26 – next bureaucratic challenge – the italian health system

My mother awoke one morning suffering from severe backache and a very painful leg.  The following day she was finding it almost impossible to walk.  We decided that we needed to seek urgent medical help and telephoned Salvatore who advised us to go to the “Pronto Soccorso” department of a nearby hospital.  This was to be our first encounter with the Italian Medical System – We had no idea what would lay in store.

Arriving at the hospital Mamma was immediately assessed by the triage nurses, and only had a few moments wait before being examined by a doctor.  She was then taken off to have numerous X-rays, they seemed to be very thorough in their work.  It was decided that she needed to go to another nearby hospital to see a Orthopaedic Specialist.  Expecting to be given an appointment for a couple of months time, we were amazed that she was told to go straight there, as the Specialist was currently available.

On arriving at the second hospital we were swiftly directed to the appropriate department, and after a wait of only 15 minutes we were ushered inside the Specialist’s consulting room.  He at first seemed rather brusque, however realising that we were English he began to loosen up, chatting in rather a jocular fashion.  The X-ray had shown that all the cartilage in one knee had been worn away over the years.  Tina had been born with a congenital hip deformation (which strangely was quite common in some Italian babies, in fact one of Tina’s sisters had suffered from the same disability).  Mamma had always told the story that she had weighed 14 pounds at birth, which may have been a contributing factor !!!  At any rate, the dislocation had been left uncorrected, thus she had one leg shorter than the other, and had always walked with a significant limp. Thus her “good leg” had taken the strain over many years.  The Specialist told her that she had severe arthritis in many joints, and that basically she required a knee replacement, however she was a poor candidate for surgery, having had one lung removed.  During the Second World War, whilst living in London during the Blitz, Tina and several members of her family had contracted Tuberculosis. For several years she had been sent away to a Sanatorium, before eventually undergoing surgery to remove a lung.  The Specialist apologised that there was, in fact, little he could do to help her.  However just understanding what was causing the problem seemed to significantly reassure Mamma.

Thus, we were considerably impressed with the service we had received, so far, through the Italian National Health System, and as Mamma was a pensioner and we were European citizens, we were not required to pay for the consultations.  For the next few days Tina  rested in bed, and gradually the pain and inflammation receded, however we resolved to get ourselves registered with a local General Practitioner as soon as possible.

When we first arrived in Italy, as EU citizens, we found that we were covered for health treatment by the normal E111 Travellers Health Form, which allowed us to take advantage of reciprocal health agreements.  We were then told that as we were to be permanent residents in Italy, we needed to register with the “SSN”, the Italian National Health System – this was to be our next bureaucratic challenge.

We were so fortunate to have found a dear friend, by the name of Angelina, who works in a local town hall.  We mentioned to her that there was a delay in getting the “Certificati di Residenza” for my elderly mother, father and that we were rather concerned as it was very important to get them registered with a local doctor as soon as possible.  She told us “non vi preocupare”,  and that she would see what she could do to assist us.  It seems she had a relative who worked in the appropriate office and amazingly enough managed to pull a few strings to get my parents’ Certificati processed swiftly.

Angelina then asked if we came down to town very often, as she said she had not seen us out and about.  She invited us to meet up with her one evening in the main square. Normally, by this time of night we were winding down for the evening, but we made the effort to stir ourselves into action on this occasion.  She soon appeared at the designated meeting place accompanied by her husband Luigi, who greeted us warmly.  Angelina said that she had arranged for us to go to the local “USL” (L’Unita Sanitaria Locale) (pronounced “oozz-la”) which was a clinic where we could meet a senior doctor who could help organise our registration.  The couple then invited us to “passeggiata” with them.  We now realised why she said she had not seen us around, as up until this point we had not often partaken in this somewhat peculiar Italian evening ritual.  Together we sauntered around the streets and eventually stopped for refreshments at their favourite bar.  Here we were introduced to Angelina’s mother and some of their friends.  They were all thoroughly intrigued to know just how and why we had come to live in Itri, and were full of questions.  We chatted for some time and took pleasure in their genial company.

The following morning we duly presented ourselves at the local “USL” clinic. The waiting area was incredibly chaotic.  Eventually, after a prolonged wait, we were able to talk to a medic, who was very helpful and obliging.  He advised us to continue using our European E111 health forms, which were valid up until the end of the year and he provided us with a list of local general practitioners. However, when we proceeded to contact one of these doctors, he told us to do the complete opposite – to register immediately with the Italian National Health System.

Consequently, our next destination was to be the nearest ASL (Azienda Sanitaria Locale) or Regional Health Authority office in a larger nearby town. We made enquiries at the reception kiosk, but were told that the department we required was not open on certain days, and we were advised to come back on Wednesday morning.  Yet another wasted journey – this happens so often in Italy and can be quite exasperating.

So, on the following Wednesday morning we accordingly trudged yet again to the ASL” office, clutching our bulging file of paperwork. The receptionist directed us to the “Department for New Applications” which was on the ground floor.  Here we were greeted by a plump, heavily bespectacled lady in her late 50’s who informed us that the department was very soon to shut for lunch.  But …….. it was only 11.30 am?   She proceeded to draw down the counter’s blinds to signify the department’s imminent closure.  However, she seemed to take pity on us, so we were directed to go round to the back of the office to continue our discussion.

However, when she realised that we were in fact “stranieri”, and that the form filling might be slightly complex, AND that there were 5 people to be registered she began to melodramatically remonstrate, feigning to wipe the sweat from her brow.    Meanwhile another unfortunate customer further irritated her by daring to lift up the office’s shutters in the hope of speaking to a member of staff, but was only to be brusquely dismissed with a flea in their ear.

