We got to the hospital and took our number to be served at the “make appointments” information window or whatever it’s called. We had number 90 and they were serving number 86, so it looked good–except that there were about 20 other people in the room apparently waiting for something.

Yeah well, I don’t know if they were all stranieri, i.e., clueless, or what, but 87 popped up, and literally, in stunning rapid fire succession, so did 88, 89, and (bam!) 90. Apparently those in between 87 and us didn’t react quickly enough, so Happy Button Pusher just kept on pushin. Fine by me.

So HBP turned Behind The Window Guy said they could take me immediately up in the GYN department, and that would be 46 euro please. Ugh. I was hoping for somewhere around 25, but fine. If it wasn’t my gynecological health, I probably would’ve thought “Now there *better* be something wrong!” but we women don’t joke with these things.

See, basic health care is free, but you have to pay for the extras through what they call “tickets,” using this word in English. It’s kind of funny to hear them say it, although all humor is lost when handing over an orange-colored bill. That’s a fifty for those non-Euro-inclined. They say you can get these expenses reimbursed on your taxes, though, so my receipt is in a safe place.

Anyway, we headed up to the GYN section and promptly joined the line of 5 women already waiting–many who had probably been there since their 9 a.m. scheduled appointment so I couldn’t really complain. There was my longest wait of the day, so I thought I’d take a picture in the meantime, which we’ll get back to later:

Here’s a view of the entrance, er, exit to the operating room:

As you can see, we’ve settled on a charming puke green theme with just a touch (too much) of One Flew Over the Cuckoo’s Nest.

Moving on.

I won’t bore you with the fact that even after I was called back for the ultrasound, I had to stand and wait in another hallway for a half hour, shifting back and forth from foot to foot, puppy dog-looking into the eyes of everyone in white that passed only to be greeted with lowered (shameful, I say) heads. I got back there eventually.

And then the fun began.

The doctor was awesome, but first we had some ice to break as I’m sure he thought I was an idiot when he asked why I was there, and I didn’t remember anymore. I *did* know the word that started with a “u” when I left the clinic, I swear, but so many hours had passed. Should’ve written it down.Or, um, maybe the doctor should have?

This doc was forgiving, though, as he inserted the Eye on a Stick, as I call it, and shouted to the nurse the measurements of my uterus and ovaries–and (this is so cool) showed me that there was an egg sac in my left ovary ready to explode. Yeah, you moms have your babies in the womb pics, but do you have a nearly exploding ovary in your files?

I even got to keep the pictures, which I won’t post here on some very sage advice. But, you know, if anyone’s interested. . . .

So everything is fine and in working order, should it be called upon, but as usual, it was an experience. And on the bright side, I really liked the doctor at the hospital even though he was a man. Ladies, I know you hear me on this one.

Now, back to the hospital pics. The reason I thought to take the first one was because of what had been going on in Italian news at the time–Hygiene Scandal Hits Italy’s Biggest Hospital. Perhaps some thought I was joking when I said there was paint peeling off the walls when I got my health card?

Joking aside, this is serious stuff.

Some Italian hospitals, often in the south, have deplorable conditions–and we’re not just talking about paint. Many places aren’t stocked with certain medications because it’s too expensive. Seriously.

From what I’ve read on a certain Expats site, this includes epidurals for pregnant women, which apparently you must reserve in advance, but then may not even receive if someone more worthy (?) comes along. There are also an extraordinary number of C-sections performed in the south, and many are apparently unnecessary but are done in the doctors’ pockets best interests.

Then there are the types of hygiene problems discussed in the above article–dirty floors, problems with waste disposal, little to no protocol for cleaning used instruments. It’s scary stuff folks, and it’s exactly why the public health care system needs more funding and why that funding needs to end up in the right places, or alternatively, simply not in the wrong ones.

Italian citizens already subsidize the care through their tax euro, paying some of the highest taxes in Europe. Unfortunately, the health care system doesn’t reflect this. Aren’t we in an industrialized, 1st world (kinda) nation here? Shouldn’t our health care correspond?

There’s no reason that socialized health care can’t work, but in Italy, there’s a lot of work yet to be done. I know it’s already been addressed in the Italian media, but fellow expats, does our particular interest group need to call Striscia on this one too?

Let’s talk.