Saturday, September 12, 2009

Taking it in the Rear – Part II

In my attempts thus far to provide anecdotal support for the case against government run health care, I have talked about my generally positive experience with the U.S. healthcare system. Of course the other side of the coin is all the negatives of socialized medicine in places like England and Canada where people have to wait months for surgeries, interventions, treatments and even medical tests which we take for granted in the USA. The results, such as significantly lower survival rates for cancer and other serious illnesses, are well documented.

Of course, the amount of time I have spent in England or Canada can be expressed in terms of hours, so I have not had the pleasure of personal exposure to their public health systems. Italy is another matter, though I am reticent to criticize the beloved homeland of my fathers. Indeed, there are some good things I can say about Italian health care. They have some excellent medical schools. They have also conducted some decent research which has resulted in medical innovations. I remember last year translating some Italian articles for a friend of a friend who was almost fatally injured in a roadway accident in Salerno, Italy. The article discussed the excellent care he received from Italian orthopedic surgeon Antonino Valente, and the innovative techniques used to bring about an incredibly speedy recovery, which was acknowledged in congratulatory letters from the U.S. Consul and from U.S. doctors who provided follow-up treatment. And in the interest of full disclosure, I must mention my father’s positive experience with a back operation in Rome (for which he did not pay a dime because he was also an Italian citizen), shortly after having had a less-than-positive outcome months earlier at the University of Maryland Medical Center.

Based on the above information relayed to me by others, I suppose there are some things to boast about Italian medical care, but my personal experience tells me that it leaves much to be desired. I have personally visited relatives at Italian hospitals and found a barracks-like atmosphere, with three and four beds to a room. Very often, patients’ families have to bring toilet paper, soap and other personal hygiene items that are routinely supplied by U.S. hospitals.

One might argue that what I witnessed in Italy was more typical of southern Italy. While one can indeed make a case that Italian civilization and organization are directly proportional to geographic latitude, medical care and hospitals in northern Italy are nothing to write home about either. My aunt from Genoa (who by the way has been waiting almost a year for cataract surgery and knee replacement surgery) recently visited the U.S. and had occasion to visit a relative at Christiana Hospital in Delaware. She was astounded at the spacious rooms and the cleanliness, comparing the facility to a luxury hotel. Given what she is used to with Italian hospitals, I am sure it seemed that way.

But there I go again talking about someone else’s experience. Let me tell you about a very personal experience I had with Italian medical care.

The year was 2004, and Susan and I were spending a glorious three weeks in Italy to celebrate our 25th anniversary. Just thinking about the wonderful time we had brings a smile to my face, except for one little detail. Prior to departure, I had just finished a round of antibiotics to treat an infection, the side effects of which caused me to start my vacation with a mild case of jock itch. At that point it was probably treatable with generous doses of medicated powder, which of course I did not pack. With each passing day, the burning and itching in my hind quarters was getting more excruciating.

By day four we were in Assisi, and I had noticed that there was a major hospital just outside the city limits. After spending another night periodically awakening with excruciating posterior pain, I decided the next morning that it was time to get some medical attention. The hospital’s outpatient facility seemed clean and orderly, and they were able to get to me right away, but what followed was almost comical.

I explained that I was a tourist with a bad case of jock itch, and I desperately needed some kind of anti-fungal medication, whether internal or topical. Of course, that wasn’t good enough for the lady doctor, who felt compelled to examine me. As I dropped my drawers and jumped up on the examining table, I thought, “Okay, Leo. Don’t pay it any mind. This will be over soon, and you will not see these people again.”

“I see,” she said, as she stared intently at my anus. “But I am not sure this is jock itch. Let me call over my colleague to see what he thinks.” After what seemed like an eternity of lying on the table with exposed buttocks, she came back with her colleague, this time a male. I was starting to wonder if I was dealing with a couple of janitors getting their jollies by pretending to be doctors.

The colleague also examined my aggravated anal aperture, and after attentive analysis, agreed that I did not have jock itch. “This is not a fungus,” the lady practitioner said with a great deal of confidence. “Rather, you have a peculiar growth on your anus that will need to be surgically removed. In the meantime, the only thing you can do is take some analgesic for the pain.”

Having received the brilliant diagnosis, I felt I needed to be honest enough to volunteer the fact that I was a U.S. citizen and therefore not covered by “la mutua”, i.e., government provided health insurance. She handed me an invoice and indicated that I would need to walk over to the billing office on the following day, because today was a national holiday.

“Not a problem,” I thought, because we were leaving Assisi the next morning, and we could stop by the billing office on our way out of town. As it turns out, I could not pay then either, because the office was still closed, this time with handbills taped to the door indicating that all non-essential medical personnel were on a national strike.

I endured the pain for several more days and nights until I made it down to my parents’ hometown in Sicily. There, I prevailed upon my second cousin, an extremely overworked medical doctor, to find time to stop by the house and provide me with a second opinion. I wasn’t sure whether it was more humiliating to have my gluteus maximus examined by the lady doctor in Assisi or by my second cousin whom I had known since childhood, but at least the latter provided a correct diagnosis. I had jock itch.

Once I returned to the States, my honesty still compelled me to write a letter to the address stamped on the invoice from Assisi, explaining that I made two unsuccessful attempts to pay for medical services or at least submit my American insurance information. I never did hear back from them. I got what I paid for.

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