Nothing will be like before. As the weeks go by, all those deaths and the fear of dying will slip into oblivion. And yet, in social relations, made of politics, economics, culture, this accident health lasting three months will change the patterns of coexistence. It will happen slowly. At the beginning these incidents seem like small episodes of history, subsequently they manifest themselves in their grandeur.
It happened to CColombo refreshment stop when he discovered America thinking he had found only one new way to trade spices and silk. Instead he had sown the seed of: Canada, the United States andd Latin America.
There are three guiding threads on which history runs: humanistic culture, the search for well-being and religious abstraction. These are the three lines of identity. Then there are specific directions of the places:
- Sant’Antioco is identified with its port and the sea;
- Carloforte in its insularity;
- Sulcis in its vineyards andd farms;
- Carbonia and Iglesias in their hospitals and industrial activities.
Furthermore, these cities recognize a common identity in their history “Sanitary system”.
The Sanità di Carbonia began exactly on 18 December 1938 with the speech of Benito Mussolini from the Torre Littoria, in popular triumph.
Then there was a small hospital in Carbonia in Piazza Cagliari. The history of those early years is sparse. We have more news in 1941. We are in full fascism and in full war. The mines produced the raw material for war energy consumption.
The first healthcare professionals they were hired, on a regular basis deliberates in 1941.
The first employee was a lady Liliana Casotti, nurse midwife. She was hired on August 16, 1941. She alone, gave birth to thousands of children to women from the vast city of 65,000 inhabitants just arisen.
On September 16, 1944, the doctor was hired Renato Meloni, surgeon, urologist, hematologist, oncologist, obstetrician and gynecologist. He was 25 years old.
These two characters were the progenitors of the future healthcare world.
On Youtube there is a beautiful documentary film with images of Carbonia in those years. “Fascism in the family “. Very interesting. It was filmed by Barbara Serra, the famous London correspondent for Al Jazeera. It tells of the Podestà of Carbonia of those years: Vitale Piga. It was the Barbara’s grandfather. In the film it is well hatched the human environment of which the hospital in Piazza Cagliari took care.
At the end of the war, the new hospital, built outside the city, it was used by British troops. Then in 1956, after the end of the war, all the staff of Piazza Cagliari moved to Sirai. The hospital had become “Municipal Hospital Authority”, and was classified as “Zonal hospital”. Above the zonal hospital there was the“Provincial Hospital of Cagliari”, the Saint John of God. In the passage between the 60s and 70s, Sirai, for its volume of activity, was about to be reclassified as a hospital “Provincial”. He was Mayor Pietro Cocco. The procedure did not end.
Meanwhile, the Healthcare team had grown:
- In 1945 the new primary surgeon was hired, coming from the Surgical Pathology of the University of Cagliari, doctor Gaetano Fiorentino. It was a veteran of the Russian campaign as an ARMIR surgeon.
- In 1951 the doctor was hired Luciano Pittoni, surgeon, pediatrician, gynecologist, obstetrician, traumatologist, neurosurgeon and, above all, anesthesiologist. He was the first specialist in Anesthesiology in Sardinia.
- In 1953 Dr. Giuseppe Porcella, surgeon, traumatologist, from Sassari was hired.
- In 1954, Dr. Enrico Pasqui was hired who, at the age of 25, began to direct Internal Medicine and Pediatrics.
- In 1955 Dr. Pasquale Tagliaferri was hired: ophthalmologist.
- In 1956 Dr. Mario Casula was hired: pharmacist.
- In 1956, Dr. Enrico Floris was hired: a new chief internist.
In 1956, the health body was made up of 9 people, including: 7 doctors, 1 midwife, 1 pharmacist.
From that primordial crucible the complex subsequent health organization was generated.
During the years of growth, the hospital was governed by the Mayor Pietro Cocco. The administrator was Dioclide Michelotto. The “Board of Directors” it was the same “Municipal Council of Carbonia”. The Mayor of the city was the President of the Hospital Body.
The number of sick people placed in the hands of these few doctors was immense. Consider that Carbonia in the early 1960s had 60,000 inhabitants; Sant’Antioco had 14,000; Carloforte had 7,000 of them.
The hospital had 384 beds, three times as many as today beds for treble. There were two departments of Internal Medicine, one of pediatrics, one of General Surgery, one of Traumatology, one of Obstetrics and Gynecology, the Emergency Department, Radiology, a well-equipped Laboratory, a Transfusion Center, an ophthalmological surgery for eye surgery. cataract and removal of foreign bodies from the eye, an Otolaryngology clinic, kitchens for inpatients, laundry, carpentry, boilers for heating, the team of electricians, the workshop, the team of technical workers. The Ursuline Sisters and doctors (Dr Gaetano Fiorentino, doctor Renato Meloni, doctor Luciano Pittoni). The surgeons were immediately present for emergencies.
1,600 surgeries were performed per year, compared to around 800 today.
2,000 children were born a year, compared to the current 300 or so of Carbonia and Iglesias together.