Now where was she? ….. ah… Sí. “5 application forms !!! All in one morning !!! But this was all too much!!!”  She didn’t know if the department could cope with such intense pressure !!!  There was a solitary, archaic computer in the whole department, and the signora  apprehensively began the task of entering our details, one by one, onto a simple form on the system.  It soon became apparent that her IT skills were sadly lacking, as we observed her stumbling her way through this relatively simple process. She moodily huffed and puffed, wringing her hands and grumbling to her colleagues about how much she had to do, and how difficult and taxing it all was –  Oh woe is me !!!  As she struggled onwards she was further harassed by more people rattling the blind for assistance. How could she possibly cope !!!  

Finally, over an hour later, the printer finally spat out the documents.   The “signora” proceeded shuffling the sheets of paper in an exaggerated fashion, in an attempt to look especially efficient and professional, before summoning one of her colleagues from an adjoining room to take some photocopies.  Ten minutes later the original printouts and their copies arrived back.  There were three more female clerks in the office, and we soon learned that one’s speciality was rubber stamping, the other’s was tearing off strips of paper from the bottom of the forms, stapling them together in the correct order and the third folded the documents and put them in envelopes.  Well, if this was the normal way of going about things, no wonder the Italian wheels of bureaucracy grind so incredibly slowly !!!

In any case, it had taken a deal of time and patience, but each of us now were suitably registered with the Italian Health System, and had been allocated a “Tessera Sanitaria”.  Impatiently the clerks handed us some more forms to decipher, before bundling us out of the office and loudly slamming the door behind us.

We were fast learning, through bitter experience, that nothing in Italy can be simple and easy. Public offices don’t seem to always open according to the written timetable, being open just for odd hours and unexpectedly closed without any apparent reason. To get anything official done is an epic struggle taking up at least 3 or 4 visits !!!  One needs “Pazienza … Molta Pazienza !!!”

At the “USL” office in back in Itri, we attempted to obtain further information regarding assistance for pensioners with medical expenses. Here the accommodating administrative assistant helped us complete and sign the necessary forms.  For most people there is a system of co-payment for drugs, specialists’ consultations,  treatments and analytic laboratory tests.

We were then asked to choose who we would like to be our family doctor, or “Medico Generico”.  Angelina had already given us her recommendation: Dottore Rossi.  Presently, when we all presented ourselves at his studio or “ambulatorio”. At first he seemed to be very sombre and reserved, however in hindsight I think he was just rather shy and a little in awe of us.   The previous day I had spent several hours writing down details of all our medical histories, ailments, and various medications, and had then translated them all into Italian.  The doctor studiously read through this information.  He took both of my parents’ blood pressure, and then took out a small book which seemed to contain information regarding various medications, and he looked up individual drug names to find the Italian equivalents.  This took some considerable time and a great deal of concentration, and throughout he didn’t utter a single word.  We sat anxiously, twiddling our thumbs and shuffling our feet, wondering how long this silence would prevail.  He then began writing out numerous “ricette”, red printed prescription forms to be taken to the “farmacia”. By this time we had been in his surgery for over an hour, and we didn’t have the courage to ask him to sort out prescriptions for Paul and for myself in addition.  As you may well imagine, the other patients who had been waiting to see the doctor were somewhat irked by us “stranieri” taking up so much of the doctor’s precious time.

An example of a Ricetta – ● public domain image

Since then we have come to know Dottore Rossi well.  He is a kind, gentle, caring man.  He drives a shiny red Mercedes, and wears designer sunglasses to co-ordinate with his colourful stylish knitwear.  He has a shocking racking cough as he is a heavy smoker  –  Perhaps not exactly the best advertisement for healthy living !!!

When we needed to see him at his surgery, we soon learned that there was absolutely no point in rushing, as the 10 o’clock  morning surgery inevitably starts a good deal later.  First he must complete all his house calls. Italian GP’s seem to generally operate individually, not in the group practices that we are familiar with in the UK.  It is said that Italy has the highest number of doctors per capita than any country in the world, yet the system at first sight seems somewhat haphazard.  There is no appointment system at all, it seems there is no point as there is little likelihood of being seen on time anyway.  Patients are just seen on a “first come, first served basis”, which consequently involves a lot of waiting around with patients sniffing, coughing and spluttering and generally complaining about their afflictions and the doctor’s inevitable tardiness.

As more patients arrive, each acknowledges the others in the waiting room politely with a loud, “Buongiorno”. There is an extremely important phrase to master for these circumstances which is: “Chi è l ’último”? or “Who was the last one to arrive ?

Finalmente il Dottore will make an appearance, to everyone’s great relief, as by now we are all shivering and our noses and toes have will have become quite numb in the icy waiting room.

It seemed that just recently Doctor Rossi had been presented with a new computerised system, which he struggles to master, as previously he had always written everything out by hand.  Alas, the computer seems to be more of a hindrance than an aid.

On certain days “il Dottore” has a receptionist, or perhaps she should be more aptly known as the “prescriptionist” because Elisabetta is armed with a pad of pre-signed prescriptions, so if you take along an empty box of the medication you require she is happy to oblige by writing out a “ricetta” for you. We soon learned that Dottore Rossi was only too happy to carry out home visits for elderly patients, such as my ailing parents and was happy to hand out his mobile phone number.

* cc flickr photo by alex e. proimois


Chapter 26  –  let work commence


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