Healthcare benefits were paid by Mutual Funds. The body’s budget was always active and the surplus was used for public works in the city of Carbonia. Currently instead annual accounts are in debt for millions of euros.
Then came the mining crisis, but the hospital under the leadership of the municipality increased the number of its employees, and distributed wages that kept the local commercial network alive. Therefore, the good functioning of Healthcare also translated into an economic benefit for the territory.
He was always President Pietro Cocco when the most important law in Republican history was promulgated: law 833 of 1978. It was the “Health Reform Law “. It was a great revolution. ASSLs were born. Carbonia was the n. 17; that of Iglesias was the n. 16. The Municipal Hospital Bodies disappeared and the “Local Social Healthcare Companies”. All the Municipalities of the hinterland, that is the Sulcis, appointed the Municipal Delegates in 1982 for the “ASSL Management Committee”. Among the elected municipal councilors, he came formed the ASSL Board of Directors. The first President, later Pietro Cocco, it was Antonio Zidda; the vice president was Andrea Siddi, who was also Mayor of Sant’Antioco.
The resolutions of the ASSL were taken after close discussions both between the municipal councilors of the territory, and between the Administration and Trade Unions.
The era of the Management Committees was a ferment of ideas and popular participation. Up to now hospital service improvement decisions were made.
The number of Healthcare workers increased and the Doctors’ requests were represented, in Administration, fromthe “Health Council”. The Medici’s opinion was fundamental for any health decision. The collaboration was fruitful.
The Administrative Health Department of Sardinia was attributed to the Regional Health Councilor who acted as super-president of the ASSL.
In this hierarchical scale of the management chain, the popular will of the area was genuinely represented.
In the 1990s, the course of the history of hospital health abruptly changed direction.
The “Technicians”. Sad Bocconi school figures who overturned the sense of “Take care of the Other”. The hospitals changed their name: they called each other “Establishments”. Also “Patients” they changed their name: they called each other “customers”. The product of the “Establishment” it had to be managed with the same rules with which industrial products are produced and sold. Well-being was no longer the goal sanitary but the “balance”. The number of beds per thousand inhabitants was increased from 6 to 3. The “balance” was the prevailing accounting obsession and yes he claimed to keep “Efficiency and effectiveness” while cutting beds, organic and expenses for instrumental and structural updating. The decision-making dynamics no longer stemmed from the comparison between popular needs and the political part, but from the rigid sequence of actions dictated by the ladder of an algorithm. The algorithm ousted him “Spirit of service” and the “mediation” with the “Social forces” through a retinaculum of bureaucratic passages, impenetrable to the ordinary citizen. The ordinary citizen, and also the the city’s highest health representative, the Mayor, were technically expelled from the place where they are formulated programmatic proposals and decisions are made. This was the result of continuous reworking until the total subversion of law 833.
The center of the new health world was occupied by the “Bureaucratic apparatus”. Patients and i doctors were placed on the outskirts of that world or, more frequently, outside.
The domain of pure result “Accountant” on the mission of health protection of 833 produced:
- The cancellation of the doctors in the health decision-making dynamics,
- The cancellation of the Nurses,
- The reduction of staff,
- The consequent closure of medical and surgical departments,
- The decrease in expenses for equipment and updates,
- The unification of deteriorated departments,
- Failure to replace primary and retired staff,
- The dissatisfaction of the population forced to seek assistance elsewhere by generating passive mobility,
- The centralization of health in the capital cities,
- The impoverishment of the Services,
- The scandalous waiting lists.
And they followed:
- Passive mobility towards Cagliari, Sassari and the Continent,
- The transfer of huge sums of the Budget to pay for the Health Services bought from the capital and from private Nursing Homes.
- The loss, slow, about 1,000 jobs between Carbonia and Iglesias for the benefit of Cagliari.
- The 1,000 payslips disappeared in progression from Sulcis Iglesiente, between the late 90s and today, corresponds to over one and a half million euros of salaries per month which is missing from the local commercial network.
- In one year, at least 18 million euros are missing from the money circuit in the Sulcis Iglesiente.
- The lack of money from our territory to the advantage of territories already overflowing with privileges and services such as Cagliari generates: poverty.
- Poverty and lack of work close the circle and feed themselves.
- The escape of the young couples that follows results in depopulation and relative aging.
- The less young remain at the mercy of a system that is no longer “Cozy” as in the days of “Management Committees “ but “bumper”.
- The very long “waiting lists” are the perfect graphic representation of the “rejection” in place.
During the “Lockdown” we have witnessed an unthinkable phenomenon: the “silence” of the Hospital Doctors.
Nobody speaks, nobody informs, nor participates in people’s anxieties. Muti work, looking away. The “silence” dei Medici Ospedalieri is the clear symptom of their exclusion from Healthcare.
Now is the time.
If it is true that nothing will be as before, we must be careful. Change can be for the better or worse.
For all that I said in the introduction, this is a historic moment: on the running horse of our Health History the rider has been changed. We need to verify who he is, and in what direction he intends to run this post-Covid knight.